Oncology Interview Questions & Answers

  1. Question 1. What Percentage Of All Breast Cancer Cases Is Related To Genetic Susceptibility?

    Answer :

    Genetic susceptibility to breast cancer accounts for approximately 25% of all breast cancer cases. In familial breast cancer, mutations in the BRCA1, BRCA2, CHEK2, TP53, and PTEN genes account for approximately 5% to 10% of breast and ovarian cancer cases overall. The prevalence of BRCA1 or BRCA2 mutations varies considerably among ethnic groups and geographical areas. In North America, 1 in every 300 to 500 people is estimated to harbor BRCA germline mutations.

  2. Question 2. Scenario: A 68-year-old Woman With A History Of Heavy Tobacco Use Is Found To Have A Solitary Lung Nodule On Chest Computed Tomography. Pathology From A Recent Bronchoscopy Reveals Adenocarcinoma.

    What Further Staging Work-up Is Necessary For This Patient Before Surgical Resection?

    Answer :

    FDG([18F]2-Fluoro-2-deoxy-glucose)-PET for baseline locoregional staging is now part of the standard work-up for non-small cell lung cancer (NSCLC). The true strength of this test for the mediastinum is its negative predictive value (NPV) when FDG uptake in the primary tumor is sufficient and a central tumor or important hilar lymph node disease is absent. Two well-designed, prospective studies confirmed the high NPV (98%) of the mediastinum of patients with resectable NSCLC and that significantly fewer invasive tests (ie, mediastinoscopy) were required in the PET group than in the traditional work-up group.

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  4. Question 3. A 55-year-old Woman Recently Completed Induction Chemotherapy For Acute Myelogenous Leukemia (aml) With Evidence Of Complete Remission On Bone Marrow Biopsy. She Subsequently Was Found To Have A Platelet Count Of 25,000/microliter With No Clinical Evidence Of Bleeding.

    Is A Platelet Transfusion Necessary At This Time?

    Answer :

    No, Bleeding complications occur more frequently as the severity of thrombocytopenia increases, but only after the platelet count crosses a threshold of about 10 to 30 x 103. A normal platelet count is not required to support hemostasis. Clinically important spontaneous bleeding does not occur unless the platelet count is very low or other disorders are present. In a study conducted at the National Cancer Institute to assess the risk for bleeding in patients with thrombocytopenia, the investigators were not able to determine a threshold below which platelets should have prophylactic transfusion. However, following this study prophylactic transfusion became common practice for patients with a platelet count below 20 x 103. Several subsequent randomized studies showed that using a platelet count < 10 x 103 as the trigger for prophylactic transfusion did not increase the risk for bleeding.

  5. Question 4. Obesity Is A Risk Factor For Which Types Of Cancer?

    Answer :

    Excess body weight is becoming increasingly recognized as an important risk factor for cancer. Renehan and colleagues conducted a systematic review and meta-analysis of 141 articles that included 282,137 cases of cancer. Using data from these studies, they calculated the effect of gaining weight that was equivalent to an increase of 5 kg/m2 in body mass index (BMI). Such a weight gain doubles the risk for esophageal adenocarcinoma in both sexes (relative risk [RR], 1.52; P < .0001). In women, it also slightly more than doubles the risk for endometrial cancer (RR, 1.59; P < .0001) and increases risk for renal cancer by about a third (RR, 1.34; P < .0001).

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  7. Question 5. Which Of The Following Is Not Among The Uses Of Pet Imaging In The Management Of Cervical Cancer?

    Answer :

    The use of functional imaging techniques, such as FDG-PET and PET-CT, to manage patients with cervical cancer is constantly increasing. Current roles include pretreatment staging and diagnosis of recurrent disease. Reports have also shown ability to predict survival based on pre- and posttherapy scans. Cervical cancer spreads primarily through direct extension, although lymphatic and hematogenous spread can result in distant metastases. Traditionally, clinical examination and cross-projectional imaging have been used to stage cervical cancer but are accurate in only 60% of cases. Detection of lymphatic metastases seems to be more successful with functional imaging techniques, such as FDG-PET or PET-CT.

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  9. Question 6. A 63-year-old Man With A Remote History Of Tobacco Use Presents With Hematuria. He Undergoes A Transurethral Resection (tur), Which Reveals T1 Superficial Bladder Cancer.

    What Is His Risk For Bladder Cancer Recurrence In The Next 5 Years Without Further Therapy?

