Practise Questions FRCR CO2A Flashcards by Doc R

A 20-year-old man presents with a metastatic testicular tumour. Which of the following features would put him into the poor-risk category?

(a) Pure seminoma with 20 lung metastases

(b) Pure seminoma with hCG 50× upper limit of
normal (ULN)

(c)Choriocarcinomawith20lungmetastases

(d) Embryonal germ cell tumour (GCT) with
αFP 50× ULN

(e)MixedGCTwith10lungand2liver
metastases

(e) Mixed GCT with 10 lung and 2 liver
metastases

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With regard to cancer-related emergencies, which of the following statements is correct?
(a) SIADH gives rise to hyponatraemia and reduced plasma osmolarity in the presence of inappropriately dilute urine
(b) In patients with SIADH who do not respond to fluid restriction, cautious administration of intravenous sodium chloride should be considered
(c) The addition of surgery to radiotherapy has been shown to improve functional outcome compared to surgery alone in the treatment of spinal cord compression
(d) In good-performance-status patients with solitary intracerebral metastases, radiotherapy with 12 Gy in 2 fractions is equivalent to 30 Gy in 10 fractions
(e) Patients at high risk
from neutropenic sepsis should receive intravenous ciprofloxacin and co-amoxiclav on admission to hospital

c) Theadditionofsurgerytoradiotherapyhas been shown to improve functional outcome compared to surgery alone in the treatment of spinal cord compression

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A 45-year-old man presents with an enlarging mass on the penis. Biopsy reveals invasive squamous carcinoma. The tumour is invading the corpus cavernosum and there are two mobile, palpable inguinal node metastases. What is
the stage?
(a) T3 N1 MX
(b) T1 N1 MX
(c) T3 N2 MX
(d) T2 N1 MX
(e) T2 N2 MX

(e) T2 N2 MX

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Xeroderma pigmentosa is associated with which of the following?
(a) Autosomal dominant inheritance
(b) Jaw cysts
(c) Medulloblastoma
(d) A defect of nucleotide excision repair
(e)A decreased risk of skin cancer

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A patient presents with multiple bilateral pulmonary opacities suggestive of malignancy but with no obvious underlying primary site of disease. A CT-guided biopsy reveals adenocarcinoma on which the following immunohistochemical tests are performed: cytokeratin-7 (CK7) positive, cytokeratin-20 (CK20) negative, thyroid transcription factor (TTF-1) positive, thyroglobulin negative. The most likely underlying primary site of disease is which of these?
(a) Colon
(b) Bladder
(c) Lung
(d) Thyroid
(e) Pancreas

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A 53-year-old woman presents with a painless right-sided thyroid nodule and normal TFTs. There is no family history of thyroid disease or endocrine malignancy. US confirms a solitary 3 × 2 cm hypoechoic nodule with no abnormal nodes. FNA is reported as showing a follicular neoplasm. The next most appropriate step is:
(a)Serummthyroglobulinmmeasurement
(b) Repeat FNAC
(c)To request CT scan oftheneck,thoraxand
abdomen with intravenous contrast

(d) To advise a right-sided thyroid lobectomy
(e) Total thyroidectomy and central lymph node
dissection

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A 54-year-old man presents with a 6-month history of a hoarse voice and no other ENT symptoms. Clinic room examination reveals
a proliferative lesion on the left false cord
with normal true cord mobility and palpable lymphadenopathy in level II on the ipsilateral side. EUA and CT scan confirm involvement of the false cord with extension along the aryepiglottic fold towards the epiglottis and involvement of the pre-epiglottic space. There is a left level II lymph node measuring 3 cm. There is no evidence of distant metastases. Biopsy from the false cord shows moderately differentiated squamous carcinoma. According to the 7th edition TNM classification, what stage disease is this?
(a) T2 N1 M0
(b) T2 N2a M0
(c) T2 N2b M0
(d) T3 N1 M0
(e) T3 N2a M0

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A 54-year-old patient has hepatocellular carcinoma associated with hepatitis C infection. Investigations reveal three tumors in the right lobe of the liver: 2 cm, 2 cm and 3 cm in size. There is no evidence of metastatic disease. Which of the following options is the treatment of choice?
(a) Radiofrequency ablation
(b) Liver transplantation
(c)Trans arterial chemoembolization
(d) External beam radiotherapy
(e)Noneoftheaboveissuperiortotheothers

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In electron therapy, which of the following statements is correct?
(a) The therapeutic range (on the central axis) is approximately E/2 cm (where E is the energy of the incident electron beam in MeV)
(b) Unlike kV photons, electron treatments rarely require the use of bolus
(c) The 80% isodose is wider at depth than at the surface
(d) Hot and cold spots caused by inhomogeneities can be easily corrected for, provided their position is known
e)The 10% isodose is wider at depth than at the surface

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Which of the following conditions is most typically associated with an increase in colorectal adenocarcinomas?
(a) Neurofibromatosis
(b) Xeroderma pigmentosa
(c) A germ line mutation in BRCA1
(d) Turcot’s syndrome
(e) A genetic defect in the Hedgehog pathway

Turcot syndrome is a CRC + brain tumor syndrome driven by APC or Lynch mutations, requiring aggressive screening/surgery.

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A 62-year-old woman presents with
postmenopausal bleeding. Ahysteroscopy shows
a tumour in the uterus which on biopsy is found
to be a well-diff erentiated adenocarcinoma. An
MRI scan suggests that the tumour is invading
3mm into the myometrium, with a myometrial
thickness of 7mm. What initial treatment would
you recommend?
(a) TAH, BSO and pelvic lymphadenectomy
(b) TAH,BSO
(c) Radical radiotherapy
(d) Intrauterine progesterone
(e) TAH, BSO and infracolic omentectomy

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A 54-year-old woman presents with an enlarging
mass on the vulva that has been present for
12months. Abiopsy confi rms this is squamous
carcinoma. Th ere is no other fi nding on
examination. Th e tumour involves the right
side of the vulva, measures 8cm in maximum
diameter and extends to within 3mm of the
anal margin. She does not wish to have an
anovulvectomy. What is the most appropriate
treatment?
(a) Local excision
(b) Radical vulvectomy and groin node
dissection
(c) Radical radiotherapy to include the primary
tumour with an electron fi eld to the
perineum
(d) Radical chemoradiotherapy to the vulva and
groinnodes
(e) Symptomatic treatment

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A 65-year-old man with pancreatic carcinoma
undergoes a Whipple’s operation. Final histology
shows a T3 N1 (5 of 15 nodes positive) grade 3
adenocarcinoma with vascular invasion, distance toclosest resection margin is 1mm. Based on current
evidence (and outside the context of a clinical trial),
what is the most appropriate management?
(a) No adjuvant therapy
(b) Adjuvant 5-FU chemotherapy
(c) Adjuvant gemcitabine chemotherapy
(d) Adjuvant chemoradiation
(e) Re-operation

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A patient presenting with SVCO is given oxygen, commenced on high-dose steroids and his condition stabilizes. CT scanning confirms the presence of a large superior mediastinal mass. What is the most appropriate management at this stage?
(a) Radiotherapy to the mediastinum using parallel opposed anterior and posterior fields; dose 20 Gy in 5 fractions over 5 days
(b) Chemotherapy with BEP
(c) Referral for biopsy
(d) Anticoagulation
(e) Insertion of a percutaneous stent into
the IVC

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For someone on MST 60 mg b.d.,what should the breakthrough dose of oral morphine be?
(a) 20 mg
(b) 10 mg
(c) 30 mg
(d) 40 mg
(e) 60 mg

Breakthrough dose is typically 10 mg oral morphine IR every 2–4 hours as needed. If the patient requires >2 breakthrough doses/day, their regular MST dose should be increased.

