The ASCO Oncology Self-Assessment Series on ASCO Connection consists of free case-based multiple-choice practice questions, educational links, and answer rationales. Questions are developed by a group of oncology experts in multiple tumor topic areas. The self-assessment questions are aligned with the American Board of Internal Medicine (ABIM)’s Medical Oncology blueprints and ASCO’s Medical Oncology In-Training Exam (ITE) blueprints. 

Find more self-assessment questions at ASCO Education. 

Correct answers are listed at the bottom of the page.

Question 1: Breast Cancer

A 60-year-old post-menopausal woman in good health has completed adjuvant chemotherapy for a stage II breast cancer. The cancer was ER+, PR+, and HER2/neu negative. She had a mastectomy as initial therapy. She asks you what she should do next to maximally reduce her risk of recurrence. Which of the following is the most appropriate next step?

1. An aromatase inhibitor for 2 years followed by tamoxifen for 5 years
2. Tamoxifen for 5 years followed by an aromatase inhibitor for 5 years
3. Tamoxifen for 2 years followed by an aromatase inhibitor for 3 years
4. Tamoxifen for 5 to 10 years
5. An aromatase inhibitor for 5 to 10 years

Question 2: Gynecologic Cancer

After having gastrointestinal symptoms for over a year and an unremarkable work-up, a 71-year-old woman undergoes a pelvic ultrasound, which is significant for a left ovarian mass. CT abdomen/pelvis is obtained and reveals left inguinal lymphadenopathy. She is referred to Gynecologic Oncology and undergoes full cytoreductive surgery with left inguinal lymphadenectomy. Pathology is significant for 2.5-cm left ovarian papillary serous carcinoma, implants on the left fallopian tube, one left pelvic lymph node and two left inguinal lymph nodes. What is the stage of the patient’s ovarian cancer?

1. II
2. I
3. IV
4. III

Question 1 Rationale and References

Correct Answer: E. An aromatase inhibitor for 5 to 10 years

Rationale: Since the patient is post-menopausal she should start with an aromatase inhibitor. The recommended duration of 5 versus 10 years is currently controversial because the evidence is mixed with positive and negative trials. Tamoxifen is recommended as the first- line endocrine therapy for pre-menopausal breast cancer.

References:

• Burstein HJ, Temin S, Anderson H, et al. J Clin Oncol. 2014;32;2255-2269.
• Goss PE, Ingle JN, Pritchard KI, et al. N Engl J Med. 2016;37;3.

Question 2 Rationale and References

Correct Answer: C. IV

Rationale: Positive inguinal lymph node is considered stage IV.

Reference:

• Prat J, FIGO Committee on Gynecologic Oncology. J Gynaecol Obstet. 2014;124:1.

Originally published March 2019; reviewed and updated October 2021.