Hn Flashcards
A 55-yearold man presents for **first-time colon cancer screening. ** Colonoscopy reveals a mass lesion in the **sigmoid colon, biopsy shows adenocarcinoma , with immunohistochemistry demonstrating high probability of microsatellite instability (MSI-H) . Imaging reveals no evidence of metastatic disease . He undergoes sigmoid colectomy . Pathology reveals tumor invading through the muscularis propria (T2) , and 14 lymph nodes are negative for malignancy
Which of the following is the next step
Observation
A 53-year-old woman with no significant past medical or smoking history presented increasing shortness of breath during her marathon training. CT chest shows dominant left lower lobe lung mass and numerous bilateral pulmonary lesions with mediastinal adenopathy. **Biopsy of the dominant lung mass shows NSCLC ** adenocarcinoma. MRI brain shows six punctate lesions . Molecular studies show no EGFR/ALK/ROS mutation
PD-L1 100% . Which of the following is the most appropriate next step?
Pembrolizumab
A 29-year-old woman in excellent health presents for her annual examination. Her examination and PAP smear were normal, but her HPV screen was positive for HPV 6. She has not received HPV vaccination and inquires whether vaccination is indicated at this time.
Prescribe HPV vaccination
A 61-year-old woman presents to the oncology clinic for follow-up after completing eight cycles of treatment for right-sided colon cancer merastatic to the liver and lung . She was treated with 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX) and bevacizumab for 4 months . Prior CT scan, showed a partial response to treatment with reduction in discase burden in her liver and lungs, She reports developing fatigue that prevents her from hiking. as well as tingling neuropath; that prevents her from hiking as well as. She had already received oxiplatin treatment with reduced dosage. Molecular testing of her tumor shows microsatellie sable disease, Wild type RAS and a BRAF V600E mutation
WHICH OF THE FOLLOWING IS THE MOST APPROPRIATE NEXT STEP?
Switch to encorafenib and cetuximab
A 58-year-old woman with history of gastritis presents to the clinic with several weeks off abdominal pain and 10-pound (4.5 kg) weight loss. ** Esophagogastroduodenoscopy reveals a diffuse 6-cm mass in the gastric cardia . Biopsy of the mass shows poorly differentiated adenocarcinoma . PET scan demonstrates multiple liver and bone metastases.
Immunchistochemistry analysis of the biopsy sample revealed HER2-positive disease 3+ on immunohistochemistry). Further molecular analysis showed microsatellite high (MSI high** ).
HER2- positive, and PD-L1 negative status. Her Eastera Cooperative Oncology Group performance status is 1. Laboratory workup revealed a hemoglobin level of 11 g/dl , platelet count of 160,000/ul., and total bilirubin level of 1 mg/dl.
Which is the following best next step
Capecitabine with oxaliplatin, trastuzumab, and pemorolizumab
A 55-year-old male presents with a history of chronic gastroesophageal reflux disease
(GERD) for the past 10 years. He reports frequent heartburn and regurgitation. Upper endoscopy reveals Barrett’s esophagus with dysplastic changes. What is the major risk factor contributing to his increased risk of esophageal cancer?
Chronic GERD
Which virus is the primary cause of cervical cancer?
Human Papillomavirus (HPV)
Which demographic group highest risk of developing colon cancer and may require earlier or more frequent screening?
Individuals with a family history of colon cancer
Which of the following is a commonly used targeted therapy for treating EGFR-positive non-small cell lung cancer (NSCLC)?
Osimertinib
Which of the following is a screening tool commonly used for early detection of
breast cancer?
Mammography
35 year-old patient is treated with combination chemotherapy for ovarian cancer . After 3 cycles she develops numbness and tingling in her finger on both sides . Which of the following drugs is a potential cause of this adverse event?
Paclitaxel
Which of the following is a potential neurological complication associated with
FOLFOX ircatment in metastatic colon cancer?
Peripheral neuropathy
A 62-year-old female presented with epigastric pain. Endoscopie evaluation found a mass in the middle of esopagus . Biopsy of the mass revealed squamous cell carcinoma stage III. Which of the following is the most appropriate next step?
concomitant chemoradiation
A 60-year-old woman presents after undergoing surgery and two lines of therapy for **ovarian cancer ** (paclitaxel, carboplatin). She initially responded to platinum therapy, but progressed 7 months after her last carboplatin course. Her mother and sister died of breast cancer before the age of 50 . The patient expresses concern that her daughter may also be at risk for ovarian cancer or breast cancer . You explain a possible cause for her and her relatives’ cancers and discuss treatment options.
Which of the following tests should you order now?
BRCA 1/2
A postmenopausal 48-year-old woman presents to your oncology clinic after undergoing lumpectomy for breast cancer. Pathologic findings revealed a grade 1 invasive ductal carcinoma spanning 9 mm. Her closest surgical margin was 2 mm. None of the two sentinel nodes sampled were involved. Biomarker testing showed estrogen receptor-positive (80%), progesterone receptor-positive (70%}, HER2-negative (0 on immunohistochemistry) disease with a Ki67 expression of 5%. She asks for your recommendation regarding adjuvant therapies.
