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ABPTS Oncology study materials
ABPTS Oncology study resources

ABPTS Oncology practice questions

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Question 1Patient/Client Assessment and Diagnosis

A patient reports a new firm, fixed, painless mass in the axilla after breast cancer treatment. Which finding most strongly raises suspicion for metastatic disease rather than a benign reactive lymph node?

  1. Fluctuation in size over days
  2. Mobility of the node
  3. Firmness and fixation to surrounding tissue Correct answer.
  4. Tenderness with palpation

Explanation

Malignant lymph nodes are characteristically hard, matted, and fixed because tumor infiltration and extracapsular spread tether them to adjacent structures. Tenderness and rapid fluctuation more often reflect inflammation or infection. Mobility suggests a reactive or benign process.

Question 2Patient/Client Assessment and Diagnosis

During initial oncology assessment, which element of the history most directly informs prognosis and treatment selection for a solid tumor?

  1. Dietary preferences
  2. Family history of hypertension
  3. Tumor stage at diagnosis Correct answer.
  4. Marital status

Explanation

Stage at diagnosis captures tumor size, nodal involvement, and metastasis and is a primary determinant of prognosis and treatment approach. The other items are relevant to general health but do not define tumor burden.

Question 3Patient/Client Assessment and Diagnosis

Which finding on physical examination is most consistent with superior vena cava syndrome in a patient with lung cancer?

  1. Unilateral leg swelling with calf tenderness
  2. Facial and upper extremity edema with distended neck veins Correct answer.
  3. Painless jaundice with hepatomegaly
  4. Bilateral basilar crackles with orthopnea

Explanation

Obstruction of the superior vena cava impairs venous return from the head and upper extremities, producing facial and arm swelling and distended neck veins. Leg swelling suggests deep vein thrombosis or heart failure, and the other findings reflect different organ involvement.

Question 4Patient/Client Assessment and Diagnosis

A patient with breast cancer has a sentinel lymph node biopsy. Which statement best describes the purpose of this procedure?

  1. It measures tumor hormone receptor status
  2. It removes all axillary nodes for definitive staging
  3. It identifies the first draining node to assess for regional spread Correct answer.
  4. It determines the tumor's histologic grade

Explanation

Sentinel node biopsy samples the first node(s) in the lymphatic drainage pathway to detect early regional metastasis while sparing unnecessary full dissection. Receptor status and grade come from tumor tissue analysis, not nodal sampling.

Question 5Patient/Client Assessment and Diagnosis

Which laboratory value is most useful for monitoring tumor burden in a patient with metastatic colorectal cancer?

  1. Serum amylase
  2. Prostate-specific antigen (PSA)
  3. Carcinoembryonic antigen (CEA) Correct answer.
  4. Serum creatinine

Explanation

CEA is a tumor marker commonly used to track disease burden and response in colorectal cancer. PSA is specific to prostate tissue, amylase reflects pancreatic disease, and creatinine reflects renal function.

Question 6Patient/Client Assessment and Diagnosis

Which symptom reported by a patient with advanced cancer most strongly suggests hypercalcemia of malignancy?

  1. Polyuria, constipation, and confusion Correct answer.
  2. Productive cough and hemoptysis
  3. Dysphagia with odynophagia
  4. Pruritus with jaundice

Explanation

Hypercalcemia classically produces polyuria, constipation, confusion, and lethargy. Hemoptysis suggests pulmonary involvement, dysphagia suggests esophageal disease, and pruritus with jaundice suggests biliary obstruction.

Question 7Patient/Client Assessment and Diagnosis

Which imaging modality is most appropriate for initial evaluation of a suspected bone metastasis in a patient with prostate cancer?

  1. Magnetic resonance imaging of the whole body
  2. Positron emission tomography with fluorodeoxyglucose
  3. Plain radiograph of the affected region
  4. Technetium-99m bone scan Correct answer.

