Oncology F
Q: Preferred term for “progression-free survival”
A: “Progression-free interval”
The time from when a Tx is started until that Tx is no longer controlling the cancer
Q: Checkpoint inhibitor toxicity
A: Autoimmune disease
Checkpoint inhibitors: a type of cancer immunotherapy that works by blocking proteins called checkpoints that normally prevent the immune system from attacking cancer cells
Releasing the brakes on the body’s immune system -> attack cancer cells
Q: Prevention of BRCA-mutation ovarian cancer
A: Bilateral salpingo-oophorectomy
(Removal of ovaries and fallopian tubes)
Q: Genetic mutation indication for annual mammography and breast MRI
A: BRCA gene mutation
Q: Treatment of breast cancer with HER2 overexpression
A: Trastuzumab
(Human epidermal growth factor receptor 2)
Q: Mammogram features of ductal carcinoma in situ
A: Calcifications
DCIS: early form of breast cancer where abnormal cells are found in the milk ducts but have not spread outside the ducts. Considered stage 0
in situ: その場で
Q: Treatment of extensive ductal carcinoma in situ
A: Mastectomy
DICS: lumpectomy + irradiation or mastectomy if extensive
Q: Surgical breast cancer staging with clinically negative axillary nodes
A: Sentinel node biopsy
Done at the time of surgery -> axillary dissection not required if no more than 2 sentinel nodes involved
Q: Scaly red rash with ulceration of the nipple and areola
A: Paget disease of the breast
Q: Antiestrogen therapy not effective in premenopausal women
A: Aromatase inhibitors (letrozole, anastrozole)
Tamoxifen: selective estrogen receptor modulator, effective for both pre-and-post menopausal
Aromatase inhibitor: not effective for premenopausal, prevent conversion of adrenal androgen to estrogen but don’t inhibit ovarian estrogen production
Q: Duration of postmenopausal breast cancer endocrine therapy
A: 5-10 years
Q: Breast cancer hormone therapy associated with musculoskeletal syndrome
A: Aromatase inhibitors (letrozole, anastrozole)
1/3 develop symmetric arthralgia, joint stiffness and bone pain
(vs tamoxifen slows bone loss by acting as estrogen agonist in postmenopausal women)
Q: Adjuvant treatment of premenopausal, hormone receptor-positive, low-risk breast cancer
A: Tamoxifen
Q: Treatment of premenopausal hormone receptor–positive, high-risk early breast cancer
A: Ovarian suppression (leuprolide) plus antiestrogen therapy (exemestane)
Leuprolide: gonadotropin-releasing hormone agonist, initially stimulating, then subsequently suppressing the release of LH and FSH, leading to a decrease in estrogen
Exemesane: aromatase inhibitor
Q: Adverse effects of trastuzumab
A: Infusion reactions and cardiomyopathy
Trastuzmab: monoclonal Ab that targets HER2-positive cancer
Q: Fertility preservation in women undergoing adjuvant chemotherapy
A: Oocyte (卵母細胞) or embryo (胚: 受精卵が分裂を始めてから8週目まで) banking
Q: Breast cancer mimic of infectious mastitis
A: Inflammatory breast cancer
Q: Role of routine breast cancer surveillance blood tests and imaging studies
A: None
(Should have Annual mammograms of remaining breast tissue)
Q: Management of lymphedema after axillary dissection
A: Physical therapy
Q: Management of nocturnal hot flushes post breast cancer therapy
A: Gabapentin
(Menopausal Sx should be managed with nonhormonal options)
Q: Treatment of breast cancer with bone metastases
A: Chemotherapy and bisphosphonates
Bone-modifying agents decrease fracture, pain and need for irradiation
Q: Painful bone metastases treatment
A: Radiation therapy
(Palliative radiation)
Q: Diagnostic management of presumed breast cancer metastases
A: Biopsy; assess hormone receptor, HER2, and biomarker status (e.g., PIK3CA/ESR1 mutations, programmed death ligand 1).
