ONCOLOGY PAST PAPERS

25/11/2021 END OF ROTATION

SECTION A

Question 1

Question: Risk factors associated with colorectal cancer include which one of the following?
a) Irritable bowel syndrome
b) Contraceptive use
c) Chronic aspirin therapy
d) Low intake of dietary fiber
e) All the above

Correct Answer: d) Low intake of dietary fiber

Explanation: A diet low in fiber is a well-established risk factor for colorectal cancer. Irritable bowel syndrome (a) is not a pre-malignant condition. Contraceptive use (b) is not a significant risk factor, and chronic aspirin therapy (c) is actually associated with a reduced risk of colorectal cancer.

Question 2

Question: Characteristic presenting features of left sided colorectal tumors include:
a) Iron deficiency anemia
b) Painless abdominal mass
c) Foul smelling stools which are difficult to flush
d) Acute large bowel obstruction
e) All the above

Correct Answer: d) Acute large bowel obstruction

Explanation: Left-sided colorectal tumors often present with obstructive symptoms like a change in bowel caliber, constipation, and even acute obstruction because the lumen is narrower and the stool is more solid. Iron deficiency anemia (a) and a painless abdominal mass (b) are more characteristic of right-sided tumors. Foul-smelling, difficult-to-flush stools (c) are a sign of steatorrhea, which is not typical for colorectal cancer.

Question 3

Question: Which virus is both associated with both Nasopharyngeal Cancers and NK Lymphomas?
a) HPV
b) HIV
c) EBV
d) HHV8
e) HSV

Correct Answer: c) EBV

Explanation: The Epstein-Barr Virus (EBV) is strongly associated with both Nasopharyngeal Carcinoma and certain types of Natural Killer (NK)/T-cell lymphomas, particularly the extranodal NK/T-cell lymphoma, nasal type.

Question 4

Question: Risk factors for prostate cancer include which of the following?
a) Castration before age 40 years
b) Asian race
c) Young age
d) Black race
e) White race

Correct Answer: d) Black race

Explanation: Black race is a significant risk factor for prostate cancer, with a higher incidence and more aggressive disease. Castration before age 40 (a) is protective. Asian race (b) is associated with a lower risk, and young age (c) is not a risk factor (risk increases with age). White race (e) carries an intermediate risk compared to Black and Asian races.

Question 5

Question: In diagnosis of prostate cancer:
a) Biopsy is usually by fine needle aspiration
b) Urinary obstructive symptoms are highly suggestive
c) Most patients with a PSA > 4ng/ml will have prostate cancer.
d) All patients should have a digital rectal examination (DRE)
e) None of the above

Correct Answer: e) None of the above

Explanation:

(a) is false; the standard is a core needle biopsy, not fine needle aspiration.
(b) is false; obstructive symptoms are common in benign prostatic hyperplasia and are not highly specific for cancer.
(c) is false; while PSA >4ng/ml raises suspicion, most men with an elevated PSA do not have prostate cancer (low specificity).
(d) is false; while DRE is recommended, it is not performed on all patients (e.g., asymptomatic men undergoing screening may or may not have one).

Question 6

Question: At what age should one start colon cancer screening according to NCCN guidelines?
a) 30 yrs.
b) 40 yrs.
c) 45 yrs.
d) 50 years
e) 60-70 years

Correct Answer: c) 45 yrs.

Explanation: Recent updates to guidelines, including those from the NCCN and USPSTF, recommend starting average-risk colorectal cancer screening at age 45.

Question 7

Question: Which of following can be a harm or harms as a result of cancer screening program?
a) False positive results
b) False negative results
c) Over diagnosis
d) Overburden on the country’s health system
e) All of the above

Correct Answer: e) All of the above

Explanation: All are potential harms of screening. False positives cause anxiety and lead to unnecessary procedures. False negatives provide false reassurance. Overdiagnosis detects indolent cancers that would never have caused harm, leading to overtreatment. Screening programs can also place a significant burden on healthcare systems.

Question 8

Question: Which of the following can be a benefit/benefits of a cancer screening program?
a) Reduced incidence
b) Reduced mortality
c) Early diagnosis
d) Reduced burden on the health system of a country
e) Both b and c

Correct Answer: e) Both b and c

Explanation: The primary benefits of effective screening are reduced disease-specific mortality (b) and early diagnosis (c), which can lead to less invasive and more successful treatment. Screening does not typically reduce incidence (a), except in cases like colorectal cancer where removal of precancerous polyps achieves this. It generally increases, not reduces, the short-term burden on the health system (d).

Question 9

Question: Which virus(es) is most commonly associated with Oropharyngeal cancers?
a) EBV
b) HPV 16
c) HPV 18
d) HHV 8
e) b and c

Correct Answer: e) b and c

Explanation: The majority of oropharyngeal cancers, particularly those of the tonsils and base of tongue, are now caused by Human Papillomavirus (HPV), with HPV 16 being the most common subtype, followed by HPV 18.

Question 10

Question: Which is the most cost-effective way to screen colon cancer in low middle-income countries?
a) Colonoscopy
b) PSA
c) Faecal occult blood test
d) DRE
e) DRE, Colonoscopy and CT scan

Correct Answer: c) Faecal occult blood test

Explanation: The faecal occult blood test (FOBT) or its more modern version, the Faecal Immunochemical Test (FIT), is a low-cost, non-invasive test that is the most feasible and cost-effective initial screening method in resource-limited settings. Colonoscopy is more expensive and requires significant infrastructure. PSA (b) is for prostate cancer. DRE (d) is not an effective screening tool for colorectal cancer.

Question 11

Question: All of below are risk factor for cervical cancer EXCEPT
a) Obesity
b) Prolonged use of oral contraception
c) HIV or Immunosuppression
d) HPV
e) Multiple sexual partners

Correct Answer: a) Obesity

Explanation: While obesity is a risk factor for other cancers (like endometrial and breast), it is not a direct risk factor for cervical cancer. The primary risk factor is persistent HPV infection (d). Other co-factors include prolonged oral contraceptive use (b), immunosuppression (c), and early sexual activity with multiple partners (e).

Question 12

Question: Which one of the following symptom is rare in patients with progressive prostate cancer?
a) Symptomatic anemia
b) Urinary retention
c) Sexual dysfunction
d) Hematemesis
e) Dysuria

Correct Answer: d) Hematemesis

Explanation: Hematemesis (vomiting blood) is not a typical feature of prostate cancer. It is related to upper GI tract pathology. All the other options are common complications: anemia from bone marrow replacement, urinary retention from local obstruction, sexual dysfunction, and dysuria.

Question 13

Question: How often should a colonoscopy be done as a screening test in colorectal cancers?
a) Every 1 year
b) Every 2 years
c) Every 5 years
d) Every 10 years
e) None of the above

Correct Answer: d) Every 10 years

Explanation: For average-risk individuals with a normal initial colonoscopy, the recommended screening interval is 10 years.

Question 14

Question: What imaging can be used to screen for clients at high risk of breast cancer?
a) CT chest /Abdomen and Pelvis
b) Mammogram
c) Ca 15.3
d) PET/CT
e) MRI

Correct Answer: e) MRI

Explanation: For women at high risk (e.g., BRCA mutation carriers, strong family history), annual screening breast MRI in addition to mammography is recommended due to its higher sensitivity. Mammogram (b) alone is for average-risk screening. CT (a), tumor markers (c), and PET/CT (d) are not screening tools.

Question 15

Question: Which of the following is a rare site of breast cancer metastases?
a) Brain
b) Liver
c) Bone
d) Kidney
e) Skin

Correct Answer: d) Kidney

Explanation: The most common sites of breast cancer metastasis are bone, lung, liver, and brain. Metastasis to the kidney is relatively rare.

Question 16

Question: Which of the following statements is true of palliative treatment of metastatic breast cancer?
a) Hypercalcemia should be treated with increased oral fluids and oral bisphosphonates.
b) Bisphosphonates are used in treatment of liver metastases.
c) Neuropathic pain usually responds quickly to opioid analgesics.
d) Increased back pain and weak legs require prompt investigation.
e) Sometimes no counselling is necessary.

Correct Answer: d) Increased back pain and weak legs require prompt investigation.

Explanation: This is a classic presentation of potential spinal cord compression, which is an oncologic emergency. (a) is incorrect because severe hypercalcemia requires IV fluids and IV bisphosphonates. (b) is false; bisphosphonates are for bone metastases, not liver. (c) is false; neuropathic pain responds poorly to opioids alone and requires adjuvants like gabapentin. (e) is false; counselling and psychosocial support are always a crucial part of palliative care.

Question 17

Question: What staging system is used for staging for Melanomas?
a) TNM staging
b) European Staging
c) FIGO staging
d) Ann Arbor staging
e) All the above

Correct Answer: a) TNM staging

Explanation: Melanoma is staged using the AJCC (American Joint Committee on Cancer) TNM system. FIGO (c) is for gynecological cancers, and Ann Arbor (d) is for lymphomas.

Question 18

Question: A 25 year old HIV- lady has a 4 cm by 2 cm cervical mass involving both parametrium but not extending to the side walls bilaterally. What is the stage for her cervical cancer?
a) IVA
b) IB2
c) IIIB
d) IIB
e) None of the above

Correct Answer: d) IIB

Explanation: According to the FIGO staging system, tumor invasion into the parametrium but not to the pelvic sidewall defines Stage IIB. The size of the primary tumor is irrelevant for this stage once parametrial involvement is present.

Question 19

Question: In which type of cancer is a stage IV patient potentially curable in special cases?
a) Liver cancer
b) Colon cancer
c) Cervical cancer
d) Breast cancer
e) All of the above

Correct Answer: b) Colon cancer

Explanation:

Question 20

Question: The drug Temozolomide belongs to which anticancer group of drugs?
a) Alkylating agents
b) Bleomycin
c) Antitumor antibiotics
d) Antimetabolites
e) All of the above

Correct Answer: a) Alkylating agents

Explanation: Temozolomide is an oral alkylating agent that cross-links DNA, commonly used in gliomas.

Question 21

Question: 5 Fluorouracil belongs to which type of anticancer drug?
a) Alkylation agents
b) Antimetabolite
c) Topoisomerase inhibitors
d) Cytotoxic
e) Plant alkaloids

Correct Answer: b) Antimetabolite

Explanation: 5-Fluorouracil (5-FU) is a classic antimetabolite that inhibits thymidylate synthase, disrupting DNA synthesis.

Question 22

Question: Which of the following treatments can be used in managing stage IV prostate cancer with extensive bone mets?
a) Palliative Radiotherapy
b) Bisphosphonates
c) Medical Castration
d) Surgical Castration
e) All of the above

Correct Answer: e) All of the above

Explanation: All are standard management options. Palliative radiotherapy (a) for painful bone mets, bisphosphonates (b) or RANK-ligand inhibitors to reduce skeletal-related events, and androgen deprivation therapy (medical (c) or surgical (d) castration) as first-line systemic treatment.

Question 23

Question: Which one of the following is least commonly seen in tumor lysis syndrome?
a) Hyperuricemia
b) Hypercalcemia
c) Hyperkalemia
d) Hyperphosphatemia
e) All of the above

Correct Answer: b) Hypercalcemia

Explanation: The classic metabolic abnormalities in Tumor Lysis Syndrome (TLS) are hyperuricemia, hyperkalemia, hyperphosphatemia, and consequent hypocalcemia. Hypercalcemia is not a feature of TLS; it is associated with other malignancies like multiple myeloma and breast cancer.

Question 24

Question: The superior venae cava is formed by which veins?
a) Internal jugular and subclavian veins
b) Left and Right brachiocephalic veins
c) Right and left subclavian veins
d) It’s a continuation of the internal jugular vein
e) None of the above

Correct Answer: b) Left and Right brachiocephalic veins

Explanation: The superior vena cava is formed by the union of the left and right brachiocephalic veins.

Question 25

Question: Ca 15.3 is a tumor marker for which type of cancer?
a) Prostate cancer
b) Breast cancer
c) Lung cancer
d) Colon cancer
e) Vaginal cancer

Correct Answer: b) Breast cancer

Explanation: CA 15-3 is a tumor marker used primarily in monitoring metastatic breast cancer.

Question 26

Question: Two studies showed the benefit of the use of chemotherapy in metastatic prostate cancer. Which chemo drug was used?
a) 5-FU
b) Cisplatin
c) Paclitaxel
d) Docetaxel
e) Bleomycin

Correct Answer: d) Docetaxel

Explanation: The landmark TAX 327 study established docetaxel-based chemotherapy as a standard first-line treatment for metastatic castration-resistant prostate cancer, showing a survival benefit.

Question 27

Question: What would be your biggest concern in treating an 8-year-old male with Hodgkin’s lymphoma with radiation to the chest wall?
a) Nausea and Vomiting
b) Secondary Malignancies
c) Pneumonitis
d) Fertility
e) Skin discoloration

Correct Answer: b) Secondary Malignancies

Explanation: In a young child, the long-term risk of inducing a secondary malignancy (e.g., breast cancer, thyroid cancer, sarcoma) years after radiation therapy is a major concern and a key factor in favoring chemotherapy-based approaches to minimize or avoid radiotherapy in pediatric patients.

