Clinical Oncology – Previous Examination Papers
has been referred to you for further management.
a)
What investigations would you recommend for this patient?
b)
Histopathology review confirmed a diagnosis of poorly differentiated carcinoma (non-small cell) and
investigations failed to identify a primary site. Staging investigations confirmed nodal disease in his left
axilla and supraclavicular fossa, but no evidence of disease elsewhere.
What would be your recommended management plan for this patient?
FEBRUARY 2009
Question 1
a)
Describe the potential endocrine and metabolic side effects of cancer treatment in adults, giving
examples.
b)
How would you prevent and manage these effects in a man with prostate cancer on long-term androgen
deprivation therapy?
Question 2
A previously well 54 year old woman presents with weakness in her right leg. She has no other symptoms and
has not lost weight. An MRI scan demonstrates 8 cerebral metastases, measuring up to 3cm in size. A CT scan
of the chest reveals a 3cm primary lesion in the left lower lobe. An FNA of the lung lesion shows non-small cell
lung cancer. The cerebral lesions are not considered operable or suitable for stereotactic radiation therapy.
a)
Describe your approach to the further investigation of this patient.
b)
What is her prognosis and how would you convey this information to her?
c)
Discuss the factors that impact on the decision to treat a patient with cerebral metastases with radiation
therapy.
This woman is taking dexamethasone, 4mg every 6 hours, at the start of her radiation therapy.
d)
How would you manage this medication in this woman? Justify your answer.
Question 3
a)
Discuss the causes of renal failure in patients with malignancy.
b)
What factors would you take into consideration in determining the management of renal failure in a
cancer patient under your care?
Question 4
A 43 year old woman finds a mass in her left breast. A mammogram shows a spiculated density measuring 2cm
in the 2 o’clock position in the left breast, 6cm from the nipple. An FNA confirms carcinoma.
a)
Discuss her treatment options with respect to management of the breast and axilla.
A wide local excision is performed showing a 2.1cm, grade 3 infiltrating duct carcinoma with clear margins. The
tumour is ER and PR negative, and HER-2 positive. One of 27 lymph nodes contains cancer. A decision is
made in the multidisciplinary team meeting to treat her with anthracycline-based chemotherapy and Herceptin.
b)
Discuss the issues associated with sequencing adjuvant therapies (both locoregional and systemic) in
relation to this patient. Include in your answer potential interactions between treatments.
Question 5
A 35 year old pregnant woman presents at 28 weeks gestation with vaginal bleeding. Investigations reveal an
invasive squamous cell carcinoma of the cervix.