Which of the following should you recommend now?
Radiation and endocrine therapy
A 61-year-old postmenopausal woman with increased BMI who was previously healthy resents to her gynecologist complaining of spotting and intermittent vaginal bleeding for the past 2 months. She is a nonsmoker but has reported exposure to heavy secondhand smoke all her life. She is very anxious and worried about her health since her mother took diethylbestrol for nausea while pregnant. On pelvic examination, she is found to have a dime-size ulcerated lesion on the lateral wall of the vagina. Cervical smear findings show atypical squamous cells;
HPV screen is positive for HPV16 strain . Biopsy is consistent with squamous carcinoma.
Which of the following risk factors has highest impact for this patient’s disease?
Infection with HPV16
A 45-year-old woman presents to the oncology clinic with a recent diagnosis of breast cancer. She palpated a right breast mass on self-examination. Diagnostic breast imaging revealed a 3.5-cm tumor with one enlarged right axillary lymph node . Biopsy of the right breast mass reveals invasive ductal carcinoma, grade 3 , that is estrogen receptor-negative, progesterone receptor- negative, and HER2-positive (3+ by immunohistochemistry). Biopsy of the right axillary lymph node shows metastatic invasive ductal carcinoma . Laboratory test results are within normal limits. PET/CT shows FDG activity in the right breast mass and in one axillary lymph node, corresponding to the known malignancy, with no evidence of distant metastatic disease. An echocardiogram shows normal left ventricular ejection fraction.
Neoadjuvant chemotherapy plus anti-her2 treatment, followed by surgery
69-year-old woman with **history of diabetes mellits type 2 ** and hyperlipidemia presents with two months of intermittent constipation and fatigue. Colonoscopy reveals a mass in the cecum: biopsy-proven adenocarcinoma. On molecular analyses, tumor is mismatch repair proficient with KRAS mutation and BRAF wild type CT of the chest, abdomen, and pelvis with IV contrasts reveals innumerable hepatic lesions and bilateral pulmonary nodules suggestive of metastatic disease. Baseline carcinoembryonic antigen (CEA) is 34 ng/L.
Which of the following is the most appropriate next step?
S-fluorouracil, leucovorin, and oxaliplatin (FOLFOX) with bevacizumab
A 65-year-old postmenopausal woman presents to the medical oncology clinic for isolated left breast tumor recurrence. She has a history of stage I left breast cancer diagnosed 7 years ago that was estrogen receptor (ER)-positive , progesterone receptor (PR)-positive, and HER2-negative. She received treatment with breast-conserving therapy. She received oral tamoxifen 20 mg daily, which she continues taking. On routine mammography, a left breast nodule measuring 28 mm was found. Core biopsy was consistent with grade 3 invasive ductal carcinoma, ER/PR 50%, and HER2-negative. CT imaging revealed no regional or distant metastasis. She underwent left total mastectomy, with final pathology confirming grade 3 invasive ductal carcinoma measuring 35 mm, with no evidence of nodal involvement or lymphovascular invasion.
Switch tamoxifen to letrozole, without adjuvant chemotherapy
The patient is a 67-year-old man with a 3-cm mass in the right upper lobe of his lung and FDG-avid mediastinal adenopathy demonstrated on PET/CT. Endoscopic bronchial ultrasonogram documents involvement of paratrachcal, hilar, and subcarinal lymph nodes . He in a former swoker with 35 pack-year history of tobacco use. His Eastern Cooperative Oncology Group performance status is 0 to 1 .
Which of the following should you recommend now?
Concurrent chemoradiation therapy (CRT), followed by immunotherapy
A 56-year-old man presented with a left breast retroareolar mass 3 months ago. Diagnostic breast imaging revealed a 5-cm left breast mass and lymphadenopathy . A breast mass biopsy reveals a grade 3 invasive ductal carcinoma, estrogen receptor-positive (greater than 90%), progesterone receptor-positive (greater than 90%), and HER2-negative. Biopsy of an enlarged left axillary lymph node confirms metastatic disease. He undergoes left mastectomy and axillary lymph node dissection. Final pathology reveals a 6.5-cm invasive ductal carcinoma, with four of 16 nodes positive for metastasis. He has met with a radiation oncologist and is recommended to undergo postmastectomy radiation therapy. He now presents to the medical oncologist for adjuvant systemic therapy recommendations.
Adjuvant chemotherapy, followed by adjuvant tamoxifen
A 68-year-old otherwise healthy man presented with epigastric pain. Endoscopic evaluation found a mass near the gastroesophageal (GE) junction. Biopsy of the mass revealed adenocarcinoma; staging was completed with endoscopic ultrasonography and systemic imaging. Patient stage was defined - TIN0M0 . The tumor was HER2/neu-positive on fluorescent in situ hybridization (FISH}. The initial biopsy specimen yielded a combined positive score (CPS} of 15 . The patient was diagnosed with stage I disease. His Eastern Cooperative Oncology Group (ECOG} performance status is 1 . Which of the following is the most appropriate next step?
