Oncology Question Bank

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.

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.

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

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

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.

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.

Rare

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

Serotonin

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.

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

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.

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

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

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.

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.

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.

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.