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Flashcards in Oncology II Deck (22):
1

A 7-year-old male has presented with a lump at the outer orbit of the left eye. The lesion has been present since birth. On examination there is a 1 cm firm cyst which is not attached to the overlying skin.

Dermoid cyst
Inclusion dermoid cysts occur at the sites of closure of embryonal fissures and may appear at the inner or outer angles of the orbit, the midline of the neck abdomen or on the scalp.

Inclusion dermoid cysts differ from implantation dermoid (epidermoid) cysts in that they contain hair, hair follicles, sweat and sebaceous glands. Excision is recommended as they may become infected.

2

A 22-year-old female presents with a small mobile lump on the lateral aspect of her right lower leg. She reports a mosquito bite in the same area the previous summer. On examination there is a 1 cm mobile lump which is fixed to the epidermis.

Dermatofibroma
Dermatofibromata (histiocytomas) present as firm nodules which are fixed to the epidermis but which are freely mobile. The lesions are usually found on the lower leg, are usually singular and are thought to result from minor trauma or insect bites which cause a reactive proliferation of histiocytes leading to fibrosis and scarring. Excision is for cosmesis.

3

A 68-year-old male presents with a pearly nodule on the right side of his forehead. On examination he has fair skin and blue eyes. The nodule is pearly with tiny venules coursing across its surface.

Basal cell carcinomas
Basal cell carcinomas are more common in individuals with fair skin or hair and blue eyes. Most occur in older patients. The majority of lesions occur on the face above the line joining the angle of the mouth and the lobe of the ear, but they can occur anywhere on the skin. Later the nodule ulcerates centrally to produce an ulcer with the classic raised, rolled or beaded edge.

4

In which of the following is serum alpha-fetoprotein not increased?
(Please select 1 option)
Acute hepatitis
Bladder carcinoma
Hepatocellular carcinoma
Neuroblastoma
Teratomas

Bladder carcinoma

Serum alpha-fetoprotein is a fetal serum protein produced by the yolk sac and liver.

Increased serum levels in adults are seen in tumours (hepatocellular carcinoma, neuroblastomas and teratoma) and acute hepatitis and colitis.

In patients with tumours, serum levels often correlate with tumour size.

Resection is usually associated with a fall in serum levels.

Serum levels are useful in assessing response to treatment.

5

Which of the following agents is correctly paired with the named tumour?
(Please select 1 option)
Aflatoxins: liver cell carcinoma
Androgenic steroids: vaginal clear cell adenocarcinoma
Asbestos: hepatic angiosarcoma
Beta-naphthylamine: bronchial carcinoma
Vinyl chloride: peritoneal mesothelioma

Aflatoxins: liver cell carinoma

Aflatoxins are a product of moulds and eating foods contaminated with aflatoxin increases the risk of hepatoma.

Anabolic androgenic steroids such as nandrolone/stanazolol may cause hepatic tumours.

Diethylstilboestrol exposure in utero is associated with the later development of vaginal clear cell carcinoma.

Mesiothelioma is perishingly rare and prior exposure to asbestos is the culpable agent even in the peritoneum.

Beta naphthylamine exposure increases the risk of bladder cancers.

Vinyl chloride is implicated in the development of the rare tumour angiosarcoma of the liver.

6

In Hodgkin's disease, which of the following is associated with a favourable prognosis?
(Please select 1 option)
Leukocytosis
Mixed cellularity pathology on lymph node biopsy
Presence of Reed-Sternberg cells on bone-marrow trephine
Presentation over the age of 60 years
Female patient

Female patient This is the correct answerThis is the correct answer
Classification is based histological grading or clinical staging.

The basic Ann Arbor clinical stages are:

Stage Description
I Disease limited to one region
II Disease limited to two regions on the same side of the diaphragm
III Disease on both sides of the diaphragm, limited to lymphadenopathy
III1 As Stage III, plus involvement of the spleen
III2 As Stage III, plus involvement of para-aortic, iliac or mesenteric nodes
IV Diffuse extralymphatic involvement - bone marrow, liver or extra-nodal site not contiguous with lymph nodes
There is some controversy as to whether histology is an important prognostic factor.

The stage of disease is a predominant prognostic factor. Men appear to have a slightly worse prognosis. Other factors that may predict a worse prognosis are:

age over 60
anaemia
leukocytosis
lymphocytopenia, and
a low albumin1.
Serum markers that have been associated with an adverse outcome include:

Soluble vascular cell adhesion molecule-1
Tumour necrosis factor
Soluble CD-30
BETA-2 microglobulin
Serum IL-10 level.

7

A less than 60% five year survival is now likely after diagnosis and appropriate management in which situation?
(Please select 1 option)
20-year-old female with nodular sclerosing Hodgkin's disease confined to neck and mediastinal nodes without systemic symptoms
22-year-old man diagnosed with a right testicular teratoma and found to be node negative on staging
37-year-old man with papillary carcinoma of the thyroid confined to one lobe
52-year-old female with a 2 cm invasive ductal carcinoma which is lymph node positive
46-year-old man who has undergone a successful liver resection for a single hepatic metastasis

46-year-old man who has undergone a successful liver resection for a single hepatic metastasis This is the correct answerThis is the correct answer
In the case of the 20-year-old, survival with Hodgkin's lymphoma which is confined would be expected to be higher than 50%, with figures for survival approaching 80%.