If the patient requires >2 breakthrough doses/day, their regular MST dose should be increased.

Why Not Higher?
30–60 mg (options c-e) would risk overdose (excessive sedation/respiratory depression).

20 mg (option a) is the calculated dose before adjusting for bioavailability.

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Another wise fit and well 61-year-oldman presents with dysphagia and is found to have
an adenocarcinoma of the oesophagus. A CT scan shows no evidence of metastatic disease.
An EUS confirms the tumour to be from 36 to
39 cm ab oral, extending into the right crus of the diaphragm together with two malignant lymph nodes in the peritumoural region. What stage
is this and what is the standard treatment in the UK?
(a) StageT3N1M0:4cyclesepirubicin,cisplatin and capecitabine (ECX) chemotherapy prior to surgery
(b) Stage T3 N1 M1b: definitive chemoradiotherapy
(c)StageT4N1M0:2cyclescisplatinand5-FU followed by surgery
(d) Stage T4 N1 M1b: 2 cycles cisplatin and 5-FU followed by surgery
(e) Stage T3 N1 M0: 2 cycles cisplatin and capecitabine followed by surgery

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The age-specific incidence in England and Wales is decreasing for which of these cancers?
(a) Pancreaticcancer
(b) Gastric cancer
(c) Colorectalcancer
(d) Oesophagealcancer
(e) Testiculargermcelltumours

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Criteria for urgent referral with suspicion of colorectal cancer include:
(a) Rectalbleedingwithanalsymptomsina 62-year-old
(b) Eight weeks change in bowel habit without rectal bleeding in a 45-year-old
(c) Persistentrectalbleedingwithoutanal symptoms in a 35-year-old
(d) Unexplained iron deficiency anaemia in men Hb < 110 g/L
(e) Leftiliacfossamass

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A previously fit 46-year-old woman is found to have a 4 cm basaloid carcinoma of the anal canal. On examination she has a palpable lymph node in her left groin. There is no evidence of distant metastatic disease. An FNA of the groin node
is negative for malignancy. What is the correct initial treatment?
(a) Surgeryalonebecausebasaloidtumoursare not radiosensitive
(b) Cisplatin/5-FU concurrent with radiotherapy to the GTV plus 3 cm
(c) 5-FU plus mitomycin concurrent with radiotherapy to the GTV plus 3 cm
(d) 5-FU and mitomycin concurrent with radiotherapy to the stage-defined CTV
(e) Cisplatin and 5-FU concurrent with radiotherapy to the stage-defined CTV

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Regarding radical radiotherapy for prostate cancer, which of the following statements is correct?
(a) The GTV to PTV margin is usually 2cm
(b) 3D conformal radiotherapy allows dose
escalation to 64 Gy
(c) If included in the treatment,an appropriate seminal vesicle dose is 56 Gy
(d) The use of neoadjuvant hormone therapy causes greater rectal toxicity
(e) A three-field plan with an anterior field and two laterals causes greater rectal toxicity than a three-field plan with an anterior field and two posterior obliques

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An otherwise fit 45-year-old woman presents with epigastric discomfort. An endoscopy
reveals a smooth 3 cm submucosal lesion at the gastric cardia. A CT scan is consistent with a gastrointestinal stromal tumour. What would you recommend next?
(a) Widelocalsurgicalresection
(b) Endoscopic ultrasound-guided FNA (c) Imatinib
(d) A D2 total gastrectomy
(e) APETscan

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TheMRCCR07studyhasdemonstrated:
(a) Animprovementinoverallsurvivalwith preoperative radiotherapy
(b) A reduction in CRM positivity with pre- over postoperative radiotherapy
(c) Asignificantreductioninlocalrecurrence confined to lower-third tumours in patients receiving preoperative radiotherapy
(d) A significant reduction in local recurrence in patients receiving selective postoperative chemoradiotherapy
(e) A significant reduction in local recurrence in patients receiving preoperative radiotherapy

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An84-year-oldwomanpresentstoan ophthalmologist with diplopia and reduced
visual acuity in her left eye. A CT scan shows a left retro-orbital mass. She had a mastectomy 10 years previously for a left breast cancer, followed by tamoxifen for 5 years. Other staging scans are negative. The CA15-3 is 310 u/mL. The original tumour was ER+ve. The most appropriate management now is:
(a) Anastrozole
(b) Urgent palliative radiotherapy to orbit
(c) Urgentpalliativeradiotherapytoorbitand
anastrazole
(d) Palliative chemotherapy
(e) Surgicalexcisionofthemass

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Whichofthefollowingstatementsaboutopioids is correct?
(a) Morphine is glucuronated in the liver ,so renal impairment does not lead to opioid toxicity
(b) Tachycardia is a characteristic feature of opioid toxicity
(c) Patients with opioid toxicity may think they have seen animals running under their bed
(d) Low-dose morphine is classed as a ‘weak opioid’ on the WHO analgesic ladder
(e) Opioidtoxicitytypicallycausespupil
dilatation

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A fit 60-year-old woman undergoes surgery for a carcinoma of the tranverse colon. Histology shows a grade 2 adenocarcinoma, T3 N2 (4 out of 14 nodes involved) with vascular invasion and perineural invasion. There is no evidence of metastatic disease. What is the most appropriate management? (a) Weekly5-FU/folinicacid (b) Modified de Gramont 5-FU (c) Oxaliplatin–fluoropyrimidine-based regimen (d) Oxaliplatin–capecitabine (e) Irinotecan–modified de Gramont

A 45-year-old man presents with gradual onset of right-sided weakness. An MRI scan of the brain shows an enhancing tumour in the right frontal and parietal region. The tumour is excised surgically and histology shows a glioma with frequent mitoses and necrosis. It is decided to treat with radical postoperative radiotherapy. Which of the following statements is correct? (a) Treatingeachfieldeachday,Mondayto Friday, 5 days a week, the dose to the ICRU reference point should be 54 Gy in 30 fractions (b) Craniospinal axis radiotherapy improves survival by reducing the risk of recurrence elsewhere in the central nervous system (c) CTandMRIimageco-registrationisnot usually helpful in planning because of difficulties correcting for scale, rotation and lateral translation (d) The GTV is the contrast-enhancing tumour as seen on imaging e)If megavoltage photons are used, alopecia is unlikely because of the skin sparing in the build-up region

Whichofthefollowingisassociatedwithapoor prognosis in neuroendocrine tumours? (a) Well-differentiatedtumour (b) High Ki-67 index (c) Originintheappendix (d) Bronchial origin (e) Absenceofatypicalcells