Question 28

Question: Brachytherapy is used for treatment in which type of cancer(s)?
a) Prostate
b) Cervical
c) Small Lip cancers
d) Breast cancer
e) All of the above

Correct Answer: e) All of the above

Explanation: Brachytherapy (internal radiation) is a highly conformal technique used in all the listed cancers: prostate (seeds), cervix (tandem and ovoids), breast (balloon catheter), and small lip cancers (interstitial needles).

Question 29

Question: All of the following are risk factors of breast cancer EXCEPT
a) Early menarche
b) Smoking
c) Late menopause
d) Obesity
e) Alcohol intake

Correct Answer: b) Smoking

Explanation: While smoking is a risk factor for many cancers, its link to breast cancer is weaker and less consistent than the other listed factors. Early menarche, late menopause, obesity (in postmenopausal women), and alcohol intake are well-established risk factors.

Question 30

Question: Which of the following is an /are Acquired risk factor(s) of developing Gastric Cancer?
a) H.Pylori
b) Smoking
c) Salted food
d) Obesity
e) All of the above

Correct Answer: e) All of the above

Explanation: All are acquired (non-genetic) risk factors. H. Pylori infection is the most significant. Diet high in salted/preserved foods, smoking, and obesity also increase risk.

Question 31

Question: Which of the following is/are genetic risk factor(s) of developing Gastric Cancer?
a) CDH-1 gene mutation
b) Blood group A
c) Li Fraumeni syndrome
d) a,b and c
e) a and b

Correct Answer: d) a,b and c

Explanation: All are genetic risk factors. CDH-1 mutation causes Hereditary Diffuse Gastric Cancer syndrome. Blood group A is associated with a slightly higher risk. Li-Fraumeni syndrome (TP53 mutation) also increases the risk of gastric cancer.

Question 32

Question: How do you investigate a suspected Lymphoma cancer patient?
a) CXR
b) Abdominal U/S
c) Excision biopsy of the any palpable node
d) PET/CT
e) Both (c) and (d)

Correct Answer: e) Both (c) and (d)

Explanation: The gold standard for diagnosis is an excision biopsy (c) of an entire lymph node for histology. PET/CT (d) is then used for staging. CXR and U/S may be used initially but are not sufficient for definitive diagnosis or staging.

Question 33

Question: October is breast cancer awareness month. ALL of the below are methods that Cancer Diseases Hospital of Zambia can use to screen clients EXCEPT?
a) Self-breast examination
b) Mammogram
c) Clinical breast exam
d) MRI
e) None of the above

Correct Answer: d) MRI

Explanation: All the listed methods are valid for breast cancer screening, though they are used in different risk groups and resource settings. SBE and CBE are low-cost methods, mammogram is for average-risk screening, and MRI is for high-risk individuals, but too expensive, hence not used in Zed.

Question 34

Question: A 76 year old man is admitted with Laryngeal carcinoma stage III. Which one of the following is the most common risk factor for laryngeal cancer?
a) Alcohol abuse
b) Cigarette smoking
c) Exposure to air pollution
d) Genetics
e) All of the above

Correct Answer: b) Cigarette smoking

Explanation: Cigarette smoking is the single most important and common risk factor for laryngeal cancer. Alcohol is a significant co-factor, but smoking carries the highest risk.

Question 35

Question: Which of the following is not necessary when a patient first presents with a breast lump?
a) Fine needle aspiration (FNA)
b) Examination of axillary lymph nodes
c) Examination of breasts with patient supine
d) Chest X-rays
e) None of the above

Correct Answer: d) Chest X-rays

Explanation: A chest X-ray is not part of the initial routine workup for a benign-appearing breast lump. It is only indicated if metastatic disease is suspected. Physical exam (b, c) and tissue diagnosis (a) are essential first steps.

Question 36

Question: Which syndromes are mostly associated with colon cancer?
a) HNPCC
b) FAP and HNPCC
c) FAP
d) WARG syndrome
e) All of the above

Correct Answer: b) FAP and HNPCC

Explanation: The two major hereditary syndromes associated with a very high risk of colorectal cancer are Familial Adenomatous Polyposis (FAP) and Hereditary Non-Polyposis Colorectal Cancer (HNPCC/Lynch syndrome).

Question 37

Question: Bleomycin belongs to which type of cytotoxic drug?
a) Antimetabolite
b) Alkylating agent
c) Tumor antibiotics
d) Topoisomerase inhibitor
e) None of the above

Correct Answer: c) Tumor antibiotics

Explanation: Bleomycin is classified as an antitumor antibiotic. It causes DNA strand breaks.

Question 38

Question: Which is the dose limiting toxicity for Bleomycin?
a) Ototoxicity
b) Neurotoxicity
c) Nephrotoxicity
d) Cardiotoxicity
e) Pulmonary fibrosis

Correct Answer: e) Pulmonary fibrosis

Explanation: The dose-limiting and most serious toxicity of Bleomycin is pulmonary fibrosis, which is irreversible. Cumulative dose and oxygen exposure are key risk factors.

Question 39

Question: What is the most appropriate test or tests for Stage 4 prostate cancer patients with bone mets?
a) PSMA scan
b) Bone scan
c) CT chest/abdomen/pelvis
d) a and b
e) MRI

Correct Answer: d) a and b

Explanation: For staging known high-risk or metastatic prostate cancer, a PSMA PET/CT (a) is now the gold standard due to its high sensitivity and specificity. A Bone Scan (b) is also a traditional and effective way to detect bone metastases. A standard CT (c) is less specific for prostate cancer metastases in the bone.

Question 40

Question: A marker for the diagnosis of pancreatic cancer is:
a) CA 15-3
b) AFP
c) CEA
d) CA 19-9
e) All of the above

Correct Answer: d) CA 19-9

Explanation: CA 19-9 is the most commonly used serum tumor marker for pancreatic adenocarcinoma, though it is not specific enough for diagnosis alone. CA 15-3 is for breast, AFP for liver, and CEA for colorectal/other GI cancers.

Question 41

Question: A marker for the diagnosis of choriocarcinoma is:
a) CA 15-3
b) AFP
c) CEA
d) BHCG
e) None of the above

Correct Answer: d) BHCG

Explanation: Beta-Human Chorionic Gonadotropin (BHCG) is the quintessential tumor marker for gestational trophoblastic neoplasia, including choriocarcinoma. It is used for diagnosis and monitoring.

Question 42

Question: Which one of the following statements is true of lung cancer?
a) Most are small cell in type.
b) Approximately 25% of lung cancers are large cell anaplastic in histology
c) Screening has proven beneficial.
d) 80% are due to smoking.
e) All of the above

Correct Answer: d) 80% are due to smoking.

Explanation:

(a) is false; Non-Small Cell Lung Cancer (NSCLC) accounts for about 85% of cases.
(b) is false; large cell is a less common subtype of NSCLC.
(c) is misleading; screening with low-dose CT is proven beneficial only for specific high-risk groups, not the general population.
(d) is true; smoking is responsible for approximately 80-90% of lung cancer cases.

Question 43

Question: Which one of the following symptoms is rare in patients with progressive lung cancer?
a) Haemoptysis
b) Hypercalcemia
c) Headache
d) Urinary retention
e) All of the above

Correct Answer: d) Urinary retention

Explanation: Haemoptysis is a common presenting symptom. Hypercalcemia can occur due to bone metastases or paraneoplastic syndromes. Headache can signal brain metastases. Urinary retention is not a typical direct presentation of progressive lung cancer.

Question 44

Question: Which of the following tumors may cause elevated CEA levels?
a) Breast cancer
b) Gastric cancer
c) Lung cancer
d) Colorectal cancer
e) All of the above

Correct Answer: e) All of the above

Explanation: Carcinoembryonic Antigen (CEA) is a non-specific tumor marker that can be elevated in many adenocarcinomas, including colorectal, gastric, pancreatic, lung, and breast cancers.

Question 45

Question: Mutation of P53 gene is involved in a number of cancers. What type of gene is P53?
a) Cell cycle gene
b) Mitotic gene
c) Proto-oncogene
d) Tumor suppressor gene
e) Oncogene

Correct Answer: d) Tumor suppressor gene

Explanation: P53 is a critical tumor suppressor gene often called the "guardian of the genome." It arrests the cell cycle for DNA repair or initiates apoptosis if damage is irreparable. Loss of its function allows damaged cells to proliferate.

Question 46

Question: The high incidence of HIV infection in Africa can be associated with increased incidence of which of the following malignancies?
a) Epidemic Kaposi Sarcoma
b) Colon cancer
c) Cervical cancer
d) Hepatocellular carcinoma
e) a and c

Correct Answer: e) a and c

Explanation: HIV-associated immunosuppression dramatically increases the risk of Virus-Associated Cancers. This includes Epidemic Kaposi Sarcoma (associated with HHV-8) and Cervical Cancer (associated with HPV). Colon cancer is not strongly linked to HIV. Hepatocellular carcinoma is linked to Hepatitis B/C, which may be co-endemic.

Question 47

Question: Ca 125 can be raised in which type of condition or conditions?
a) Pelvic Inflammatory disease
b) Gastric cancers
c) Ovarian cancers
d) a and c
e) None of the above

Correct Answer: d) a and c

Explanation: CA-125 is primarily a marker for ovarian cancer (c). However, it is non-specific and can be elevated in many benign conditions, including menstruation, pregnancy, endometriosis, and pelvic inflammatory disease (a). It is not typically associated with gastric cancers (b).

Question 48

Question: Round blue cells are a characteristics for which type of cancers?
a) Colorectal
b) Rhabdomyosarcomas
c) Neuroendocrine tumors
d) Lymphomas
e) b,c and d

Correct Answer: e) b,c and d

Explanation: "Small round blue cell tumors" is a histologic description for a group of malignancies that appear as sheets of small, blue-staining cells with scant cytoplasm. This group includes Rhabdomyosarcoma, Neuroendocrine tumors, Lymphomas, as well as Ewing sarcoma, Neuroblastoma, and Wilms tumor. Colorectal cancer (a) is an adenocarcinoma, not a small round blue cell tumor.

Question 49

Question: Which of the following is not a hallmark of cancer?
a) Sustaining proliferative signalling
b) Evading apoptosis
c) Inducing angiogenesis
d) Cell cycle specific
e) Invasion and metastasis

Correct Answer: d) Cell cycle specific

Explanation: "Cell cycle specific" is a property of some chemotherapy drugs (they act on a specific phase of the cell cycle), not a fundamental hallmark of cancer itself. The other options are all part of the original Hanahan and Weinberg "Hallmarks of Cancer."

Question 50

Question: What characteristic(s) are associated with Orophygneal cancers in young people?
a) Most of the are HPV (-)
b) Smokers
c) They respond very well to treatment
d) Most tumours are chemoradiation resistant
e) None of the above

Correct Answer: c) They respond very well to treatment

Explanation: Oropharyngeal cancers in younger patients are typically HPV-positive (a is false), often occur in non-smokers (b is false), and are known for their superior response to chemoradiation therapy and better overall prognosis compared to HPV-negative, smoking-related tumors (c is true, d is false).

Question 51

Question: What is the most common histologic subtype of colon cancer?
a) Squamous cell carcinoma
b) Infiltrating type
c) Adenosquamous
d) Adenocarcinoma
e) None of the above

Correct Answer: d) Adenocarcinoma

Explanation: Over 95% of colorectal cancers are adenocarcinomas, which arise from the glandular epithelium of the colon lining.

Question 52

Question: What is the most common Oncological emergency in a right sided non small cell Lung carcinoma?
a) Tumour Lysis syndrome
b) SIAH
c) Superior Vena Cava syndrome
d) Spinal cord compression
e) Neutropenic Sepsis

Correct Answer: c) Superior Vena Cava syndrome

Explanation: Tumors in the right lung and mediastinum (like right-sided NSCLC) are anatomically positioned to compress the Superior Vena Cava, leading to SVCO. Tumor Lysis Syndrome (a) is more common in hematologic malignancies. Spinal Cord Compression (d) is more common with cancers that metastasize to bone (e.g., prostate, breast).

Question 53

Question: Visual Inspection with Acetoacetic acid (VIA) is the method used for screening for cervical cancer. Which of the following are the advantage(s) of this screening test?
a) It’s cheap
b) Patients get results on same day
c) No need for highly skilled workers
d) All of the above
e) Only B and A are true

Correct Answer: d) All of the above

Explanation: VIA is a low-cost, point-of-care test that provides immediate results, allowing for same-day treatment ("see and treat"). It can be performed by trained nurses or mid-level providers, making it highly suitable for resource-limited settings.

Question 54

Question: Toxicity secondary to irradiation of the breast may manifest as
a) Breast fibrosis
b) Arm edema
c) Pneumonitis
d) Cardiac toxicity
e) All of the above

Correct Answer: e) All of the above

Explanation: All are potential late effects of breast radiotherapy. Fibrosis of the breast tissue, lymphedema of the arm if axillary nodes were irradiated, radiation pneumonitis (especially with tangents), and cardiac toxicity (if the left breast was treated without modern techniques to spare the heart).

