Deck 11: Treatment Options for T1N0N0 Rectal Cancer

Question 1

Predisposing factors to oesophageal adenocarcinoma include the following except

A)Achalasia
B)Gastro-oesophageal reflux disease
C)Alcohol
D)Smoking
E)Ingestion of caustic substances

Answer 1

Achalasia

Question 2

Young woman with amenorrhoea & large uterus. CXR shows rounded opacities. What is the best test to monitor this condition?

A)CEA
B)HCG
C) -fetoprotein
D)LDH

Answer 2

-fetoprotein

Question 3

How would you treat metastatic Ca Breast in a postmenopausal woman?

A)Anti-oestrogen
B)Oestrogen
C)Progesterone
D)Anti-androgen
E)Aromatase inhibitor

Answer 3

Anti-oestrogen

Question 4

What is the best prognostic indicator of post op survival for Ca Breast?

A)Tumour size
B)Lymph node involvement
C)HER 2 +ve
D)Tumour grade/ stage
E)Age

Question 5

Which malignancy is least amenable to treatment?

A)Adeno Ca of axillary lymph nodes
B)Adeno Ca with sclerotic lesion in bone
C)Adeno Ca in liver
D)Squamous cell Ca in cervical lymph nodes
E)Poorly differentiated Ca in chest - midline (?mediastinal lymph nodes) in a young man

Question 6

Associations for 1o Ca can be made for all of the following except

A)Adeno Ca mets in the liver in a middle aged man
B)Adeno Ca mets in axillary lymph nodes in a woman
C)Squamous Cell mets in cervical lymph nodes in a smoker
D)Mediastinal Adeno Ca in a young man
E)Skeletal sclerotic lesion in vertebrae in an elderly man

Question 7

Mechanism of drug resistance of chemotherapeutic drugs

A)P glycoprotein
B)P53
C)Bcl 2
D)P450

Question 8

A middle-aged man has a melanoma fully excised. What is the most important reason to follow him closely?

A)Local and systemic recurrence
B)New site recurrence
C)In transit metastasis
D)Lymph nodes
E)New primary

Question 9

A 68 year old man is admitted to the ER having had three large maroon colored stools. On arrival, he passes more bloody stools and clots. He is pale, orthostatic and tachycardic. NG aspirates are bilious. After resuscitation is begun, which of the following is the most appropriate initial test?

A)Angiography
B)Nuclear medicine red blood cell scan
C)Rigid proctoscopy
D)Colonoscopy
E)Barium enema

Question 10

The most common mode of spread of colon cancer is

A)Hematogenous
B)Lymphatic
C)Direct extension
D)Implantation

Question 11

The following is the most important prognostic determinant of survival after treatment for colorectal cancer?

A)Lymph node involvement
B)Transmural extension
C)Tumor size
D)Histologic differentiation
E)DNA content

Question 12

A 68-year-old man presents to his primary care physician for a routine physical examination. The patient"s medical history is significant for hypertension. The patient is found to have guaiac-positive stools and is subsequently referred for colonoscopy. Colonoscopy reveals a "golf ball"-size, near-obstructing tumor in the descending colon, not admitting the scope. The biopsy is positive for adenocarcinoma of the colon. Which of the following is the next step in the management of this patient?

A)Full metastatic workup first, and if negative, then plan for colon resection
B)A course of radiation therapy prior to any resection
C)Plan for pre-operative chemotherapy
D)Do metastatic work up, but plan for colon resection anyway
E)Schedule a barium enema to evaluate the proximal colon

Question 13

For previous patients, after the appropriate evaluation, the patient undergoes surgery. No intraoperative evidence of metastases is identified. Postoperatively, the pathology report reveals that the tumor is an adenocarcinoma invading into the pericolonic fat, with 2 involved lymph nodes. After the patient recovers from surgery, which of the following is the most appropriate next step in his management?

A)Abdominal CT scan every 6 months
B)No further therapy is indicated, because the involved nodes were removed
C)Chemotherapy with 5-fluorouracil (5-FU) based regimen
D)Measurement of CEA levels yearly
E)Colonoscopy every 6 months

Question 14

A 65-year-old woman with no significant past medical history presents to the emergency department with a 2-day history of left lower quadrant abdominal pain. The patient denies nausea and vomiting, although she claims decreased oral intake. She also reports a low-grade fever and mild diarrhea. She describes a milder episode several years ago, which resolved on its own. On physical examination, the patient is found to have left lower quadrant tenderness with some mild guarding, but no rebound. She is hemodynamically stable, and her heart rate is 82 per minute. In the initial management of this patient, which of the following is the most sensitive diagnostic test?

