Deck 8: Understanding Carcinoma and Other Neoplasms in the Gastrointestinal Tract: Part B

Question 1

A 76-year-old male was admitted for symptoms including constipation, change in stool character and weight loss. Colonoscopy revealed multiple polyps in the rectosigmoid area. An adenomatous polyp was removed. Another colonic tumor was seen in the same patient which was flat with irregular "shaggy rug" surface. A biopsy showed frond-like glandular architecture. Atypical epithelial cells in clusters were seen beneath the muscularis mucosae. The most likely diagnosis is:

A)adenomatous polyp
B)villous adenoma with atypism
C)focus of adenocarcinoma arising in villous adenoma
D)colitis cystica profunda
E)NONE of above

Answer 1

focus of adenocarcinoma arising in villous adenoma

Question 2

An elderly male had rectal bleeding. A flat velvety mass was observed in the cecum. The provisional diagnosis was villous adenoma. A partial colectomy was performed. Invasion through the muscularis mucosae, but not into the muscularis propria, was observed on paraffin sections. Therefore, the final diagnosis was:

A)pseudopolyp
B)adenomatous polyp
C)adenocarcinoma Dukes A
D)adenocarcinoma Dukes B
E)adenocarcinoma Dukes C

Answer 2

adenocarcinoma Dukes A

Question 3

A male heavy smoker develops increasing difficulty in swallowing gradually over six months. Constriction of the mid-esophagus is seen on x-ray of barium swallow. The most likely diagnosis is:

A)pulsion diverticulum
B)achalasia
C)hiatal hernia
D)squamous cell carcinoma
E)Mallory-Weiss syndrome

Answer 3

squamous cell carcinoma

Question 4

Which of the following chemotherapy drug is likely to be toxic to gonads?

A)Adriamycin
B)Vinblastine
C)Paclitaxel
D)Procarbazine
E)Prednisolone

Question 5

High dose chemotherapy given prior to stem cell transplant may be associated with gonadal failure. Risk is least with the use of

A)Busulfan + cyclophosphamide
B)Cyclophosphamide + TBI
C)Ifosfamide +carboplatin+ Etoposide
D)Fludarabine + ATG

Question 6

Incidence of Gallbladder cancer is highest in

A)Chile
B)India
C)United Kingdom
D)South Africa

Question 7

Which of the following is least to occur as Gallbladder primary?

A)Adenocarcinoma
B)Squamous cell carcinoma
C)Lymphoma
D)Carcinoid tumor

Question 8

Which of the following is less likely to be associated with Gallbladder cancer?

A)Obesity
B)Use of tobacco and alcohol
C)Aflatoxins
D)Past history of enteric fever

Question 9

On immunohistochemistry, classical Hodgkin"s lymphoma Reed sternberg cells are likely to be

A)CD15(-), CD 30(+),CD45(-)
B)CD15(+), CD 30(+),CD45(+)
C)CD15(+), CD 30(+),CD45(-)
D)CD15(-), CD 30(+),CD45(+)

Question 10

Most common site of metastasis in breast cancer is

A)lung
B)liver
C)bone
D)brain

Question 11

Which one of the following cancers is usually associated with a moderate to high uptake of 18F-fluorodeoxyglucose (18 FFDG)?

A)Bladder
B)Colorectal
C)Thyroid
D)Testicular

Question 12

Which one of the following is an accurate definition of the sensitivity of a screening test?

A)The percentage of screening tests that is positive
B)The percentage of screening tests that is negative among patients who remain unaffected by the condition of interest after screening
C)The percentage of screening tests that is positive among patients who remain unaffected by the condition of interest after screening
D)The probability of a diagnosis of the condition of interest after a positive screening test

Question 13

Epstein-Barr virus-associated Hodgkin"s lymphoma is …

A)common in the elderly
B)common in young children
C)more common in industrialized countries
D)more common in females

Question 14

Treatment of early stage favorable Hodgkin"s lymphoma …

A)necessarily includes radiotherapy
B)requires 6 to 8 cycles of multiagent chemotherapy
C)with 4 cycles of chemotherapy and low dose involved-filed radiotherapy is the standard of care
D)With complete response to 2 chemotherapy cycles further treatment is not needed.

Question 15

Regarding G-CSF - the best description of its mechanism of action and role in chemotherapy is

A)reduced PMN nadir when used as prophylaxis
B)reduced duration of neutropenia when used as prophylaxis
C)not useful unless already neutropenic
D)reduce thrombocytopenia severity
E)potentiates effects of chemotherapy

Question 16

A 44-year-old woman presented with post-coital bleeding. Investigation revealed a 2-cm grade 1, stage IB1 squamous cell carcinoma of the cervix. There was no evidence of lymphovascular space invasion. She had completed her family.What is the most appropriate treatment?

A)brachytherapy
B)chemo-radiotherapy
C)excision cone biopsy only
D)radical hysterectomy
E)vaginal trachelectomy

Question 17

Mutations in which gene are least likely to be associated with breast cancer if inherited in the germ-line?

A)ATM (ataxia-telangiectasia)
B)BRCA l
C)BRCA2
D)Bcl-2
E)p53

Question 18

The least likely to be associated with bowel cancer is

A)Ataxia telangiectasia
B)Der-abl gene translocation
C)BRCA-1
D)BRCA-2
E)Pcl-2

Question 19

14 year old girl with Hodgkin's disease is treated with radiotherapy (mantle field). Which is the most likely secondary carcinoma that could develop

A)breast
B)Lung
C)thyroid
D)NHL
E)AML

Question 20

Young male with germ cell cancer. He is on bleomycin. etoposide and cisplatinum. What side effect would make you stop the treatment?

A)Peripheral neuropathy
B)neutropenic septicaemia
C)interstitial lung disease
D)high tone hearing loss

Question 21

Most likely route of ovarian cancer spread:

A)peritoneal
B)direct spread to adnexae
C)lymphatic
D)direct spread to other organs
E)none of above

Question 22

Man with medullary carcinoma of thyroid, worried about his son. What do you do?

A)yearly calcitonin
B)look for ret oncogene in the cancer
C)look for ret oncogene in blood
D)pentagastrin stimulation test
E)reassure

Question 23

Metastatic renal cell carcinoma, symptomatic:

A)best supportive care
B)radiotherapy
C)Surgery
D)interferon
E)Vinblastine

Question 24

An older woman with breast cancer with bony metastases who was on aminoglutamethonine. Picture of rash which covered right breast and covered left breast a little, small nodules, some dead skin and a few scaly bits. Most likely cause of rash?

A)fungal
B)radiation
C)aminoglutamethonine reaction
D)skin recurrence
E)zoster

Question 25

Male with bone pain from metastatic prostate cancer will be started on LHRH antagonist. He refuses orchidectomy. His illness will show:

A)immediate improvement
B)initially worse than improvement
C)immediate improvement then decline
D)slow improvement
E)no change