Oncology

Question 1

Hypercalcemia occurs most commonly in which type of lung cancer?

Answer 1

Hypercalcemia in lung cancer is most associated with squamous cell cancer.

Question 2

How do you initially manage acute hypercalcemia?

Answer 2

Acute hypercalcemia is initially treated with IV fluids with normal saline followed by bisphosphonates.

Question 3

What are the most common causes of SVC syndrome? What is the treatment?

Answer 3

SVC syndrome is most commonly caused by lung cancer, lymphoma, and medastinal germ cell tumors.

Question 4

Name the cancers that commonly metastasize to bone?

Answer 4

The most common cancers that metastasize to bone are lung, breast, prostate, and kidney. Also consider multiple myeloma and NHL.

Question 5

What is the urgent treatment when you suspect spinal cord compression due to bone metastases?

Answer 5

The initial treatment of malignant spinal cord compression is dexamethasone. This may be followed by radiation, surgery, or chemotherapy.

Question 6

Which treatment option is available to patients with 3 or fewer small brain mets?

Answer 6

Patients with 3 or fewer brain mets less than 3cm should be considered for stereotactic radiosurgery.

Question 7

Which malignancies are associated with pericardial metastases?

Answer 7

The most common malignancies associated with pericardial metastases are lung cancer, breast cancer, and non-Hodgkin lymphoma.

Question 8

Rasburicase is used in the management of what condition?

Answer 8

Rasburicase is used in the management of tumor lysis syndrome. It oxidizes uric acid to the more soluble allantoin.

Question 9

List the factors associated with an increased risk for breast cancer.

Answer 9

Risk factors for breast cancer include female sex and age. There is also increased risk with early menarche, late menopause, late 1st pregnancy or mulliparity, and mantle field radiation.

Question 10

Which cancers are associated with BRCA mutations?

Answer 10

The cancers associated with BRCA mutations are breast cancer and ovarian cancer.

Question 11

Definitely recommend mammography, either yearly or every 2 years, as a screening tool for women at which ages?

Answer 11

Mammography is definitely recommended, either yearly or every 2 years, in patients age 50-69 years old.

Question 12

When should you consider MRI screening for breast cancer?

Answer 12

MRI is considered for breast cancer screening in patients with lifetime risk of breast cancer of 20-25%.

Question 13

Clinical mastitis in a woman who is not breastfeeding should make you consider what diagnosis?

Answer 13

A woman who is not breastfeeding who presents with clinical mastitis could have inflammatory breast cancer.

Question 14

What is the sequence of actions used in the workup of a suspicious breast mass? Explain in detail.

Answer 14

A suspicious breast mass should be evaluated with mammogram and ultrasound. Unless there is a clearly benign mass, a biopsy should then be undertaken.

Question 15

What are the indications for breast-conserving therapy for treatment of DCIS?

Answer 15

Most woman with DCIS are candidates for breast conserving therapy as long as as long as a good surgical margin can be achieved and the resection would be cosmetically acceptable.

Question 16

What is the most important prognostic indicator for localized invasive breast cancer? How important is the size of the tumor?

Answer 16

The most important prognostic factor for localized invasive breast cancer is the presence or absence of lymph node metastases. The second most important factor is size of tumor. If tumor is <1 cm with no lymph node metastases, the 5 year relapse rates is around 10%. If >2 cm, the 5 year relapse rate is 20%. If any axillary nodes are positive, the relapse rate rises to 50-80%.

Question 17

What is the significance of HER2/neu oncogene overexpression?

Answer 17

HER2/neu oncogene overexpression is associated with increased likelihood of distant metastases and a more aggressive cancer.

Question 18

What is the significance of positive estrogen and progesterone receptors?

Answer 18

Positive estrogen and progesterone receptors are favorable prognostic factors because they predict response to hormonal therapy.

Question 19

What factors influence the type of adjuvant therapy selected for a breast cancer patient?

Answer 19

The type of adjuvant therapy selected for breast cancer is based on the following factors: size of tumor and nodal status, hormonal status, and gene expression.

Question 20

Which drugs, when given concomitantly, decrease the efficacy of tamoxifen?

Answer 20

CYP2D6 inhibitors, particularly SSRIs, can decrease the efficacy of tamoxifen.

Question 21

What are the significant risks of tamoxifen therapy?

Answer 21

The most significant risks of tamoxifen therapy are thromboembolic disease and slight increased risk of endometrial cancer.

Question 22

What is the role of aromatase inhibitors in the treatment of breast cancer?

Answer 22

Aromatase inhibitors markedly suppress estrogen levels by inhibiting the enzymes responsible for synthesizing estrogens from androgen substrates. They are used only in post-menopausal women since they do not block ovarian estrogen production.