A)Complete blood count, SMA-7
B)An obstructive series
C)A barium enema study
D)Abdominal/pelvic CT with oral contrast
E)Abdominal ultrasound

Question 15

A 60-year-old man presents for an annual physical examination. The examination is normal except for a palpable mass in the rectum on digital rectal examination. The patient denies any change in bowel habits and feels well. Rectal cancer is suspected. What is the next best step in the evaluation of this patient?

A)Computed tomography scan of the abdomen and pelvis
B)Double-contrast barium enema
C)Flexible sigmoidoscopy with biopsy of the lesion
D)Full colonoscopy with biopsy of the lesion
E)Magnetic resonance imaging scan of the abdomen and pelvis

Question 16

A 78-year-old woman with coronary artery disease and severe chronic obstructive pulmonary disease is admitted to the hospital with painless jaundice. CT scan reveals the presence of multiple lesions in the liver, suggestive of metastases, and a nearly obstructing upper rectal mass. Colonoscopy demonstrates a large, ulcerated tumor in the proximal rectum and a residual lumen of less than 1 cm in diameter. While in the hospital, the patient develops a large bowel obstruction. What is the best treatment modality for this patient?

A)Immediate radiation therapy of the rectal mass
B)Placement of a colonic decompression tube
C)Emergency surgery with resection of the mass
D)Emergency surgery with creation of a diverting colostomy
E)Placement of a rectal self-expanding metal stent

Question 17

A 57-year-old man is found to have a rectal mass 3 cm from the anal verge on digital rectal examination. Subsequent colonoscopy and biopsy confirm rectal adenocarcinoma. EUS examination demonstrates penetration of the tumor into, but not through, the muscularis propria, but shows significant perirectal lymph nodes. CT scan of chest/abdomen/pelvis demonstrates no metastases. The patient is staged as T2N1M0. What procedure should be attempted to remove the primary lesion in this patient?

A)Endoscopic mucosal resection (EMR) to remove the lesion
B)Endoscopic argon plasma coagulation (APC) therapy to cauterize and ablate the lesion
C)Surgical transanal excision of the lesion
D)Neo-adjuvant chemoradiation followed by transanal excision
E)Neo-adjuvant chemoradiation followed by abdominoperineal resection (APR)

Question 18

A 70-year-old man is found to have distal rectal cancer during a screening colonoscopy. The patient undergoes preoperative staging and is found to have a 1.5-cm rectal mass that does not invade the muscularis propria of the rectal wall. There is no regional lymphadenopathy and no evidence of distant metastases. The patient is staged at T1N0M0. The patient is advised to undergo APR but refuses because it will lead to anal sphincter loss and permanent colostomy. Which of the following represents a viable alternate therapeutic option for this patient?

A)Chemotherapy alone
B)Radiation therapy alone
C)Chemoradiation therapy
D)Full-thickness surgical removal of tumor (transanal excision)
E)Endoscopic ablation of the tumor with Argon Plasma Coagulator (APC).

Question 19

Which of the following may be appropriate initial therapy for a 4 cm cancer of the anal canal?

A)Local excision
B)Abdominoperineal resection
C)Combined chemotherapy and radiotherapy
D)Laser therapy
E)Cryotherapy

Question 20

Which of the following processes is most likely to be associated with apoptosis?

A)Nucleosomal DNA laddering
B)Loss of plasma membrane integrity
C)Swelling of the nucleus
D)Endoreduplication

Question 21

The purpose of a phase II clinical trial is to:

A)estimate the toxicity of treatment to be tested.
B)estimate the efficacy of treatment to be tested.
C)estimate the preclinical toxicity of an experimental agent.
D)determine a safe starting dose of an experimental agent.

Question 22

Which of the following chemotherapy agents is most effective against soft tissue sarcoma?

A)Thiotepa
B)Cyclophosphamide
C)Dactinomycin
D)Doxorubicin

Question 23

What number of axillary lymph nodes removed for sampling during a level I/ II node dissection for breast cancer most likely would require postoperative radiation therapy to the axilla?

A)02
B)06
C)08
D)10

Question 24

Which of the following types of cancer was associated with a statistically significant improvement in survival for patients who had one to three solitary brain metastases and received whole brain radiation therapy with the addition of stereotactic radiosurgery, according to results of the RTOG 9508 phase III trial?

A)Breast cancer
B)Renal cell cancer
C)Non-small cell lung cancer
D)Melanoma

Question 25

In RTOG 8501, what was the 5-year overall survival rate for patients who had esophageal cancer and received radiation therapy alone?

A)00%
B)10%
C)25%
D)35%