Esophagectomy
Which antigen should be monitored when patient has colon cancer
CEA
A 40-year-old female presents with a history of colorectal cancer at age 35 and endometrial cancer at age 38.
Genetic testing reveals a mutation in the MLHI gene. What is the most likely diagnosis?
Lynch syndrome
A 55-year-old male smoker with a 30-pack-year smoking history presents for lung cancer screening. He has no respiratory symptoms. What is the most appropriate screening test for this patient?
Low-dose computed tomography (LDCT)
A 28-year-old female patient with a lump in her right breast came for consultation. Which of the following imaging modalities is the recommended initial imaging modality to further evaluate her lump?
Ultrasound
Which of the following is associated with increased relative risk of breast cancer development?
Radiation for Hodgkin disease before 30
Among the following, which is a significant concern related to the long-term use of trastuzumab in breast cancer management?
Cardiomyopathy
Which of the following best describes the mechanism of action of zoledronic acid in breast cancer bone metastases?
Inhibition of osteoclast activity
What complication is specifically associated with the use of bevacizumab in colon cancer patients?
Gastrointestinal perforation
Which targeted therapy is specifically indicated for metastatic colorectal cancer patients with KRAS/NRAS/BRAF wild-type tumors?
Cetuximab
Which of the following is a commonly used targeted therapy for treating EGFR-positive non-small cell lung cancer (NSCLC)?
Osimertinib
A 42-year-old man with non-small cell lung cancer is enrolled in a clinical trial for a new chemotherapeutic drug.
The drug prevents microtubule depolymerization by binding to the beta subunit of tubulin. The mechanism of action of this new drug is most similar to which of the following?
Paclitaxel
- A 53-year-old woman with no significant past medical or smoking history presented with increasing shortness of breath during her marathon training. CT chest shows dominant left lower lobe lung mass and numerous bilateral pulmonary lesions with mediastinal adenopathy. Biopsy of the dominant lung mass shows NSCLC adenocarcinoma.
MRI brain shows six punctate lesions. Pathology shows IHC positive for ALK, no EGFR mutation, PD-L1 100%. ALK FISH is pending as well as next-generation sequencing testing. Which of the following is the most appropriate next step?
Alectinib
A 44-year-old man recently immigrated from Egypt. He is evaluated by a urologist for hematuria that has persisted over the past three months. His medical history is notable for recurrent schistosomiasis infections over the past two decades. Cystoscopy reveals a bladder mass suspicious for malignancy. He has never smoked and personal history does not reveal any occupational exposures. Which of the following is the most likely histology of his bladder cancer?
Squamous cell carcinoma
A 68-year-old man with stage IV prostate adenocarcinoma is referred to you by his local urologist for treatment.
Two months ago, he was diagnosed with stage IV disease, after a prostate-specific antigen (PSA) level of 24 ng/mL led to biopsy. Prostate adenocarcinoma was discovered with a Gleason score of 9. Abdominopelvic CT scan and bone scintigraphy demonstrated a single osteoblastic lesion in the pelvis and enlarged bilateral internal iliac lymph nodes. He reported pelvic pain and moderate lower urinary tract symptoms. Which of the following should you recommend now?
Start androgen deprivation therapy (leuprolide acetate combined with abiraterone and prednisone)
A 69-year-old woman with history of diabetes mellit us type 2 and hyperlipidemia presents with two months of intermittent constipation and fatigue. Colonoscopy reveals a mass in the
cecum: biopsy-proven adenocarcinoma. On molecular analyses, tumor is mismatch repair proficient with wildtype KRAS and BRAF. CT of the chest, abdomen, and pelvis with IV contrasts reveals innumerable hepatic lesions and bilateral pulmonary nodules suggestive of metastatic disease. Baseline carcinoembryonic antigen (CEA) is 34 ng/ L.
Which of the following is the most appropriate next step?
5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX) with bevacizumab
What are the most commonly used induction therapy drugs in AML?
Cytarabine ARA-C and Anthracylines(daunorubicin or idarubicin) 7+3 Regimen
A 60-year-old woman presents after undergoing surgery and two lines of therapy for ovarian cancer (pacitaxel, carboplatin). She initially responded to platinum therapy, but progressed 7 months after her last carboplatin course. Her mother and sister died of breast cancer before the age of 50. The patient expresses concern that her daughter may also be at risk for
ovarian cancer or breast cancer. You explain a possible cause for her and her relatives’ cancers and discuss treatment options.
Which of the following tests should you order now?
BRCA1/2
A 53-year-old woman comes to the physician because of increasing shortness of breath on exertion for 5 months. She reports that she can not climb more than 2 flights of stairs and she is no longer able to run her errands as usual. One year ago, she was diagnosed with triple-negative breast cancer. She underwent a right-sided modified radical mastectomy and adjuvant chemotherapy. Cardiac examination shows a laterally displaced point of maximal impulse. Coarse inspiratory crackles are heard in both lower lung fields. Echocardiography shows a left ventricular ejection fraction of 30%. The physician informs the patient that her symptoms are most likely due to an adverse effect of her chemotherapy. Which of the chemotherapy drugs is most likely responsible for the patient’s current symptoms?
Doxorubicin
