Oncology Question Bank


Oncology is a field of medicine that focuses on the prevention, diagnosis, and treatment of cancer. Cancer is a group of diseases characterized by the uncontrolled growth and spread of abnormal cells in the body. Oncologists use a range of treatment options, including chemotherapy, radiation therapy, immunotherapy, and targeted therapy, to manage and treat cancer in their patients.

As a medical student, it is important to have a solid understanding of oncology, as cancer is one of the leading causes of death worldwide. By studying oncology, you will learn about the various types of cancer, their causes and risk factors, the latest treatments available, and how to provide compassionate care to cancer patients and their families.

To help reinforce your knowledge in this area, take the following multiple choice questions. These questions will test your understanding of oncology and provide an opportunity for you to see how much you have learned. By taking these questions, you can also identify any areas where you may need to improve your understanding.

Match treatment to class of drug

From the following list, match the breast cancer treatment with the class of drug.

  • Trastuzamab
  • Tamoxifen
  • Anastrazole
  • Letrozole

Drug classes:

  • Oestrogen receptor antagonist
  • Aromatase inhibitor
  • Herceptin receptor

Trastuzamab is more commonly known by its tradename: herceptin, and has provoked controversy in the media regarding its restricted use and relatively high cost. Its use is currently predominantly in herceptin receptor positive breast cancer.

Tamoxifen is an oestrogen receptor antagonist (or SERM selective oestrogen receptor modulator).

Anastrazole and letrozole are 2 aromatase inhibitors: i.e. they block the aromatization of androstenedione. They are reccomended for oestrogen receptor positive post menopausal women.

Operability of lung cancer

Regarding conventional guidance for “operability ” of lung cancer which of teh following are thought to be contraindications for a curative pneumonectomy of lobectomy:

  • Lymph node involvement
  • Age over 80 alone
  • Metastasis
  • Hypercalcaemia
  • Hyponatraemia
  • FEV1 of >1l
  • Evidence of spread outside the thorax

Examiners love this question type in lung cancer as its easy to write and tests concepts around knowledge and assessment of performance status for lung cancer

Less than 15% of patients who are diagnosed in the UK with lung cancer are fit for surgery.

If there is Lymph node involvement: then the tumour is inoperable. This can be judged via CT scanning / PET scanning (positron emission tomography) / VATS & biopsy (video assisted thoracoscopy)

If there is metastasis (liver/ brain/bone etc): therefore patients require history / examination / CT chest and upper abdomen / isotope bone scan.

Note here that hypercalcaemia may be related to bone mets. However it may also relate to ectopic PTH secretion by a Squamous Cell tumour and therefore is not in itself a contraindication to surgery.

By the same arguments: hyponatraemia / LEMS etc are not in themselves contraindications to surgery. They may well be inoperable, and they are not good prognostic signs. However they are not contraindications to surgery.

Evidence of spread outside the thorax e.g. from sympathetic chain involvement (horners syndrome with a pancoast tumour) or pleural effusion or laryngeal nerve palsy ( hoarse voice) all make the tumour inoperable.

Performance status will be included in the criteria so:
FEV1 of <1l (patients with underling COPD) have such a high anasthetic risk and post operative complications surgery is not recommended.

Remember non small cell lung cancer (NSCLC) is potentially operable.

Risk Factors for Gastric cancer

Which of the following are risk factors for gastric cancer?

  • Conditions like HNPCC
  • Blood Group A
  • Crohn’s
  • Pernicious anaemia
  • Gastric Polyps

A few points: Conditions like HNPCC does increase the risk of both colon and gastric cancer.

Pernicious anaemia is complicated by gastric cancer in a proportion of cases. This should be remembered for MCQ questions!

Crohn’s is a strong risk factor for colonic cancer but not so for gastric cancer.