There may be treatment altering discordance in the receptors in the metastatic lesion compared with the primary breast cancer in 10-15%
Q: Most common ovarian cancer susceptibility genes
A: BRCA and mismatch repair genes (MMR)
(MMR gene mutation associated with Lynch syndrome (colorectal, endometrium, small bowel, transition cell carcinoma of ureter or renal pelvis))
Q: Genetic testing for women with epithelial ovarian cancer
A: BRCA1 and BRCA2
Q: Criteria for genetic testing in women with ovarian cancer
A: Should be offered to all women with ovarian cancer
Q: Treatment of stage III ovarian cancer after surgical debulking
A: IV and intraperitoneal chemotherapy
Surgical Debulking: aims to remove as much of a cancerous tumor as possible, even if complete removal isn’t achievable
Q: Ovarian cancer posttreatment surveillance
A: History and physical exam
Other testing is recommended only to evaluate symptoms or findings suggesting recurrence
Q: Effective cervical cancer prevention
A: HPV vaccination
Q: Fertility-preserving treatment of stage IA cervical cancer
A: Conization
(Cone biopsy)
Q: Cervical cancer posttreatment surveillance
A: History and physical examination
(Annual vaginal cytology, cervical cytology or both recommended)
Q: Role of PET scans in colorectal cancer management
A: None
(Colonoscopy, contrast CT of chest/abdomen/pelvis)
Q: Stage I rectal cancer treatment
A: Surgical resection
Q: Stage II or III rectal cancer adjuvant treatment options
A: Irradiation or chemotherapy
(Chemotherapy and irradiation given before surgery is widespread practice)
Q: Low-risk stage I-II colorectal cancer adjuvant treatment
A: None
Q: Treatment of oligometastatic colorectal cancer
A: Surgical resection
Complete resection of oligometastaticfoci confied to a single organ can be curative in 25%
Q: Stage III colorectal cancer adjuvant treatment
A: Chemotherapy (e.g., FOLFOX)
Q: Role of routine radiation therapy for colon cancer
A: None
Q: Genetic studies for metastatic colorectal cancer
A: KRAS, NRAS, BRAF, mismatch repair genes
These studies rarely affect the choice of 1st line Tx, but will define subsequent Tx options
Q: Major chemotherapeutic agent for most metastatic colorectal cancers
A: 5-FU
Q: Panitumumab and cetuximab common skin adverse effect
A: Acneiform rash (painful)
Q: Antibody that potentiates metastatic colon cancer chemotherapy
A: Bevacizumab
Anti-vascular endothelial growth factor (VEGF) monoclonal antibody
Q: Anal cancer associated virus
A: HPV
Q: Treatment of locally invasive advanced anal cancer
A: Irradiation and concurrent chemotherapy
Unlike rectal cancer (adenocarcinoma), anal cancer is a squamous cell carcinoma. Often curable with combined irradiation and chemotherapy
Q: Role of surgery for anal cancer
A: Local recurrence or incomplete response to irradiation and chemotherapy
Q: Role of routine PET scans in pancreatic cancer management
A: None
CT chest and abdomen are appropriate for staging
Q: Resected pancreatic cancer adjuvant treatment
A: Chemotherapy (gemcitabine, capecitabine)
Q: Procedure to determine esophageal cancer depth and involved lymph nodes
A: Endoscopic ultrasound
Q: Hormonal testing for upper gastrointestinal tumors
A: HER2
Human epidermal growth factor receptor 2, 25% of gastroesophageal cancer overexpress HER2
Q: Infection associated with gastric mucosa-associated lymphoid tissue lymphoma
A: Helicobacter pylori
MALT lymphoma strongly linked to H.pylori
(vs EB virus -> Burkitt lymphoma)
Q: Liver metastases, diarrhea, facial flushing
A: Gastrointestinal neuroendocrine tumor
(Formerly called carcinoid tumor)
Q: Initial management of nonfunctional metastatic neuroendocrine tumors
A: Observation
Asymptomatic patients may do well, with minimal growth and no symptoms for years, even with metastatic disease
Q: Genetic marker in gastrointestinal stromal tumors
A: Overexpression of KIT gene
GIST is sarcoma
Stroma: 間質
Q: Therapy following resection of high-risk gastrointestinal stromal tumors
A: Imatinib
Tyrosine kinase inhibitor
Q: Assessment of pulmonary reserve before lung cancer lobectomy
A: FEV1 and DLCO
Q: Treatment of nonresectable early-stage lung cancer
A: Irradiation
No data supporting the use of chemotherapy combined with irradiation in patients with stage I or II disease
Q: Stage II-III NSCLC treatment
A: Surgery and cisplatin-based chemotherapy
Q: Metastatic NSCLC treatment in absence of driver mutations
A: Platinum-based chemotherapy
(Cisplatin, carboplatin, oxaliplatin)
Q: Genetic testing for all nonsquamous metastatic NSCLC
A: EGFR, ALK, ROS1 genes
EGFR, ALK, ROS1 mutations are less common in squamous cell carcinoma
-epidermal growth factor receptor (EGFR)
-human epidermal growth factor receptor 2 (HER2) particularly breast cancer
Q: Treatment of EGFR-positive NSCLC
A: Erlotinib or osimertinib
Q: Metastatic NSCLC cancer treatment after response to first-line chemotherapy
A: Maintenance chemotherapy
Q: Treatment of metastatic NSCLC positive for PD-L1
A: Pembrolizumab
Programmed death-ligand 1 is protein (not gene mutation), checkpoint molecule, interacting with the PD-1 receptor on immune cells, particularly T cells to suppress their activity
Pembrolizumab: immunotherapy, helping the immune system fight cancer cells by blocking a protein called PD-1
Q: Testing for all patients with metastatic NSCLC to guide therapy
A: PDL1 expression
Q: Treatment of limited SCLC
A: Concurrent chemotherapy and irradiation
Q: SCLC staging procedures
A: Bone scan; brain MRI; chest, abdomen, pelvis CT
Q: Complication of cranial irradiation in older patients with SCLC
A: Cognitive impairment
Q: Infectious agent with increased risk of oropharynx cancers
A: HPV
Q: Biopsy procedure for suspected head and neck cancer
A: Fine-needle aspiration
Q: Oropharynx cancer with positive p16 stain
A: HPV positive
p16 immunohistochemistry, to detect the presence and pattern of p16 protein expression.
