Mock Medical Oncology Module 4

A 55-year-old woman presents with orthopnoea and paroxysmal nocturnal dyspnoea. She has a history of breast cancer treated with chemoradiotherapy and surgery 10 years ago. She has no known cardiac risk factors.

On examination, her apex beat is displaced to the 6th intercostal space in the mid-axillary line. She has bibasal crackles on auscultation. She receives treatment with frusemide with good effect.

Which chemotherapeutic agent is responsible for her condition?

Doxorubicin

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Capecitabine

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Carboplatin

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Docetaxel

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Tamoxifen

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A 45-year-old woman presents with a new breast lump.

Which imaging modality is recommended as the initial step in her diagnostic workup according to current guidelines?

Both mammography and ultrasound

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Ultrasound only

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Mammography only

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MRI

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PET-CT

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A 55-year-old woman presents to your clinic with a palpable lump in her left breast that she noticed 2 weeks ago. She denies any nipple discharge or skin changes over the lump. On examination, the lump is firm and located in the upper outer quadrant of the left breast. You perform a core biopsy, and the pathology report describes atypical ductal hyperplasia.

Which of the following is the most appropriate next step in management?

Surgical referral for further evaluation and management

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Provide reassurance and arrange a routine follow-up in 6 months

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Initiate antibiotic therapy and reassess in 2 weeks

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Order a full blood count and inflammatory markers

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Start topical treatment and review in 1-2 weeks

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A 42-year-old woman has recently had a mastectomy after being diagnosed with breast carcinoma. Her paternal grandmother had ovarian carcinoma in her early fifties. She has a 32-year-old well sister.

Apart from advising her on appropriate adjuvant therapy, the next most important issue you should also discuss with her is:

Screening her for a genetic mutation

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Prophylactic oophorectomy.

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Radiation ovarian ablation

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Prophylactic contralateral mastectomy

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Screening her sister for a genetic mutation

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A 48-year-old woman presents to your clinic with a 3-month history of spontaneous, unilateral bloody discharge from her right nipple. She denies any palpable lump or recent trauma to the breast. On examination, the nipple appears slightly inverted but can be easily everted with manipulation, and no skin changes are observed. Mammography and ultrasound of the right breast have been performed, showing no definitive mass. Nipple discharge cytology was performed, and no malignant cells were identified.

Which of the following statements is most accurate regarding this clinical scenario?

The presence of spontaneous, unilateral bloody discharge from a single duct warrants further evaluation despite negative imaging and cytology.

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Given the slit-like retraction of the nipple that can be easily everted, no further investigation is necessary.

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Ulceration and eczematous-like changes of the nipple are required to suspect malignancy in the presence of bloody nipple discharge.

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Mammography alone is sufficient for the evaluation of nipple discharge.

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The absence of malignant cells on nipple discharge cytology effectively rules out cancer.

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According to a study using the Cancer Intervention and Surveillance Modeling Network (CISNET) models to simulate US breast cancer mortality rates from 1975 to 2019, which factor contributed the most to the observed reduction in breast cancer mortality?

Treatment of stage I to III breast cancer

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Treatment of metastatic breast cancer

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Mammography screening

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Lifestyle and dietary modifications

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Genetic screening and counseling

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A 62-year-old woman is diagnosed with breast cancer. Histopathological examination reveals that the tumour expresses oestrogen receptors (ER) but not progesterone receptors (PR).

Based on the hormone receptor status, which of the following characteristics is most likely associated with this patient’s breast cancer subtype?

Indolent disease course with a higher rate of late recurrence and death (>5 years after diagnosis)

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Aggressive disease with a high likelihood of early recurrence

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Predominantly brain metastases

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Very low risk of metastasis

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High likelihood of responding well to chemotherapy alone

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In a study analysing gene expression patterns in breast cancer patients using cDNA microarrays, which of the following findings was NOT observed?

Hierarchical cluster analysis segregated tumors into groups correlating with menopausal status.