In the case of the 22-year-old man, the prognosis is excellent at nearly 100% if node negative, and 90% if node positive.

The prognosis is excellent for the 37-year-old man, approaching 99% at five years.

The 52-year-old lady will undergo a mastectomy/wide local excision and axillary lymph node clearance and chemotherapy with a five year survival of approximately 70%.

In the case of the 60-year-old man, with what appears to be curative liver resection, the survival at five years has improved to over 50%.

8

Choose the one malignancy in which α-feto protein and β-human chorionic gonadotrophin are useful tumour markers:
(Please select 1 option)
Carcinoma of the breast
Carcinoma of the pancreas
Carcinoma of the prostate
Medullary carcinoma of the thyroid
Testicular tumour

Testicular tumour This is the correct answerThis is the correct answer
α-feto protein and β-human chorionic gonadotrophin are sensitive indicators of testicular carcinoma. One or both of these serum markers are elevated in more than 90% of patients with non-seminomatous germ cell tumours of the testis.

Elevated levels of these markers after appropriate treatment indicate the presence of residual disease and thus the need for further therapy. 

9

Which of the following has oncogenic properties in humans?
(Please select 1 option)
Enteroviruses
Hepatitis B virus
Papovavirus
Rabies virus
Rubella virus

Hep B

Although the majority of patients recover completely from Hepatitis B, some patients may go on to develop hepatocellular carcinoma. The remaining viruses do not have oncogenic properties in humans.

The human Papovavirus is associated with plantar warts and unlike the papilloma virus, is not oncogenic.

10

Which of the following is correct regarding pancreatic carcinoma?
(Please select 1 option)
Is associated with diabetes insipidus
Is the third most common cause of death due to cancer
Presents too late for curative surgical intervention in over 90% of cases
Produces progressive jaundice occurs in less than 40%
Usually presents with jaundice and a palpable tender gall bladder

Presents too late for curative surgical intervention in over 90% of cases
Pancreatic carcinoma is the eighth most common cancer (UK 2010). There are around 4000 cases per year in both men and women with almost equal incidence.

Over 90% present late with no chance of cure, and only 25% present with Courvoisier's law, which states that if, in painless jaundice, the gallbladder is palpable, the cause will not be gallstones.

Progressive jaundice occurs in over 75% and only 5% will present with pancreatitis.

It is unclear whether diabetes mellitus is an aetiological factor or if pancreatic cancer induces glucose intolerance.

It is the fourth commonest cause of cancer mortality in men, after lung, prostate,and bow

11

Which of the following is not associated with an increased risk of malignancy?
(Please select 1 option)
Acromegaly
Cisplatin chemotherapy
Coeliac disease
Crohn's disease
Ulcerative colitis

Cisplatin chemotherapy
Inflammatory bowel disease, particularly ulcerative colitis, is associated with an increased risk of large bowel carcinoma.

Acromegaly is also associated with an increased risk of skin, colonic and stomach neoplasia.

Coeliac disease is associated with an increased risk of small bowel lymphoma.

12

Non-metastatic consequences of renal carcinoma include which of the following?
(Please select 1 option)
Cerebellar ataxia
Hypocalcaemia
Hyponatraemia
Myasthenia gravis
Polycythaemia

Polycythaemia This is the correct answerThis is the correct answer
The non-metastatic consequences of renal carcinoma include the synthesis of erythropoietin which may cause polycythaemia and hypercalcaemia through parathyroid hormone (PTH)-related peptide synthesis.

It may also be associated with disseminated intravascular coagulation (DIC) and leucopenia.

13

The BRCA1 tumour suppressor gene is associated with which of the following?
(Please select 1 option)
Basal cell carcinoma
Cervical carcinoma
Ovarian carcinoma
Renal carcinoma
Thyroid carcinoma

Ovarian carcinoma

BRCA1 (and possibly 2) are tumour suppresor genes involved in the repair of double strand breaks by association with Rad51 protein.

These mutations are involved in the development of both breast and ovarian malignancies.

14

Which of the following is a complication of radiotherapy?
(Please select 1 option)
Basal cell carcinoma of the skin
Hypercalcaemia
Skin ulceration
Superior vena caval obstruction

Skin ulceration

Radiotherapy may cause skin ulceration with squamous cell skin cancer a recognised late event.

It is not a cause of a thymoma and is used to treat superior vena caval obstruction and metastatic bony involvement that may lead to hypercalcaemia.

15

Which one of the following is not a complication of cranial irradiation?
(Please select 1 option)
Cranial osteosarcoma
Deafness
Decreased IQ
Hyperprolactinaemia
Meningioma

Cranial osteosarcoma
Recognised complications may include

Skin ulceration
Meningioma
Hyperprolactinaemia
Deafness
Stroke and
A decreased IQ.
Cranial osteosarcoma is not associated.