Which of the following statements about radiotherapy for thyroid eye disease is correct? (a) It should begiven prophylactically (b) Proptosis usually pushes the lenses so far forward that their radiation dose can be ignored (c) NICE recommends avoiding radiotherapy because of the risk of long-term side effects (d) The long-term risk of cataract is 10% (e) The usual dose is 40 Gy in 20 fractions over 4 weeks

Which of the following statements regarding retinoblastoma is correct? (a) 40%ofcasesareassociatedwithagermline loss of one of the RB1 alleles (b) External beam radiotherapy is the treatment of choice (c) Chemotherapyshouldbeavoidedbecauseof the risk of significant toxicity (d) Enucleation is the treatment of choice (e) Smalltumoursdonotrequireimmediate treatment and can be observed

A43-year-oldmanpresentswithaswellingin the right thigh. Investigations show a soft tissue mass within the quadriceps muscle. A biopsy is undertaken, followed by surgery to remove the tumour. Histology shows a leiomyosarcoma with 20 mitoses per high-power field and more than 50% necrosis. The tumour measured 3 cm diameter and had an excision margin of 25 mm. According to the TNM 7th edition classification, what stage is the tumour? (a) pT1 NX MX (b) pT2 N0 M0 (c) pT1 N0 M0 (d) R1 NX MX (e) G3 T2 N0 M0

A63-year-oldmaleisbeingplannedfor potentially curative definitive platinum-based chemoradiationforasquamouscellcarcinoma starting at 30 cm ab oral using a two-phase technique: phase 1 with anterior–posterior parallel-opposed fields; phase 2 with three fields, one anterior and two posterior obliques. You are asked to review the plans: PTVmax = 106%; PTVmin = 95%; the spinal cord V45 = 20%; combined lung V20 = 10%; and heart V30 = 70%. What action do you recommend? (a) Acceptthecurrentplan (b) Increase the dose contribution from phase 2 (c) Increase the contribution of the anterior field during phase 1 (d) Increase the dose contribution from phase 1 (e) Increase the contribution of the posterior field during phase 1

A45-year-old maths teacher has just completed adjuvant treatment for a right breast cancer. She had a 2.0 cm grade 3 tumour, with 1 of 17 nodes involved. The tumour was ER +ve but HER-2 − ve. She has had 6 cycles of FEC chemotherapy and radiotherapy to the conserved breast. She has started tamoxifen. She wants to know what her prognosis is. According to the Nottingham prognostic index, what is her 10-year survival likely to be? (a) 51% (b) 41% (c) 61% (d) 71% (e) 31%

c NPI=(0.2×Tumor Size in cm)+Grade+Lymph Node Stage

A 57-year-old fit woman presents with abdominal distension, poor appetite and weight loss. CT scan shows bilateral ovarian masses and an omental ‘cake’. Her CA125 is 763 U/mL. She undergoes laparotomy and debulking. Tumour deposits are found in the ovaries and on the omentum and surface of the liver measuring 2.5 cm. What stage is her ovarian cancer? (a) FIGO stage IIIC (b) FIGO stage IVA (c) FIGO stage IIC (d) FIGO stage IIIB (e) FIGO stage IIIA

Which of the following statements about radiotherapy for vulval cancer is correct? (a) The dose of concurrent weekly cisplatin is 50 mg/m2 (b) Moist desquamation of the vulval skin can occur, but it is not usually painful (c) The vulva doesnot tolerate radiotherapy well, so radiation doses in excess of 60 Gy cannot be given (d) The clinical target volume in advanced vulval cancer includes the primary tumor, vulva, groin and pelvic nodes (e)Post operative radiotherapy does not reduce the local recurrence rate in patients with a resection margin of less than 8 mm

In mega voltage photon therapy ,which of the following statements is correct? (a) The width of the radiation beam increases linearly with distance from the treatment head because of the inverse-square law (b) The beam penumbra is the distance between the 30% and 70% depth doses (c) As the energy increases, the dmax decreases (d) When the distance from the treatment machine to the patient increases, the inverse-square law causes percentage depth doses below the dmax to increase (e)As the field size increases, the central axis receives less radiation per monitor unit because of reduced scatter from the machine head and within the patient

Which of the following statements about radiotherapy for mesothelioma is correct? (a) Wide-field palliative radiotherapy can alleviate pain in around 60% of patients (b) Palliative radiotherapy to the chest for mesothelioma usually alleviates shortness of breath (c) The dose for prophylactic needle-track radiotherapy can be kept as low as 50 Gy in 25 fractions because only microscopic disease is being treated (d) In postoperative radiotherapy following extrapleural pneumonectomy, the GTV is the entire hemithorax (e) Symptomatic disease in the thorax should be treated with high-dose palliation

Which of these is the correct estimated 5-year overall survival following an Ivor–Lewis oesophagectomy on a fit patient with a T3 N1 adenocarcinoma? (a) 60% (b) 40% (c) 5% (d) 20% (e) 0%

Which of the following aspects of reporting trials can actually lead to less reliable conclusions? (a) Ensuring as complete a follow-up as possible (b) Reporting trials whether or not they show a ‘positive’ or ‘negative’ result (c) Stressing to readers those outcomes where there is a difference between subgroups (d) Performing a meta-analysis (e) Reporting treatment effects and confidence intervals

Which one of the following cytotoxic drugs is a vesicant when extravasated – that is, is associated with a high risk of causing inflammation and blistering of local skin and underlying tissue leading to tissue death and necrosis? (a) Carboplatin (b) Bleomycin (c) Paclitaxel (d) Etoposide (e) Methotrexate

Which of the Following statements relating to the cervical lymph nodes is correct? (a) LevelII contains the submandibular nodes (b) Preauricular and intraparotid nodes are included in level I (c) Lower jugular nodes lie in level III (d) Level III extends from the hyoid bone superiorly to the lower border of the cricoid cartilage (e) LevelV I containstheanteriorcentral compartment nodes and extends between

Whose law states that a palpable non-tender gallbladder is a typical feature of an obstructive tumour of the lower biliary tree? (a) Kruckenberg (b) Courvoisier (c) Trousseau (d) Bismuth (e) Virchow

b In the presence of jaundice, a palpable, non-tender gallbladder suggests malignant obstruction of the biliary tree (e.g., pancreatic cancer, cholangiocarcinoma), rather than a gallstone-related obstruction.