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Gene expression patterns were strongly associated with estrogen receptor (ER) status.

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Genes involved in cell cycle, DNA replication, and chromosomal stability were elevated in poor prognostic groups.

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Glutathione S-transferase M3 was identified as an important marker for survival.

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A set of 16 genes was significantly associated with relapse-free survival at a stringent significance level.

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A 32-year-old premenopausal woman presents to your oncology clinic for a follow-up visit after recently undergoing breast-conserving surgery for early-stage breast cancer. She is otherwise healthy, with no significant past medical history or family history of breast or ovarian cancer. She does not smoke, consumes alcohol socially, and leads an active lifestyle. The surgery was uncomplicated, and she has recovered well, with no residual pain or significant side effects.

The final pathology report from her surgery provides the following details about the tumour:

Size: 2 cm
Hormone status: Oestrogen Receptor (ER) negative, Progesterone Receptor (PR) negative
HER2 status: Positive
Histology: Well-differentiated ductal carcinoma
Nodal status: No lymph node involvement (Node negative)

Given her young age, the tumour’s characteristics, and her current post-operative status, you are considering the best adjuvant treatment options to improve her overall survival. The goal is to address the aggressive nature of HER2-positive tumours while considering the patient’s quality of life and potential treatment-related side effects.

What is the best adjuvant treatment to improve her overall survival?

Chemotherapy and Trastuzumab

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Chemotherapy and Tamoxifen

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Chemotherapy alone

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Chemotherapy and letrozole

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Lapatinib

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A 48-year-old postmenopausal woman presents to your clinic with a recent diagnosis of breast cancer. She has been participating in annual breast cancer screening programmes due to her dense breast tissue, which is known to increase the risk of breast cancer and can make mammograms less effective at detecting tumours.

During her most recent screening, a new 1.5 cm area of microcalcifications was detected in her left breast, without any associated palpable mass. Subsequent biopsy of this area revealed a Grade 2, ER/PR negative, and HER2-negative infiltrating ductal carcinoma.

The patient has a family history of breast cancer, with a maternal aunt diagnosed at the age of 50. Aside from her current diagnosis, she reports being in good health, with no significant past medical history. Her medications include a daily multivitamin and occasional ibuprofen for headaches. She denies any history of hormone replacement therapy.

On physical examination, she appears well, with normal vital signs and no lymphadenopathy. The only abnormal finding is ecchymosis at the site of the recent breast biopsy.

Given her postmenopausal status, tumour characteristics, and family history, you are considering the most appropriate next step in her management, focusing on local control of the disease while minimising the risk of recurrence and considering the patient’s quality of life.

Which of the following is the most appropriate next step in management?

Left lumpectomy with sentinel lymph node biopsy followed by breast irradiation

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Left lumpectomy with axillary node dissection followed by breast irradiation

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Left lumpectomy with sentinel lymph node biopsy without breast irradiation

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Left modified radical mastectomy

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Left modified radical mastectomy and right simple mastectomy

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A 42-year-old premenopausal woman presents to your clinic with a recent diagnosis of early-stage hormone receptor-positive breast cancer. She has no significant past medical history and her family history is notable for breast cancer in her mother at the age of 50.

On examination, there is a palpable 2 cm mass in the upper outer quadrant of the left breast, with no palpable axillary lymph nodes. Mammography and biopsy have confirmed the diagnosis, and the tumour is found to be oestrogen and progesterone receptor positive, HER2 negative, with no lymphovascular invasion.

As part of the multidisciplinary team meeting to discuss her management, you are considering adjuvant systemic therapy options to reduce the risk of recurrence.

Given her premenopausal status and tumour characteristics, which of the following medications should generally be avoided in her treatment plan?

Aromatase inhibitor monotherapy

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Tamoxifen alone

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Tamoxifen plus ovarian function suppression

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Aromatase inhibitor plus ovarian function suppression

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Ovarian function suppression with goserelin

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In the APHINITY trial, which patient group demonstrated a statistically significant improvement in 3-year invasive-disease-free survival (IDFS) rates when treated with pertuzumab added to adjuvant trastuzumab and chemotherapy for operable early-stage breast cancer?

