Oncology

Question 1

A 25-year-old man is screened for primary infertility and there is a history of left orchidopexy at the age of 7 years. Left testicular volume is 5cc, right testicular volume is 15 cc. Ultrasound shows microcalcification and an inhomogeneous parenchyma on the left side. What should be done?

A. Nothing, since the risk of testis cancer is not increased
B. Testicular biopsy, since the risk of carcinoma in situ is clearly elevated
C. Testicular biopsy, since the chance of testis cancer is more than 30%
D. Orchidectomy on the left side, since the risk of cancer in this man is very high

Answer 1

B. Testicular biopsy, since the risk of carcinoma in situ is clearly elevated

Question 2

What is the approximate recurrence risk of patients treated surgically for penile cancer with lymph node metastases?

A. 5%
B. 20%
C. 40%
D. 60%

Answer 2

B. 20%

Question 3

What is the prognosis for signet ring cell urachal adenocarcinoma?

A. Poor
B. Normal
C. Good
D. Excellent prognosis

Answer 3

A. Poor

Question 4

What is the approximate percentage of understaging of patients with clinical stage T2b prostate cancer?

A. 20%
B. 40%
C. 60%
D. 80%

Answer 4

C. 60%

Question 5

In cases of PSA measurements, if serum cannot be processed within 3 hours of collection, serum total and free PSA long-term storage should be done at what temperature?

A. 0°C
B. -20°C
C. -50°C
D. -70°C

Answer 5

D. -70°C

Question 6

What is the most important factor used to decide whether a nerve sparing approach for a radical prostataectomy is appropriate?

A. Patients BMI
B. Prostate volume
C. Sexual activity before surgery
D. Clinical stage, PSA level, biopsy Gleason score

Answer 6

C. Sexual activity before surgery

Question 7

What is the standard approach to cT1a RCC of 3,5cm?

A. Laprascopic radical nephrectomy
B. Watchful waiting
C. Open och laprascopic partial nephrectomy
D. Ablative techniques: cryo and radiofrequency

Answer 7

C. Open och laprascopic partial nephrectomy

Question 8

If there is positive cytology and a normal cystoscopy, the most likely explanation is:

A. Carcinoma in situ
B. False positive cytology
C. The endoscopist has missed a lesion in the bladder.
D. Carcinoma of the upper tract

Answer 8

D. Carcinoma of the upper tract

Question 9

What effects can androgen deprivation therapy have on the skeleton?

A. Increased risk of fracture
B. Exacerbation of osteopenia or osteoporosis that might have been present at baseline
C. Increased bone metabolism that may render the bone microenvironment more favourable for the development of bone metastases
C. All of the above

Answer 9

C. All of the above

Question 10

In patients with locally advanced prostate cancer on watchful waiting, what is an important factor associated with a high-risk for progression and death due to prostate cancer?

A. A PSA doubling time (PSADT) of <12 months
B. A PSADT of > 12 months
C. A PSADT of < 6 months
D. A PSADT of > 6 months

Answer 10

A. A PSA doubling time (PSADT) of <12 months

Question 11

Which biomarker has shown to be a predictor for survival in kidney cancer patients?

A. PSA
B. CEA
C. CD4/CD8 ratio
D. Carbonic anhydrase IX (CA IX)

Answer 11

D. Carbonic anhydrase IX (CA IX)

Question 12

What drug is accepted as the standard first-line therapy in metastatic RCC with low or intermediate risk criteria?

A. Sunitinib
B. Sorafenib
C. Bevacizumab
D. Temsirolimus

Answer 12

A. Sunitinib

Question 13

Laprascopic partial nephrectomy is:

A. Not an accepted alternativ to open partial nephrectomy
B. Considered the gold standard treatment for kidney tumours ≤ 4cm (T1a)
C. Considered the gold standard treatment for kidney tumours ≤ 7cm (T1b)
D. Considered an acceptable alternative to open partial nephrectomy for kidney tumours ≤4 cm

Answer 13

D. Considered an acceptable alternative to open partial nephrectomy for kidney tumours ≤4 cm

Question 14

Increased tolerability of TRUS prostatic biopsy is best achieved by:

A. Intrarectal local anaesthesia (IRLA)
B. Oral medication (tramadol/acetaminophen)
C. Periprostatic nerve block with lidocaine injection (PPNB)
D. Intrarectal local anaesthesia (IRLA) and periprostatic nerve block with lidocaine injection (PPNB)

Answer 14

C. Periprostatic nerve block with lidocaine injection (PPNB)

Question 15

Which substance has to be evaluated for the result of the PCA3 test?

A. PCA3-DNA
B. PCA3-mRNA
C. PCA3-mRNA and PSA-DNA
D. PCA3-mRNA and PSA-mRNA

Answer 15

D. PCA3-mRNA and PSA-mRNA

Question 16

The most important risk factor for the development of bladder carcinoma is:

A. Smoking
B. Exposure to radiotherapy
C. Exposure to aromatic amines
D. Occupational exposure to urothelial carcinogens

Answer 16

A. Smoking

Question 17

Bone metastases:

A. Can result in potentially debilitating skeletal-related events (SREs)
B. Occur in less than 10% of patients with urogenital meastatic malignancies
C. Occur as a result of the balanced activity between osteoclasts and osteoblasts
D. Are typically indolent and do not require treatment beyond standard anticancer therapy

Answer 17

A. Can result in potentially debilitating skeletal-related events (SREs)

Question 18

The only bisphosphonate to recieive widespread regulatory approval because it demonstrated objective and long-term clinical efficacy in delaying the onset and reducing the risk of skeletal-related events (SREs) in patients with castration-resistant prostate cancer is:

A. Clodronate
B. Risedronate
C. Pamidronate
D. Zoledronic acid

Answer 18

D. Zoledronic acid

Question 19

When tumour cells invade bone, they:

A. Reduce bone resorption
B. Prevent osteoclast-mediated release of growth factors
C. Secrete growth factors that promote the release of RANK Ligand
D. Increase the expression of osteoprotegerin relative to RANK Ligand

Answer 19

C. Secrete growth factors that promote the release of RANK Ligand

Question 20

Bone metastases from prostatic carcinoma are most frequently found in the:

A. Ribs
B. Bony Pelvis
C. Lumbar spine
D. Proximal part of the femur

Answer 20

C. Lumbar spine

Question 21

Randomized controlled trials comparing placebo versus antibiotic prophylaxis in prostate biopsy show the following results:

A. There are no studies assessing the incidence of symptomatic UTI with placebo versus antibiotic
B. Significant reduction inte the incidence of bacteriuria and symptomatic UTI for the antibiotic arm
C. For the antibiotic arm, bacteriuria varies between 8.6% and 20% and symptomatic UTI between 3% and 30%
D. Significant reduction in the incidence of bacteriuria and no difference in the incidence of symptomatic UTI for the antibiotic arm

Answer 21

D. Significant reduction in the incidence of bacteriuria and no difference in the incidence of symptomatic UTI for the antibiotic arm

Question 22

Regardin the complications of laparoscopic partial nephrectomy which statement is correct?

A. Bleeding is the most common major complication
B. Urinary fistulas can be reduced by the use of sealing agents
C. The incidence of complications is directly related to tumour size
D. The complications are less frequent when a transperitoneal approach is used

Answer 22

A. Bleeding is the most common major complication

Question 23

Laprascopic-assisted and open radical cystectomy differ significantly EXCEPT in:

A. Postoperative neobladder function
B. Operative time
C. Blood loss and transfusion rate
D. Postoperative complications

Answer 23

A. Postoperative neobladder function

Question 24

What is the half-life time of human choriogonadotropin (HCG)?

A. 1-2 days
B. 5-7 days
C. 14-16 days
D. 30 days

Answer 24

A. 1-2 days

Question 25

The most important risk factor for germ cell testicular tumour is:

A. Cryptorchidism
B. Testicular cancer at the father
C. Tumour in the contralateral testicle
D. Oestrogen therapy of the mother during pregnancy

Answer 25

C. Tumour in the contralateral testicle

Question 26

What does minimal androgen blockade (peripheral androgen blockade) mean?

A. Extracellular inhibition of 5-α-reductase and intracellular blockade of androgen receptor
B. Intracellular inhibition of 5-α-reductase and intracellular blockade of androgen receptor
C. Intracellular inhibition of 5-α-reductase and extracellular blockade of androgen receptor
D. Extracellular inhibition of 5-α-reductase and extracellular blockade of androgen receptor

Answer 26

B. Intracellular inhibition of 5-α-reductase and intracellular blockade of androgen receptor

Question 27

During laparoscopic partial nephrectomy the average intra-operative ischaemia time:

A. Is shorter than in the open approach
B. Is comparable to the open approach
C. Is longer than in the open approach
D. Has no significant impact om long-term renal fuction

Answer 27

C. Is longer than in the open approach

Question 28

How frequently do febrile complications occur after transrectal prostate biopsies in patients?

A. <5%
B. 8-12%
C. 15-20%
D. ≥20%

Answer 28

A. <5%

Question 29

There is an increased risk of malignant change in the foreskin in:

A. Psoriasis
B. Lichen planus
C. Lichen sclerosus
D. Fixed drug eruption

Answer 29

C. Lichen sclerosus

Question 30

Laparoscopic nephroureterectomy for upper urinary tract cell carcinoma:

A. Is the gold standard treatment
B. Has a high risk of tumour seeding
C. Has better oncological results than the open approach
D. Has better functional outcomes than the open approach

Answer 30

D. Has better functional outcomes than the open approach

Question 31

Which statement regarding distant recurrence of penile cancer is correct?

A. Up to 50% of distant recurrences occur in the first year of follow up
B. Most distant recurrences occur in the first 2 years of follow up
C. Most distant recurrences occur in the 2nd and 3rd year of follow up
D. After successful initial treatment there are no distant recurrences during follow up

Answer 31

B. Most distant recurrences occur in the first 2 years of follow up

Question 32

The best imaging modality to stage urethral carcinoma is:

A. Pelvic MRI
B. Cystoscopy
C. Urethral biopsy
D. High-resolution ultrasound

Answer 32

A. Pelvic MRI

Question 33

What is the probability of developing muscle invasive bladder cancer in patients with carcinoma in situ of the bladder, that previously responded to intravesical BCG treatment?

A. 0-5%
B. 10-20%
C. 30-40%
D. 50-60%

Answer 33

B. 10-20%

Question 34

What is the improvement of 5-year survival in patients with muscle-invasive bladder cancer treated with cisplatinum-based neoadjuvant chemotherapy?

A. 0%
B. 5%
C. 15%
D. 25%

Answer 34

B. 5%

Question 35

To detect bone metastases of the spine and the pelvifemoral area in patients with high-risk PCa, MRI evaluation is:

A. Similar to that of a combination of bone scan and CT
B. As sensitive as that of 11C-choline PET/CT
C. Less sensitive than a combination of bone scan and targeted radiographs
D. Less sensitive than ultrasound

Answer 35

B. As sensitive as that of 11C-choline PET/CT

Question 36

A parasite that may infect humans is strongly linked to the development of bladder cancer. Which one?