Question 55

Question: Breakthrough cancer (BTCP) pain:
a) Is a transient exacerbation of pain.
b) Always occurs in patients with stable background pain
c) May occur in the absence of background pain
d) Is the same as incident pain
e) May interfere with activities of daily living

Correct Answer: e) May interfere with activities of daily living

Explanation:

(a) is true but vague.
(b) is false; BTCP can occur without background pain.
(c) is true.
(d) is false; incident pain is a subtype of BTCP (triggered by an action), not synonymous.
(e) is a key characteristic; BTCP significantly impacts quality of life and function.

Question 56

Question: All of the below are subtypes of Classic Hodgkin’s Lymphoma EXCEPT?
a) Nodular sclerosing
b) Mixed cellularity
c) Lymphocyte depleted
d) Lymphocyte rich
e) Nodular lymphocyte predominate

Correct Answer: e) Nodular lymphocyte predominate

Explanation: Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL) is a distinct entity from the four subtypes of Classic Hodgkin Lymphoma (Nodular Sclerosing, Mixed Cellularity, Lymphocyte Rich, and Lymphocyte Depleted).

Question 57

Question: Factor(s) that can be used as evidence of end organ damage in Multiple Myeloma include ALL of the below except.
a) Hypercalcaemia
b) Renal insufficiency
c) Anemia
d) Bone lesions
e) Hypertraemia

Correct Answer: e) Hypertraemia

Explanation: The acronym CRAB defines the evidence of end-organ damage in Multiple Myeloma: Calcium elevation (hypercalcemia), Renal failure, Anemia, Bone lesions. "Hypertraemia" is not a recognized medical term and is likely a distractor.

Question 58

Question: In which type of cancer is whole brain radiation given as prophylactic treatment?
a) Non small lung cancer
b) Small cell lung cancer
c) Renal cell carcinoma
d) Melanoma
e) Breast cancer

Correct Answer: b) Small cell lung cancer

Explanation: Prophylactic Cranial Irradiation (PCI) is a standard treatment for patients with Small Cell Lung Cancer who have achieved a good response to initial chemotherapy, as it significantly reduces the risk of developing brain metastases.

Question 59

Question: Cervix cancer Stage IIIC2 means cancer has spread to?
a) Rectum
b) Liver
c) Brain
d) Lymph nodes to para-aortic
e) Lungs

Correct Answer: d) Lymph nodes to para-aortic

Explanation: In the 2018 FIGO staging, Stage IIIC is defined by pelvic or para-aortic lymph node metastasis. IIIC1 is for pelvic nodes, and IIIC2 is for para-aortic nodes. Spread to rectum, bladder, or beyond (liver, lung, brain) is Stage IV.

Question 60

Question: Diagnosis of metastatic spinal cord compression is best made by:
a) Clinical impression
b) Isotope bone scan
c) Computerised tomography
d) Plain film X – ray
e) Magnetic resonance imaging

Correct Answer: e) Magnetic resonance imaging

Explanation: MRI of the entire spine is the gold standard imaging modality for diagnosing spinal cord compression. It provides excellent detail of the soft tissue, cord, and nerves, and can define the full extent of disease.

SECTION B

Question 2

(13 marks)

a) What factors (5) are associated with increased HPV infection in cervical cancer? (5 marks)

Answer:
Factors associated with increased risk of acquiring and having persistent HPV infection, which is the primary cause of cervical cancer, include:

Early age of first sexual intercourse.
Multiple sexual partners (or a partner who has had multiple partners).
High-risk sexual behavior of the partner.
Immunosuppression (e.g., HIV/AIDS, organ transplant).
Co-infection with other sexually transmitted infections (e.g., Chlamydia, Herpes Simplex Virus).

b) List all the risk factors associated with cervical cancer. (4 marks)

Answer:
Risk factors can be categorized as follows:

Primary Cause: Persistent infection with a high-risk strain of Human Papillomavirus (HPV).
Behavioral Co-factors:
- Early age of first sexual intercourse.
- Multiple sexual partners.
- Tobacco smoking.
Biological Co-factors:
- Immunosuppression (e.g., HIV).
- Long-term use of oral contraceptives (>5 years).
- High parity (having many children).
Other:
- Low socioeconomic status (limiting access to screening and care).
- Family history.

c) Mention the vaccines used in the prevention of cervical cancer and what subtypes of viruses they prevent against. (4 marks)

Answer:

Bivalent Vaccine (e.g., Cervarix): Protects against HPV subtypes 16 and 18 (the two most common high-risk types causing ~70% of cervical cancers).
Quadrivalent Vaccine (e.g., Gardasil 4): Protects against HPV 16, 18, 6, and 11 (adds protection against the low-risk types causing ~90% of genital warts).
Nonavalent Vaccine (e.g., Gardasil 9): Protects against HPV 16, 18, 31, 33, 45, 52, 58, 6, and 11 (extends protection to 7 high-risk types causing ~90% of cervical cancers, plus the 2 low-risk types).

Question 3

(5 marks)

a) What factors (5) are associated with unopposed estrogen increase in breast cancer?

Answer:
Factors associated with increased lifetime exposure to estrogen ("unopposed estrogen") include:

Early menarche (starting periods at a young age).
Late menopause (ending periods at an older age).
Nulliparity (never having given birth) or late age at first full-term pregnancy (after 30).
Hormone Replacement Therapy (HRT) using combined estrogen and progestin.
Obesity (in postmenopausal women, as adipose tissue converts androgens to estrogen).
Additional factor: Alcohol consumption.

Question 4

(4 marks)

a) What are the types of Kaposi sarcoma?

Answer:
The four classic types of Kaposi Sarcoma are:

Classic (Sporadic) Kaposi Sarcoma: Typically found in elderly men of Mediterranean or Eastern European descent; it is indolent and primarily affects the skin of the lower limbs.
Endemic (African) Kaposi Sarcoma: Occurs in HIV-negative individuals in sub-Saharan Africa; can be more aggressive and involve lymph nodes.
Iatrogenic (Immunosuppression-associated) Kaposi Sarcoma: Occurs in patients on long-term immunosuppressive therapy (e.g., post-organ transplant).
Epidemic (AIDS-associated) Kaposi Sarcoma: The most common and aggressive form, associated with HIV/AIDS. It is an AIDS-defining illness.

Question 5

(4 marks)

a) What is tumor lysis syndrome?
Answer:
Tumor Lysis Syndrome (TLS) is an oncologic emergency characterized by a massive and rapid breakdown of tumor cells, leading to the release of their intracellular contents (such as potassium, phosphate, and nucleic acids) into the bloodstream. This overwhelms the body's homeostatic mechanisms, resulting in metabolic derangements that can cause severe organ dysfunction and death.

b) How does tumor lysis syndrome occur?
Answer:
TLS occurs due to the rapid destruction of a large volume of tumor cells, typically following the initiation of cytotoxic therapy (chemotherapy, radiation, targeted therapy, or immunotherapy). It can also occur spontaneously in highly aggressive, treatment-sensitive tumors (e.g., high-grade lymphomas, leukemias). The process is:

Cell Lysis: Therapy causes rapid tumor cell death.
Release of Contents: Intracellular ions and metabolites are released into the blood.
Metabolic Derangements:
- Hyperkalemia: From potassium release.
- Hyperphosphatemia: From phosphate release.
- Hyperuricemia: Nucleic acids (purines) are metabolized into uric acid.
- Hypocalcemia: Calcium binds to the excess phosphate, forming precipitates.
End-Organ Damage: These imbalances can lead to acute kidney injury (from uric acid and calcium phosphate crystal deposition), cardiac arrhythmias (from hyperkalemia and hypocalcemia), seizures, and death.

19/04/2022 END OF ROTATION

SECTION 1: Multiple Choice Questions (25 marks)

1. Which of following is a tumor marker for breast cancer?
(a) Ca 125
(b) Cea
(c) Psa
(d) Ca 15.3
(e) Bhcg

Correct Answer: (d) Ca 15.3

Explanation: CA 15-3 is a serum tumor marker primarily used for monitoring response to treatment and detecting recurrence in patients with metastatic breast cancer. CA-125 (a) is for ovarian cancer, PSA (c) is for prostate cancer, and BhCG (e) is for gestational trophoblastic disease. CEA (b) can be elevated in breast cancer but is non-specific and more commonly associated with gastrointestinal cancers.

2. Palliative care for cancer patients includes which of the following?
(a) Pain management
(b) Spiritual counselling
(c) Palliative radiotherapy
(d) End life care
(e) All of the above

Correct Answer: (e) All of the above

Explanation: Palliative care is a holistic approach that focuses on improving the quality of life for patients and their families. It includes symptom control (e.g., pain management), psychosocial and spiritual support, specific treatments like palliative radiotherapy for symptom relief, and comprehensive end-of-life care.

3. Which virus is the common cause of cervical cancer?
(a) HIV
(b) HPV
(c) HBV
(d) HHV8
(e) HSV

Correct Answer: (b) HPV

Explanation: Persistent infection with high-risk strains of the Human Papillomavirus (HPV) is the necessary cause of nearly all cervical cancers. HIV (a) is a co-factor that increases risk, HBV (c) causes liver cancer, HHV8 (d) causes Kaposi Sarcoma, and HSV (e) is not a direct cause of cancer.

4. Which is most common type of skin cancer?
(a) Squamous cell carcinoma
(b) Basal cell carcinoma
(c) Melanoma
(d) Cutaneous T cell Lymphoma

Correct Answer: (b) Basal cell carcinoma

Explanation: Basal cell carcinoma (BCC) is the most common form of skin cancer, accounting for about 80% of cases. It is rarely metastatic but can be locally destructive. Squamous cell carcinoma (SCC) is the second most common. Melanoma is less common but far more aggressive.

5. How is cervical cancer commonly screened?
(a) Colonoscopy
(b) PSA
(c) VIA
(d) DRE
(e) None of the above

Correct Answer: (c) VIA

Explanation: In many resource-limited settings, including Zambia, Visual Inspection with Acetic Acid (VIA) is a common, low-cost screening method for cervical cancer. Pap smear and HPV testing are also used globally. Colonoscopy (a) is for colorectal cancer, PSA (b) for prostate, and DRE (d) is a physical exam, not a specific screening test for cervical cancer.

6. All of the below are risk factors for cervical cancer EXCEPT?
(a) Prolonged use of oral contraception
(b) HIV
(c) HPV
(d) Multiple sexual partners
(e) Obesity

Correct Answer: (e) Obesity

Explanation: While obesity is a risk factor for other cancers (like endometrial and breast), it is not a direct risk factor for cervical cancer. The primary risk factor is HPV (c), with co-factors including immunosuppression like HIV (b), prolonged oral contraceptive use (a), and multiple sexual partners (d).

7. What is the gold standard imaging modality of Hodgkin’s Lymphoma?
(a) CT scan
(b) CXR
(c) Ultrasound
(d) PET/CT
(e) MRI

Correct Answer: (d) PET/CT

Explanation: PET/CT is the gold standard for initial staging and response assessment in Hodgkin's Lymphoma. It is more accurate than CT alone (a) for detecting nodal and extranodal disease and for distinguishing viable tumor from fibrosis post-treatment.

8. What age (group) is being targeted for the cervical cancer vaccine that is being done by the ministry of health in Zambia?
(a) 14 yrs.
(b) 11 yrs.
(c) 9 yrs.
(d) 9 to 13 yrs.
(e) None of the above

Correct Answer: (a) 14 yrs.

Explanation: This is a specific local policy question. In Zambia, the HPV vaccination campaign often targets 14-year-old girls through school-based programs. The correct answer reflects the specific national guideline.

9. Which virus is the common cause for Kaposi Sarcoma?
(a) HPV
(b) HIV
(c) HIV8
(d) HSV
(e) Both HPV and HIV

Correct Answer: (c) HIV8

Explanation: Kaposi Sarcoma is caused by Human Herpesvirus 8 (HHV-8), also known as Kaposi Sarcoma-associated Herpesvirus (KSHV). HIV (b) is a major co-factor that promotes the development of the disease through immunosuppression, but it is not the direct cause. There is a typo in the options; "HIV8" is intended to be "HHV8".

10. What imaging can be used in metastatic work up of breast cancer?
(a) CT chest /Abdomen and Pelvis
(b) CXR
(c) Abdominal/Pelvis Ultrasound
(d) PET/CT in a few special cases
(e) All of the above

Correct Answer: (e) All of the above

Explanation: The metastatic workup depends on the clinical scenario and stage. CT chest/abdomen/pelvis (a) is standard for staging. CXR (b) can be used for a basic chest assessment. Ultrasound (c) is useful for the liver. PET/CT (d) is used for high-risk or locally advanced disease or when other imaging is equivocal.

11. What staging system is used for staging Cervical cancer?
(a) TNM staging
(b) European Staging
(c) PGO staging
(d) Ann Arbor staging
(e) All of the above

Correct Answer: (a) TNM staging

Explanation: Cervical cancer is staged using the International Federation of Gynecology and Obstetrics (FIGO) system, which is a clinical staging system. The TNM (Tumor, Node, Metastasis) system is also used and is equivalent to the FIGO stages. "PGO staging" is a likely typo for FIGO. Ann Arbor (d) is for lymphomas.