Patients with HER2-positive, node-positive disease

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Patients with HER2-positive, node-negative disease

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Patients with hormone-receptor-negative disease

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All patients regardless of node or hormone-receptor status

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Patients with HER2-negative, node-positive disease

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A 45-year-old woman with HER2-positive early breast cancer underwent neoadjuvant chemotherapy consisting of a taxane and trastuzumab. Post-treatment surgical assessment revealed residual invasive disease in the axilla. Considering the patient’s prognosis and the potential benefits of further adjuvant therapy, you are contemplating the next step in her treatment plan.

Which adjuvant therapy should be considered to significantly reduce the risk of recurrence of invasive breast cancer or death in this patient?

Switch to adjuvant T-DM1 (Trastuzumab Emtansine) for 14 cycles

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Continue with trastuzumab for 14 cycles

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Initiate adjuvant anthracycline-based chemotherapy

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Administer adjuvant hormone therapy regardless of hormone receptor status

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No further adjuvant therapy is indicated

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In a postmenopausal patient, which one of the following is the best initial hormonal therapy for hormone receptor-positive metastatic breast cancer?

Aromatase inhibitor

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Androgen

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Anti-oestrogen

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Oestrogen.

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Progesterone

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A 60-year-old postmenopausal woman has recently undergone surgery for early-stage breast cancer. She is oestrogen receptor-positive and is starting adjuvant endocrine therapy. You are considering additional treatments to reduce her risk of recurrence, particularly given her postmenopausal status.

Which of the following is the most appropriate addition to this patient’s treatment plan to reduce the rate of breast cancer recurrence in the bone and improve breast cancer survival?

Start adjuvant bisphosphonate treatment for 2-5 years

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Initiate adjuvant chemotherapy with a taxane-based regimen

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Prescribe a monthly dose of oral cholecalciferol

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Short-course adjuvant bisphosphonate treatment for 6 months

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No additional treatment is needed beyond endocrine therapy.

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With regards to cancer screening, which of the following cancers is routinely recommended for population-based screening in Australia?

Bowel cancer

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Prostate cancer

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Testicular cancer

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Melanoma

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Ovarian cancer

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How do CDK4/6 inhibitors, such as palbociclib, ribociclib, and abemaciclib, exert their therapeutic effect in HR+, HER2-negative breast cancer?

By inducing complete dephosphorylation of the retinoblastoma (Rb) tumor suppressor protein, resulting in cell cycle arrest at the G1 phase.

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By enhancing the expression of estrogen and progesterone receptors, thereby increasing the sensitivity of breast cancer cells to endocrine therapy.

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By activating the protein p53, leading to apoptosis of breast cancer cells

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By inhibiting the HER2 receptor, leading to a decrease in cell proliferation and growth in HER2-positive breast cancer cells.

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By inhibiting the mTOR pathway, which is involved in cell growth and proliferation.

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A 52-year-old woman with advanced HR+, HER2-negative breast cancer is being considered for treatment following progression on first-line endocrine therapy. Given the proven efficacy of CDK4/6 inhibitors in combination with endocrine therapy in this setting, you are evaluating which CDK4/6 inhibitor to include in her treatment regimen.

Which of the following factors is most critical in selecting the optimal CDK4/6 inhibitor for this patient?

The specific toxicity profile and cost of each CDK4/6 inhibitor

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The patient's previous response to endocrine therapy alone

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Individual physician's experience and hospital preference policy

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The presence of specific biomarkers indicating resistance to CDK4/6 inhibitors

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The need for combination therapy with chemotherapy instead of endocrine therapy

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A 48-year-old woman with previously untreated, locally recurrent inoperable or metastatic triple-negative breast cancer (TNBC) is under consideration for first-line treatment. Her tumour has a PD-L1 combined positive score (CPS) of 12.