16

Cancer is unlikely to cause which of the following systemic effects?
(Please select 1 option)
Arthritis
Myopathy
Nephrotic syndrome
Polyneuropathy
Thromboembolic disease

Arthritis
Systemic effects of cancer include:

Myopathy (polymyositis)
Neuropathy
Increased thromboembolic tendency (DVT/PE)
Skin rashes (for example, acanthosis nigricans, dermatomyositis)
Cerebellar ataxia (bronchogenic Ca)
Hypertrophic (pulmonary) osteoarthrophathy*, and
Ectopic hormonal secretions - PTHrp, ACTH.
*Hypertrophic osteoarthropathy is a combination of subperiosteal new bone formation, arthrophathy of adjacent joints and clubbing. It most often involves the tibia but may also involve the fibula, radius, ulnar, humerus or clavicle. The combination of symptoms and signs usually distinguishes it from uncomplicated arthritis.

17

A metaplastic process is involved in the histogenesis of the following tumours.
In which of the following is this statement true?
(Please select 1 option)
Oesophageal adenocarcinoma
Ovarian adenocarcinoma
Prostate carcinoma
Scirrhous carcinoma of the breast
Vulval squamous cell carcinoma

Oesophageal adenocarcinoma

A metaplastic process may be found preceding the development of many overt carcinomas, particularly

Cervical
Carcinoma of the oesophagus
Gastric (Barrett's oesophagus)
Bronchial carcinoma

18

Which one of the following viruses does not have an aetiological role in human cancer?
(Please select 1 option)
Epstein-Barr virus
Hepatitis type B
Herpes zoster
Human immunodeficiency virus
Human papillomavirus

Herpes zoster

Viruses associated with human cancer:

Epstein-Barr virus is associated with Burkitt's lymphoma and nasopharyngeal carcinoma
Human papilloma is associated with cervical cancer
Hepatitis type B is associated with hepatic cancer
Human immunodeficiency virus is associated with Kaposi's sarcoma and non-Hodgkin's lymphoma of the central nervous system.

19

In Hodgkin's disease which of the following is not associated with an unfavourable prognosis?
(Please select 1 option)
Clinical presentation with pyrexia of unknown origin
Mixed cellularity pathology on lymph node biopsy
Presence of Reed-Sternberg cells on bone-marrow trephine
Presentation over the age of 60 years
Pruritus

Pruritus This is the correct answerThis is the correct answer
Classification is based histological grading or clinical staging.

Peters described four clinical stages which include

Disease limited to one region
Disease limited to two regions on the same side of the diaphragm
Disease on both sides of the diaphragm limited to lymphadenopathy
Extralymphatic involvement.
There is some controversy as to whether histology is an important prognostic factor.

Serum markers that have been associated with an adverse outcome include

Soluble vascular cell adhesion molecule-1
Tumour necrosis factor
Soluble CD-30
BETA-2 microglobulin
Transferrin and
Serum IL-10 level.
High levels of caspase 3 in Reed-Sternberg cells have been associated with a favourable outcome.

20

Which is the commonest cancer to affect women?
(Please select 1 option)
Breast cancer
Cervical cancer
Colonic cancer
Lung cancer
Ovarian cancer

Breast cancer
Breast cancer is now the most common cancer in the United Kingdom.

In the UK in 2006 more than 45,500 women were diagnosed with breast cancer.

21

Which of the following is true regarding neuroblastoma?
(Please select 1 option)
Is a non-secreting tumour
Is easily eradicated by radiotherapy
Is an embryonic tumour
Metastasises most commonly to the lungs
Usually has a familial incidence

Is an embryonic tumour

Neuroblastoma is a tumour derived from neural crest tissue and so is properly regarded as an Amine Precursor Uptake and Decarboxylation (APUD) tumour.

The most common sites are (approximately):

50% adrenal medulla
20% abdominal sympathetic ganglia
20% chest
5% pelvis
5% neck.
The tumour may secrete catecholamines hence urine vanillylmandelic acid (VMA) concentrations are elevated.

Spontaneous remission is well recognised in this condition.

Extra abdominal sites generally have a better prognosis.

22

In which of the following is the prognosis in Hodgkin's disease worse?
(Please select 1 option)
Associated with alcohol-induced pain in chest lymph nodes
Female gender
Histology shows lymphocyte depletion
Onset is in late adolescence
Presentation is with normal body temperature

Histology shows lymphocyte depletion

Alcohol-induced pain in chest lymph nodes is a clinical feature but it is not related to poor prognosis.

The main poor prognostic indicators are:

Advanced stage
Older age
Lymphocyte depleted histology
Relapse in less than one year
B symptoms
Male sex.
The Rye classification:

Lymphocyte predominant, 2-10% cases, excellent prognosis
Nodular sclerosing, 40-80%, very good prognosis
Mixed cellularity, 20-40%, good prognosis
Lymphocyte depleted, 2-15%, poor prognis.
The younger the age of onset the better the prognosis.

Symptoms are:

Fever
Sweats
>10% weight loss in six months.