Which of the following genetic defects is most commonly associated with the adenoma–carcinoma sequence for colorectal carcinoma? (a) A loss of heterozygosity in the RB gene (b) DNA mismatch repair (c) Chromosome 22 loss (d) HER 2 amplifi cation (e) DNA hypomethylation

Regarding carcinoma of the anus, which of the following statements is correct? (a) Anal-margin tumors have a worse prognosis than tumors in the anal canal (b) Patients with HIV/AIDS are at reduced risk of toxicity from treatment (c) Anal fissure is a risk factor for anal cancer (d) A history of intraepithelial neoplasia of the cervix, vagina or vulva is a risk factor for anal cancer (e) Patients who are treated with radical chemoradiotherapy have a significantly better life expectancy than patients treated with radical surgery

Osteolytic bone metastases are a typical feature of: (a) Prostate cancer (b) Gastric cancer (c) Renal cell cancer (d) Carcinoid tumours (e) Bladder cancer

A man presents with a grade 3, pT1 bladder cancer. Th e most appropriate management is transurethral resection of bladder tumour (TURBT) followed by: (a) Radical radiotherapy with regular cystoscopic follow-up (b) Radical cystectomy (c) Neoadjuvant chemotherapy and radical cystectomy (d) Systemic chemotherapy with regular cystoscopic follow-up (e) Intravesical BCG with regular cystoscopic follow-up

Which one of the following statements about bone scans is true? (a) Bone scans are very useful for diagnosing myeloma deposits (b) Bone scans are not useful for showing metastases from bladder cancer (c) Th e isotope used is 123 I (d) Bone scans show osteoblast activity (e) Bone scans show high activity in the brain and heart

A 58-year-old man presents with an enlarging mass on the penis. A biopsy confirms this is squamous carcinoma. Clinical examination and staging investigations are otherwise normal. The tumour is staged as T2 invading the corpus carvernosus, grade 3. What is the most appropriate management? (a) Brachytherapy (b) External beam radiotherapy to the penis and groin nodes (c) Sentinel node biopsy, partial amputation of the penis and inguinal node dissection if sentinel node is positive (d) Partial amputation of the penis and prophylactic radiotherapy to the groin nodes (e) Topical chemotherapy with 5-FU

A 25-year-old man with stage II non-seminomatous germ cell cancer undergoes treatment with four cycles of BEP chemotherapy. After treatment, a CT scan shows a significant response, but the presence of a residual mass measuring 4 cm diameter. The treatment should be: (a) Give a further two cycles of BEP and rescan (b) Observe with serial CT scans (c) Surgery to remove the mas (d) Observe with serial CT scans and tumour markers (e) Radiofrequency ablation of the mas

A 57-year-old fi t woman presents with abdominal distension, poor appetite and weight loss. A CT scan shows bilateral ovarian masses and an omental ‘cake’. Her CA125 is 763 U/mL. She undergoes laparotomy and debulking. Tumour deposits are found in the ovaries and on the omentum and surface of the liver measuring 2.5 cm. There is 0 cm residual disease. Of available cytotoxic chemotherapy agents, which would you recommend now? (a) Offer single-agent carboplatin chemotherapy (b) Discuss options of platinum-based chemotherapy alone or platinum-based chemotherapy with paclitaxel (c) Discuss options of platinum-based chemotherapy alone or paclitaxel alone (d) Offer cisplatin, doxorubicin and cyclophosphamide chemotherapy (e) Offer single-agent cisplatin

A 65-year-old woman presents with postmenopausal bleeding. A hysteroscopy shows polyps and biopsy confi rms adenocarcinoma. She undergoes TAH and BSO and histology shows a FIGO stage IA grade I tumour and there is adenomyosis extending into the deep myometrium. What management would you recommend? (a) Adjuvant progestin (b) Radiotherapy with external beam and obturator (c) External beam radiotherapy alone (d) Clinical follow-up only (e) Radiotherapy with obturator alone

A patient with cervical cancer is undergoing radical chemoradiotherapy and has received five cycles of cisplatin chemotherapy. She developed paranesthesia, muscle cramps, tremor and hyperreflexia. Her calcium level was 1.89 mmol/L. She was given calcium supplements and her most recent serum calcium is within the normal range but her symptoms have not resolved. What is the most likely biochemical cause of her symptoms? (a) Hypercalcaemi (b) Hypokalaemia (c) Hypomagnesaemia (d) Hyponatraemia (e) Hyperphosphataemi

Which statement regarding patients with small-cell lung cancer and a good performance status (PS 0–1) is correct? (a) Platinum-based systemic chemotherapy in patients with limited disease does not prolong survival (b) Single-agent chemotherapy is as eff ective as combination chemotherapy (c) Prophylactic cranial irradiation in patients with limited disease and a complete response to chemotherapy does not prolong survival (d) There is no survival benefit from thoracic radiotherapy in patients with extensive disease. (e) Consolidation thoracic radiotherapy in patients with limited disease and a complete response to chemotherapy prolongs survival

A 43-year-old man presents with a swelling in the right thigh. Investigations show a soft -tissue mass within the quadriceps muscle. A biopsy is undertaken, followed by surgery to remove the tumour. Histology shows a leiomyosarcoma with 20 mitoses per high-power field and with more than 50% necrosis. Th e tumour measured 3 cm diameter and had an excision margin of 25 mm. What is the most appropriate management? (a) Clinical follow-up with chest X-ray every 3 months (b) Adjuvant chemotherapy with ifosphamide and doxorubicin (c) Re-excision (d) Postoperative radiotherapy (e) Sentinel node lymph node biopsy followed by groin-node dissection if positive

A 30-year-old woman presents with an enlarging mass of lymph nodes in the right neck. It is mobile, measures 5 cm in diameter, and has a rubbery feel. She has no ‘B’ symptoms. A lymph node biopsy confirms classical Hodgkin lymphoma. There is no evidence of any other sites of disease and the ESR was 16. Out of the options listed, what is the most appropriate treatment? (a) Six cycles of CHOP chemotherapy b) Mantle radiotherapy with a radiotherapy dose of 40 Gy in 20 fractions (c) Six cycles of ABVD chemotherapy (d) Two cycles of ABVD chemotherapy followed by involved fi eld radiotherapy (20 Gy) (e) Surgery to remove the rest of the mass followed by involved fi eld radiotherapy

A 75-year-old woman develops small-volume lymphadenopathy in the left axilla and left neck. A CT scan shows no other sites of disease. Her haemoglobin is 12.5 g/dL and her LDH is in the normal range. Biopsy of one of the lymph nodes shows grade 1 follicular lymphoma. What is the best management? (a) CHOP chemotherapy (b) Single-agent chlorambucil (c) Surveillance (d) ABVD chemotherapy (e) Single-agent fl udarabin

A 70-year-old man, who is on warfarin for atrial fi brillation, presents with a slowly enlarging lesion at the inner canthus of his left eye. On examination, the lesion diameter is 0.75 cm and depth is 0.5 cm. Biopsy confi rms a basal cell carcinoma. Th e most appropriate management is: (a) Surgical excision (b) Radiotherapy with 90 kV X-rays (c) Radiotherapy with 6 MeV electrons (d) Radiotherapy with 170 kV X-rays (e) Radiotherapy with 9 MeV electron

A patient has an excisional biopsy for an ulcerated pigmented cutaneous lesion. Th e histology is of a 4.2-mm thick nodular melanoma completely excised. Which of the following options would be considered as standard to offer the patient? (a) A further 5-cm wide excision (b) Sentinel lymph node biopsy followed by lymph node dissection (c) Elective lymph node dissection (d) Adjuvant low-dose interferon α (e) A staging CT scan