Which treatment option would most likely provide a significant and clinically meaningful improvement in progression-free survival (PFS) for this patient?

Pembrolizumab in combination with chemotherapy

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Chemotherapy alone

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Pembrolizumab monotherapy

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Endocrine therapy in combination with a CDK4/6 inhibitor

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PARP inhibitor monotherapy

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A 55-year-old woman with relapsed metastatic triple-negative breast cancer (TNBC), after receiving a taxane-based regimen, is evaluating treatment options with her oncologist. She has no history of brain metastases and is looking for a treatment that could potentially offer her a longer progression-free survival (PFS) and overall survival (OS).

Which treatment option is most likely to offer this patient a significant improvement in PFS and OS?

Initiating treatment with sacituzumab govitecan

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Continuing with another line of standard single-agent chemotherapy (eribulin, vinorelbine, capecitabine, or gemcitabine)

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Starting treatment with a PD-1 or PD-L1 inhibitor monotherapy

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Combining chemotherapy with a PD-1 or PD-L1 inhibitor

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Utilizing an HER2-targeted antibody–drug conjugate

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A 47-year-old woman with HER2-positive metastatic breast cancer, previously treated with trastuzumab and a taxane, is discussing second-line treatment options with her oncologist. She has an Eastern Cooperative Oncology Group (ECOG) performance status of 1 and at least one measurable lesion.

Which treatment is most likely to offer this patient the longest median progression-free survival (PFS) in the second-line setting for HER2-positive metastatic breast cancer?

Initiating treatment with trastuzumab deruxtecan

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Initiating treatment with trastuzumab emtansine

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Continuing treatment with trastuzumab alone

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Combining trastuzumab with a chemotherapy agent of the physician's choice

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Starting treatment with a PD-1 or PD-L1 inhibitor in combination with trastuzumab

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A 55-year-old woman with a history of hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced breast cancer presents to the oncology clinic. She has previously received endocrine therapy. On further investigation, her tumour is found to have a PIK3CA mutation. Based on her cancer profile and previous treatments, she is considered for a new treatment regimen.

Given the patient’s HR-positive, HER2-negative advanced breast cancer with confirmed PIK3CA mutation, which of the following treatment options is most likely to prolong her progression-free survival?

Alpelisib 300 mg per day plus fulvestrant 500 mg every 28 days (and once on day 15 of cycle 1).

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Fulvestrant 500 mg every 28 days and once on day 15 alone

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High-dose oestrogen therapy

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Lapatinib plus capecitabine

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Pembrolizumab plus chemotherapy.

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Which of the following is considered an established risk factor for the development of bowel cancer?

Ulcerative colitis with a disease duration of 10-20 years, especially in patients with primary sclerosing cholangitis

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Routine consumption of fresh vegetables

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Engagement in regular physical activity

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High intake of unprocessed red meats

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History of lower limb radiation therapy

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Which gene mutation is most frequently observed in colorectal cancer?

APC

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KRAS

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BRAF

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TP53

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PIK3CA

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A 62-year-old male with metastatic colorectal cancer, confirmed to have microsatellite-instability-high (MSI-H) and mismatch-repair-deficient (dMMR) markers, is evaluating first-line treatment options with his oncologist.

Given his condition, which of the following treatment strategies is more likely to result in better progression-free survival?

Initiate pembrolizumab at a dose of 200 mg every 3 weeks.

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Start with 5-fluorouracil–based chemotherapy combined with bevacizumab

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Begin treatment with cetuximab monotherapy.

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Initiate combination therapy consisting of pembrolizumab and bevacizumab.

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Use of high-dose intermittent pembrolizumab as the initial treatment to intensify the immune response.

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A 55-year-old woman with metastatic colorectal adenocarcinoma is found to have a BRAF V600E mutation. She initially received first-line oxaliplatin-based chemotherapy but developed radiological disease progression. Her tumor is microsatellite stable (MSS), and she has not previously received targeted therapy.