When a cell is infected with HPV, the virus can interfere with the function of p16, leading to its overexpression
Q: Treatment of locally advanced head and neck cancer
A: Irradiation plus either cetuximab or chemotherapy
Cetuximab: monoclonal epidermal growth factor receptor antibody
Q: Therapy of advanced programmed death ligand 1–positive head and neck cancer
A: Pembrolizumab alone with platinum chemotherapy
Q: Genetic testing for metastatic prostate cancer
A: BRCA gene mutation
(Risk for Breast cancer, ovarian cancer, and also other cancer including prostate)
Q: Treatment of high-risk prostate cancer
A: Combined radiation and GnRH therapy
Gonadotropin (FSH/LH)-releasing hormone agonist, known as androgen deprivation therapy. GnRH agonist or antagonist interfere with the hypothalamic-pituitary-testis axis, which regulates testosterone production
Q: Nontreatment option for low-risk prostate cancer
A: Active surveillance
DRE, serial measurement of serum PSA and repeat biopsy
Q: Management of asymptomatic early-stage prostate cancer with multiple comorbidities
A: Observation
(Active surveillance)
Q: Bone complication of androgen deprivation therapy
A: Osteoporosis
Q: Prevent flare reactions when starting GnRH agonist for metastatic prostate cancer
A: Antiandrogen therapy
GnRH agonist initially stimulate FSH/LH, leading to temporary surge in testosterone production
Q: Lower fracture risk in men with castrate-resistant metastatic prostate cancer
A: Bisphosphonates or denosumab
Castrate: 去勢する, castrate-resistant prostate cancer: disease continues to progress despite androgen deprivation therapy. Osteoclast (破骨細胞) inhibitor (bisphosphonate or denosumab) will reduce bone pain and lower fracture risk
Q: Surgical approach to diagnose testicular cancer
A: Radical inguinal orchiectomy
Diagnosis is made most commonly through radical inguinal orchiectomy
Biopsy: risk of cancer cell spread
Q: Most common site of testicular cancer metastases
A: Retroperitoneal lymph nodes
Q: Tumor markers to evaluate testicular mass
A: α-fetoprotein and β-HCG
Beta-human chorionic gonadotropin
Q: Primary treatment of metastatic renal cell carcinoma
A: Nephrectomy
Resection or debulking of the primary renal cell cancer improves survival for select patients with metastatic disease
Q: Erythrocytosis, markedly elevated erythropoietin, hematuria
A: Renal cell cancer
Q: Primary treatment of muscle-invasive bladder cancer
A: Cystectomy
Most patients found to have non-muscle invasive disease -> transurethral resection of bladder tumor
Q: Infection associated with Burkitt lymphoma
A: Epstein-Barr virus
Swollen lymph nodes, particularly in the neck, armpit and groin. Could involve abdomen, including ileocecal region
Q: Diagnostic procedure for suspected lymphoma
A: Lymph node excisional or core biopsy
(Fine-needle aspiration cytology is generally inadequate to make a specific diagnosis)
Q: Asymptomatic advanced-stage follicular lymphoma management
A: Observation
Most indolent B-cell lymphoma. Many patients are not symptomatic at diagnosis and may not require therapy for many years
Q: Follicular lymphoma, new systemic symptoms, progression of localized disease
A: Transformed follicular lymphoma
Histologic transformation, most typically to a diffuse large B-cell lymphoma, occurs in 30% of patients with follicular lymphomas and is associated with an aggressive course and poor prognosis
Q: Management of transformed follicular lymphoma
A: Biopsy, then appropriate treatment of new lymphoma
Biopsy to confirm transformation
Q: Treatment of H pylori-associated gastric MALT
A: PPI plus antibiotics
Generally indolent behavior and a low propensity for transformation
Q: Elevated lymphocyte count, smudge cells, lymphadenopathy
A: CLL
Smudge (しみ、ぼかされた部分) cell: lymphocytes appear flattered or ditorted
Q: Test to establish the diagnosis of CLL
A: Peripheral blood flow cytometry