Question 23

What is the role of tamoxifen in the prevention of breast cancer? For which women is it considered?

Answer 23

Tamoxifen prophylaxis is indicated for a duration of 5 years in patient at high risk for invasive breast cancer (defined as 1.67% 5-year risk).

Question 24

What are the established risk factors for cervical cancer?

Answer 24

The major risk factor for cervical cancer is HPV infection. Other risk factors reflect the risk of exposure to HPV including early onset of coitus, number of sexual partners, smoking, and history of other sexually transmitted diseases.

Question 25

Which patient populations are approved for receipt of the HPV vaccine?

Answer 25

The HPV vaccine is approved in both females and males aged 9 to 26.

Question 26

At what age and with which test results is it appropriate to stop screening for cervical cancer?

Answer 26

It is appropriate to stop cervical cancer screening in patients >65 years of age with prior adequate screening (3 or more negative test results in a row or 2 consecutive negative co-tests in the past 10 years with the most recent within the past 5 years).

Question 27

What is the appropriate procedure to follow up an LGSIL Pap smear result?

Answer 27

Both LGSIL and HGSIL require colposcopy with biopsy of abnormal areas. ASCUS should have colposcopy if high-risk HPV DNA is detected.

Question 28

Which type of ovarian cancer is usually benign? In what age group do you typically find these cancers?

Answer 28

Most ovarian germ cell tumors which make up 5% of ovarian cancers, are benign. They typically occur in young women (aged 10-30).

Question 29

What is the lifetime risk of ovarian cancer in a woman with BRCA1? With BRCA2?

Answer 29

The lifetime risk of ovarian cancer in woman with BRCA1 mutation is 40%. With BRCA2 the lifetime risk of ovarian cancer is 10-20%.

Question 30

Describe the diagnostic approach to a painless testicular mass?

Answer 30

In a man with a painless testicular mass, an ultrasound should be performed. If a solid mass is found, an inguinal orchiectomy should be performed.

Question 31

What are the risk factors for testicular cancer?

Answer 31

Risk factors for testicular cancer include cryptorchidism, family history of testicular cancer, infertility and HIV.

Question 32

Which biologic markers are used for testicular cancer, and how are they used?

Answer 32

AFP and HCG are used to help determine type of testicular cancer. AFP is never produced by seminomas. These markers are used for staging and prognosis, monitoring for disease relapse, and monitoring for efficacy of therapy.

Question 33

What is the significance of finding AFP elevation in a patient with a testicular mass?

Answer 33

An elevated AFP in a patient with testicular mass means that he does not have a seminoma.

Question 34

What is the association between benign prostatic hypertrophy and prostate cancer?

Answer 34

BPH is not a risk factor for prostate cancer.

Question 35

What is the normal level of PSA in men between 60 and 64 years of age?

Answer 35

The upper limit of normal for PSA in a man aged 60-64 is 5.4.

Question 36

Where are the likely sites of metastases in patients with prostate cancer?

Answer 36

The likely sites of metastases of prostate cancer are bones and pelvic lymph nodes.

Question 37

Name the side effects of androgen-deprivation treatment.

Answer 37

Androgen-deprivation therapy causes weight gain, osteoporosis, gynecomastia, loss of muscle mass, anemia, sexual dysfunction, hot flashes, and increased risk of diabetes.

Question 38

What drug actually decreases the risk of prostate cancer when used long-term?

Answer 38

The use of finasteride decreases the risk of prostate cancer by 25% as seen in a 7 year study. There was however, an increased risk of more aggressive prostate cancers.

Question 39

Which cancers are associated with a history of radiation therapy?

Answer 39

The cancers most associated with a history of ionizing radiation are leukemia and thyroid cancer.

Question 40

Know these unique chemotherapy drugs: rituximab, imatinib, trastuzumab, ATRA, paclitaxel, and lenalidomide.

Answer 40

Rituximab: anti-CD20 mAb used in lymphomas
Imatinib: tyrosine kinase inhibitor uses for CML
Trastuzumab: mAb used in HER2/neu positive breast cancer
ATRA: used in acute promyelocytic leukemia
Paclitaxel: used for ovarian, breast, and lung cancers
Lenalidomide: used in multiple myeloma and 5q deletion MDS

Question 41

What is the dose-limiting toxicity of vinblastine? Vincristine?

Answer 41

The dose limiting side effect of vinblastine is myelosuppression. The dose limiting side effect of vincristine is neurotoxicity.

Question 42

Which agent causes magnesium wasting?

Answer 42

Cisplatin causes magnesium wasting.