Explanation

Radionuclide bone scanning is sensitive for detecting osteoblastic skeletal metastases, which are typical of prostate cancer. Plain films are insensitive for early lesions, and FDG-PET is less reliable for sclerotic prostate metastases.

Question 8Patient/Client Assessment and Diagnosis

Which assessment finding best distinguishes cancer-related fatigue from ordinary tiredness?

  1. It occurs only after vigorous exercise
  2. It is disproportionate to activity and persists despite rest Correct answer.
  3. It resolves completely with a single night of rest
  4. It is always accompanied by fever

Explanation

Cancer-related fatigue is persistent, disproportionate to recent activity, and not relieved by rest. Ordinary tiredness typically improves with rest and correlates with exertion.

Question 9Patient/Client Assessment and Diagnosis

A patient with lung cancer reports new right-sided ptosis, miosis, and anhidrosis. Which structure is most likely involved?

  1. Phrenic nerve
  2. Sympathetic chain Correct answer.
  3. Recurrent laryngeal nerve
  4. Brachial plexus

Explanation

This triad constitutes Horner syndrome, caused by interruption of the sympathetic pathway, often by an apical lung tumor. Recurrent laryngeal involvement causes hoarseness, phrenic involvement causes diaphragm elevation, and brachial plexus involvement causes arm pain or weakness.

Question 10Patient/Client Assessment and Diagnosis

Which finding on a complete blood count most directly increases bleeding risk in a patient receiving myelosuppressive chemotherapy?

  1. Platelet count 18,000/µL Correct answer.
  2. Absolute neutrophil count 800/µL
  3. Hemoglobin 9.5 g/dL
  4. White blood cell count 2,000/µL

Explanation

Thrombocytopenia below roughly 20,000/µL markedly increases spontaneous bleeding risk. Low hemoglobin causes anemia, and low white cell or neutrophil counts raise infection risk rather than bleeding risk.

Question 11Patient/Client Assessment and Diagnosis

A patient with known malignancy develops sudden severe back pain, lower extremity weakness, and urinary retention. Which action is most appropriate?

  1. Initiate opioid analgesia and reassess in 24 hours
  2. Obtain urgent MRI of the spine and notify the oncology team Correct answer.
  3. Schedule an outpatient bone scan in one week
  4. Recommend bed rest and physical therapy

Explanation

These findings suggest malignant spinal cord compression, a neurologic emergency requiring urgent imaging and decompression or radiation to preserve function. Delaying evaluation risks irreversible deficit.

Question 12Patient/Client Assessment and Diagnosis

Which finding on breast examination most warrants further evaluation for malignancy?

  1. Bilateral symmetric nodularity
  2. Bilateral diffuse tenderness that varies with menses
  3. A soft, mobile mass that changes with the menstrual cycle
  4. A fixed, irregular mass with skin dimpling Correct answer.

Explanation

A fixed, irregular mass with skin retraction or dimpling raises concern for carcinoma because malignancy invades and tethers surrounding tissue. Cyclic tenderness and symmetric nodularity usually reflect benign fibrocystic change.

Question 13Patient/Client Assessment and Diagnosis

A patient reports progressive dysphagia that began with solids and now includes liquids, along with unintentional weight loss. Which diagnosis should be highest on the differential?

  1. Peptic ulcer disease
  2. Esophageal carcinoma Correct answer.
  3. Achalasia
  4. Gastroesophageal reflux disease

Explanation

Progressive dysphagia from solids to liquids with weight loss is a classic presentation of esophageal malignancy. Achalasia also causes progressive dysphagia but typically lacks prominent weight loss, and reflux and ulcer disease less often cause progressive solid-to-liquid dysphagia.

Question 14Patient/Client Assessment and Diagnosis

Which parameter is most important when assessing a patient's performance status before planned cancer treatment?

  1. Serum potassium level
  2. Visual acuity
  3. Resting heart rate
  4. Degree of independence in activities of daily living Correct answer.

