Board Preparation: Lung Cancer, Genitourinary Cancers

Mar 02, 2017

Test your knowledge of lung and genitourinary cancers to assist your preparations for Board examinations with questions from a past edition of ASCO-SEP®, ASCO’s self-evaluation program in oncology.

The new fifth edition of ASCO-SEP is available for purchase in the ASCO University® bookstore. Featuring 21 updated chapters and more than 180 new self-assessment questions in the book, as well as a 120-question comprehensive mock exam online, this resource is perfect for Board preparation, and can be used to earn Maintenance of Certification and continuing medical education credit. Visit university.asco.org for information about the latest edition of ASCO-SEP and other self-assessment resources.

Correct answers, rationales, and suggested reading are listed at the bottom of the page.

  1. A 62-year-old woman with a 70 pack year smoking history and COPD presents to your clinic for routine follow-up. Physical exam shows oxygen saturation 97% on room air, prolonged expiratory phase and is otherwise unremarkable. She requests a screening study for lung cancer. Which of the following is the best screening test for lung cancer in this patient?
  1. Chest X-ray
  2. Low dose non-contrast CT-scan of the chest
  3. PET-CT
  4. Serum carcinoembryonic antigen

 

  1. A patient presents to you with chronic cough. Chest x-ray shows a hilar mass. This is followed by a PET-CT that shows an FDG-avid 4 cm right hilar mass, mediastinal adenopathy, and right supraclavicular adenopathy. What do you order for pathologic diagnosis?
  1. Mediastinoscopy for biopsy and mediastinal lymph node staging
  2. Biopsy of right supraclavicular node
  3. Bronchoscopy with endobronchial biopsy of an accessible mediastinal lymph node
  4. CT guided core biopsy of hilar mass by interventional radiology

 

  1. A 57-year-old man is diagnosed with metastatic bladder cancer involving lung, bone, and lymph nodes. He does not have any coexisting medical problems and his Karnofsky performance status is 90%. Laboratory studies reveal a normal hemoglobin, elevated total leukocyte count, and normal albumin. Which of the following variables may be used to predict survival?
  1. Lung metastases
  2. Performance status
  3. Hemoglobin
  4. Lymph node metastases
  5. All of the above

 

Rationales

1: B

Low dose non-contrast CT-scan of the chest. The recent NLST trial showed a 20% reduction in lung cancer related mortality and a 6.7% reduction in rate of death from any cause with low dose CT scan of the chest in patients age 55-74 with at least 30 pack-years of smoking. Since a great majority of abnormalities identified on screening are non-malignant, an organized multi-disciplinary team approach to evaluation of findings from CT screening is highly recommended.

Suggested Readings

Aberle, DL et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365:395-409.

Humphery, LL et al. Screening for Lung Cancer With Low-Dose Computed Tomography: A Systematic Review to Update the U.S. Preventive Services Task Force Recommendation. Ann Intern Med. 2013;159(6):411-420.

2: B

Fine needle aspiration and core biopsy of the right supraclavicular node. This is the least invasive location to biopsy of the answer choices and would provide the most useful pathologic staging. If the supraclavicular node is positive he would have Stage IIIB (N3 disease), which would exclude surgery as a treatment option.

3: E 
Several prognostic models have been developed to predict survival in patients with metastatic bladder cancer. An early model incorporating two variables, Karnofsky performance status (less than 80%), and presence of visceral metastases (lung, liver or bone), demonstrated survival times for patients who had zero, one, or two risk factors of 33 months, 13.4 months, and 9.3 months, respectively. More recently, two nomograms for predicting survival in patients with metastatic urothelial cancer include the following pre-treatment variables: the presence and number of visceral metastases, albumin, performance status, hemoglobin, site of the primary tumor, lymph node metastases and leukocyte count. 

Suggested Readings
Bajorin DF, Dodd PM, Mazumdar M, et al. Long-term survival in metastatic transitional-cell carcinoma and prognostic factors predicting outcome of therapy. J Clin Oncol. 1999;17:3173-81.

Galsky MD, Moshier E, Krege S, et al. Nomogram for predicting survival in patients with unresectable and/or metastatic urothelial cancer who are treated with cisplatin-based chemotherapy. Cancer. 2013;119:3012-9.

Apolo AB, Ostrovnaya I, Halabi S, et al. Prognostic model for predicting survival of patients with metastatic urothelial cancer treated with cisplatin-based chemotherapy. J Natl Cancer Inst. 2013;105:499-503.

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