Deck 16: Pathologic Findings and Treatment Indications in Cervical Cancer: Insights From Swog 8797 Peters

Question 1

Based on the results of SWOG 8797 (Peters), which of the following pathologic findings after a radical hysterectomy and pelvic lymph node dissection is an indication for adjuvant chemotherapy with radiation therapy for patients with high-risk cancers of the cervix?

A)Tumor size >5 cm
B)Lymphovascular space invasion
C)Depth of invasion into the deep third of the cervical stroma
D)Microscopic involvement of the parametrium

Answer 1

Microscopic involvement of the parametrium

Question 2

A 29-year-old woman had a 2.5-mm Breslow thickness melanoma removed from her right shin. She was referred for wide local excision of the scar and consideration of sentinel node biopsy. In what proportion of patients with a negative sentinel node biopsy does nodal recurrence subsequently develop in the same lymph node basin?

A)<1%
B)1-4%
C)5-9%
D)10-14%
E)15-25%

Answer 2

1-4%

Question 3

According to the VA Lung Cancer Group's classification, which of the following sites of lymphadenopathy is associated with extensive-stage small cell lung cancer?

A)Ipsilateral hilar lymph nodes
B)Ipsilateral supraclavicular lymph nodes
C)Contralateral supraclavicular lymph nodes
D)Contralateral mediastinal lymph nodes

Answer 3

Contralateral supraclavicular lymph nodes

Question 4

Which of the following factors increases a patient's risk for the development of leukemia?

A)Occupational exposure to benzene
B)Occupational exposure to aluminum
C)Use of mitomycin C
D)Exposure to HPV

Question 5

Which of the following genetic abnormalities is most commonly associated with Ewing sarcoma?

A)t(8;14)
B)t(11;22)
C)1p/19q gene deletion
D)Loss of heterozygosity (LOH) of the retinoblastoma gene

Question 6

Which of the following statements about the diagnosis of inflammatory breast cancer is true?

A)There may not be a discrete palpable mass at presentation.
B)At presentation, a patient may report having a longstanding breast mass that developed skin changes over time.
C)A biopsy is not required, since the diagnosis is clinically established.
D)Dermal lymph node involvement must be demonstrated.

Question 7

Which of the following cell cycle phase transitions is most affected when the TP53 gene is lost or mutated?

A)G ? G01
B)G ? S1
C)G2 ? M
D)S ? G2

Question 8

Which of the following molecular mechanisms is specifically implicated in the oncogenesis of cervical cancer associated with prior HPV infection?

A)The E7 protein expression inactivates p53.
B)The E7 protein expression inhibits Rb function.
C)The E6 protein expression suppresses G -M cell cycle arrest. 2
D)The E6 protein expression activates c-myc.

Question 9

A 30-year-old man presented with a swelling in the testis and an ultrasound scan confirmed the presence of a malignant mass. Following orchidectomy, he was found to have a 40-mm seminomatous germ cell tumour without non-seminomatous components. There was evidence of vascular invasion within the testis.Investigations: serum lactate dehydrogenase (LDH) 1250 U/L (10-250) serum ?-fetoprotein normal serum ?-human chorionic gonadotrophin (HCG) 700 U/L (<5) A CT scan of body showed retroperitoneal lymphadenopathy of up to 7 cm in size, a 3- cm mediastinal lymph node and over 30 pulmonary metastases. There were no signs of liver, brain or bone metastases. What is the most appropriate International Germ Cell Cancer Collaborative Group classification?

A)good prognosis because of the absence of liver, bone and brain metastases
B)good prognosis because of the raised HCG and LDH
C)intermediate prognosis because of the presence of lung metastases
D)intermediate prognosis because of the raised serum HCG and LDH
E)poor prognosis because of the raised serum HCG and LDH

Question 10

What is the most common site of metastatic disease in patients with Ewing sarcoma?

A)Lung
B)Bone
C)Bone marrow
D)Lymph nodes

Question 11

A 50-year-old woman with early breast cancer presented with fatigue to the accident and emergency department on day 7 of her first adjuvant chemotherapy cycle. On examination, her temperature was 38.5°C, her pulse was 110 beats per minute and her blood pressure was 110/70 mmHg. A full blood count was requested. What is the most appropriate next step?

A)await full blood count result
B)intravenous broad-spectrum antibiotics
C)intravenous broad-spectrum antibiotics and granulocyte colony-stimulating factor (G-CSF)
D)oral broad-spectrum antibiotics
E)oral broad-spectrum antibiotics and G-CSF

Question 12

Which of the following statements about metastasis of breast cancer to the bone is true?