Explanation

Performance status scales such as the ECOG score are based on independence in self-care and daily activities, which predicts treatment tolerance and prognosis. Electrolytes, heart rate, and vision are not components of performance status.

Question 15Patient/Client Assessment and Diagnosis

A patient with lymphoma presents with a rapidly enlarging neck mass, stridor, and facial swelling. Which assessment conclusion is most appropriate?

  1. This suggests a benign reactive lymph node
  2. This suggests a chronic pain syndrome
  3. This suggests an uncomplicated upper respiratory infection
  4. This suggests airway compromise requiring emergent evaluation Correct answer.

Explanation

A rapidly enlarging mass with stridor and facial swelling indicates impending airway and venous compromise, requiring emergent evaluation and airway protection. Benign nodes and infections do not typically produce stridor with facial swelling.

Question 16Patient/Client Assessment and Diagnosis

Which screening test is recommended for early detection of cervical cancer in an average-risk adult?

  1. Colonoscopy
  2. Papanicolaou test with or without HPV testing Correct answer.
  3. Mammography
  4. Serum CA-125

Explanation

Cervical cytology with or without HPV co-testing is the standard screening method for cervical cancer. CA-125 is used in ovarian cancer evaluation, colonoscopy screens the colon, and mammography screens the breast.

Question 17Patient/Client Assessment and Diagnosis

A patient with metastatic cancer reports new-onset confusion and polyuria. Serum calcium is 13.5 mg/dL. Which intervention is the priority?

  1. Restrict oral fluids
  2. Administer intravenous fluids and notify the physician Correct answer.
  3. Encourage a high-calcium diet
  4. Begin a low-sodium diet

Explanation

Severe hypercalcemia causes neurologic and renal symptoms and requires volume repletion with intravenous saline plus physician-directed therapy such as bisphosphonates. High-calcium intake or fluid restriction would worsen the condition.

Question 18Patient/Client Assessment and Diagnosis

Which finding on a patient's medication review most increases concern for chemotherapy-induced peripheral neuropathy?

  1. Recent influenza vaccination
  2. History of platinum-based or taxane chemotherapy Correct answer.
  3. Recent course of oral antibiotics
  4. Use of inhaled bronchodilators

Explanation

Platinum agents and taxanes are well-recognized causes of peripheral neuropathy, producing stocking-glove sensory loss and gait changes. Antibiotics, bronchodilators, and vaccination are not typical culprits.

Question 19Patient/Client Assessment and Diagnosis

A patient with pancreatic cancer develops new jaundice, pale stools, and dark urine. Which finding best explains this presentation?

  1. Hemolytic anemia
  2. Biliary obstruction Correct answer.
  3. Renal failure
  4. Hypercalcemia

Explanation

Obstructive jaundice from a pancreatic head tumor blocks bile flow, producing jaundice, pale stools, and dark urine from conjugated bilirubin. Hemolysis causes jaundice with dark stools, and renal or calcium disorders do not produce this pattern.

Question 20Patient/Client Assessment and Diagnosis

Which finding on assessment most suggests lymphedema rather than deep vein thrombosis in an arm previously treated for breast cancer?

  1. Abrupt onset with erythema and warmth
  2. Unilateral calf tenderness
  3. Sudden dyspnea
  4. Gradual onset with pitting and Stemmer sign Correct answer.

Explanation

Lymphedema develops gradually, is often pitting early, and shows a positive Stemmer sign (inability to pinch the skin at the base of the digits). Acute erythema, warmth, calf tenderness, and sudden dyspnea suggest thrombosis or embolism.

Question 21Patient/Client Assessment and Diagnosis

A patient with a known brain tumor develops a new generalized seizure. Which initial assessment priority applies?

  1. Airway protection and safety during the postictal period Correct answer.
  2. Scheduling an outpatient electroencephalogram in one month
  3. Referral for routine vision screening
  4. Immediate ambulation to assess gait

Explanation

New seizures in a patient with a brain tumor require airway protection, injury prevention, and postictal monitoring. Immediate ambulation is unsafe during or after a seizure, and routine or delayed referrals do not address acute risk.