A. Mycobacteria tuberculosis
B. Neisseria gonorrhoeae
C. Entamoeba histolyticum
D. Schistosomiasis haematobium

Answer 36

D. Schistosomiasis haematobium

Question 37

The most common histological type of testicular cancer with a peak incidence between the age of 35 and 39 years is:

A. Seminoma
B. Chorioncarcinoma
C. Yolk Sac tumour
D. Embryonal carcinoma

Answer 37

A. Seminoma

Question 38

A 70-year-old man had a retropubic adenomectomy for BPH 100g; his pre-operative PSA-level was 10 ng/mL. Histologically an adenocarcinoma of <5% is found, Gleason 6. The most common treatment would be:

A. Close follow-up
B. Pelvic irradiation
C. Endocrine therapy
D. Radical prostatectomy

Answer 38

A. Close follow-up

Question 39

Von Hippel-Lindau syndrome is a disease commonly associated with renal cell carcinoma and:

A. Renal cysts only
B. Epididymal and renal cysts
C. Seminal vesicle and renal cysts
D. Epididymal and seminal vesicle cysts

Answer 39

B. Epididymal and renal cysts

Question 40

Retroperitoneal lymphadenectomy is indicated in:

A. Stage 1 seminoma
B. Stage 2 seminoma
C. Residual masses after chemotherapy for non-seminoma with serum markers at least 5 times above normal levels
D. Residual retroperitoneal masses after chemotherapy of non-seminomatous germ-cell tumours with normal markers

Answer 40

D. Residual retroperitoneal masses after chemotherapy of non-seminomatous germ-cell tumours with normal markers

Question 41

Which benign renal tumour is more frequently associated with hypertension?

A. Leiomyoma
B. Haemangioma
C. Angiomyolipoma
D. Juxtaglomerular tumour

Answer 41

D. Juxtaglomerular tumour

Question 42

Nomograms are commonly used for preoperative risk assessment before nerve-sparing radical prostatectomy. Which is a typical parameter analyzed for stage estimation?

A. Patient’s age
B. IIEF score
C. Gleason score
D. Prostate volume

Answer 42

C. Gleason score

Question 43

Hormonal therapy with LHRH analougues is indicated:

A. To decrease prostate size before radical prostatectomy
B. To treat positive surgical margins after radical prostatectomy
C. To improve survival when used in association with radiotherapy
D. As neoadjuvant therapy to improve survival after radical prostatectomy

Answer 43

C. To improve survival when used in association with radiotherapy

Question 44

Concerning external beam radiotherapy for localized prostate cancer:

A. It is administered at a low dose in low-risk patients.
B. It has more side effects compared to radical surgery
C. Second malignancies after many years are a serious problem
D. Dose escalation has improved oncological outcome of treatment

Answer 44

D. Dose escalation has improved oncological outcome of treatment

Question 45

Which statement is correct regarding the indication and extent of pelvic lymph node dissection (LND) in the treatment of prostate cancer?

A. Lymphocoeles are the most common complication, being more frequent following the transperitoneal approach
B. When comparing extended versus limited LND, similar complication rates have been reported
C. A recent prospecitve mapping study confirmed that a template including the external iliac, obturator and internal iliac areas was able to correctly stage 54% of patients
D. Extended LND includes removal of the nodes overlying the external iliac artery and vein, the nodes within the obturator fossa located carnially and caudally to the obturator nerve, and the nodes medial and lateral to the internal iliac artery

Answer 45

D. Extended LND includes removal of the nodes overlying the external iliac artery and vein, the nodes within the obturator fossa located carnially and caudally to the obturator nerve, and the nodes medial and lateral to the internal iliac artery

Question 46

According to EAU guidelines, a second TURB or RE-TUR will be indicated in all the following cases, EXEPT:

A. In all pT1 tumours
B. In all G3 tumours except primary CIS
C. After an incomplete initial resection of a pT1G1 tumour
D. If there is no muscle in the specimen efter initial resection of a pTaG1 lesion

Answer 46

D. If there is no muscle in the specimen efter initial resection of a pTaG1 lesion

Question 47

What is preferred method treatment in renal tumour T1b in men fit for any surgery?

A. Laprascopic nephrectomy
B. Open nephrectomy with staging lympadenectomy
C. Percutaneous radiofrequency ablation or cryoablation
D. Resection of tumour. Laparoscopic/robot assisted or open

Answer 47

D. Resection of tumour. Laparoscopic/robot assisted or open

Question 48

In patients with penile cancer and inguinal lymph node metastases, the treatment of choice is:

A. Upfront radiotherapy followed by chemotherapy
B. Chemotherapy only as this represents systemic disease
C. Radical inguinal lymphadenectomy with adjuvant radiotherapy
D. Radical inguinal lymphadenectomy with adjuvant chemotherapy

Answer 48

D. Radical inguinal lymphadenectomy with adjuvant chemotherapy

Question 49

The most important risk factor for prostate cancer is:

A. Race
B. Age
C. High BMI
D. Genetic

Answer 49

B. Age

Question 50

The Phoenix criteria describe recurrence after radiation therapy and brachytherapy and are defined as:

A. 3 consecutive PSA rises after therapy
B. PSA levels exceeding 2 ng/ml from the nadir after therapy
C. PSA levels exceeding 4 ng/ml from the nadir after therapy
D. PSA levels exceeding 8 ng/ml from the nadir after therapy

Answer 50

B. PSA levels exceeding 2 ng/ml from the nadir after therapy

Question 51

What is the most frequent complication of transrectal prostate biopsy?