12. A 40-year-old HIV+ lady has a 4 cm by 2 cm cervical mass involving both parametrium. Abdominal U/S shows left mild hydronephrosis. Cystoscopy confirms bladder infiltration. CT scan showed paraaortic nodal involvement. What is the stage for her cervical cancer?
(a) IVA
(b) IIIC1
(c) IIIA
(d) IIIC2
(e) None of the above

Correct Answer: (a) IVA

Explanation: According to FIGO 2018 staging, tumor invasion into the bladder mucosa (confirmed by biopsy) automatically upgrades the cancer to Stage IVA, regardless of other findings. Para-aortic nodal involvement (IIIC2) and hydronephrosis (IIIB) are present, but the bladder invasion defines the highest stage.

13. Cervix cancer stage IVB means the tumor has spread to?
(a) Liver
(b) Bladder
(c) Rectum
(d) Vagina
(e) All of the above

Correct Answer: (a) Liver

Explanation: Stage IVB is defined by distant metastasis beyond the pelvic organs. Spread to the liver, lungs, bones, or distant lymph nodes qualifies as IVB. Invasion of the bladder or rectum (b, c) is Stage IVA. Vaginal involvement (d) is typically an earlier stage (II).

14. Which of the following is not a group of anticancer medication?
(a) Alkylating agents
(b) Heomycin
(c) Antitumor antibiotics
(d) Antimetabolites
(e) All of the above

Correct Answer: (b) Heomycin

Explanation: "Heomycin" is not a recognized class or name of an anticancer drug. It is likely a misspelling or distractor. Alkylating agents, antitumor antibiotics, and antimetabolites are all standard classes of chemotherapy drugs.

15. Cisplatin belongs to which type of anticancer drug?
(a) Alkylation agents
(b) Antimetabolite
(c) Topoisomerase inhibitors
(d) Cytotoxic
(e) Plant alkaloids

Correct Answer: (a) Alkylation agents

Explanation: Cisplatin is a platinum-based compound that functions as an alkylating agent, forming cross-links in DNA to inhibit cell division. "Cytotoxic" (d) is a general term for all chemotherapy drugs that kill cells, but the specific class is alkylating agent.

16. Which one of the following is least commonly seen in tumor lysis syndrome?
(a) Hyperuricemia
(b) Hypercalcemia
(c) Hyperkalemia
(d) Hyperphosphatemia
(e) All of the above

Correct Answer: (b) Hypercalcemia

Explanation: The classic metabolic abnormalities in Tumor Lysis Syndrome are hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia (as calcium binds to excess phosphate). Hypercalcemia is not a feature of TLS and is more commonly associated with multiple myeloma or bone metastases.

17. The superior venae cava is formed by which veins?
(a) Internal jugular and subclavian veins
(b) left and right brachiocephalic veins
(c) Right and left subclavian veins
(d) It’s a continuation of the internal jugular vein
(e) None of the above

Correct Answer: (b) left and right brachiocephalic veins

Explanation: The superior vena cava is formed by the union of the left and right brachiocephalic (innominate) veins behind the first right costal cartilage.

18. Helicobacter pylori is believed to be associated with which cancer?
(a) Prostate cancer
(b) Gastric cancer
(c) Lung cancer
(d) Colon cancer
(e) Vaginal cancer

Correct Answer: (b) Gastric cancer

Explanation: Chronic infection with Helicobacter pylori is a major risk factor for gastric adenocarcinoma and gastric MALT (Mucosa-Associated Lymphoid Tissue) lymphoma.

19. Colorectal cancer screening include all of the following, EXCEPT:
(a) Fecal occult blood testing
(b) Papanicolaou smears test
(c) Digital rectal examination
(d) Barium contrast studies
(e) None of the above

Correct Answer: (b) Papanicolaou smears test

Explanation: A Papanicolaou (Pap) smear is a screening test for cervical cancer, not colorectal cancer. Fecal occult blood tests (a), digital rectal examination (c), and barium enema (d) are all methods that have been used for colorectal cancer screening.

20. Brachytherapy is a type of therapeutic radiation of cancer tissue in which:
(a) Beams of radiation generated at a distance and aimed at the tumor within the patient
(b) Encapsulated sources of radiation implanted directly into or adjacent to tumor
(c) Radioactive substances are injected in the blood stream
(d) Radionuclides targeted in some fashion to a site of tumor
(e) All of the above

Correct Answer: (b) Encapsulated sources of radiation implanted directly into or adjacent to tumor

Explanation: Brachytherapy is defined by placing a radioactive source inside or very close to the tumor. Option (a) describes external beam radiotherapy. Options (c) and (d) describe systemic radionuclide therapy.

21. All of the following are risk factors of breast cancer EXCEPT
(a) Early menarche
(b) Smoking
(c) Late menopause
(d) Obesity
(e) Alcohol intake

Correct Answer: (b) Smoking

Explanation: While smoking is a risk factor for many cancers, its link to breast cancer is weaker and less consistent than the other well-established factors listed, which all relate to increased lifetime exposure to estrogen.

22. How do you investigate a suspected breast cancer patient?
(a) Clinical examination
(b) Imaging
(c) Biopsy of the lesion
(d) All of the above
(e) Only A and C

Correct Answer: (d) All of the above

Explanation: The triple assessment is the standard for diagnosing breast cancer: 1) Clinical Examination, 2) Imaging (Mammogram and/or Ultrasound), and 3) Histopathological Diagnosis (Biopsy).

23. What is the gold standard for screening for high-risk breast cancer young clients?
(a) Self-breast examination
(b) Mammogram
(c) Clinical breast exam
(d) Itrasound
(e) MRI

Correct Answer: (e) MRI

Explanation: For young women at high genetic risk (e.g., BRCA carriers), annual screening breast MRI is recommended in addition to mammography due to its higher sensitivity in dense breast tissue common in younger women.

24. What would be your biggest concern in treating a 25-year-old female with Ca cervix with chemoradiation who just recently got married?
(a) Nausea and vomiting
(b) Diarrhea
(c) Vaginal stenosis
(d) Fertility
(e) Skin discoloration

Correct Answer: (c) Vaginal stenosis

Explanation: While all are side effects, for a young, recently married woman, the impact on sexual function is a major quality-of-life issue. Pelvic radiation and brachytherapy can cause vaginal dryness, fibrosis, and stenosis, which can make sexual intercourse difficult or painful. Fertility (d) is also a concern, but definitive chemoradiation for cervical cancer typically results in loss of ovarian and uterine function, making infertility a near-certainty, which is a separate but related issue.

25. A catholic nun has inflammatory breast cancer. What’s the T stage?
(a) T1
(b) T2
(c) T3
(d) T4
(e) None of the above

Correct Answer: (d) T4

Explanation: Inflammatory breast cancer is clinically characterized by redness, edema (peau d'orange), and warmth involving a third or more of the breast. This clinical presentation automatically classifies it as T4d, regardless of the actual tumor size.

SECTION 2: True or False (5 marks)

1. The HPV subtypes responsible for cervical cancer are 7 and 29.
Answer: FALSE
Explanation: HPV subtypes 7 and 29 are low-risk types. High-risk types like 16 and 18 are responsible for the majority of cervical cancers.

2. All cervical cancer regardless of stage receive chemotherapy.
Answer: FALSE
Explanation: Early-stage cervical cancer (e.g., Stage IA1) can be treated with surgery alone. Chemotherapy is used for locally advanced stages (concurrently with radiation) and for metastatic disease.

3. To confirm bladder infiltration in cervical cancer a cystoscopy and biopsy should be done
Answer: TRUE
Explanation: FIGO staging rules state that bullous edema alone does not permit allocation to Stage IVA; there must be biopsy-proven invasion of the bladder or rectal mucosa.

4. PET/CT scan maybe used in the work up for advanced cervical cancer
Answer: TRUE
Explanation: PET/CT is highly valuable for staging locally advanced disease to detect involved lymph nodes and distant metastases, which guides treatment planning.

5. Severe bleeding in cervical cancer is an emergency and can be treated with a single treatment
Answer: TRUE
Explanation: Severe vaginal bleeding from cervical cancer is an oncologic emergency. It can often be controlled with a single, high-dose treatment of emergency radiotherapy (brachytherapy or external beam) to the tumor.

6. All breast cancer patients receive hormonal treatment
Answer: FALSE
Explanation: Hormonal treatment (e.g., Tamoxifen, Aromatase Inhibitors) is only effective for cancers that express estrogen (ER) or progesterone (PR) receptors. Patients with hormone receptor-negative breast cancer do not benefit from this treatment.

7. Men breast cancer constitute 1% of breast cancers
Answer: TRUE
Explanation: Male breast cancer is rare, accounting for approximately 1% of all breast cancer cases.

8. Active surveillance can be used in high-risk prostate patients
Answer: FALSE
Explanation: Active surveillance is a management strategy for men with very low-risk or low-risk prostate cancer to avoid or delay treatment. High-risk prostate cancer requires definitive treatment.

9. Brachytherapy is a treatment option in very low risk prostate cancer
Answer: TRUE
Explanation: Brachytherapy (permanent seed implantation) is a standard and effective treatment option for patients with very low, low, and favorable intermediate-risk prostate cancer.

10. PSA is for screening and follow up post treatment in prostate cancer patients
Answer: TRUE
Explanation: PSA (Prostate-Specific Antigen) is used for population screening (with DRE) and is the primary tool for monitoring for recurrence after definitive treatment for prostate cancer.

SECTION 3: Comprehensive Answers (Total 20 marks)

1. A 21-year-old female presents with a confirmed biopsy of squamous cell carcinoma. She is HIV+ with CD4 count of 456 and VL undetectable.

(a) What is the lymphatic drainage of the cervix?
Answer: The primary lymphatic drainage of the cervix is to the paracervical, parametrial, obturator, internal iliac, external iliac, and presacral lymph nodes. From there, drainage proceeds to the common iliac nodes and then to the para-aortic nodes.

(b) What organs are at risk for local spread of this cancer?
Answer: Cervical cancer can spread locally to the:

Vagina
Parametrium
Uterine corpus
Bladder
Rectum
Pelvic sidewall (can cause ureteric obstruction leading to hydronephrosis)

(c) How are you going to investigate this patient?
Answer:

Staging Workup: Clinical examination under anesthesia (EUA) including cystoscopy and proctosigmoidoscopy.
Imaging: PET/CT is ideal for staging. If unavailable, CT chest/abdomen/pelvis and CXR can be used. MRI pelvis is excellent for assessing local tumor extent and parametrial invasion.
Blood Tests: Full blood count, renal and liver function tests.
HIV Monitoring: Continue monitoring CD4 count and viral load.

(d) The tumor is found to be 3 cm by 4 cm involving both parametrium with pelvic nodes. Mets work up shows no Mets. What is the stage of this patient?
Answer: According to FIGO 2018 staging:

Tumor >4cm but limited to the cervix/upper vagina would be Stage IB3.
However, parametrial involvement moves the stage to IIB.
The presence of pelvic nodal involvement upgrades it further to Stage IIIC1.
Final Stage: IIIC1.

(e) What is the general management of this patient?
Answer: The standard management for Stage IIIC1 cervical cancer is Concurrent Chemoradiation. This involves:

External Beam Radiotherapy (EBRT) to the whole pelvis, covering the primary tumor and involved nodes.
Concurrent Chemotherapy, typically weekly Cisplatin.
Brachytherapy boost to the cervix following EBRT.
Antiretroviral Therapy (ART) should be continued and optimized in collaboration with her HIV physician.

2. A 59-year-old female premenopausal patient had confirmed ductal carcinoma of the right breast. ER+, PR+, Her2 (-).

(a) The tumor measures 40mm by 45 mm with one mobile right axillary node. No Mets. What is the TNM staging?
Answer:

T (Tumor): Tumor >40mm = T2 (Note: 45mm is technically T3, but 40mm is the upper limit for T2. The exact measurement would determine this, but based on "40mm by 45mm," it is often classified as T2 if the larger dimension is used with some discretion, but strictly by size >4cm = T3. For accuracy, assuming 45mm is the key dimension: T3).
N (Nodes): Mobile ipsilateral axillary node = N1.
M (Metastasis): No distant metastases = M0.
Clinical Stage: T3 N1 M0 = Stage IIIA.

(b) What is the lymphatic drainage of breast cancer?
Answer: The primary lymphatic drainage of the breast is to the axillary lymph nodes (Level I, II, III). Drainage also occurs to the internal mammary (parasternal) nodes. There can also be drainage to the supraclavicular and infraclavicular nodes.

(c) List 5 risk factors of breast cancer
Answer:

Female gender and increasing age.
Family history, especially BRCA1/BRCA2 mutations.
Early menarche (<12 years) or late menopause (>55 years).
Nulliparity or late age at first full-term pregnancy (>30 years).
Personal history of benign breast disease (e.g., atypical hyperplasia) or prior breast cancer.
Other: Hormone replacement therapy, obesity (postmenopausal), alcohol consumption.

(d) How do you investigate this patient?
Answer:

Triple Assessment:
- Clinical: Full history and physical examination of both breasts and axillae.
- Imaging: Bilateral Diagnostic Mammogram and Breast Ultrasound. Ultrasound of the axilla to assess the node.
- Pathology: Core biopsy of the breast mass. Fine needle aspiration (FNA) or core biopsy of the palpable axillary node.
Staging: CT scan of chest/abdomen/pelvis and a Bone Scan (for Stage III disease) to rule out distant metastases.
Blood Tests: Baseline blood work.