A 39-year-old man with medullary thyroid cancer underwent surgery with total thyroidectomy and lymph node dissection. Postoperatively, serum calcitonin was 163 pg/mL, but imaging studies showed no evidence of disease. Th e patient iSsymptomatic. What is the most appropriate course of action? (a) Postoperative radiotherapy to the neck (b) Treatment with vandetanib (c) Treatment with octreotide (d) Measure serum calcitonin and CEA and perform physicial examination every 6 months initially (e) Th erapeutic radioiodinE

A 51-year-man old undergoes an ileal resection and right hemicolectomy for a locally advanced, node-positive, well-diff erentiated carcinoid tumour. Five years later the patient presents with flushing and palpitations and a CT scan reveals three tumours in segments 2 and 3 of the liver. What is the most appropriate next investigation? (a) Twenty-four-hour urine 5-HIAA (b) Serum chromogranin A (c) PET scan (d) Somatostatin receptor scintigraphy (OctreoScan®) (e) 123 I-MIBG scan

Which of the following is an ‘unfavorable’ subset of carcinoma of unknown primary site? (a) Poorly differentiated carcinoma in the midline (b) Female patient with papillary serous adenocarcinoma of the peritoneal cavity (c) Female patient with axillary lymphadenopathy (d) Adenocarcinoma of the pleura (e) Squamous cell cervical lymphadenopathy

Regarding heterotopic bone formation, which of the following statements is correct? (a) It causes clinical problems in 43% of patients after a hip replacement (b) It typically develops 6 months after hip surgery (c) Prophylactic radiotherapy is effective if given up to 4 days aft er re-operation of the hip (d) Prophylactic radiotherapy is ineff ective if given just before re-operation (e) Fractionated radiotherapy is more eff ective than a single fraction

Which of the following statements is correct? (a) Th esoesophageal pharyngeal syndrome of oxaliplatin is made worse by exposure to heat (b) Palmar–plantar erythrodysaesthesia caused by liposomal doxorubicin is made worse by exposure to cold (c) Scalp warming can reduce alopecia caused by some chemotherapy drugs (d) An anthracycline extravasation is best treated with a cold compress (e) A vinca alkaloid extravasation is best treated with a cold compress

74-year-old woman presents with a painless smooth swelling in the right neck (3 × 4 cm). Th ere are no ENT symptoms and no abnormalities detectable in clinic. She has been a smoker of 20 cigarettes a day for 40 years. Th ere is no comorbidity and her WHO PS = 0. US of the neck shows a solitary cystic mass at level II only. FNAC shows squamous carcinoma cells. What would you do next? (a) Contrast-enhanced CT neck (b) FDG-PET scan (c) Pan endoscopy of upper aerodigestive tract (d) Right modified radical neck dissection (e) Excision of cystic mass for definitive pathology

65-year-old man underwent abdominoperineal resection in January 2004 for a T3 N0 M0 rectal carcinoma. At routine follow-up in January 2005, his CEA was found to be elevated at 25 U/mL and a CT scan showed a solitary liver metastasis that was resectable on radiological grounds. Based on current evidence, the standard treatment outside of a clinical trial is: (a) Liver resection only (b) Preoperative modifi ed de Gramont chemotherapy followed by liver resection (c) Preoperative oxaliplatin-based chemotherapy followed by liver resection (d) Preoperative irinotecan-based chemotherapy followed by liver resection (e) Radiofrequency ablatio

fit 66-year-old man presents with a bilateral cT3a prostate cancer, PSA = 25 ng/mL and Gleason 4 + 4 = 8 in all eight cores, maximum core length = 12 mm. MRI/bone scan confirm T3a N0 M0 disease. The most appropriate management is (a) Radical prostatectomy, lymph node dissection and adjuvant radiotherapy (b) Radical prostatectomy, lymph node dissection and 2 years of adjuvant hormonal therapy (c) Radical external beam radiotherapy with a high-dose-rate brachytherapy boost (d) Neoadjuvant androgen deprivation and radical external beam radiotherapy (e) Neoadjuvant and adjuvant androgen deprivation and radical external beam radiotherapy

A patient is to receive a course of definitive chemoradiation for an inoperable carcinoma of the tail of the pancreas. Both kidneys are functioning. You are given a radiotherapy plan for approval that has an anterior and two lateral fields. The liver V30 = 40%, small bowel D max = 45 Gy, left kidney V30 = 90%, the right kidney V20 = 25%. What do you do? (a) Reduce the dose to the PTV (b) Accept the plan (c) Reduce the margin given to the GTV (d) Add a posterior field (e) Increase the weight to the anterior field

D Why Not Other Options? (a) Reduce PTV dose: Compromises tumor control (definitive chemoradiation requires full dose). (b) Accept the plan: Left kidney toxicity is unacceptable. (c) Reduce GTV margin: Risks geographic miss (pancreatic tumors need adequate margins). (e) Increase anterior weight: May worsen kidney/liver dose inhomogeneity.

With regard to brachytherapy for carcinoma of the cervix, which of the following statements is correct? (a) For practical purposes, Manchester point A is sometimes defined as 1 cm above and 1 cm lateral to the flange at the lower end of the uterine tube (b) Manchester point B is 3 cm from the midline (c) Th e ICRU 38 bladder point is the anterior surface of the bladder balloon (d) The ICRU 38 rectal point is 5 mm behind the posterior vaginal wall at the level of the lower end of the intrauterine tube (e) Th e rectal dose should be less than half of the dose to point A

You are shown a plan for a radical lung treatment for CHART radiotherapy (54 Gy in 36 fractions over 12 days). The V20 for the lung is 45%. The dose to the PTV lies between 95% and 107%. The maximum spinal cord dose is 15 Gy. What action should you take? (a) Accept the plan b) Accept the plan but reduce the prescribed dose of radiotherapy (c) Treat the patient with 60 Gy in 30 fractions over 6 weeks instead (d) Move one or more beams so they pass through the spinal cord rather than the lung (e) Move one or more beams so they pass through lung rather than spinal cor

which of the following is important for minimizing measurement bias in clinical studies? (a) Meta-analysis (b) Adjusted analyses (c) Blinding (d) Per protocol analysis (e) A transparent randomization process

The ICRU reference point should be: (a) Always at the centre of the tumour (b) Representative of the PTV dose (c) At the isocentre if there is one (d) At the point of maximum dose within the PTV (e) At the point of minimum dose within the PTV

A patient has a 5 cm squamous cancer of the lower anal canal. An MRI demonstrates evidence of left -sided internal iliac lymphadenopathy. No other disease is found. Th e correct stage is: (a) T2 N1 M0 (b) T2 N2 M0 (c) T3 N1 M0 (d) T3 N1 M1 (e) T2 N1 M1

which of the following statements about gastrointestinal stromal tumours is correct? (a) They arise from the intestinal cells of Jacal (b) They are associated with dysregulation of the tumour suppressor gene, KIT (c) An increase in size of the tumour can occur when responding to imatinib (d) Standard treatment for patients whose tumours have been resected is adjuvant imatinib (e) GIST tumours stain positively with CD119

