Sample Written Exam – Medical Oncology
Question 1
A 73-year-old woman presents with iron deficiency anemia. She is found to have a right-sided colon
cancer.
a. List THREE staging investigations you would recommend prior to surgical intervention.
MODEL ANSWER (3 marks)
• CT or MRI abdomen/pelvis
• Chest imaging (CT or plain x-ray)
• CEA
b. Staging investigations are negative. She undergoes right hemicolectomy. There are no
unexpected findings at surgery. The pathology report describes a low-grade
adenocarcinoma, T2N0, with no metastases in 14 lymph nodes. There is no evidence of
lymphovascular invasion, perineural invasion or tumour deposits. What is the overall stage
of her cancer?
MODEL ANSWER (1 mark)
• Stage I
c. She is referred to medical oncology for consideration of adjuvant chemotherapy. What
would you recommend and why?
MODEL ANSWER (2 marks)
• No adjuvant chemotherapy. Risk of recurrence is low and there is no evidence to
support the use of adjuvant chemotherapy in this setting.
Question 2
A 19-year-old man is diagnosed with a non-seminomatous testicular germ cell tumour, with the
predominant elements being embryonal carcinoma and teratoma. After orchiectomy, he is found to
have extensive retroperitoneal lymphadenopathy and a β-hCG level of 800 IU/L. No other
abnormalities are identified in his staging work-up.
a. Based on the information available, identify his prognostic grouping status and estimated 5-
year survival rate.
MODEL ANSWER (2 marks)
• Good prognosis. >90% 5-year survival
b. You recommend chemotherapy. Name TWO standard chemotherapy regimens
commonly used in this setting. Specify individual agents and number of cycles.
MODEL ANSWER (4 marks)
• Etoposide and cisplatin x 4 cycles, or bleomycin, etoposide and cisplatin x 3 cycles
c. After he completes his chemotherapy, he complains of persistent ringing in his ears. What is
name of this side effect? Identify the chemotherapeutic agent responsible for this side
effect.
MODEL ANSWER (2 marks)
• Cisplatin-induced tinnitus
d. How would your treatment recommendation have differed had this proven to be a
seminoma with exactly the same staging findings?
MODEL ANSWER (1 mark)
• No difference
Question 3
Osteoradionecrosis is a significant complication of head and neck radiation. List 3 risk factors.
MODEL ANSWER (2 marks)
• Concurrent chemotherapy
• Alcohol use
• Tobacco Use
• Large radiation fields
• Mandible Surgery
• Poor dentition/dental carries
2
Question 4
A patient with relapsed chronic lymphocytic leukemia (CLL) progresses through second-line
chemotherapy and is placed on ibrutinib. Two months into therapy, the lymphocyte count is still
rising.
a. What is the MOST likely explanation for this increase?
MODEL ANSWER (1 mark)
• Blockade of the Bruton kinase on the BCR prevents lymphocyte return to marrow or
nodes, forcing them to stay in circulation and die. They are joined by other cells
entering circulation resulting in an increase in WBC count. Normal action of
Ibrutinib.
b. What action needs to be taken?
MODEL ANSWER (1 mark)
• No action or could say continue to monitor.
WRONG to say stop therapy.