(e) How would you treat this patient?
Answer: This is a locally advanced (Stage III), hormone-positive, HER2-negative breast cancer.

Neoadjuvant Systemic Therapy: Start with chemotherapy to shrink the tumor (e.g., AC-T regimen: Doxorubicin/Cyclophosphamide followed by a Taxane). This allows for assessment of response and may enable breast-conserving surgery.
Surgery: After neoadjuvant therapy, perform a Modified Radical Mastectomy (or breast-conserving surgery if feasible) with Axillary Lymph Node Dissection.
Adjuvant Radiotherapy: Post-mastectomy radiotherapy to the chest wall and regional lymph nodes is indicated for T3 tumors and node-positive disease.
Adjuvant Endocrine Therapy: As the cancer is ER+/PR+, she will receive 5-10 years of hormonal therapy (e.g., Tamoxifen for premenopausal women).

2018 END OF ROTATION

SECTION I: Multiple Choice Questions

1. Which virus is the common cause for cervical cancer?
(a) HIV
(b) HPV
(c) HBV
(d) HHV8
(e) HSV

Correct Answer: (b) HPV
Explanation: Persistent infection with high-risk strains of the Human Papillomavirus (HPV) is the necessary cause of over 99% of cervical cancers. HIV is a co-factor that increases risk, HBV causes liver cancer, HHV8 causes Kaposi Sarcoma, and HSV is not a direct cause.

2. How is cervical commonly screened?
(a) Colonoscopy
(b) PSA
(c) VIA
(d) DRE
(e) None of the above

Correct Answer: (c) VIA
Explanation: Visual Inspection with Acetic Acid (VIA) is a common, low-cost screening method for cervical cancer in many resource-limited settings. Pap smear and HPV testing are also used globally. The other options are for different cancers.

3. All of below are risk factor for cervical cancer EXCEPT
(a) Prolonged use oral contraceptions
(b) HIV or Immunosuppression
(c) HPV
(d) Multiple sexual partners
(e) Obesity

Correct Answer: (e) Obesity
Explanation: While obesity is a risk factor for other cancers (like endometrial and breast), it is not a direct risk factor for cervical cancer. The primary risk factor is HPV, with co-factors including immunosuppression, prolonged oral contraceptive use, and multiple sexual partners.

4. What imaging can be used in metastatic work up cervical cancer?
(a) CT chest / Abdomen and Pelvis
(b) CXR
(c) Abdominal/ Pelvis Ultrasound
(d) PET/CT
(e) All of the above

Correct Answer: (e) All of the above
Explanation: The choice of imaging depends on availability and stage. CT chest/abdomen/pelvis is standard for detecting distant metastases. CXR can detect lung metastases. Ultrasound can evaluate the liver and kidneys. PET/CT is the most sensitive for detecting nodal and distant disease in locally advanced cancers.

5. What is used for staging Cervical Cancer?
(a) TNM staging
(b) European Staging
(c) Figo staging
(d) WHO staging
(e) None of the above

Correct Answer: (c) Figo staging
Explanation: Cervical cancer is primarily staged using the International Federation of Gynecology and Obstetrics (FIGO) system, which is a clinical staging system. The TNM system is also used and is equivalent.

6. 23 year old HIV+ has 4 cm by 5 cm involving both parametrium; Abdominal U/S shows mild left sided hydronephrosis . What is her stage?
(a) 1b1
(b) 1b2
(c) IIa
(d) IIb
(e) IIIb

Correct Answer: (e) IIIb
Explanation: According to FIGO staging, hydronephrosis or a non-functioning kidney secondary to tumor extension to the pelvic sidewall is classified as Stage IIIB. Parametrial involvement alone would be Stage IIB, but the hydronephrosis upgrades it to IIIB.

7. Stage Iva means the tumour has spread to?
(a) Bladder
(b) Rectum
(c) Vagina
(d) Liver
(e) A,b,c

Correct Answer: (e) A,b,c
Explanation: Stage IVA is defined by tumor invasion into the mucosa of the bladder or rectum. Vaginal involvement (c) is typically an earlier stage. Spread to the liver (d) is Stage IVB.

8. How is Ca Cervix Stage 1B1 treated?
(a) Chemoradiation
(b) Chemotherapy alone
(c) Radiation alone
(d) Surgery
(e) None of the above

Correct Answer: (d) Surgery
Explanation: Stage IB1 cervical cancer can be treated effectively with either radical hysterectomy and pelvic lymph node dissection or with definitive chemoradiation. Surgery is often preferred in young, healthy patients as it preserves ovarian function.

9. How is Ca Cervix stage IIIB?
(a) Chemoradiation
(b) Chemotherapy alone
(c) Radiation alone
(d) Surgery alone
(e) None of the above

Correct Answer: (a) Chemoradiation
Explanation: The standard of care for locally advanced cervical cancer (Stages IB3 to IVA) is concurrent cisplatin-based chemotherapy and radiotherapy (chemoradiation).

10. What would be your biggest concern in treating a 25 year old female with Ca cervix with chemoradiation who just recently got married?
(a) Nausea and Vomiting
(b) Diarrhoea
(c) Vaginal stenosis
(d) Fertility
(e) Skin discoloration

Correct Answer: (c) Vaginal stenosis
Explanation: While all are side effects, for a young, recently married woman, the impact on sexual function from vaginal dryness, fibrosis, and stenosis is a major quality-of-life issue. Fertility is also a concern, but chemoradiation typically causes irreversible infertility, which is a separate issue.

11. A catholic nun has inflammatory breast cancer .What T stage is she?
(a) T1
(b) T2
(c) T3
(d) T4
(e) None of the above

Correct Answer: (d) T4
Explanation: Inflammatory breast cancer is clinically characterized by redness, edema (peau d'orange), and warmth involving a third or more of the breast. This presentation is classified as T4d.

12. All of the below are risk factors of breast cancer EXCEPT
(a) Early menarche
(b) Late menopause
(c) Obesity
(d) Alcohol intake
(e) Smoking

Correct Answer: (e) Smoking
Explanation: While smoking is a risk factor for many cancers, its link to breast cancer is weaker and less consistent than the other well-established factors listed, which all relate to increased lifetime exposure to estrogen.

13. How do you investigate a suspected breast Ca patient?
(a) Clinical exam
(b) Imaging
(c) Biopsy
(d) A,b,c
(e) None of the above

Correct Answer: (d) A,b,c
Explanation: The standard diagnostic approach is the "triple assessment": 1) Clinical Examination, 2) Imaging (Mammogram and/or Ultrasound), and 3) Histopathological Diagnosis (Biopsy).

14. What is the most appropriate test or tests in a breast cancer patient you suspect to have bone mets?
(a) ALP
(b) Bone scan
(c) CT chest/abdomen/pelvis
(d) MRI
(e) a and b

Correct Answer: (e) a and b
Explanation: A Bone Scan (b) is the primary imaging modality to screen for bone metastases. Alkaline Phosphatase (ALP) (a) is a blood test that can be elevated with bone turnover, providing supportive evidence. A CT scan (c) is used for staging soft tissue organs, and MRI (d) is for detailed imaging of a specific area of the spine or brain.

15. How do treat a 1 cm by 1 cm breast cancer mass with no mets?
(a) Lumpectomy followed by radiation
(b) Radiation alone
(c) Surgery alone
(d) Chemotherapy alone
(e) Hospice referral for best supportive care

Correct Answer: (a) Lumpectomy followed by radiation
Explanation: For early-stage breast cancer (like this T1N0 tumor), breast-conserving therapy (lumpectomy followed by whole-breast radiotherapy) is a standard treatment option, offering equivalent survival to mastectomy.

16. How do screen for prostate cancer?
(a) PSA alone
(b) DRE alone
(d) Bone Scan
(e) Both PSA and DRE
(f) None of the above

Correct Answer: (e) Both PSA and DRE
Explanation: The most common method for prostate cancer screening is a combination of Prostate-Specific Antigen (PSA) blood test and Digital Rectal Examination (DRE). A bone scan is used for staging, not screening.

(17) 70 year old male known with prostate ca presents to you with a PSA of 4000u/gl and weakness in both lower limbs for 2 days . What’s your diagnosis?
(a) Stroke
(b) Spinal cord compression
(c) Paraplegia
(d) Epilepsy
(e) None of above

Correct Answer: (b) Spinal cord compression
Explanation: This is a classic presentation of metastatic spinal cord compression, an oncologic emergency. The extremely high PSA indicates advanced, high-volume disease, which often metastasizes to the spine, causing compression and neurological deficits like weakness.

(18) A 60 year old male had a prostate biopsy. His confirmed an adenocarcinoma with Gleason 9. His PSA was 7.5u/gl. What is his risk category?
(a) High risk
(b) Intermediate Risk
(c) Low risk
(d) Metastatic disease
(e) A and c

Correct Answer: (a) High risk
Explanation: A Gleason score of 8-10 automatically places a patient in the High-risk category for prostate cancer, regardless of PSA level or T-stage.

19) What is the most common Oncological emergency in Lymphomas?
(a) Spinal cord compression
(b) Tumour Lysis syndrome
(c) Hypercalcaemia
(d) Bleeding
(e) Neutropneanic Sepsis

Correct Answer: (b) Tumour Lysis syndrome
Explanation: Tumor Lysis Syndrome (TLS) is a common and characteristic emergency in aggressive, treatment-sensitive lymphomas (e.g., Burkitt lymphoma, ALL) due to the rapid cell death after initiating chemotherapy.

20) What is the first line treatment in a patient with Stage IV Prostate cancer with bone mets?
(a) Zometa alone
(b) Zoladex alone
(c) Zometa and Zoladex
(d) Radiation
(e) Chemotherapy

Correct Answer: (c) Zometa and Zoladex
Explanation: The first-line treatment for metastatic prostate cancer is Androgen Deprivation Therapy (ADT). Zoladex (goserelin) is a form of ADT. Zometa (zoledronic acid) is a bisphosphonate used to prevent skeletal-related events from bone metastases. They are often used together.

SECTION 2: True or False

1. The HPV subtypes responsible for Cervical cancer are 7 and 29.
Answer: FALSE
Explanation: HPV 7 and 29 are low-risk types. High-risk types like 16 and 18 cause cervical cancer.

2. All Cervical cancer regardless of stage receive chemotherapy.
Answer: FALSE
Explanation: Early-stage disease (e.g., IA1) can be treated with surgery alone.

3. To confirm Bladder infiltration in cervical cancer a cystoscopy and biopsy should be done.
Answer: TRUE
Explanation: FIGO staging requires biopsy proof of bladder or rectal mucosal invasion for Stage IVA.

4. PET/CT scan maybe used in the work up for advanced cervical cancer.
Answer: TRUE
Explanation: PET/CT is valuable for detecting involved lymph nodes and distant metastases in locally advanced disease.

5. Severe bleeding in cervical cancer is an emergency and can be treated with a single treatment of radiation.
Answer: TRUE
Explanation: Emergency radiotherapy (often brachytherapy) is highly effective at controlling severe bleeding from cervical cancer.

6. All breast cancer patients receive Hormonal treatment.
Answer: FALSE
Explanation: Only patients with hormone receptor-positive (ER+ and/or PR+) cancer benefit from hormonal treatment.

7. Men breast cancer constitute 1 % of breast cancers.
Answer: TRUE
Explanation: Male breast cancer is rare, accounting for about 1% of all cases.

8. Active surveillance can be used in high risk prostate cancer.
Answer: FALSE
Explanation: Active surveillance is for very low and low-risk disease. High-risk disease requires definitive treatment.

9. Brachytherapy is a treatment option in very low risk Prostate cancer.
Answer: TRUE
Explanation: Brachytherapy is a standard definitive treatment option for patients with very low, low, and favorable intermediate-risk prostate cancer.

10. PSA is for screening and follow up post treatment in prostate cancer patients.
Answer: TRUE
Explanation: PSA is used for population screening and is the primary tool for monitoring recurrence after treatment.

SECTION 3: Short Brief Answers

1. A 21 year old female presents with a confirmed biopsy of squamous cell carcinoma. She is also HIV + with CD4 count of 456 and VL undetectable.

(a) What is the lymphatic drainage of cervix?
Answer: The cervix drains to the paracervical, parametrial, obturator, internal iliac, external iliac, and presacral lymph nodes, then to the common iliac and para-aortic nodes.

(b) What organs are at risk for local spread of this cancer?
Answer: Vagina, parametrium, uterine corpus, bladder, rectum, pelvic sidewall (ureters).

(c) How are you going to investigate this patient?
Answer: Clinical examination under anesthesia (EUA) with cystoscopy/proctoscopy, MRI pelvis for local extent, and CT chest/abdomen/pelvis or PET/CT for metastatic workup. Continue ART.

(d) The tumour is found to be 3cm by 4 cm involving both parametrium .Mets work up shows no mets. What is the stage is this patient?
Answer: Stage IIB (due to parametrial involvement). The size would make it IB3 if confined to the cervix, but parametrial invasion defines IIB.