56-year-old woman undergoes breast screening. A 1.5 cm abnormality is detectedn the left breast, which is biopsied and shows lobular carcinoma in situ . She has a very strong family history of breast cancer and does not wish to accept observation alone. What surgical treatment would you recommend? (a) Wide local excision followed by postoperative radiotherapy (b) Wide local excision alone (c) Unilateral mastectomy (d) Bilateral mastectomy (e) Bilateral mastectomy with unilateral axillary lymph node dissection

62-year-old man undergoes a radical nephrectomy for renal cell carcinoma. Histology confi rms an 8 cm tumour confi ned to the kidney with three positive regional lymph nodes. What stage is this? (a) T2 N1b (b) T3 N2 (c) T3 N1b (d) T2 N2 (e) T2 N3

A man is discussed at the multidisciplinary meeting following TURBT. A large papillary mass was fully resected. Pathology shows a grade 3 transitional cell carcinoma with invasion of the muscularis propria. What stage is he? (a) T2a (b) pT2a at least (c) pT1b (d) pT2b (e) pT3a

man with metastatic NSGCT is being treated with his fi rst course of chemotherapy with standard 5-day BEP. When he attends for his third cycle of chemotherapy, he mentions some mild exertional dyspnoea. What is the most appropriate management? (a) Delay chemotherapy for 1 week to allow the patient time to improve (b) Stop chemotherapy aft er two cycles (c) Stop BEP and change to TIP for the remaining cycles (d) Treat with oxygen, antibiotics and high-dose intravenous steroids and continue with the third cycle of BEP without delay (e) Investigate with CXR, CT of the chest and pulmonary function tests, proceeding with EP for a total of four cycles if bleomycin toxicity is suspecte

. Which of the following is a risk factor for ovarian cancer? (a) Breast feeding (b) Tubal ligation (c) Use of the oral contraceptive pill (d) A germline mutation in the HNPCC gene (e) Early menopause

45-year-old woman presents with FIGO stage IB1 carcinoma of the cervix. Following radical hysterectomy and lymph node dissection, she is found to have a 6 cm tumour with extension into the parametrium with negative lymph nodes. Th ere is no evidence of distant metastases. What stage is the tumour? (a) FIGO IIA (b) pT2b pN0 (c) FIGO IIB (d) pT1b2 pN0 (e) FIGO IIIB

In vaginal cancer, which of the following statements is correct? (a) Vaginal cancer is a rare disease, so treatment should always follow the standard protocol (b) Radiotherapy phase 1 includes the pelvic and paraaortic lymph nodes (c) Th e radiotherapy fi eld for carcinoma of the upper third of the vagina should include the inguinal nodes (d) Vaginal cancers in the lower vagina usually have a worse prognosis than those in the upper vagina (e) Th ere is a strong evidence base for the use of concurrent chemoradiotherapy for squamous carcinoma of the upper vagina

A 53-year-old man had a left upper lobectomy for a moderately diff erentiated pT2 pN1 M0 squamous cell carcinoma of the lung. Resection margins were reported as clear, with a medial resection margin of 6 mm. What further therapy is it appropriate to off er him (outside a clinical trial)?a) Adjuvant radiotherapy to the mediastinum (b) Adjuvant chemotherapy (c) Adjuvant radiotherapy to the mediastinum followed by adjuvant chemotherapy (d) Further surgical resection (e) Concomitant chemoradiotherapy

Which of the following statements about Ewing sarcoma is correct? (a) Relapsed disease can oft en be cured with second-line intensive chemotherapy (b) Th e incidence of distant metastases is low (c) It is a chemoresistant tumour (d) Radiotherapy should not be given in inoperable disease because of the risk of fracture when the tumour responds (e) Radiotherapy is indicated for sites of metastases, including the whole luny

A 59-year-old woman presents with vague abdominal symptoms of nausea, weight loss, leg oedema and urinary pressure. Her serum CA125 level is 2537 U/mL. A CT scan shows bilateral pelvic masses with para-aortic lymphadenopathy. A biopsy and immunohistochemistry are performed. Th e tumour is found to be cytokeratin negative, CD19 positive, and CD20 positive and Ki-67 of 95%. What is the most appropriate initial treatment? (a) Laparotomy, debulking, total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy (b) Chemotherapy with carboplatin and paclitaxel (c) Rasburicase then chemotherapy with R-CHOP (d) Radiotherapy to sites of bulky disease (e) Allopurinol then chemotherapy with ABVD

which statement best describes the role of chemotherapy in primary tumours of the central nervous system? (a) Concurrent chemotherapy with radical radiotherapy has been shown to more than double the 2-year survival in patients with grade IV gliomas (b) Th e improvement seen with concurrent chemotherapy and radical radiotherapy Ws greatest in patients with a poor performance status (c) Radiological features of primary CNS lymphoma are typical, so that patients should receive chemotherapy without the need for histological confi rmation (d) Adjuvant chemotherapy has been shown to double median survival in grade gliomas (e) Th e usual dose of temozolamide is 20 mg/m2

An 85-year-old lady presents with a non-healing ulcer on the left lower leg. It measures 6 cm in maximum diameter, 1 cm in depth, and has a rolled edge. Clinical examination reveals no other tumours. A biopsy is undertaken that shows moderately diff erentiated squamous carcinoma. What is the optimal management? (a) Observation (b) Radiotherapy with 170 kV photons, 40 Gy in 8 fractions over 8 days (c) Radiotherapy with 9 MeV electrons and 1 cm bolus, 60 Gy in 30 fractions over 6 weeks (d) Surgical excision and healing with secondary intention (e) Surgical excision and skin graft ing

Concerning malignant melanoma, which of the following statements is true? (a) Nodular melanoma is the most common subtype (b) Sunscreens have been shown to reduce the risk of malignant melanoma (c) A 10 mm choroidal melanoma can be treated with scleral plaque therapy instead of enucleation (d) Adjuvant low-dose interferon α has been shown to improve survival (e) Th e addition of carmustine, tamoxifen and cisplatin to dacarbazine improves survival over dacarbazine alone in advanced melanoma

A 51-year-old woman develops appendicitis. During surgery, it is noted that the appendix forms a mass that is locally invasive. Th e mass is excised and shows a carcinoid tumour with atypical cells. Four years later she develops some mild right upper quadrant discomfort and an ultrasound shows a 3 cm mass in segment8 of the liver. Further investigations show no other sites of disease. What is the optimal management? (a) Capecitabine and streptozocin (b) Interferon α (c) 90 Y octreotide isotope therapy (d) 131 I MIBG isotope therapy (e) Surgical resection

A 4-year-old boy presents with painless swelling of the abdomen. An abdominal ultrasound shows a large tumour in the right fl ank. A CT scan shows that this is arising from the right kidney and is invading the perinephric structures. A biopsy is not undertaken because of the risk of tumour rupture. What is the most likely diagnosis? (a) Neuroblastoma (b) Wilm’s tumour (c) Rhabdomyosarcoma (d) Non-Hodgkin lymphoma (e) Teratoma

Which of the following statements about keloids is correct? (a) Keloids should not be excised before radiotherapy because this would increase the risk of recurrence (b) Radiotherapy should be given within 1 month of excision (c) Radiotherapy is eff ective in about half of all cases (d) Keloids are unsuitable for treatment with brachytherapy (e) A single fraction of 6 Gy with 100 kV photons is adequate for small keloidS