A. Haemospermia
B. Haematuria >3 days
C. Rectal bleeding >1 day
D. Urinary tract infection

Answer 51

A. Haemospermia

Question 52

Which drug in NOT approved as first-line treatment in metastatic renal cell cancer?

A. Sunitinib
B. Axitinib
C. Pazopanib
D. Temsirolimus

Answer 52

B. Axitinib

Question 53

What is the treatment option for a distal, invasive urethral carcinoma, in a femal patient who is otherwise fit and healthy?

A. Radical TURBT
B. Radical cystourethrectomy with ileal conduit.
C. Radical cystourethrectomy with ileal neobladder
D. Radical urethrectomy with bladder neck closure and appendico-vesicostomy

Answer 53

D. Radical urethrectomy with bladder neck closure and appendico-vesicostomy

Question 54

Which is a complication of androgen deprivation therapy in prostate cancer?

A. Hepatotoxicity
B. Nephrotoxicity
C. Hyperthyroidism
D. Metabolic syndrome

Answer 54

D. Metabolic syndrome

Question 55

A man with a tumour of the left testicle underwent radical orchiectomy with the following postoperative results: Pure seminoma, 25 mm in maximal diameter, no rete testis invasion and negative tumour markers. What is the best management?

A. Active surveillance
B. Adjuvant chemotherapy-one or two courses of carboplatin
C. Adjuvant radiotherapy-paraaortic field hockeystick (dog-leg) files (para-aortic and ipsilateral iliac node) with moderate dose 20-24 Gy
D. Retroperitoneal lymph node dissection

Answer 55

A. Active surveillance

Question 56

What is the indication for a FDG-PET-CT investigation in men with a testicular tumour?

A. In all patients with a testicular tumour as a standard part of initial staging
B. In all patients with non-seminomatous tumours
C. In the follow-up of a seminoma with a residual mass of >3cm at least 2 months after chemotherapy
D. No indication

Answer 56

C. In the follow-up of a seminoma with a residual mass of >3cm at least 2 months after chemotherapy

Question 57

How should a 70-year-old man with haematuria, positive cytology, left wal lbladder tumour of 3 cm, and an additional flat lesion behind the bladder neck be treated?

A. Radical cystectomy
B. BCG instillations
C. Mitomycin instillations
D. Transurethral resection of the bladder tumour

Answer 57

D. Transurethral resection of the bladder tumour

Question 58

A 65-year-old man with a good Performance Status, normal GFR and no comorbidities has been diagnosed with a pT3N0M0 muscle-invasive bladder cancer. How should he be treated?

A. Radical cystectomy
B. Neoadjuvant chemotherapy and subsequent radical cystectomy
C. Partial cystectomy adn adjuvant chemotherapy
D. Pre-operative radiotherapy (RT) and subsequent radical cystectomy

Answer 58

B. Neoadjuvant chemotherapy and subsequent radical cystectomy

Question 59

Which factor may influence the choice between abiraterone and enzalutamide for castrate-resistant prostate cancer treatment?

A. Level of PSA
B. Gleason score
C. History of seizures
D. Number of bone metastasis

Answer 59

C. History of seizures

Question 60

What is correct about renal medullary carcinoma? It:

A. Is not radiosensitive
B. Only affects female patients.
C. Has a median survival of 5 months
D. Is mainly frequent in Asian countries

Answer 60

C. Has a median survival of 5 months

Question 61

A 60-year-old man is diagnosed with low-risk prostate cancer. What should be done before deciding about treatment options?

A. Bone scan
B. Pelvic CT scan
C. Multiparametric magnetic resonance imaging (mpMRI)
D. No additional imaging

Answer 61

D. No additional imaging

Question 62

Which treatment has been shown to have survival benefit in the setting of castrate resistant prostate cancer?

A. Zoledronic acid
B. Denosumab
C. Radium-223
D. Bicalutamide

Answer 62

C. Radium-223

Question 63

What is the risk of malignancy in a Bosniak III renal cyst?

A. 5-10%
B. 20-30%
C. 50-60%
D > 90%

Answer 63

C. 50-60%

Question 64

What is the mean annual growth rate of the tumour in patients with small renal masses on active surveillance?

A. 0,1-0,3 cm
B. 0,5-0,7 cm
C. 0,9-1,1 cm
D. 2,0-2,2 cm

Answer 64

A. 0,1-0,3 cm

Question 65

Question 1: Topic - RECIST Criteria for Target Lesions (Complete Response)
A 58-year-old male with bladder cancer has been on targeted therapy. A recent imaging study reveals the disappearance of all target lesions and the lymph nodes show a reduction in short axis to <10 mm. According to RECIST criteria, how would you classify the response?

A. Partial Response (PR)
B. Stable Disease (SD)
C. Complete Response (CR)
D. Progressive Disease (PD)

Answer 65

Correct Answer: C. Complete Response (CR)

Explanation: According to RECIST criteria, a complete response in the evaluation of target lesions is characterized by the disappearance of all target lesions and any pathological lymph nodes must have a reduction in the short axis to <10 mm (Paragraph 1, Table 6.1).

Memory Tool: Think “CR = Cancer Removed” to remember the criteria for Complete Response.

Rationale: Understanding the RECIST criteria is essential for interpreting treatment outcomes and for designing treatment plans.

Reference Citation: Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45(2):228–247, 2009.

Question 66

Question 2: Topic - RECIST Criteria for Target Lesions (Progressive Disease)
A 47-year-old woman with renal cell carcinoma has been on immunotherapy. Her latest scans show a 25% increase in the sum of diameters of target lesions from the smallest sum recorded in the study. The sum also shows an absolute increase of 7 mm. No new lesions were detected. How would you categorize her response according to RECIST?