(e) What’s your general management of this patient?
Answer: Concurrent Chemoradiation (External Beam Radiotherapy + weekly Cisplatin chemotherapy + Brachytherapy boost). Continue ART.

(f) How are u going to counsel this patient before treatment?
Answer: Counsel on: diagnosis and stage, treatment plan and duration, potential side effects (short-term: nausea, diarrhea; long-term: vaginal stenosis, infertility, ovarian failure), importance of adherence to ART and radiotherapy, and importance of sexual health and vaginal dilators post-treatment.

2. A 59 year old Female postmenopausal presents with confirmed ductal carcinoma of right breast

(a) The tumour measures 40 mm by 45mm with one mobile right axillary node. No mets. What is the TNM staging?
Answer: T2 (tumor >2cm but ≤5cm), N1 (metastasis in movable ipsilateral level I, II axillary node), M0. Stage: IIB.

(b) What is the lymphatic drainage of breast cancer?
Answer: Primarily to the axillary nodes. Also to internal mammary (parasternal), supraclavicular, and infraclavicular nodes.

(c) List 5 risk factors of breast cancer
Answer:

Female gender & increasing age
Family history / BRCA mutations
Early menarche / Late menopause
Nulliparity / Late first pregnancy (>30)
Postmenopausal obesity
Hormone replacement therapy
Alcohol consumption

(d) How do you investigate this patient?
Answer: Triple Assessment: Clinical exam, Imaging (Mammogram/US of breast and axilla), Biopsy (core biopsy of mass). Staging with CT chest/abdomen/pelvis and bone scan.

(e) How would you treat this patient?
Answer: Multimodal treatment: Neoadjuvant chemotherapy (to downstage), followed by surgery (modified radical mastectomy or breast-conserving surgery + axillary dissection), followed by adjuvant radiotherapy (to chest wall/axilla), followed by adjuvant endocrine therapy (e.g., Aromatase Inhibitors as she is postmenopausal).

(f) If this patient had a strong family history of breast cancer what would u advise her?
Answer: Advise referral for Genetic Counseling and Testing (e.g., for BRCA1/2 mutations). Discuss risk-reducing strategies for herself (e.g., contralateral prophylactic mastectomy) and for family members.

3. Prostate Cancer

(a) What are the risk factors of prostate cancer?
Answer: Increasing age, Black race, family history (especially BRCA2), genetic syndromes.

(b) What are the signs and symptoms of prostate cancer?
Answer: Often asymptomatic in early stages. Can present with Lower Urinary Tract Symptoms (LUTS - hesitancy, frequency, nocturia), hematuria, hematospermia, erectile dysfunction. Advanced disease: bone pain (from mets), weight loss, spinal cord compression symptoms.

(c) What are the 3 risk groups of Prostate cancer? Give an example of each and give one treatment option in each group.
Answer:

Low Risk: e.g., T1-T2a, Gleason 6, PSA <10.
- Treatment: Active Surveillance.
Intermediate Risk: e.g., T2b-T2c, Gleason 7, PSA 10-20.
- Treatment: Radical Prostatectomy.
High Risk: e.g., T3a or Gleason 8-10 or PSA >20.
- Treatment: Radical Prostatectomy + Pelvic Lymph Node Dissection or External Beam Radiotherapy + Androgen Deprivation Therapy (ADT).

(d) (I) How do you manage prostate cancer with bone mets.
Answer: This is metastatic (Stage IV) disease. First-line treatment is Androgen Deprivation Therapy (ADT). Add Androgen Receptor Pathway Inhibitors (e.g., Abiraterone, Enzalutamide). Use Bone-targeting agents (e.g., Zoledronic acid, Denosumab) to prevent complications. Use palliative radiotherapy for symptomatic bone lesions.

(ii) If this patient progresses on treatment (raised PSA on follow up) how will manage this patient?
Answer: A rising PSA despite ADT defines Castration-Resistant Prostate Cancer (CRPC). Management includes: ensuring castrate levels of testosterone, then adding/changing therapy: Abiraterone, Enzalutamide, Chemotherapy (Docetaxel), Radium-223 (for symptomatic bone mets), or Sipuleucel-T.

4. Oncological Emergencies

(i) Hypercalcemia

(a) Definition: A metabolic emergency characterized by abnormally high levels of calcium in the blood, often due to bone resorption from metastases or paraneoplastic syndrome.
(b) General management: Aggressive IV hydration with normal saline, IV bisphosphonates (e.g., Zoledronic acid), calcitonin, and treatment of the underlying cancer.

(ii) Neutropenic Sepsis

(a) Definition: A life-threatening complication of chemotherapy-induced neutropenia, characterized by fever and a high risk of severe infection.
(b) General management: Immediate administration of broad-spectrum IV antibiotics after obtaining cultures. Use of Granulocyte Colony-Stimulating Factor (G-CSF). Supportive care.

(iii) Spinal Cord Compression

(a) Definition: Compression of the spinal cord or cauda equina by metastatic tumor, causing neurological deficits. It is an oncologic emergency.
(b) General management: High-dose corticosteroids (Dexamethasone) to reduce edema. Urgent MRI of the whole spine. Definitive treatment with emergency radiotherapy or surgery (decompression).

END OF ROTATION

SECTION A

Question 1

Question: Risk factors associated with colorectal cancer include which one of the following?
a) Irritable bowel syndrome
b) Contraceptive use
c) Chronic aspirin therapy
d) Low intake of dietary fiber
e) All the above

Correct Answer: d) Low intake of dietary fiber

Explanation: A diet low in fiber is a well-established risk factor for colorectal cancer. Irritable bowel syndrome (a) is not a pre-malignant condition. Contraceptive use (b) is not a significant risk factor, and chronic aspirin therapy (c) is actually associated with a reduced risk of colorectal cancer.

Question 2

Question: Characteristic presenting features of left sided colorectal tumors include:
a) Iron deficiency anemia
b) Painless abdominal mass
c) Foul smelling stools which are difficult to flush
d) Acute large bowel obstruction
e) All the above

Correct Answer: d) Acute large bowel obstruction

Explanation: Left-sided colorectal tumors often present with obstructive symptoms like a change in bowel caliber, constipation, and even acute obstruction because the lumen is narrower and the stool is more solid. Iron deficiency anemia (a) and a painless abdominal mass (b) are more characteristic of right-sided tumors. Foul-smelling, difficult-to-flush stools (c) are a sign of steatorrhea, which is not typical for colorectal cancer.

Question 3

Question: Which virus is both associated with both Nasopharyngeal Cancers and NK Lymphomas?
a) HPV
b) HIV
c) EBV
d) HHV8
e) HSV

Correct Answer: c) EBV

Explanation: The Epstein-Barr Virus (EBV) is strongly associated with both Nasopharyngeal Carcinoma and certain types of Natural Killer (NK)/T-cell lymphomas, particularly the extranodal NK/T-cell lymphoma, nasal type.

Question 4

Question: Risk factors for prostate cancer include which of the following?
a) Castration before age 40 years
b) Asian race
c) Young age
d) Black race
e) White race

Correct Answer: d) Black race

Explanation: Black race is a significant risk factor for prostate cancer, with a higher incidence and more aggressive disease. Castration before age 40 (a) is protective. Asian race (b) is associated with a lower risk, and young age (c) is not a risk factor (risk increases with age). White race (e) carries an intermediate risk compared to Black and Asian races.

Question 5

Question: In diagnosis of prostate cancer:
a) Biopsy is usually by fine needle aspiration
b) Urinary obstructive symptoms are highly suggestive
c) Most patients with a PSA > 4ng/ml will have prostate cancer.
d) All patients should have a digital rectal examination (DRE)
e) None of the above

Correct Answer: e) None of the above

Explanation:

(a) is false; the standard is a core needle biopsy, not fine needle aspiration.
(b) is false; obstructive symptoms are common in benign prostatic hyperplasia and are not highly specific for cancer.
(c) is false; while PSA >4ng/ml raises suspicion, most men with an elevated PSA do not have prostate cancer (low specificity).
(d) is false; while DRE is recommended, it is not performed on all patients (e.g., asymptomatic men undergoing screening may or may not have one).

Question 6

Question: At what age should one start colon cancer screening according to NCCN guidelines?
a) 30 yrs.
b) 40 yrs.
c) 45 yrs.
d) 50 years
e) 60-70 years

Correct Answer: c) 45 yrs.

Explanation: Recent updates to guidelines, including those from the NCCN and USPSTF, recommend starting average-risk colorectal cancer screening at age 45.

Question 7

Question: Which of following can be a harm or harms as a result of cancer screening program?
a) False positive results
b) False negative results
c) Over diagnosis
d) Overburden on the country’s health system
e) All of the above

Correct Answer: e) All of the above

Explanation: All are potential harms of screening. False positives cause anxiety and lead to unnecessary procedures. False negatives provide false reassurance. Overdiagnosis detects indolent cancers that would never have caused harm, leading to overtreatment. Screening programs can also place a significant burden on healthcare systems.

Question 8

Question: Which of the following can be a benefit/benefits of a cancer screening program?
a) Reduced incidence
b) Reduced mortality
c) Early diagnosis
d) Reduced burden on the health system of a country
e) Both b and c

Correct Answer: e) Both b and c

Explanation: The primary benefits of effective screening are reduced disease-specific mortality (b) and early diagnosis (c), which can lead to less invasive and more successful treatment. Screening does not typically reduce incidence (a), except in cases like colorectal cancer where removal of precancerous polyps achieves this. It generally increases, not reduces, the short-term burden on the health system (d).

Question 9

Question: Which virus(es) is most commonly associated with Oropharyngeal cancers?
a) EBV
b) HPV 16
c) HPV 18
d) HHV 8
e) b and c

Correct Answer: e) b and c

Explanation: The majority of oropharyngeal cancers, particularly those of the tonsils and base of tongue, are now caused by Human Papillomavirus (HPV), with HPV 16 being the most common subtype, followed by HPV 18.

Question 10

Question: Which is the most cost-effective way to screen colon cancer in low middle-income countries?
a) Colonoscopy
b) PSA
c) Faecal occult blood test
d) DRE
e) DRE, Colonoscopy and CT scan

Correct Answer: c) Faecal occult blood test

Explanation: The faecal occult blood test (FOBT) or its more modern version, the Faecal Immunochemical Test (FIT), is a low-cost, non-invasive test that is the most feasible and cost-effective initial screening method in resource-limited settings. Colonoscopy is more expensive and requires significant infrastructure. PSA (b) is for prostate cancer. DRE (d) is not an effective screening tool for colorectal cancer.

Question 11

Question: All of below are risk factor for cervical cancer EXCEPT
a) Obesity
b) Prolonged use of oral contraception
c) HIV or Immunosuppression
d) HPV
e) Multiple sexual partners

Correct Answer: a) Obesity

Explanation: While obesity is a risk factor for other cancers (like endometrial and breast), it is not a direct risk factor for cervical cancer. The primary risk factor is persistent HPV infection (d). Other co-factors include prolonged oral contraceptive use (b), immunosuppression (c), and early sexual activity with multiple partners (e).

Question 12

Question: Which one of the following symptom is rare in patients with progressive prostate cancer?
a) Symptomatic anemia
b) Urinary retention
c) Sexual dysfunction
d) Hematemesis
e) Dysuria

Correct Answer: d) Hematemesis

Explanation: Hematemesis (vomiting blood) is not a typical feature of prostate cancer. It is related to upper GI tract pathology. All the other options are common complications: anemia from bone marrow replacement, urinary retention from local obstruction, sexual dysfunction, and dysuria.

Question 13

Question: How often should a colonoscopy be done as a screening test in colorectal cancers?
a) Every 1 year
b) Every 2 years
c) Every 5 years
d) Every 10 years
e) None of the above

Correct Answer: d) Every 10 years

Explanation: For average-risk individuals with a normal initial colonoscopy, the recommended screening interval is 10 years.

Question 14

Question: What imaging can be used to screen for clients at high risk of breast cancer?
a) CT chest /Abdomen and Pelvis
b) Mammogram
c) Ca 15.3
d) PET/CT
e) MRI

Correct Answer: e) MRI

Explanation: For women at high risk (e.g., BRCA mutation carriers, strong family history), annual screening breast MRI in addition to mammography is recommended due to its higher sensitivity. Mammogram (b) alone is for average-risk screening. CT (a), tumor markers (c), and PET/CT (d) are not screening tools.

Question 15

Question: Which of the following is a rare site of breast cancer metastases?
a) Brain
b) Liver
c) Bone
d) Kidney
e) Skin

Correct Answer: d) Kidney

Explanation: The most common sites of breast cancer metastasis are bone, lung, liver, and brain. Metastasis to the kidney is relatively rare.

Question 16

Question: Which of the following statements is true of palliative treatment of metastatic breast cancer?
a) Hypercalcemia should be treated with increased oral fluids and oral bisphosphonates.
b) Bisphosphonates are used in treatment of liver metastases.
c) Neuropathic pain usually responds quickly to opioid analgesics.
d) Increased back pain and weak legs require prompt investigation.
e) Sometimes no counselling is necessary.

Correct Answer: d) Increased back pain and weak legs require prompt investigation.