Other risk factors include:

Gastric Polyps
Pernicious anaemia
Barret’s oesophagus (metaplasia)
Family History
Blood Group A
Smoking (although link less strong than other malignancies e.g. lung)
Social deprivation

Tumour Markers

Match the substances with the cancers they are associated with:


  • AFP
  • Beta HCG
  • Ca 19-9
  • Calcitonin
  • CA125
  • CEA
  • Protein Electrophoresis
  • PSA
  • Urinary 5HIAA
  • Urinary Catecholamines


  • Carcinoid
  • Choriocarcinoma
  • Colorectal cancer
  • Hepatoma
  • Myeloma
  • Ovarian cancer
  • Pancreatic Cancer
  • Phaeochromocytoma
  • Prostate cancer
  • Thyroid Medullary cancer

Substance Associated with Notes
AFP Hepatoma: also some seminomatous tumours remmber high risk populations including hepatitis virus and alcoholics
CEA Colorectal cancer Note its use in follow up rather than diagnosis
Calcitonin Thyroid Medullary cancer Diagnosis and follow up
CA125 Ovarian cancer
Urinary Catecholamines Phaeochromocytoma Rember to consider this in patients presenting with palpitations and hypertension hypertension and
Protein Electrophoresis Myeloma Any questions that include the test “immunoglobulins and protein electrophoresis” is essentially looking for the monoclonal production of immmunoglobulin seen in myeloma
Ca 19-9 Pancreatic Cancer Levels of >10,000 can correlate with metastatic spread in this aggressive tumour
Beta HCG Choriocarcinoma Almost ‘always’ elevated. Also elevated in germ cell tumours
PSA Prostate cancer
Urinary 5HIAA Carcinoid Symptoms often imply metastases

Breast cancer

What proportion of breast cancer is oestrogen receptor positive?

  • <10%
  • 25%
  • 50%
  • 75%
  • >90%

About 50% of breast cancer is oestrogen receptor positive. There is a similar proportion of progesterone receptor positive tumors, making the total proportion OR and PR positive about 25%.

Breast Cancer TNM

Regarding TNM staging for breast cancer what does the following imply about a tumour?


  • Cancer present with metastases
  • Cancer present with involvement of the chest wall
  • Cancer with tumour fixed to muscle
  • Cancer present with lymph node and metastases
  • None of the answers listed here

None of the answers listed here

TNM = Tumor / Lymph node involvement / metastasis
For breast cancer its often used at MDT meeting following resection of suspected breast cancer (i.e. resection and ‘lymph node clearance’)

T2 implies a tumour of >2cm
T3=fascia and muscle involvement
T4 implies involvement of the chest wall. This is seen in some elderly patients who present with locally advanced breast cancer which may ulcerate etc. This includes the ‘peau d’orange’ or orange peel type skin seen in T4 breast cancers

N0= no lymph involved nodes at histology
M0= No mets
M1= Mets present

Breast cancer treatments

What is the current reccomended duratino of tamoxifen treatment?

  • 1 year
  • 2 years
  • 3 years
  • 5 years
  • 8 years
  • Indefinite
  • None of the listed answers are correct

5 years

Tamoxifen is currently used for 5 years for adjuvant hormonal treatment for breast cancer. Its use is currently recommended for 5 years at a dose of 20mg daily. Higher doses are not currently recommended.


A 64 year old man presents with a cough, wheezing and flushing.
He has no past medical history whatsoever.
He has never had symptoms like this in the past.
He is a non smoker
There is no history of asthma.
The symptoms occur in a paroxsymal fashion.

Which investigation is most likely to lead to the correct diagnosis?

  • 24 hour urinary 5HIAA
  • Urinary Catecholamines
  • Pituitary hormone profiles
  • Colonoscopy
  • Patch testing

24 hour urinary 5HIAA

The symtpoms sound like carcinoid:
Due to neuroendocrine secretion of this malignant tumour which often has its primary site in the GI tract or lungs.

24 hour urinary 5 hydroxy-indolacetic acid, a neuroendocrine metabolite is one of the screening tests for this condition along with appropriate imaging.


When presenting with symptoms this often is unfortunately a sign of metastatic disease (esp. liver).

Carcinoid 2

Continued from previous question:
A 64 year old man presents with a cough, wheezing and flushing.
He has no past medical history whatsoever.
He has never had symptoms like this in the past.
He is a non smoker
There is no history of asthma.
The symptoms occur in a paroxsymal fashion.

What is the most likely hormone responsible for his symptoms?

  • Serotonin
  • Neurokinin
  • Histamine
  • Dopamine
  • Gastrin


All of these hormones/proteins may be secreted in carcinoid but it is classically serotonin. Remember 5HIAA is a metabolite of serotonin and this is whats measured in the urine.


A 25 year old male presents to you as his GP. He has a family history (father) of Familial Adenomatous Polyposis (FAP). His mother does not have the condition.

He asks you what his risks are of having the condition?