A. Partial Response (PR)
B. Stable Disease (SD)
C. Complete Response (CR)
D. Progressive Disease (PD)

Answer 66

Correct Answer: D. Progressive Disease (PD)

Explanation: The RECIST criteria specify that Progressive Disease (PD) in target lesions is defined as at least a 20% increase in the sum of diameters, taking as a reference the smallest sum on study. There should also be an absolute increase of at least 5 mm (Paragraph 1, Table 6.1).

Memory Tool: PD = “Progressively Deteriorating” to remember the criteria for Progressive Disease.

Rationale: Recognizing progression of disease is crucial for adjusting the therapeutic strategy.

Reference Citation: Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45(2):228–247, 2009.

Question 67

Question 3: Topic - RECIST Criteria for Nontarget Lesions (Complete Response)
In a 36-year-old patient with prostate cancer, all non-target lesions have disappeared, and the tumor marker levels have normalized. However, one lymph node remains at 12 mm in size. What would this patient’s nontarget lesion response be?

A. Complete Response (CR)
B. Non-CR/Non-PD
C. Progressive Disease (PD)
D. Stable Disease (SD)

Answer 67

Correct Answer: B. Non-CR/Non-PD

Explanation: According to RECIST criteria, a Complete Response (CR) for nontarget lesions would require all lymph nodes to be <10 mm in size along the short axis. Since one lymph node remains at 12 mm, the patient cannot be classified as having a Complete Response (Paragraph 2, Table 6.1).

Memory Tool: If not completely right, it’s Non-CR/Non-PD.

Rationale: It’s crucial to distinguish between complete and non-complete responses in nontarget lesions for accurate evaluation.

Reference Citation: Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45(2):228–247, 2009.

Question 68

Question 4: Topic - RECIST Criteria for Target Lesions (Partial Response)
A 52-year-old male with testicular cancer undergoes chemotherapy. Post-treatment, imaging shows a 35% decrease in the sum of the diameters of target lesions from the baseline sum. How should the patient’s response be classified according to RECIST criteria?

A. Partial Response (PR)
B. Stable Disease (SD)
C. Complete Response (CR)
D. Progressive Disease (PD)

Answer 68

Correct Answer: A. Partial Response (PR)

Explanation: The RECIST criteria state that a Partial Response (PR) in target lesions is marked by at least a 30% decrease in the sum of diameters, taking as reference the baseline sum diameters (Paragraph 1, Table 6.1).

Memory Tool: PR = “Pretty Reduced” to remember the criteria for Partial Response.

Rationale: Accurate classification of Partial Response helps to determine if the therapy is effective and informs the next steps in the treatment plan.

Reference Citation: Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45(2):228–247, 2009.

Question 69

Question 5: Topic - RECIST Criteria for Target Lesions (Stable Disease)
A 60-year-old female with ureteral cancer is under targeted therapy. After several months, imaging reveals neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD when compared to the smallest sum diameters recorded while on study. What is the RECIST classification of her response?

A. Stable Disease (SD)
B. Complete Response (CR)
C. Partial Response (PR)
D. Progressive Disease (PD)

Answer 69

Question 5: Topic - RECIST Criteria for Target Lesions (Stable Disease)
A 60-year-old female with ureteral cancer is under targeted therapy. After several months, imaging reveals neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD when compared to the smallest sum diameters recorded while on study. What is the RECIST classification of her response?

A. Stable Disease (SD)
B. Complete Response (CR)
C. Partial Response (PR)
D. Progressive Disease (PD)

Question 70

Question 6: Topic - RECIST Criteria for Nontarget Lesions (Progressive Disease)
A 44-year-old patient with kidney cancer has multiple non-target lesions. Imaging reveals unequivocal progression of existing non-target lesions. There are no new lesions. According to RECIST criteria, what is the classification for nontarget lesions?

A. Complete Response (CR)
B. Non-CR/Non-PD
C. Progressive Disease (PD)
D. Stable Disease (SD)

Answer 70

Correct Answer: C. Progressive Disease (PD)

Explanation: RECIST criteria specify that Progressive Disease (PD) for nontarget lesions is identified by unequivocal progression of existing non-target lesions (Paragraph 2, Table 6.1).

Memory Tool: PD = “Problem Detected” to remember Progressive Disease in nontarget lesions.

Rationale: Monitoring the progression in nontarget lesions is crucial for the overall management of the disease.

Reference Citation: Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45(2):228–247, 2009.

Question 71

Topic: Uro-Oncology - Patient Assessment Tools

Clinical Vignette: A 68-year-old male patient with metastatic prostate cancer is being evaluated for chemotherapy. His performance status is described as requiring occasional assistance but able to care for most of his own needs.

A. Karnofsky Score 60, ECOG Grade 2
B. Karnofsky Score 70, ECOG Grade 3
C. Karnofsky Score 60, ECOG Grade 3
D. Karnofsky Score 70, ECOG Grade 2

Answer 71

Correct Answer: A. Karnofsky Score 60, ECOG Grade 2

Explanation: The patient’s status matches the description given for a Karnofsky Score of 60, which is accompanied by an ECOG Grade of 2. Both describe a patient who is “ambulatory and capable of all self-care but unable to carry out work activities.”

Memory Tool: “60/2”: Think of the Karnofsky Score as the “full score,” and the ECOG Grade as “reduced” to a single digit (2). So 60/2 aligns them.

Reference Citation: Paragraph from Table 6.4; Modified from Oken MM, et al. Am J Clin Oncol 5(6):649–655, 1982.