A 59-year-old fi t woman has a 10 mm mass in the upper outer quadrant of the right breast. Biopsy shows poorly diff erentiated cancer; CK7+, CK20−, TTF-1 focally+, ER−. CT scan shows multiple lung and liver metastases. Which of the following is the most appropriate chemotherapy regimen? (a) FEC (b) gemcitabine and carboplatin (c) modifi ed de Gramont (d) R-CHOP (e) Ifosphamide and doxorubiciN

A 56-year-old man in previously excellent heath has been referred to you for a second opinion about management of his epithelioid malignant mesothelioma. Which statement is correct? (a) Pleuropneumonectomy followed by postoperative chemotherapy and radiotherapy has been shown to improve survival compared to no surgery for stage I disease (b) Th e median survival for all patients is 18 months (c) Th e epithelioid variant has the best prognosis (d) Th e response rate to chemotherapy is more than 50% (e) Th e presence of pleural plaques signifi cantly increases the chance of developing mesothelioma in patients exposed to asbestos

A 36-year-old woman is undergoing surveillance aft er a molar pregnancy. Her hCG fails to fall into the normal range and her pretreatment level was 913 IU/L. What management would you recommend? (a) Chemotherapy with intramuscular methotrexate (b) Chemotherapy with actinomycin-D, methotrexate and etoposide (c) Chemotherapy with actinomycin-D, methotrexate, etoposide, vincristine and cyclophosphamide (d) Observation (e) Hysterectomy

45-year-old man has had a right hemicolectomy for a mucinous carcinoma of the caecum as an emergency. Th e stage was T2 N0, grade II, completely resected with no lymphovascular infi ltration; what further management would you advise? (a) A complete total colectomy (b) An adjuvant course of oxaliplatin and 5-FU chemotherapy (c) An adjuvant course of capecitabine chemotherapy (d) Postoperative staging including colonoscopic review of the remaining bowel (e) Postoperative CEA

Which of the following statements is true about choosing wide or restrictive entry criteria to a trial? (a) With wide entry criteria it is impossible to work out what the trial population was (b) With restrictive entry criteria there is more chance of a signifi cant result (c) Wide entry criteria make it more diffi cult to recruit patients to the trial (d) Restrictive entry criteria give more clinically meaningful results (e) Restrictive entry criteria mean that it is oft en impossible to determine if a treatment works for all people, or just some

What is the defi nition of high-dose-rate brachy-therapy? (a) Dose rate greater than 6 Gy/hr (b) Dose rate greater than 8 Gy/hr (c) Dose rate greater than 10 Gy/hr (d) Dose rate greater than 12 Gy/hr (e) Dose rate greater than 14 Gy/hr

Which of the following statements about hormonal treatments is correct? (a) Aromatase inhibitors should not be given to premenopausal women aft er ovarian function suppression (b) Tamoxifen is less likely than an aromatase inhibitor to cause thromboembolic events (c) Aromatase inhibitors are less likely than tamoxifen to cause osteoporosis (d) Tamoxifen is less likely than aromatase inhibitors to cause endometrial hyperplasia (e) Tamoxifen is less likely than aromatase inhibitors to cause arthralgia

Which of the following statements about postoperative adjuvant radiotherapy for stage IC, grade 3, carcinoma of the endometrium is correct? (a) It should be combined with concurrent chemotherapy with weekly cisplatin (b) A reasonable dose is 45 Gy in 25 fractions to the whole pelvis followed by 9–18 Gy as an external beam boost to the GTV (c) It should be followed by adjuvant hormonal therapy with a progestin(d) An acceptable dose for the boost would be 20 Gy LDR to the whole vagina (e) Th e lower border of the radiation fi eld should cover the obturator foramina

Which of the following statements regarding carboplatin and paclitaxel is correct? (a) Carboplatin and paclitaxel have diff erent routes of excretion so the order in which they are given does not matter (b) Paclitaxel is given before carboplatin; otherwise there is a 20% reduction in paclitaxel clearance (c) Paclitaxel is given aft er carboplatin to reduce the risk of myelosuppression (d) Paclitaxel and carboplatin are given simultaneously to reduce the treatment time for the patient (e) Scalp cooling should be off ered because it reduces the risk of alopecia due to carboplatin

hich of the following statements about trastuzumab is correct? (a) It has been shown to improve overall 20-year survival when used in patients with HER2-positive breast cancers as adjuvant therapy in combination with chemotherapy (b) It is a chimeric IgM antibody (c) It causes symptoms of heart failure in approximately 10% of patients (d) It should always be preceded by the administration of antihistamines and steroids (e) It is recommended with docetaxel as fi rst-line therapy in patients with HER2-positive mestastatic breast cancer who are unsuitable for an anthracycline

Regarding pineal tumours, which of the following statements is correct? (a) Due to the site of these tumours, biopsy is rarely indicated before treatment (b) Germ cell intracranial tumours rarely produce elevated serum β hCG and/or α FP (c) Pineocytomas are less chemosensitive than oligodendrogliomas (d) Pineoblastomas should be considered for stereotactic radiotherapye) Th e dose recommended for craniospinal axis radiotherapy is lower for germ cell tumours than for parenchymal tumour

A 55-year-old woman with stage 3C ovarian cancer relapses 4 months aft er carboplatin and paclitaxel chemotherapy. What would be the recommended chemotherapy treatment now? (a) Liposomal doxorubicin (b) Topotecan (c) Single-agent carboplatin (d) Carboplatin and paclitaxel (e) Carboplatin and gemcitabine

Which cancer is the most common in the UK? (a) Uterus (b) Oesophagus (c) Larynx (d) Bladder (e) Carcinoma of unknown primary site

A patient has recently been diagnosed with carcinoma of the pancreas. Investigations reveal a 3 cm mass in the head of the pancreas invading the second part of the duodenum. Th ere is evidence of coeliac lymphadenopathy but no other evidence of metastatic disease. Th e stage is: (a) T2 N1 M0 (b) T3 N1 M0 (c) T4 N1 M0 (d) T3 N1 M1a (e) T4 N1 M1a

A 45-year-old woman weighs 73 kg and her serum creatinine is 95 mM/L. Using the Cockcroft -Gault formula, what is the best estimation of her creatinine clearance in mL/ min? (a) 36 (b) 56 (c) 76 (d) 96 (e) 116

Radiotherapy doses as low as which level can aff ect sperm production? (a) 3 Gy (b) 16 Gy (c) 10 Gy (d) 5 Gy (e) 1 Gy

66-year-old electrician presents with shortness of breath. His chest X-ray shows pleural thickening and an ultrasound shows this to be solid with an associated pleural eff usion. A CT scan shows thickening of the mediastinal pleura and loss of lung volume. Out of the following, what investigation would be most likely to give the diagnosis? (a) Bronchoscopy (b) CT-guided fi ne-needle aspiration cytology (c) Th oracoscopic biopsy (d) Cytology of pleural fl uid (e) Sputum cytology