What is the correct answer?

  • 0%
  • 25%
  • 50%
  • 75%
  • 100%

FAP is an autosomal dominant condition. He has a 50% chance of inherting the gene from his father, giving him a 50% risk.


Assuming he does have the condition, what is his lifetime risk of developing colorectal cancer (assuming he has no other health problems whatsoever)?

  • Approximately 4 in 5
  • Approximately 1 in 2
  • The risk is of small bowel cancer
  • 100%


FAP will always progress to colorectal cancer. The only definitive protective intervention is a colectomy which will remove his risk of colon cancer. There is a higher incidence of thyroid and pancreatic cancer in FAP.


Continued from previous question: [A 25 year old male presents to you as his GP. He has a family history (father) of Familial Adenomatous Polyposis (FAP). His mother does not have the condition.]

He tells you his father died of colon cancer. What age was his father likely to be when he was first diagnosed with colon cancer?

  • 20
  • 30
  • 40
  • 50
  • 60


The mean age of development of colonic malignancy in people who have FAP is 39.

Gleason Score

A Gleason score is used to stratify:

  • Breast cancer
  • Prostate cancer
  • Lung Cancer
  • Colorectal Cancer
  • Renal Cancer

Prostate cancer

A gleason score is a histopathological score from 0-10 with 0 being the least malignant and 10 being teh most malignant. The scores are used to decide on tratment/ prognosis and the different options in management.

Lung Cancer

Which of the following lung cancers is considered “inoperable” as a result of disseminated spread at presentation?

  • Small Cell Lung Cancer
  • Adenocarcinoma
  • Brochoalveolar Cell Carcinoma
  • Squamous cell Carcinoma
  • Large Cell

Small Cell Lung Cancer

Lung cancer is classically divided into:
Small Cell Lung Cancer (inoperable)
Non small cell lung cancer (NSCLC- potentially operable)

Diagnose type of cancer

A 64 year old man presents with an epileptic seizure: He is found to be hyponatraemic Na+129 (normal range 135-145mmol/l).

His chest X-ray shows a ill defined lesion in the left midzone.

Based on these findings what is the most likely histological sub type of the cancer?

  • Small Cell Lung Cancer
  • Adenocarcinoma
  • Squamous Cell Carcinoma
  • Carcinoid

Small Cell Lung Cancer

The likely aetiology of the hyponatraemia is inapproprate ADH (anti diuretic hormone) secretion from the lung cancer (ectopic production of ADH). This most commonly occurs in small cell lung cancer.

Continued from previous question. What is the most likely aetiology of his seizure?

  • Syndrome of inappropriate ADH secretion
  • Idiopathic epilepsy
  • Brain Metastases
  • Hypercalcaemia
  • None of the answers listed here

Brain Metastases

The sodium isn’t particularly low enough to provoke a seizure.
Once the Na+ gets <120 and more seriously <110 the risk of seizure is greatly increased.
This makes the most likely answer brain mets.

Continued from previous question. The patient is treated with phenytoin and chemotherapy. 12 days following treatment he notices swelling around his face, neck and hands. What is the most likely diagnosis?

  • Adverse drug reation: phenytoin
  • Anaphylacoid reaction
  • Hypercalcaemia
  • Side effect of chemotherapy regime
  • SVC obstruction
  • None of the answers listed here

SVC obstruction

The symptoms suggest the diagnosis of SVCO (superior vena cava obstruction). We’ve deliberately given you only the the acronym.

Mediastinal spread impairing venous drainage from the distribution of the SVC (head neck arms) makes this the most likely of all the answers given i.e. it is the ‘best’ answer in the exams. Its a little too soon for an anaphylactoid reaction however and “adverse drug reaction” can present at any time.

Diagnosis: Clinical and CT findings.
Treatment is via percutanious stenting of the SVC. These stent’s can be seen on chest radiographs. They’re put in trans-luminally by usually an interventional radiologist.


Regarding the following statement:

“it is inevitable that significant morbidity would occur to perfectly healthy people if a national screening program was introduced for faecal occult blood testing”.

  • True
  • False

The false positive FOB (patients without colorectal cancer) will be subjected to a colonoscopy, a procedure which has significant morbidity and risk profiles of approximately 1 in 1000.

Therefore if 500,000 males are screened a significant proportion will have colonoscopies. An inevitable problem with this is potential death from an uneccessary colonoscopy.