Rationale: Understanding the interpretation of Karnofsky and ECOG scores is crucial for patient assessment, especially when considering treatment options such as chemotherapy.

Question 72

opic: Uro-Oncology - ECOG Status Grading

Clinical Vignette: A 55-year-old woman with bladder cancer is described as being fully active and able to carry out all predisease performance without restriction.

A. ECOG Grade 0
B. ECOG Grade 1
C. ECOG Grade 2
D. ECOG Grade 4

Answer 72

Correct Answer: A. ECOG Grade 0

Explanation: The description corresponds to ECOG Grade 0, which indicates that the patient is “fully active and able to carry out all predisease performance without restriction.”

Memory Tool: “Zero Restrictions” - Grade 0 means no limitations in activity.

Reference Citation: Paragraph from Table 6.4; Modified from Oken MM, et al. Am J Clin Oncol 5(6):649–655, 1982.

Rationale: The ability to quickly identify the ECOG Grade based on patient description is key in clinical decision-making

Question 73

Topic: Uro-Oncology - Karnofsky Performance Score

Clinical Vignette: A 45-year-old male with renal cell carcinoma is said to be “able to carry on normal activities with minor signs or symptoms of disease.”

A. Karnofsky Score 80
B. Karnofsky Score 90
C. Karnofsky Score 60
D. Karnofsky Score 100

Answer 73

Correct Answer: B. Karnofsky Score 90

Explanation: The patient’s status corresponds to a Karnofsky Score of 90, which is described as “able to carry on normal activities. Minor signs or symptoms of disease.”

Memory Tool: “Nine-ty is just fine-ty”: When minor symptoms are there, but normal activities can still be carried on, the score is 90.

Reference Citation: Paragraph from Table 6.4; Modified from Oken MM, et al. Am J Clin Oncol 5(6):649–655, 1982.

Rationale: A nuanced understanding of Karnofsky Scores is essential for assessing patient suitability for different treatment options.

Question 74

Topic: Uro-Oncology - ECOG Grade

Clinical Vignette: A 72-year-old female with advanced urothelial cancer is confined to her bed or chair more than 50% of her waking hours but is capable of limited self-care.

A. ECOG Grade 3
B. ECOG Grade 4
C. ECOG Grade 2
D. ECOG Grade 1

Answer 74

Correct Answer: A. ECOG Grade 3

Explanation: The patient’s condition corresponds to an ECOG Grade 3, which is described as “Capable of only limited self care. Confined to bed or chair more than 50% of waking hours.”

Memory Tool: “Grade 3, Can’t be Free”: If the patient is confined more than half the time but can do limited self-care, it’s Grade 3.

Reference Citation: Paragraph from Table 6.4; Modified from Oken MM, et al. Am J Clin Oncol 5(6):649–655, 1982.

Rationale: Accurate ECOG grading helps in treatment planning, especially in late-stage cancers.

Question 75

Topic: Uro-Oncology - Karnofsky Performance Score

Clinical Vignette: A 63-year-old male with metastatic testicular cancer is completely disabled, cannot carry out self-care, and is totally confined to bed or chair.

A. Karnofsky Score 30
B. Karnofsky Score 10
C. Karnofsky Score 20
D. Karnofsky Score 40

Answer 75

Correct Answer: C. Karnofsky Score 20

Explanation: This severe status aligns with a Karnofsky Score of 20, which describes a person who is “very sick, hospitalization required, and active supportive treatment necessary.”

Memory Tool: “Twenty = Plenty of Needs”: Score 20 signifies extensive care requirements.

Reference Citation: Paragraph from Table 6.4; Modified from Oken MM, et al. Am J Clin Oncol 5(6):649–655, 1982.

Rationale: Identifying extreme cases helps in gauging the urgency and intensity of medical intervention needed.

Question 76

Clinical Vignette: A 50-year-old female with invasive bladder cancer is severely disabled. Hospitalization may be indicated, although death is not imminent.

A. Karnofsky Score 30, ECOG Grade 4
B. Karnofsky Score 40, ECOG Grade 3
C. Karnofsky Score 50, ECOG Grade 4
D. Karnofsky Score 30, ECOG Grade 3

Answer 76

Correct Answer: A. Karnofsky Score 30, ECOG Grade 4

Explanation: The patient’s condition corresponds to a Karnofsky Score of 30 and an ECOG Grade of 4. Both indicate severe disability and the potential need for hospitalization.

Memory Tool: “3 and 4, Hospital Door”: When you see scores of 30 and 4, hospitalization is likely on the horizon.

Reference Citation: Paragraph from Table 6.4; Modified from Oken MM, et al. Am J Clin Oncol 5(6):649–655, 1982.

Rationale: Hospitalization indicators can aid in quick decision-making during acute episodes or sudden deteriorations in the patient’s condition.

Question 77

Clinical Vignette: A 40-year-old male patient is found to have colorectal carcinoma. His family history reveals multiple first-degree relatives with the same condition. A genetic test confirms the presence of an abnormality on chromosome 5q21.

Multiple-Choice Options:
A) Familial adenomatous polyposis
B) Li-Fraumeni syndrome
C) Cowden’s disease
D) 22q12

Answer 77

Correct Answer: A) Familial adenomatous polyposis

Explanation for Answer Choices:

A) Familial adenomatous polyposis is correct. This syndrome primarily presents with colorectal carcinoma and has a genetic defect at chromosome 5q21. The gene involved is APC, which regulates β-catenin activity.
B) Li-Fraumeni syndrome mainly involves sarcoma and breast carcinoma, and the genetic defect is on chromosome 17p13 involving TP53. This is not consistent with the patient’s clinical presentation.
C) Cowden’s disease usually involves breast carcinoma, and the genetic defect is on chromosome 10q23 involving PTEN. This doesn’t match the patient’s findings.
D) 22q12 is not a syndrome but a chromosomal location.
Memory Tool: APC stands for “Always Polyp Colorectal”—to remember that APC mutation primarily affects colorectal carcinoma.