    Answer :

    TUR remains the surgical mainstay for the diagnosis and treatment of stages Ta and T1 bladder cancer. After this procedure, the 10-year disease-specific survival for Ta tumors is 85% and for T1 tumors it is 70%. The initial TUR provides pathologic material to determine the histologic type, grade, and depth of invasion. The findings help to direct additional therapy, dictate the follow-up schedule, and indicate prognosis. In a literature review of more than 600 cases of T1 bladder tumors treated only by TUR, 75% to 90% recurred by 5- and 10-year follow-up. A third of the cancers progressed to muscle invasion within 5 years, 39% had progressed by 10 years, and 53% by 15 years.

  10. Question 7. A 35-year-old Woman Presents With Cervical Lymphadenopathy And Symptoms Of Fever, Night Sweats, And Weight Loss. An Excisional Biopsy Of A Supraclavicular Lymph Node Reveals Nodular Sclerosing Hodgkin’s Lymphoma. Staging Pet-ct Shows Bulky Mediastinal Lymphadenopathy (mediastinal/thoracic Ratio > 1/3), And She Has A Baseline Erythrocyte Sedimentation Rate (esr) Of 50 Mm/h.

    What Favorable Prognostic Feature Does This Patient Have For Early-stage Hodgkin’s Lymphoma?

    Answer :

    TUR remains the surgical mainstay for the diagnosis and treatment of stages Ta and T1 bladder cancer. After this procedure, the 10-year disease-specific survival for Ta tumors is 85% and for T1 tumors it is 70%. The initial TUR provides pathologic material to determine the histologic type, grade, and depth of invasion. The findings help to direct additional therapy, dictate the follow-up schedule, and indicate prognosis. In a literature review of more than 600 cases of T1 bladder tumors treated only by TUR, 75% to 90% recurred by 5- and 10-year follow-up. A third of the cancers progressed to muscle invasion within 5 years, 39% had progressed by 10 years, and 53% by 15 years.

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  12. Question 8. Temozolomide Has Emerged As An Agent That Is Active Against Glioblastoma Multiforme (gbm). What Is The Mechanism Of Action Of This Chemotherapeutic Drug?

    Answer :

    Temozolomide (TMZ) is an orally administered alkylating agent of the imidazotetrazine class that is chemically related to dacarbazine. It is rapidly and completely absorbed and passes through the blood-brain barrier, creating cerebrospinal fluid concentrations that are 20% to 40% of plasma levels. The DNA repair protein MGMT removes alkyl groups from the O6 position of guanine, a target of alkylating agents, such as TMZ. In tumors, high expression of MGMT has been associated with resistance to treatment with alkylating agents. Inactivation of the MGMT gene by promoter methylation diminishes DNA repair activity and has been associated with longer overall survival in patients with GBM who are treated with alkylating agents.

  13. Question 9. Treatment Options For Stage I Nonseminomatous Germ Cell Tumor (nsgct) Include All Of The Following, Except:

    Answer :

    Surveillance is preferred by many doctors and patients because the vast majority of patients can be cured when they relapse. However, successful surveillance requires strict compliance on behalf of both doctor and patient. RPLND is the most accurate way to stage patients, and cure rates in expert hands approach 100%, but it is associated with potentially significant morbidity. Chemotherapy, usually with 2 cycles of bleomycin, etoposide, and cisplatin, is also associated with an excellent outcome, but there are concerns regarding longer-term toxicities, such as infertility and second cancers. High-dose chemotherapy with autologous stem cell support is feasible and potentially cures a proportion of patients with resistant disease. However, data on this treatment as initial therapy for higher-risk patients are scarce.

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  15. Question 10. The Primary Treatment For Locoregionally Advanced Head And Neck Cancer Consists Of:

    Answer :

    Historically, locoregionally advanced head and neck cancer (HNC) was treated with surgery (with or without adjuvant radiotherapy) or radiotherapy alone. Only a minority of patients with locoregionally advanced disease can undergo adequate surgical resection, however, and the outcomes were poor with respect to survival and organ preservation. Furthermore, radiotherapy alone is not sufficient to successfully treat most HNC at intermediate or advanced stages. Recently, chemoradiotherapy was shown to markedly improve survival and organ preservation.

  16. Question 11. Which Of The Following Targeted Agents Is Not A Tyrosine Kinase Inhibitor That Influences The Human Epidermal Growth Factor Receptor (her) Family Signaling Pathway By Binding To The Intracellular Domain Of The Receptors?

    Answer :

    Tyrosine kinase inhibitors, such as gefitinib and erlotinib (HER1 inhibitors) and lapatinib (a HER1/HER2 inhibitor), influence the signaling pathway by interacting with the intracellular domain of the receptors of HER1 and HER2. Trastuzumab is a humanized monoclonal antibody that targets the extracellular domain of the HER2 receptor to prevent dimerization with other HER family members and subsequent downstream signaling events.