Explanation: This is a classic presentation of potential spinal cord compression, which is an oncologic emergency. (a) is incorrect because severe hypercalcemia requires IV fluids and IV bisphosphonates. (b) is false; bisphosphonates are for bone metastases, not liver. (c) is false; neuropathic pain responds poorly to opioids alone and requires adjuvants like gabapentin. (e) is false; counselling and psychosocial support are always a crucial part of palliative care.

Question 17

Question: What staging system is used for staging for Melanomas?
a) TNM staging
b) European Staging
c) FIGO staging
d) Ann Arbor staging
e) All the above

Correct Answer: a) TNM staging

Explanation: Melanoma is staged using the AJCC (American Joint Committee on Cancer) TNM system. FIGO (c) is for gynecological cancers, and Ann Arbor (d) is for lymphomas.

Question 18

Question: A 25 year old HIV- lady has a 4 cm by 2 cm cervical mass involving both parametrium but not extending to the side walls bilaterally. What is the stage for her cervical cancer?
a) IVA
b) IB2
c) IIIB
d) IIB
e) None of the above

Correct Answer: d) IIB

Explanation: According to the FIGO staging system, tumor invasion into the parametrium but not to the pelvic sidewall defines Stage IIB. The size of the primary tumor is irrelevant for this stage once parametrial involvement is present.

Question 19

Question: In which type of cancer is a stage IV patient potentially curable in special cases?
a) Liver cancer
b) Colon cancer
c) Cervical cancer
d) Breast cancer
e) All of the above

Correct Answer: e) All of the above

Explanation: While stage IV is often incurable, there are special, limited circumstances where cure is possible. For example, resectable liver or lung metastases in colorectal cancer (b), a solitary metastatic site in breast cancer (d) that can be ablated, and palliative cases of cervical cancer (c) with para-aortic nodes treated with aggressive chemoradiation may have long-term survival. Some liver cancers (a) with limited metastases may be cured with transplant.

Question 20

Question: The drug Temozolomide belongs to which anticancer group of drugs?
a) Alkylating agents
b) Bleomycin
c) Antitumor antibiotics
d) Antimetabolites
e) All of the above

Correct Answer: a) Alkylating agents

Explanation: Temozolomide is an oral alkylating agent that cross-links DNA, commonly used in gliomas.

Question 21

Question: 5 Fluorouracil belongs to which type of anticancer drug?
a) Alkylation agents
b) Antimetabolite
c) Topoisomerase inhibitors
d) Cytotoxic
e) Plant alkaloids

Correct Answer: b) Antimetabolite

Explanation: 5-Fluorouracil (5-FU) is a classic antimetabolite that inhibits thymidylate synthase, disrupting DNA synthesis.

Question 22

Question: Which of the following treatments can be used in managing stage IV prostate cancer with extensive bone diets?
a) Palliative Radiotherapy
b) Bisphosphonates
c) Medical Castration
d) Surgical Castration
e) All of the above

Correct Answer: e) All of the above

Explanation: All are standard management options. Palliative radiotherapy (a) for painful bone mets, bisphosphonates (b) or RANK-ligand inhibitors to reduce skeletal-related events, and androgen deprivation therapy (medical (c) or surgical (d) castration) as first-line systemic treatment.

Question 23

Question: Which one of the following is least commonly seen in tumor lysis syndrome?
a) Hyperuricemia
b) Hypercalcemia
c) Hyperkalcemia
d) Hyperphosphatemia
e) All of the above

Correct Answer: b) Hypercalcemia

Explanation: The classic metabolic abnormalities in Tumor Lysis Syndrome (TLS) are hyperuricemia, hyperkalemia, hyperphosphatemia, and consequent hypocalcemia. Hypercalcemia is not a feature of TLS; it is associated with other malignancies like multiple myeloma and breast cancer.

Question 24

Question: The superior venae cava is formed by which veins?
a) Internal jugular and subclavian veins
b) Left and Right brachiocephalic veins
c) Right and left subclavian veins
d) It’s a continuation of the internal jugular vein
e) None of the above

Correct Answer: b) Left and Right brachiocephalic veins

Explanation: The superior vena cava is formed by the union of the left and right brachiocephalic veins.

Question 25

Question: Ca 15.3 is a tumor marker for which type of cancer?
a) Prostate cancer
b) Breast cancer
c) Lung cancer
d) Colon cancer
e) Vaginal cancer

Correct Answer: b) Breast cancer

Explanation: CA 15-3 is a tumor marker used primarily in monitoring metastatic breast cancer.

Question 26

Question: Two studies showed the benefit of the use of chemotherapy in metastatic prostate cancer. Which chemo drug was used?
a) 5-FU
b) Cisplatin
c) Paclitaxel
d) Docetaxel
e) Bleomycin

Correct Answer: d) Docetaxel

Explanation: The landmark TAX 327 study established docetaxel-based chemotherapy as a standard first-line treatment for metastatic castration-resistant prostate cancer, showing a survival benefit.

Question 27

Question: What would be your biggest concern in treating an 8-year-old male with Hodgkin’s lymphoma with radiation to the chest wall?
a) Nausea and Vomiting
b) Secondary Malignancies
c) Pneumonitis
d) Fertility
e) Skin discoloration

Correct Answer: b) Secondary Malignancies

Explanation: In a young child, the long-term risk of inducing a secondary malignancy (e.g., breast cancer, thyroid cancer, sarcoma) years after radiation therapy is a major concern and a key factor in favoring chemotherapy-based approaches to minimize or avoid radiotherapy in pediatric patients.

Question 28

Question: Brachytherapy is used for treatment in which type of cancer(s)?
a) Prostate
b) Cervical
c) Small Lip cancers
d) Breast cancer
e) All of the above

Correct Answer: e) All of the above

Explanation: Brachytherapy (internal radiation) is a highly conformal technique used in all the listed cancers: prostate (seeds), cervix (tandem and ovoids), breast (balloon catheter), and small lip cancers (interstitial needles).

Question 29

Question: All of the following are risk factors of breast cancer EXCEPT
a) Early menarche
b) Smoking
c) Late menopause
d) Obesity
e) Alcohol intake

Correct Answer: b) Smoking

Explanation: While smoking is a risk factor for many cancers, its link to breast cancer is weaker and less consistent than the other listed factors. Early menarche, late menopause, obesity (in postmenopausal women), and alcohol intake are well-established risk factors.

Question 30

Question: Which of the following is an /are Acquired risk factor(s) of developing Gastric Cancer?
a) H.Pylori
b) Smoking
c) Salted food
d) Obesity
e) All of the above

Correct Answer: e) All of the above

Explanation: All are acquired (non-genetic) risk factors. H. Pylori infection is the most significant. Diet high in salted/preserved foods, smoking, and obesity also increase risk.

Question 31

Question: Which of the following is/are genetic risk factor(s) of developing Gastric Cancer?
a) CDH-1 gene mutation
b) Blood group A
c) Li Fraumeni syndrome
d) a,b and c
e) a and b

Correct Answer: d) a,b and c

Explanation: All are genetic risk factors. CDH-1 mutation causes Hereditary Diffuse Gastric Cancer syndrome. Blood group A is associated with a slightly higher risk. Li-Fraumeni syndrome (TP53 mutation) also increases the risk of gastric cancer.

Question 32

Question: How do you investigate a suspected Lymphoma cancer patient?
a) CXR
b) Abdominal U/S
c) Excision biopsy of the any palpable node
d) PET/CT
e) Both (c) and (d)

Correct Answer: e) Both (c) and (d)

Explanation: The gold standard for diagnosis is an excision biopsy (c) of an entire lymph node for histology. PET/CT (d) is then used for staging. CXR and U/S may be used initially but are not sufficient for definitive diagnosis or staging.

Question 33

Question: October is breast cancer awareness month. ALL of the below are methods that Cancer Diseases Hospital of Zambia can use to screen clients EXCEPT?
a) Self-breast examination
b) Mammogram
c) Clinical breast exam
d) MRI
e) None of the above

Correct Answer: e) None of the above

Explanation: All the listed methods are valid for breast cancer screening, though they are used in different risk groups and resource settings. SBE and CBE are low-cost methods, mammogram is for average-risk screening, and MRI is for high-risk individuals.

Question 34

Question: A 76 year old man is admitted with Laryngeal carcinoma stage III. Which one of the following is the most common risk factor for laryngeal cancer?
a) Alcohol abuse
b) Cigarette smoking
c) Exposure to air pollution
d) Genetics
e) All of the above

Correct Answer: b) Cigarette smoking

Explanation: Cigarette smoking is the single most important and common risk factor for laryngeal cancer. Alcohol is a significant co-factor, but smoking carries the highest risk.

Question 35

Question: Which of the following is not necessary when a patient first presents with a breast lump?
a) Fine needle aspiration (FNA)
b) Examination of axillary lymph nodes
c) Examination of breasts with patient supine
d) Chest X-rays
e) None of the above

Correct Answer: d) Chest X-rays

Explanation: A chest X-ray is not part of the initial routine workup for a benign-appearing breast lump. It is only indicated if metastatic disease is suspected. Physical exam (b, c) and tissue diagnosis (a) are essential first steps.

Question 36

Question: Which syndromes are mostly associated with colon cancer?
a) HNPCC
b) FAP and HNPCC
c) FAP
d) WARG syndrome
e) All of the above

Correct Answer: b) FAP and HNPCC

Explanation: The two major hereditary syndromes associated with a very high risk of colorectal cancer are Familial Adenomatous Polyposis (FAP) and Hereditary Non-Polyposis Colorectal Cancer (HNPCC/Lynch syndrome).

Question 37

Question: Bleomycin belongs to which type of cytotoxic drug?
a) Antimetabolite
b) Alkylating agent
c) Tumor antibiotics
d) Topoisomerase inhibitor
e) None of the above

Correct Answer: c) Tumor antibiotics

Explanation: Bleomycin is classified as an antitumor antibiotic. It causes DNA strand breaks.

Question 38

Question: Which is the dose limiting toxicity for Bleomycin?
a) Ototoxicity
b) Neurotoxicity
c) Nephrotoxicity
d) Cardiotoxicity
e) Pulmonary fibrosis

Correct Answer: e) Pulmonary fibrosis

Explanation: The dose-limiting and most serious toxicity of Bleomycin is pulmonary fibrosis, which is irreversible. Cumulative dose and oxygen exposure are key risk factors.

Question 39

Question: What is the most appropriate test or tests for Stage 4 prostate cancer patients with bone mets?
a) PSMA scan
b) Bone scan
c) CT chest/abdomen/pelvis
d) a and b
e) MRI

Correct Answer: d) a and b

Explanation: For staging known high-risk or metastatic prostate cancer, a PSMA PET/CT (a) is now the gold standard due to its high sensitivity and specificity. A Bone Scan (b) is also a traditional and effective way to detect bone metastases. A standard CT (c) is less specific for prostate cancer metastases in the bone.

Question 40

Question: A marker for the diagnosis of pancreatic cancer is:
a) CA 15-3
b) AFP
c) CEA
d) CA 19-9
e) All of the above

Correct Answer: d) CA 19-9

Explanation: CA 19-9 is the most commonly used serum tumor marker for pancreatic adenocarcinoma, though it is not specific enough for diagnosis alone. CA 15-3 is for breast, AFP for liver, and CEA for colorectal/other GI cancers.

Question 41

Question: A marker for the diagnosis of choriocarcinoma is:
a) CA 15-3
b) AFP
c) CEA
d) BHCG
e) None of the above

Correct Answer: d) BHCG

Explanation: Beta-Human Chorionic Gonadotropin (BHCG) is the quintessential tumor marker for gestational trophoblastic neoplasia, including choriocarcinoma. It is used for diagnosis and monitoring.

Question 42

Question: Which one of the following statements is true of lung cancer?
a) Most are small cell in type.
b) Approximately 25% of lung cancers are large cell anaplastic in histology
c) Screening has proven beneficial.
d) 80% are due to smoking.
e) All of the above

Correct Answer: d) 80% are due to smoking.

Explanation:

(a) is false; Non-Small Cell Lung Cancer (NSCLC) accounts for about 85% of cases.
(b) is false; large cell is a less common subtype of NSCLC.
(c) is misleading; screening with low-dose CT is proven beneficial only for specific high-risk groups, not the general population.
(d) is true; smoking is responsible for approximately 80-90% of lung cancer cases.

Question 43

Question: Which one of the following symptoms is rare in patients with progressive lung cancer?
a) Haemoptysis
b) Hypercalcemia
c) Headache
d) Urinary retention
e) All of the above

Correct Answer: d) Urinary retention

Explanation: Haemoptysis is a common presenting symptom. Hypercalcemia can occur due to bone metastases or paraneoplastic syndromes. Headache can signal brain metastases. Urinary retention is not a typical direct presentation of progressive lung cancer.

Question 44

Question: Which of the following tumors may cause elevated CEA levels?
a) Breast cancer
b) Gastric cancer
c) Lung cancer
d) Colorectal cancer
e) All of the above

Correct Answer: e) All of the above

Explanation: Carcinoembryonic Antigen (CEA) is a non-specific tumor marker that can be elevated in many adenocarcinomas, including colorectal, gastric, pancreatic, lung, and breast cancers.