Reference Citation: Table 62.2
Rationale for Information: This information is crucial for distinguishing between different tumor syndromes based on clinical presentation, genetics, and family history.

Question 78

Clinical Vignette: A 35-year-old woman presents with breast carcinoma. She mentions that her mother had pancreatic cancer and her sister had breast cancer. Genetic testing reveals a mutation on chromosome 17q21.

Multiple-Choice Options:
A) MEN1
B) TP53
C) BRCA1
D) hCHK2

Answer 78

Correct Answer: C) BRCA1

Explanation for Answer Choices:

A) MEN1 is associated with pancreatic islet cell carcinoma but is found on chromosome 11q13. It wouldn’t explain the patient’s breast cancer and its location.
B) TP53 is related to Li-Fraumeni syndrome, which can involve breast carcinoma but is located on 17p13, not 17q21.
C) BRCA1 is the correct answer. This gene is located on chromosome 17q21 and is involved in familial breast carcinoma, fitting the patient’s presentation.
D) hCHK2 is located on 22q12 and is not associated with breast carcinoma.
Memory Tool: BRCA1 - “BR” for “Breast,” “CA” for Carcinoma, and “1” to remember it’s on 17q21.

Reference Citation: Table 62.2
Rationale for Information: Understanding gene functions and their location can be vital for the proper diagnosis and treatment planning in familial cancer syndromes.

Question 79

Clinical Vignette: A 50-year-old male presents with a pancreatic islet cell carcinoma. Genetic testing shows an abnormality on chromosome 11q13.

Multiple-Choice Options:
A) APC
B) MEN1
C) PTEN
D) BRCA2

Answer 79

Correct Answer: B) MEN1

Explanation for Answer Choices:

A) APC is primarily associated with colorectal carcinoma and found on 5q21.
B) MEN1 is the correct answer. It is associated with pancreatic islet cell carcinoma and found on chromosome 11q13.
C) PTEN is associated with Cowden’s disease and primarily involves breast carcinoma.
D) BRCA2 is associated with familial breast carcinoma but not with pancreatic carcinoma.
Memory Tool: MEN1 - “Men eat 11 paninis” for chromosome 11 and pancreatic islet cell carcinoma.

Reference Citation: Table 62.2
Rationale for Information: The gene involved and the chromosomal location are critical for confirming a diagnosis and can have implications for other family members.

Question 80

Clinical Vignette: A 55-year-old woman comes in with a history of breast carcinoma. She is worried about her children’s risk. Genetic testing reveals a mutation on chromosome 10q23.

Multiple-Choice Options:
A) Cowden’s disease
B) 22q12
C) Familial adenomatous polyposis
D) Li-Fraumeni

Answer 80

Correct Answer: A) Cowden’s disease

Explanation for Answer Choices:

A) Cowden’s disease is the correct answer. It is associated with breast carcinoma and has a genetic defect on chromosome 10q23 involving the PTEN gene.
B) 22q12 is not related to breast carcinoma.
C) Familial adenomatous polyposis primarily involves colorectal carcinoma and is related to chromosome 5q21.
D) Li-Fraumeni syndrome can involve breast carcinoma, but the genetic defect is on chromosome 17p13.
Memory Tool: “Cows have 10 spots” – to remember Cowden’s disease is on chromosome 10q23.

Reference Citation: Table 62.2
Rationale for Information: Knowing the gene and chromosome related to Cowden’s disease helps in counseling family members about their risks.

Question 81

Clinical Vignette: A 30-year-old male presents with sarcoma. He mentions that his aunt had breast cancer and his grandfather had a sarcoma. Genetic testing reveals an abnormality on chromosome 17p13.

Multiple-Choice Options:
A) Familial retinoblastoma
B) Li-Fraumeni
C) Familial breast carcinoma
D) Cowden’s disease

Answer 81

Correct Answer: B) Li-Fraumeni

Explanation for Answer Choices:

A) Familial retinoblastoma involves retinoblastoma and is related to chromosome 13q14.
B) Li-Fraumeni is the correct answer. It mainly involves sarcomas and breast carcinomas and is found on chromosome 17p13.
C) Familial breast carcinoma doesn’t typically include sarcomas.
D) Cowden’s disease primarily involves breast carcinoma but not sarcoma, and it’s related to chromosome 10q23.
Memory Tool: “Li-Frau-17” – to remember Li-Fraumeni is on chromosome 17p13.

Reference Citation: Table 62.2
Rationale for Information: This question focuses on the chromosome-gene relationship for Li-Fraumeni syndrome, crucial for diagnosis and family history.

Question 82

Clinical Vignette: A 48-year-old woman has a family history of various malignancies but doesn’t know specific details. Genetic testing reveals an abnormality on chromosome 22q12.

Multiple-Choice Options:
A) hCHK2
B) BRCA2
C) MEN1
D) TP53

Answer 82

Correct Answer: A) hCHK2

Explanation for Answer Choices:

A) hCHK2 is the correct answer. It is located on chromosome 22q12.
B) BRCA2 is related to breast carcinoma but is on chromosomes 17q21 and 13q12.
C) MEN1 is related to pancreatic islet cell carcinoma and is on chromosome 11q13.
D) TP53 is located on chromosome 17p13 and is related to Li-Fraumeni syndrome.
Memory Tool: “22 checks” - to remember that hCHK2 is on chromosome 22q12.