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  18. Question 12. Standard Treatment For Locally Advanced Epithelial Ovarian Cancer Includes All Of The Following, Except:

    Answer :

    Surgery and standard intravenous chemotherapy with a platinum-taxane combination induce complete remission in most patients with newly diagnosed ovarian cancer. However, most patients eventually relapse and die from their disease. Interest is growing in the intraperitoneal delivery of chemotherapy to patients with ovarian cancer who have minimal residual disease following initial cytoreductive surgery. Three randomized trials demonstrated an improvement in overall survival with intraperitoneal cisplatin compared with intravenous chemotherapy alone.

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  20. Question 13. A 57-year-old, Obese White Man Has Symptoms Of Chronic Gastroesophageal Reflux Disease (gerd). Endoscopic Evaluation Reveals Evidence Of Barrett’s Esophagus With High-grade Dysplasia.

    What Is The Recommended Management For This Disease?

    Answer :

    The American College of Gastroenterology guidelines state that “patients with chronic GERD symptoms are those who are most likely to have Barrett’s esophagus and should undergo upper endoscopy.” However, the grade of dysplasia determines the interval for surveillance endoscopy. In patients without dysplasia on 2 consecutive endoscopies with biopsies, a 3- to 5-year interval has been proposed. For patients with low-grade dysplasia, annual surveillance is recommended. For patients with high-grade dysplasia, a mucosal resection should be attempted and the grade of dysplasia identified carefully by an expert gastrointestinal pathologist. Endoscopic ablation therapies can be considered as a viable alternative to surgery in this patient population.

  21. Question 14. Episodic Acute Overexposure To Ultraviolet (uv) Radiation (ie, Sunburn) Is An Important Risk Factor For Which Type Of Skin Cancer?

    Answer :

    Sunburn is an important risk factor for 2 types of skin cancer: basal cell carcinoma and melanoma. Melanoma is the most lethal type of skin cancer. A meta-analysis of 57 studies indicated that the relative risk for melanoma among persons with sunburn history compared with those without sunburn history was 2.03 (95% confidence interval [CI], 1.73-2.37).

  22. Question 15. Risk Factors For Anthracycline-induced Cardiomyopathy Include?

    Answer :

    In addition to increasing cumulative doses of anthracyclines, older age, preexisting cardiac disease, hypertension, irradiation to the mediastinum, simultaneous administration of other antineoplastic agents, poor nutritional status, previous treatment with anthracyclines, and diabetes mellitus have been identified as the most important risk factors for anthracyclineinduced cardiotoxicity.

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  24. Question 16. What Is A Possible Intervention To Treat Breathlessness In End-stage Cancer Patients?

    Answer :

    It has been shown that facial cooling, with use of a small mechanical fan, in the areas subserved by the second and third branches of the trigeminal nerve reduces the sensation of breathlessness and may be efficacious in cancer patients. It is an ideal, inexpensive tool to incorporate into a “breathlessness/crisis plan.” Opioids are an effective pharmacologic treatment for breathlessness; however, most evidence to date comes from nonmalignant disease. A number of case reports and uncontrolled trials of inhaled furosemide have indicated that it may relieve dyspnea in terminal cancer patients.

  25. Question 17. A 53-year-old White Man With No Family History Of Colorectal Cancer Had His First Screening Colonoscopy. He Was Found To Have A < 1 Cm Tubular Adenoma With Low-grade Dysplasia. When Should He Schedule His Next Colonoscopy?

    Answer :

    The current recommendations from the joint American Cancer Society/US Multisociety Task Force on Colorectal Cancer are that 5- to 10-year intervals are appropriate for follow-up of patients at low risk for subsequent advanced adenomas. To address this issue, a group from the University of Pennsylvania identified 1002 patients with 1 or 2 small adenomas at their first colonoscopy who had ≥ 3 colonoscopies performed within a 13-year period. Among 88 patients who had at least 1 adenoma at the third colonoscopy, 3 (3.4%) had advanced adenomas. Although this study was small, the authors concluded that it is reasonable to continue 5-year surveillance in patients with 1 to 2 small tubular adenomas found at baseline examination.

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  27. Question 18. What Is The Main Cause Of Hepatocellular Carcinoma (hcc) In The United States?

    Answer :

    The incidence of HCC in the United States is increasing, and infection with the hepatitis C virus is believed to be the major cause. Indeed, HCC is the fastest-growing cause of cancer-related death in the United States. HCC is generally associated with cirrhosis, particularly due to hepatitis C, hepatitis B, alcohol abuse, hereditary hemochromatosis, and primary biliary cirrhosis. This malignancy is becoming recognized as an early complication and the most frequent cause of death in persons with viral-associated cirrhosis. Effective therapy for hepatitis B and C has led to more patients with cirrhosis being diagnosed and screened.