According to current evidence and international guidelines, which of the following is the preferred next-line treatment?

Encorafenib, binimetinib, and cetuximab triplet therapy

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Encorafenib monotherapy

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Encorafenib and cetuximab doublet therapy

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Cetuximab and irinotecan combination therapy

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Palliative care focusing on symptom management

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Based on the background and findings of the Rectal cancer And Preoperative Induction therapy followed by Dedicated Operation (RAPIDO) trial, what was the primary endpoint of the study in evaluating treatment efficacy for high-risk locally advanced rectal cancer?

Cumulative probability of disease-related treatment failure at 3 years post-randomization

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Overall survival at 5 years post-treatment

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Disease-free survival at 2 years post-randomization

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Rate of complete pathological response post-surgery

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Incidence of grade 3 or higher adverse events during treatment

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What is the primary rationale for administering adjuvant chemotherapy in patients with resected colon cancer?

To eliminate microscopic disease and reduce the risk of recurrence

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To enhance the radiographic appearance of the colon post-surgery

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To provide symptomatic relief from post-operative pain

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To prepare the patient for a second surgical intervention

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To increase the absorption of oral medications post-surgery

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In which type of cancer is the combination of sotorasib and panitumumab primarily investigated for its therapeutic role?

Metastatic colorectal cancer with KRAS G12C mutation

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Metastatic colorectal cancer with TP53 mutation

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Breast cancer with HER2 amplification

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Melanoma with BRAF V600E mutation

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Non-small cell lung cancer with ALK rearrangement

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Which of the following statements is correct regarding the differences between left-sided and right-sided colorectal cancer?

Right-sided colorectal cancer tends to exhibit a more immunological phenotype and has a poorer prognosis compared to left-sided colorectal cancer.

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Right-sided colorectal cancer is embryologically derived from the hindgut, whereas left-sided colorectal cancer is derived from the midgut.

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Left-sided colorectal cancer generally has a poorer prognosis compared to right-sided colorectal cancer due to more aggressive histological features.

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BRAF mutations are predominantly found in left-sided colorectal cancer, while RAS mutations are more common in right-sided cancers.

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The gender distribution and epidemiology of left-sided colorectal cancer are significantly different from other gastrointestinal cancers, with a higher prevalence in females.

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A 55-year-old male patient with unresectable, RAS wild-type, left-sided, metastatic colorectal cancer is under your care.

Which treatment option would most likely improve his overall survival when added to standard first-line chemotherapy?

mFOLFOX6 plus bevacizumab

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mFOLFOX6 plus panitumumab

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mFOLFOX6 plus bevacizumab and cetuximab

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panitumumab plus bevacizumab

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cetuximab plus bevacizumab

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A 58-year-old female patient undergoing treatment for colorectal cancer presents with severe mucositis and early onset of myelosuppression after her first cycle of chemotherapy. Her treatment regimen includes a fluoropyrimidine-based chemotherapy.

Considering her clinical presentation, which underlying condition is most likely contributing to her exaggerated response to the chemotherapy?

Dihydropyrimidine dehydrogenase (DPD) deficiency, leading to increased toxicity from fluoropyrimidines

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Gilbert's syndrome, leading to increased toxicity from irinotecan metabolites

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G6PD deficiency, leading to hemolytic anemia

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UGT1A1 enzyme deficiency, leading to increased toxicity from irinotecan metabolites

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Deficiency of thymidylate synthase, leading to resistance to fluoropyrimidines

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A 62-year-old patient with gastrointestinal cancer is being treated with FOLFIRINOX.

Which of the following toxicities is most specifically associated with the oxaliplatin component of this regimen?

Peripheral neuropathy and cold dysaesthesia

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Mucositis and severe diarrhoea

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Coronary artery vasospasm

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Diarrhoea exacerbated by deficiency of UGT1A1 enzyme

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Myelosuppression due to dihydropyrimidine dehydrogenase deficiency

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Mock Medical Oncology Module 4

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