Reference Citation: Table 62.2
Rationale for Information: The gene involved and chromosomal location can provide insights into an array of familial malignancies the patient might be susceptible to.

Question 83

Clinical Vignette: A 60-year-old male patient comes in for an evaluation of a suspicious retinal lesion. After further workup, retinoblastoma is diagnosed. Which of the following tumor syndromes is not strongly associated with genitourinary malignancies?

Multiple-Choice Options:
A) Li-Fraumeni
B) Familial adenomatous polyposis
C) Familial retinoblastoma
D) Cowden’s disease

Answer 83

Correct Answer: C) Familial retinoblastoma

Explanation for Answer Choices:

A) Li-Fraumeni is not primarily associated with genitourinary malignancies, but it’s not the best answer here as it involves various tumors.
B) Familial adenomatous polyposis primarily involves colorectal carcinoma, not genitourinary malignancies.
C) Familial retinoblastoma is the correct answer. It primarily involves retinoblastoma and is not strongly associated with genitourinary malignancies.
D) Cowden’s disease involves breast carcinoma and is also not strongly related to genitourinary malignancies, but the clinical vignette describes retinoblastoma.
Memory Tool: “Retina not in the groin” – to remember retinoblastoma isn’t associated with genitourinary malignancies.

Reference Citation: Table 62.2
Rationale for Information: Recognizing which syndromes are not strongly associated with genitourinary malignancies is important for a urologist in differential diagnosis.

Question 84

Clinical Vignette: A 45-year-old man has a family history of colorectal carcinoma. Genetic testing reveals an abnormality in a gene that regulates β-catenin activity. Which syndrome should you suspect?

Multiple-Choice Options:
A) Cowden’s disease
B) Familial retinoblastoma
C) Familial adenomatous polyposis
D) Li-Fraumeni

Answer 84

Clinical Vignette: A 45-year-old man has a family history of colorectal carcinoma. Genetic testing reveals an abnormality in a gene that regulates β-catenin activity. Which syndrome should you suspect?

Multiple-Choice Options:
A) Cowden’s disease
B) Familial retinoblastoma
C) Familial adenomatous polyposis
D) Li-Fraumeni

Question 85

Clinical Vignette: A 50-year-old woman presents with breast carcinoma. On genetic testing, a mutation is found in a gene responsible for DNA double-strand break repair. What is the likely syndrome?

Multiple-Choice Options:
A) Cowden’s disease
B) Familial breast carcinoma
C) Li-Fraumeni
D) Familial adenomatous polyposis

Answer 85

Correct Answer: B) Familial breast carcinoma

Explanation for Answer Choices:

A) Cowden’s disease involves PTEN, a phosphatase and PI3K antagonist.
B) Familial breast carcinoma is correct. It involves BRCA1 and BRCA2, which are responsible for DNA double-strand break repair.
C) Li-Fraumeni involves TP53, a transcription factor and serine kinase.
D) Familial adenomatous polyposis involves APC, which regulates β-catenin activity.
Memory Tool: “Broken DNA needs a BRA” – to remember that BRCA genes are responsible for DNA double-strand break repair.

Reference Citation: Table 62.2
Rationale for Information: Identifying the gene involved in the genetic mutation can guide diagnosis, especially in cases where multiple family members may be affected.

Question 86

Clinical Vignette: A 40-year-old man comes in with pancreatic islet cell carcinoma. Genetic testing reveals a mutation on chromosome 11q13. What syndrome should be suspected?

Multiple-Choice Options:
A) Familial adenomatous polyposis
B) Multiple endocrine neoplasia type I
C) Cowden’s disease
D) Familial retinoblastoma

Answer 86

Correct Answer: B) Multiple endocrine neoplasia type I

Explanation for Answer Choices:

A) Familial adenomatous polyposis primarily involves colorectal carcinoma and has a genetic defect on chromosome 5q21.
B) Multiple endocrine neoplasia type I is the correct answer. It involves pancreatic islet cell carcinoma and has a genetic defect on chromosome 11q13.
C) Cowden’s disease primarily involves breast carcinoma and is related to chromosome 10q23.
D) Familial retinoblastoma involves retinoblastoma and is related to chromosome 13q14.
Memory Tool: “11 is MENt to be” – to remember Multiple endocrine neoplasia type I is related to chromosome 11q13.

Reference Citation: Table 62.2
Rationale for Information: For a urologist, knowing the gene and chromosome related to Multiple endocrine neoplasia type I is crucial in understanding the wider impact on the patient’s health.

Question 87

Clinical Vignette: A 35-year-old woman with a family history of breast carcinoma undergoes genetic testing, which reveals a mutation on chromosome 17q21. Which of the following syndromes should you consider?

Multiple-Choice Options:
A) Li-Fraumeni
B) Familial retinoblastoma
C) Familial breast carcinoma
D) Cowden’s disease

Answer 87

Correct Answer: C) Familial breast carcinoma

Explanation for Answer Choices:

A) Li-Fraumeni syndrome has a genetic defect on chromosome 17p13, not 17q21.
B) Familial retinoblastoma is associated with chromosome 13q14.
C) Familial breast carcinoma is the correct answer. It involves a mutation on chromosome 17q21.
D) Cowden’s disease is associated with chromosome 10q23.
Memory Tool: “17 Queens of the breast” – to remember Familial breast carcinoma is on chromosome 17q21.

Reference Citation: Table 62.2
Rationale for Information: Understanding the chromosomal location helps in identifying the syndrome and its possible manifestation, especially in familial cases.