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  29. Question 19. Rituximab In Combination With Chop (r-chop) Was Approved In 2006 By The Fda For Treatment Of Diffuse Large B-cell Lymphoma (dlbcl).

    The Addition Of Rituximab To Standard Chemotherapy Has Been Shown To Benefit Which Patient Population?

    Answer :

    Age is an important issue in the treatment of patients with DLBCL because of the greater risk for comorbid conditions. Therefore, strategies were initiated to use the IPI risk factors and the age-adjusted IPI in conjunction with stage, serum lactate dehydrogenase, and performance score as stratification factors to design therapeutic trials and appropriately select patients.

    These strategies were followed in the landmark R-CHOP trials, including the Groupe d’Etude des Lymphomes de l’Adulte (GELA) and the US Intergroup Eastern Cooperative Oncology Group (ECOG) 4494/Cancer and Leukemia Group B (CALGB) 9793 trials. Results have shown that R-CHOP is effective in both older and younger patients and in low- and high-risk IPI groups.

  30. Question 20. The Annual Risk For Endometrial Cancer In Post-breast Cancer Patients After 5 Years Of Adjunctive Therapy With Tamoxifen Is 2 Cases Per_________?

    Answer :

    In a randomized trial conducted by the National Surgical Adjuvant Breast and Bowel Project (NSABP), tamoxifen (20 mg daily) was compared with placebo as adjuvant breast cancer therapy. The relative risk for endometrial cancer after 5 years of tamoxifen use was 2.2; this is equivalent to an annual hazard rate of approximately 2 cases per 1000 women. Of note, most women who develop uterine cancer during tamoxifen therapy present with vaginal bleeding, have early-stage disease, and usually (but not always) have well-differentiated tumors.

    Furthermore, the benefits of tamoxifen in the adjuvant breast cancer setting far outweigh the small risk for uterine cancer. Currently, patients receiving tamoxifen should undergo a routine pelvic examination with prompt evaluation of abnormal vaginal bleeding by endometrial biopsy.

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  32. Question 21. Which Of The Following Statements Concerning The American Cancer Society Nutrition And Exercise Guidelines For Cancer Survivors Is False?

    Answer :

    The role of soy foods and supplements is uncertain. Soy may be an excellent source of protein; however, high doses of supplemental soy isoflavones are not recommended for women with estrogen-receptor-positive breast cancer because of the phytoestrogen content, which may stimulate growth of hormone-sensitive breast cancer.

  33. Question 22. Is Cytoreductive Nephrectomy Recommended For Patients With Metastatic Renal Cell Carcinoma (rcc) Before Cytokine Or Targeted Therapy?

    Answer :

    Approximately 30% of patients with RCC present with stage IV disease. Two randomized trials examined nephrectomy followed by interferon vs immediate therapy with interferon in patients presenting de novo with metastatic kidney cancer. Both trials showed significant trends toward survival favoring nephrectomy before interferon. Therefore, in the cytokine era, cytoreductive nephrectomy before the institution of cytokine therapy became standard. Clinical trials in patients who have received targeted therapy have required that patients have nephrectomy before enrollment, based largely on the cytokine results.

  34. Question 23. The Immunomodulating Monoclonal Antibody Alemtuzumab Is Associated With Which Infectious Complication?

    Answer :

    Alemtuzumab is a humanized monoclonal antibody directed against CD52, a surface antigen expressed in high levels by B-cell chronic lymphocytic leukemia (B-CLL) and T-prolymphocytic leukemia cells. Alemtuzumab has been shown to destroy target cells through antibodydependent cellular cytotoxicity, complement-mediated cytolysis, and induction of apoptosis.

    CD4 and CD8 T-cell counts reach their nadir approximately 4 weeks after initiation of alemtuzumab. High rates of standard and opportunistic infections, such as PCP, invasive aspergillosis, candidiasis, disseminated varicella-zoster virus, mycobacterial infection, and CMV, and extremely delayed recovery of functional immune status, have been reported with alemtuzumab use in salvage therapy of refractory or relapsed CLL.

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  36. Question 24. What Is The 5-year Survival Rate For Patients Who Undergo Curative Hepatic Resection Of Colorectal Liver Metastases?

    Answer :

    In patients with unresectable metastatic colorectal cancer, modern systemic chemotherapy regimens provide median survival times ranging from 12 to 24 months, and survival beyond 5 years is uncommon. In contrast, historical 5-year survival rates for patients undergoing hepatic resection with curative intent range from 30% to 40%, with several more recent series reporting rates approaching 60%.

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