Which of the following statements about hormonal treatments is correct? (a) Tumours that develop resistance to tamoxifen are very unlikely to respond to an aromatase inhibitor (b) Aromatase inhibitors act primarily on steroid synthesis in the adrenal gland (c) In patients with prostate cancer who are starting treatment with an LHRHa, an anti-androgen is also required to prevent tumour ‘fl are’ (d) Ovarian cancer is not a hormonally sensitive disease (e) Tumours that are oestrogen-receptor negative and progesterone-receptor positive should not be treated with tamoxifen

A 54-year-old man undergoes a left nephrectomy for renal cell cancer. Eight months later he feels short of breath and has back pain. CXR and CT scan confi rm the presence of a local recurrence and two peripheral lung metastases. His Karnofsky performance status is 50. His Hb is 10.5 g/dL and his serum-corrected calcium is 2.7 mM/L. What management would you recommend? (a) Symptomatic treatment only (b) Interferon α (c) Interleukin-2 (d) Chemotherapy with the Atzpodien regimen (e) Attempted surgical resection of the lung metastases in an attempt to control the local recurrence

Th e MRC ST02 (MAGIC) trial was recently published. Th is trial demonstrates that: (a) Preoperative epirubicin, cisplatin and capecitabine (ECX) followed by surgery is superior to surgery alone (b) Postoperative epirubicin, cisplatin and 5-fl uorouracil (ECF) has no proven role in gastric cancer (c) Preoperative chemotherapy is superior to postoperative chemotherapy in gastric cancer (d) Pre- and postoperative ECF chemotherapy is superior to surgery alone (e) Capecitabine is equivalent to 5-FU in the adjuvant therapy of gastric cancer

49-year-old woman had radical chemoradiotherapy for cervical carcinoma 2 years ago. She now presents with back pain radiating down the right leg with pain and numbness of the left knee. What is the most likely site of recurrence? (a) L3 vertebra (b) L4 vertebra (c) Left psoas muscle (d) Left para-aortic nodes (e) Pelvic nodes

A 60-year-old male smoker presents with a 6-week history of cough and swelling of the face and upper limbs. Examination fi ndings are consistent with SVCO and CXR shows right paratracheal lymphadenopathy. What is the most likely underlying diagnosis? (a) Th ymoma (b) High-grade NHL (c) Lung cancer (d) Metastatic germ cell tumour (e) Hodgkin lymphoma

55-year-old man complains of back pain. Examination is unremarkable, but spinal MRI reveal a 3 cm extradural soft tissue mass at the level of T12. Biopsy shows malignant plasma cells, but staging investigations for multiple myeloma are negative. He is referred for radiotherapy. What is the optimum PTV and dose schedule? (a) GTV plus 10 cm margin, 50 Gy in daily 2 Gy fraction (b) GTV plus 2 cm margin, 60 Gy in daily 2 Gy fractions (c) GTV plus 2 cm margin, 40 Gy in daily 2 Gy fractions (d) GTV plus 5 cm margin, 30 Gy in daily 3 Gy fractions (e) GTV plus 2 cm margin, 20 Gy in daily 4 Gy fractions

A laboratory assessment of the α / β ratio for a malignant melanoma cell line demonstrated an average value of approximately 2. Taking this information into account, which of the following radiotherapy regimens is likely to be the most eff ective in cancer control of melanoma? (a) 30 Gy in 10 fractions (b) 21 Gy in 3 fractions (c) 10 Gy in a single fraction (d) 30 Gy in 5 fractions (e) 35 Gy in 15 fraction

A 35-year-old man with a smoking history of 20 pack years presents with chest discomfort and shortness of breath. He has lost weight and has been having night sweats. He is found to have a poorly diff erentiated carcinoma in the mediastinum. What is the most appropriate chemotherapy regimen? (a) BEP (b) R-CHOP (c) FOLFOX (d) ABVD (e) ICE

Which of the following statements about erlotinib is correct? (a) It is a monoclonal antibody directed against EGFR (b) It is given intravenously (c) Patients who develop a rash typically have a worse response than those who do not (d) Th e recommended dose is 200 mg daily (e) Th e rash responds to topical clindamycin

hich of the following statements about oestrogen is correct? (a) In premenopausal women, oestrogens are mainly synthesised in the theca cells of the ovary b) In women, oestrogens are produced in the adrenal gland by the action of the aromatase enzyme (c) Oestrogen-receptor-positive breast cancers invariably respond to hormonal treatment (d) Oestrogens reduce low-density lipoproteins (e) Oestrogens are anticoagulants

n radiotherapy planning, which of the following statements is correct? (a) Th e internal margin accounts for the uncertainties and lack of reproducibility in setting up the patient day by day (b) Th e treated volume is the tissue volume that receives a dose considered signifi cant in relation to normal tissue tolerance (c) Reducing the planning CT-scan slice thickness reduces the distance required to be added to the gross tumour volume to make the clinical target volume (d) CTV + IM + SM = PTV (e) Th e function of ‘parallel’ organs may be seriously aff ected even if a small portion is irradiated above a tolerance dose, and the eff ect of radiation on the function of ‘serial’ organs is more dependent on the volume irradiated

A 64-year-old man develops jaundice with pale stools and dark urine. He also has some vague right upper quadrant pain and weight loss. Th ere are no masses palpable on examination. An ultrasound scan suggests the presence of a distal tumour in the biliary tract. Out of the following options, what is the most appropriate investigation to perform next? (a) Percutaneous transhepatic cholangiograph (b) MRI scan (c) ERCP (d) CT scan (e) Doppler ultrasound

n vaginal cancer, which of the following statements is correct? (a) Th e most common malignant tumour is squamous carcinoma of the vagina (b) Th e lymphatic drainage from the lower two-thirds of the vagina is to the pelvic nodes and from the upper third to the inguinal nodes (c) Carcinoma of the vagina is associated with procidentia (d) Previous abnormal cervical cytology is not associated with an increased risk of vaginal cancer (e) Vaginal cancer accounts for 10% of all gynaecological malignancy

Regarding malignant forms of gestational trophoblastic tumour, which statement is correct? (a) Choriocarcinoma occurs with a frequency of about 1 per 500,000 live births (b) Th e most widely used standard therapy for low-risk patients is intravenous actinomycin-D (c) Th e overall survival in the low-risk group is good at around 75% (d) Patients with high-risk disease should be off ered EMA-CO chemotherapy (etoposide, methotrexate, actinomycin-D, cisplatin and vinorelbine) e) Th e rare placental site trophoblast tumour can usually be cured if patients present within 4 years of pregnancy

45-year-old homosexual man presents with a 2-week history of multiple, painless, purple macules on his hard palate. He is found to be HIV-positive on testing. What is the most appropriate management? (a) Intralesional chemotherapy with vinblastine (b) Optimise antiretroviral therapy for 3 months and review (c) Radiotherapy to hard palate using parallel opposed 6 MV photons, 20 Gy in 10 fractions over 2 weeks (d) Radiotherapy to hard palate using parallel opposed 6 MV photons, 16 Gy in 4 fractions over 4 days (e) Systemic chemotherapy with liposomal doxorubicin 20 mg/m 2 every 3 weeks

Practise Questions FRCR CO2A Flashcards

(121 cards)