A)Metastasis to the epidural spine is most commonly associated with worsening back pain in the supine position or with the Valsalva maneuver.
B)Compression of the epidural spinal cord associated with breast cancer most commonly has a single site of vertebral metastasis.
C)Radicular pain in the thoracic spine is typically unilateral.
D)Pain from T12, L1 vertebral lesions is not associated with a referred pain pattern to the bilateral iliac crests or to the bilateral sacroiliac joints.

Question 13

A 62-year-old man with limited-stage small cell lung cancer and proximal muscular weakness is most likely to have which of the following conditions?

A)SIADH
B)Myasthenia gravis
C)Cerebellar degeneration
D)Eaton-Lambert syndrome

Question 14

A 3-year-old girl has Wilms tumor with a favorable histology and a positive surgical margin. CT scan of the chest does not reveal any pulmonary nodules. What cancer stage is most appropriate for the patient's condition?

A)Stage I
B)Stage II
C)Stage III
D)Stage IV

Question 15

Which of the following types of cancer is most frequently associated with isolated hepatic metastases at presentation?

A)Colorectal
B)Esophageal
C)Gastric
D)Lung

Question 16

Which of the following statements about the treatment of bone metastases secondary to breast cancer is true?

A)Radiation therapy will achieve partial or complete pain relief within 4 weeks.
B)Single-fraction irradiation provides equivalent results to protracted radiation treatment schedules for pain control durability and reduced risk of subsequent fracture.
C)Metastatic sites with extraosseous bone involvement should be treated with 153Sm only, because localized external-beam irradiation is not beneficial.
D)An 8-Gy dose of hemibody irradiation should be administered in a single fraction to the upper, middle, or lower hemibody regions for treatment of painful bony metastases.

Question 17

A 35-year-old man sought advice about the increased risk of cardiac complications following chemotherapy. Eight years previously, he had been successfully treated for Hodgkin"s disease with six cycles of doxorubicin, bleomycin, vinblastine and dacarbazine, and mediastinal radiotherapy. For how many years from the end of treatment will this increased risk persist?

A)1-5
B)6-10
C)11-15
D)16-20
E)>20

Question 18

A 58-year-old man presented with haemoptysis, weight loss and worsening breathlessness. He was a lifelong heavy smoker. His chest X-ray was abnormal. A CT scan of chest and abdomen demonstrated a large mass in the right lower lobe invading into the mediastinum and pericardium, extensive mediastinal lymphadenopathy, and bone metastasis (T4, N3, M1b). Bronchoscopy and biopsy confirmed a squamous cell carcinoma. Mutation analysis revealed that EGFR and K-ras genes were both wild type. What is the most appropriate first-line therapy?

A)docetaxel
B)erlotinib
C)gefitinib
D)gemcitabine and cisplatin
E)pemetrexed and cisplatin

Question 19

Which of the following diagnostic tests is NOT included in the staging of small cell lung cancer?

A)CT scan of the chest and upper abdomen
B)Brain imaging
C)Bone scan
D)PET scan

Question 20

Which of the following types of cancer is most commonly associated with myasthenia gravis?

A)Small cell lung cancer
B)Non-small cell lung cancer
C)Mesothelioma
D)Thymoma

Question 21

A 55-year-old man underwent resection of a T2 clear cell renal carcinoma. What is the most likely pathogenesis?

A)activating mutations of the VHL gene
B)MET oncogene activity
C)mutation of p53
D)up-regulated expression of HIF-controlled genes
E)von Hippel-Lindau syndrome

Question 22

During evaluation of tumor biopsy specimens, which of the following markers can be used as a histochemical indicator of cell proliferation?

A)Ki-67
B)TP53
C)c-myc
D)Nuclear/cytoplasmic ratio

Question 23

Which of the following statements about the effectiveness of cancer is true? for treating thyroid

A)Medullary carcinoma is treated more effectively than Hürthle cell carcinoma.
B)The follicular variant of papillary carcinoma is treated more effectively than Hürthle cell carcinoma.
C)Tall cell carcinoma is treated more effectively than the follicular variant of papillary carcinoma.
D)Insular carcinoma is treated more effectively than the follicular variant of papillary carcinoma.

Question 24

Which of the following processes is NOT commonly involved in the development of bone metastases?

A)Avascular necrosis
B)Activation of osteoclasts
C)Cell adhesion molecules
D)Chemotaxis of metastatic cancer cells

Question 25

SBLA syndrome is another name of

A)Lynch I
B)Lynch II
C)Li- Fraumeni syndrome
D)Cowden's syndrome
E)Peutz-Jegher"s Syndrome