Question 45

Question: Mutation of P53 gene is involved in a number of cancers. What type of gene is P53?
a) Cell cycle gene
b) Mitotic gene
c) Proto-oncogene
d) Tumor suppressor gene
e) Oncogene

Correct Answer: d) Tumor suppressor gene

Explanation: P53 is a critical tumor suppressor gene often called the "guardian of the genome." It arrests the cell cycle for DNA repair or initiates apoptosis if damage is irreparable. Loss of its function allows damaged cells to proliferate.

Question 46

Question: The high incidence of HIV infection in Africa can be associated with increased incidence of which of the following malignancies?
a) Epidemic Kaposi Sarcoma
b) Colon cancer
c) Cervical cancer
d) Hepatocellular carcinoma
e) a and c

Correct Answer: e) a and c

Explanation: HIV-associated immunosuppression dramatically increases the risk of Virus-Associated Cancers. This includes Epidemic Kaposi Sarcoma (associated with HHV-8) and Cervical Cancer (associated with HPV). Colon cancer is not strongly linked to HIV. Hepatocellular carcinoma is linked to Hepatitis B/C, which may be co-endemic.

Question 47

Question: Ca 125 can be raised in which type of condition or conditions?
a) Pelvic Inflammatory disease
b) Gastric cancers
c) Ovarian cancers
d) a and c
e) None of the above

Correct Answer: d) a and c

Explanation: CA-125 is primarily a marker for ovarian cancer (c). However, it is non-specific and can be elevated in many benign conditions, including menstruation, pregnancy, endometriosis, and pelvic inflammatory disease (a). It is not typically associated with gastric cancers (b).

Question 48

Question: Round blue cells are a characteristics for which type of cancers?
a) Colorectal
b) Rhabdomyosarcomas
c) Neuroendocrine tumors
d) Lymphomas
e) b,c and d

Correct Answer: e) b,c and d

Explanation: "Small round blue cell tumors" is a histologic description for a group of malignancies that appear as sheets of small, blue-staining cells with scant cytoplasm. This group includes Rhabdomyosarcoma, Neuroendocrine tumors, Lymphomas, as well as Ewing sarcoma, Neuroblastoma, and Wilms tumor. Colorectal cancer (a) is an adenocarcinoma, not a small round blue cell tumor.

Question 49

Question: Which of the following is not a hallmark of cancer?
a) Sustaining proliferative signalling
b) Evading apoptosis
c) Inducing angiogenesis
d) Cell cycle specific
e) Invasion and metastasis

Correct Answer: d) Cell cycle specific

Explanation: "Cell cycle specific" is a property of some chemotherapy drugs (they act on a specific phase of the cell cycle), not a fundamental hallmark of cancer itself. The other options are all part of the original Hanahan and Weinberg "Hallmarks of Cancer."

Question 50

Question: What characteristic(s) are associated with Orophygneal cancers in young people?
a) Most of the are HPV (-)
b) Smokers
c) They respond very well to treatment
d) Most tumours are chemoradiation resistant
e) None of the above

Correct Answer: c) They respond very well to treatment

Explanation: Oropharyngeal cancers in younger patients are typically HPV-positive (a is false), often occur in non-smokers (b is false), and are known for their superior response to chemoradiation therapy and better overall prognosis compared to HPV-negative, smoking-related tumors (c is true, d is false).

Question 51

Question: What is the most common histologic subtype of colon cancer?
a) Squamous cell carcinoma
b) Infiltrating type
c) Adenosquamous
d) Adenocarcinoma
e) None of the above

Correct Answer: d) Adenocarcinoma

Explanation: Over 95% of colorectal cancers are adenocarcinomas, which arise from the glandular epithelium of the colon lining.

Question 52

Question: What is the most common Oncological emergency in a right sided non small cell Lung carcinoma?
a) Tumour Lysis syndrome
b) SIAH
c) Superior Vena Cava syndrome
d) Spinal cord compression
e) Neutropenic Sepsis

Correct Answer: c) Superior Vena Cava syndrome

Explanation: Tumors in the right lung and mediastinum (like right-sided NSCLC) are anatomically positioned to compress the Superior Vena Cava, leading to SVCO. Tumor Lysis Syndrome (a) is more common in hematologic malignancies. Spinal Cord Compression (d) is more common with cancers that metastasize to bone (e.g., prostate, breast).

Question 53

Question: Visual Inspection with Acetoacetic acid (VIA) is the method used for screening for cervical cancer. Which of the following are the advantage(s) of this screening test?
a) It’s cheap
b) Patients get results on same day
c) No need for highly skilled workers
d) All of the above
e) Only B and A are true

Correct Answer: d) All of the above

Explanation: VIA is a low-cost, point-of-care test that provides immediate results, allowing for same-day treatment ("see and treat"). It can be performed by trained nurses or mid-level providers, making it highly suitable for resource-limited settings.

Question 54

Question: Toxicity secondary to irradiation of the breast may manifest as
a) Breast fibrosis
b) Arm edema
c) Pneumonitis
d) Cardiac toxicity
e) All of the above

Correct Answer: e) All of the above

Explanation: All are potential late effects of breast radiotherapy. Fibrosis of the breast tissue, lymphedema of the arm if axillary nodes were irradiated, radiation pneumonitis (especially with tangents), and cardiac toxicity (if the left breast was treated without modern techniques to spare the heart).

Question 55

Question: Breakthrough cancer (BTCP) pain:
a) Is a transient exacerbation of pain.
b) Always occurs in patients with stable background pain
c) May occur in the absence of background pain
d) Is the same as incident pain
e) May interfere with activities of daily living

Correct Answer: e) May interfere with activities of daily living

Explanation:

(a) is true but vague.
(b) is false; BTCP can occur without background pain.
(c) is true.
(d) is false; incident pain is a subtype of BTCP (triggered by an action), not synonymous.
(e) is a key characteristic; BTCP significantly impacts quality of life and function.

Question 56

Question: All of the below are subtypes of Classic Hodgkin’s Lymphoma EXCEPT?
a) Nodular sclerosing
b) Mixed cellularity
c) Lymphocyte depleted
d) Lymphocyte rich
e) Nodular lymphocyte predominate

Correct Answer: e) Nodular lymphocyte predominate

Explanation: Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL) is a distinct entity from the four subtypes of Classic Hodgkin Lymphoma (Nodular Sclerosing, Mixed Cellularity, Lymphocyte Rich, and Lymphocyte Depleted).

Question 57

Question: Factor(s) that can be used as evidence of end organ damage in Multiple Myeloma include ALL of the below except.
a) Hypercalcaemia
b) Renal insufficiency
c) Anemia
d) Bone lesions
e) Hypertraemia

Correct Answer: e) Hypertraemia

Explanation: The acronym CRAB defines the evidence of end-organ damage in Multiple Myeloma: Calcium elevation (hypercalcemia), Renal failure, Anemia, Bone lesions. "Hypertraemia" is not a recognized medical term and is likely a distractor.

Question 58

Question: In which type of cancer is whole brain radiation given as prophylactic treatment?
a) Non small lung cancer
b) Small cell lung cancer
c) Renal cell carcinoma
d) Melanoma
e) Breast cancer

Correct Answer: b) Small cell lung cancer

Explanation: Prophylactic Cranial Irradiation (PCI) is a standard treatment for patients with Small Cell Lung Cancer who have achieved a good response to initial chemotherapy, as it significantly reduces the risk of developing brain metastases.

Question 59

Question: Cervix cancer Stage IIIC2 means cancer has spread to?
a) Rectum
b) Liver
c) Brain
d) Lymph nodes to para-aortic
e) Lungs

Correct Answer: d) Lymph nodes to para-aortic

Explanation: In the 2018 FIGO staging, Stage IIIC is defined by pelvic or para-aortic lymph node metastasis. IIIC1 is for pelvic nodes, and IIIC2 is for para-aortic nodes. Spread to rectum, bladder, or beyond (liver, lung, brain) is Stage IV.

Question 60

Question: Diagnosis of metastatic spinal cord compression is best made by:
a) Clinical impression
b) Isotope bone scan
c) Computerised tomography
d) Plain film X – ray
e) Magnetic resonance imaging

Correct Answer: e) Magnetic resonance imaging

Explanation: MRI of the entire spine is the gold standard imaging modality for diagnosing spinal cord compression. It provides excellent detail of the soft tissue, cord, and nerves, and can define the full extent of disease.

continue with the remaining sections

Of course. Here are the answers, correct options, and detailed explanations for the remaining Short Answer Questions from the Clinical Oncology End of Rotation Exam.

Question 2

(13 marks)

a) What factors (5) are associated with increased HPV infection in cervical cancer? (5 marks)

Answer:
Factors associated with increased risk of acquiring and having persistent HPV infection, which is the primary cause of cervical cancer, include:

Early age of first sexual intercourse.
Multiple sexual partners (or a partner who has had multiple partners).
High-risk sexual behavior of the partner.
Immunosuppression (e.g., HIV/AIDS, organ transplant).
Co-infection with other sexually transmitted infections (e.g., Chlamydia, Herpes Simplex Virus).

b) List all the risk factors associated with cervical cancer. (4 marks)

Answer:
Risk factors can be categorized as follows:

Primary Cause: Persistent infection with a high-risk strain of Human Papillomavirus (HPV).
Behavioral Co-factors:
- Early age of first sexual intercourse.
- Multiple sexual partners.
- Tobacco smoking.
Biological Co-factors:
- Immunosuppression (e.g., HIV).
- Long-term use of oral contraceptives (>5 years).
- High parity (having many children).
Other:
- Low socioeconomic status (limiting access to screening and care).
- Family history.

c) Mention the vaccines used in the prevention of cervical cancer and what subtypes of viruses they prevent against. (4 marks)

Answer:

Bivalent Vaccine (e.g., Cervarix): Protects against HPV subtypes 16 and 18 (the two most common high-risk types causing ~70% of cervical cancers).
Quadrivalent Vaccine (e.g., Gardasil 4): Protects against HPV 16, 18, 6, and 11 (adds protection against the low-risk types causing ~90% of genital warts).
Nonavalent Vaccine (e.g., Gardasil 9): Protects against HPV 16, 18, 31, 33, 45, 52, 58, 6, and 11 (extends protection to 7 high-risk types causing ~90% of cervical cancers, plus the 2 low-risk types).

Question 3

(5 marks)

a) What factors (5) are associated with unopposed estrogen increase in breast cancer?

Answer:
Factors associated with increased lifetime exposure to estrogen ("unopposed estrogen") include:

Early menarche (starting periods at a young age).
Late menopause (ending periods at an older age).
Nulliparity (never having given birth) or late age at first full-term pregnancy (after 30).
Hormone Replacement Therapy (HRT) using combined estrogen and progestin.
Obesity (in postmenopausal women, as adipose tissue converts androgens to estrogen).
Additional factor: Alcohol consumption.

Question 4

(4 marks)

a) What are the types of Kaposi sarcoma?

Answer:
The four classic types of Kaposi Sarcoma are:

Classic (Sporadic) Kaposi Sarcoma: Typically found in elderly men of Mediterranean or Eastern European descent; it is indolent and primarily affects the skin of the lower limbs.
Endemic (African) Kaposi Sarcoma: Occurs in HIV-negative individuals in sub-Saharan Africa; can be more aggressive and involve lymph nodes.
Iatrogenic (Immunosuppression-associated) Kaposi Sarcoma: Occurs in patients on long-term immunosuppressive therapy (e.g., post-organ transplant).
Epidemic (AIDS-associated) Kaposi Sarcoma: The most common and aggressive form, associated with HIV/AIDS. It is an AIDS-defining illness.

Question 5

(4 marks)

a) What is tumor lysis syndrome?
Answer:
Tumor Lysis Syndrome (TLS) is an oncologic emergency characterized by a massive and rapid breakdown of tumor cells, leading to the release of their intracellular contents (such as potassium, phosphate, and nucleic acids) into the bloodstream. This overwhelms the body's homeostatic mechanisms, resulting in metabolic derangements that can cause severe organ dysfunction and death.

b) How does tumor lysis syndrome occur?
Answer:
TLS occurs due to the rapid destruction of a large volume of tumor cells, typically following the initiation of cytotoxic therapy (chemotherapy, radiation, targeted therapy, or immunotherapy). It can also occur spontaneously in highly aggressive, treatment-sensitive tumors (e.g., high-grade lymphomas, leukemias). The process is:

Cell Lysis: Therapy causes rapid tumor cell death.
Release of Contents: Intracellular ions and metabolites are released into the blood.
Metabolic Derangements:
- Hyperkalemia: From potassium release.
- Hyperphosphatemia: From phosphate release.
- Hyperuricemia: Nucleic acids (purines) are metabolized into uric acid.
- Hypocalcemia: Calcium binds to the excess phosphate, forming precipitates.
End-Organ Damage: These imbalances can lead to acute kidney injury (from uric acid and calcium phosphate crystal deposition), cardiac arrhythmias (from hyperkalemia and hypocalcemia), seizures, and death.

Oncology - Cuz- 19 April 2022.pdf

PDF 393.62KB

Of course. Here are the answers, correct options, and detailed explanations for the "Oncology - Cuz- 19 April 2022" exam paper.