Q: Common CLL-related autoimmune diseases
A: Hemolytic anemia and ITP
Q: B-cell disorder, cytopenia, splenomegaly, characteristic lymphocyte morphology
A: Hairy cell leukemia
Thread-like cytoplasmic projections
Q: Treatment of hairy cell leukemia
A: Cladribine or pentostatin
Purine nucleoside agent
Q: Management of double-hit lymphoma
A: Aggressive chemotherapy, up-front autologous HSCT (自己移植)
Double-hit lymphoma is an aggressive subtype of diffuse large B-cell lymphoma. It involves rearrangements in the MYC gene along with either the BCL2 or BCL6 gene. Associated with worse prognosis. (MYC + BCL2 or BCL6)
Q: Management of most advanced-stage large B-cell lymphomas
A: Rituximab plus CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone)
Q: Young man from Africa with large jaw mass
A: Burkitt lymphoma
Q: Dav 1 (?day 1) complication of Burkitt lymphoma
A: Tumor lysis syndrome
The tumor is quite chemosensitive
Q: Erythroderma, circulating malignant T cells
A: Sézary syndrome
Cutaneous T-cell lymphoma
Q: Lymphoma, Reed-Sternberg cells
A: Hodgkin lymphoma
Q: Staging of Hodgkin lymphoma
A: Physical exam, PET/CT
Q: Likely primary of poorly differentiated carcinoma presenting as midline lymphadenopathy
A: Germ cell cancer
In particular, young men with predominantly midline poorly differentiated carcinoma, such as those with large retroperitoneal or mediastinal lymphadenopathy
Q: Tumor markers to assess poorly differentiated CUP with mediastinal adenopathy
A: α-fetoprotein and β-HCG
CUP: Cancer of unknown primary site
Q: Likely primary of CUP presenting as isolated cervical lymphadenopathy
A: Head and neck cancer
Q: Likely primary of isolated axillary lymph-node adenocarcinoma in a woman
A: Stage II breast cancer
Even if mammography/MRI are negative, still assumed to have a presumptive stage II breast cancer
Q: Treatment of CUP with poor performance status
A: Hospice care
Q: Treatment of widely metastatic melanoma
A: Checkpoint immunotherapy (nivolumab, pembrolizumab)
Anti-programmed cell death protein 1 antibody that can result in significant melanoma response rates
Q: Localized melanoma prognostic determinant
A: Depth of tumor invasion
Q: Syndrome of dyspnea, facial swelling, and mediastinal mass
A: Superior vena cava syndrome
Q: Initial treatment of symptomatic brain metastases
A: Glucocorticoids
Resulting in elevated intracranial pressure. Dexamethasone is used
Q: Metastatic spinal cord compression treatment
A: Glucocorticoids, then surgery and irradiation
Q: Treatment of rapidly recurring malignant pleural effusion
A: Indwelling pleural catheter or pleurodesis
Q: Tumor lysis syndrome prophylaxis
A: Rasburicase, IV hydration
Rasburicase: urate oxidase enzyme that metabolize uric acid
Q: Treatment of symptomatic hypercalcemia of malignancy
A: IV normal saline, denosumab, calcitonin, bisphosphate (zoledronic acid)
Denosumab: human monoclonal IgG2 antibody that targets the protein RANKL, which is essential for the formation, function and survival of osteoclasts, the cell type responsible for bone resorption
Q: Secondary prevention of chemotherapy-related febrile neutropenia
A: G-CSF
Q: Risks of erythropoietin in treating cancer-related anemia
A: Cancer progression, VTE
Q: Standard antiemetic regimen for moderate-to-severe emetogenic chemotherapy
A: Ondansetron or palonosetron plus glucocorticoids
Palonosetron: longer-acting serotonin receptor antagonist.
Dexamethasone is commonly used
Q: Chemotherapeutic agents causing hand-foot syndrome
A: 5-FU and capecitabine
Palmar-plantar erythrodysesthesia: redness, peeling, and tenderness of the palms and soles
Q: Chemotherapeutic agent most commonly associated with acute kidney injury
A: Cisplatin
Associated with Acute tubular necrosis
Q: Prerequisite to chemotherapy in reproductive-age men and women
A: Fertility preservation counseling
Q: Chest wall radiation–associated cancer
A: Breast cancer