Question 22Patient/Client Assessment and Diagnosis

A patient with colon cancer has a carcinoembryonic antigen level that rises steadily over three months despite stable imaging. Which interpretation is most appropriate?

  1. CEA exclusively reflects liver function
  2. A rising CEA may indicate progression warranting further evaluation Correct answer.
  3. CEA is diagnostic of infection
  4. The rise is clinically insignificant

Explanation

A steadily rising CEA in colorectal cancer can signal disease progression or recurrence even before imaging changes and warrants further investigation. CEA is not a marker of infection or liver function alone.

Question 23Patient/Client Assessment and Diagnosis

A patient with multiple myeloma reports new mid-back pain and is found to have a compression deformity on imaging. Which pathophysiologic mechanism best explains this finding?

  1. Septic discitis
  2. Metastatic calcification of the vertebrae
  3. Osteoblastic bone formation
  4. Osteoclastic bone destruction with lytic lesions Correct answer.

Explanation

Myeloma activates osteoclasts and suppresses osteoblasts, producing lytic lesions and vertebral compression fractures. Osteoblastic lesions are characteristic of prostate cancer, and infection or calcification do not fit the myeloma picture.

Question 24Patient/Client Assessment and Diagnosis

A patient receiving chemotherapy has a temperature of 38.5°C and an absolute neutrophil count of 400/µL. Which conclusion is most appropriate?

  1. This reflects hypercalcemia
  2. This indicates a benign viral illness
  3. This is expected and requires no action
  4. This represents febrile neutropenia requiring urgent evaluation Correct answer.

Explanation

Fever with severe neutropenia defines febrile neutropenia, a medical emergency requiring urgent cultures and empiric antibiotics. It is not benign or expected, and fever is not a manifestation of hypercalcemia.

Question 25Patient/Client Assessment and Diagnosis

A patient with head and neck cancer treated with radiation develops trismus and reduced cervical range of motion. Which assessment approach best guides rehabilitation planning?

  1. Rely solely on the patient's subjective report
  2. Defer all measurement until one year after treatment
  3. Measure maximal mouth opening and cervical range with goniometry Correct answer.
  4. Assess only resting heart rate

Explanation

Objective measurement of mouth opening and cervical range quantifies impairment and establishes a baseline for tracking rehabilitation progress. Vital signs alone are insufficient, subjective report lacks precision, and deferring measurement delays intervention.

Question 26Patient/Client Assessment and Diagnosis

A patient with metastatic breast cancer reports new-onset headache, nausea, and vomiting that is worse in the morning. Which assessment finding would most increase suspicion for increased intracranial pressure?

  1. Decreased deep tendon reflexes
  2. Jaundice of the sclera
  3. Bilateral pedal edema
  4. Papilledema on fundoscopic examination Correct answer.

Explanation

Papilledema is a sign of increased intracranial pressure due to optic nerve sheath swelling. Morning headache with nausea and vomiting also suggests elevated ICP. Other findings are unrelated to intracranial pathology.

Question 27Patient/Client Assessment and Diagnosis

A patient with lung cancer presents with facial swelling, distended neck veins, and shortness of breath. Which assessment finding is most consistent with superior vena cava syndrome?

  1. Collateral venous circulation over the chest Correct answer.
  2. Pleural effusion on chest radiograph
  3. Wheezing on auscultation
  4. Unilateral leg swelling

Explanation

Superior vena cava syndrome causes venous congestion, leading to collateral veins over the chest and neck. Facial swelling and distended neck veins are classic. Pleural effusion, leg swelling, and wheezing are not primary features.

Question 28Patient/Client Assessment and Diagnosis

A patient with prostate cancer reports new-onset urinary incontinence and saddle anesthesia. Which additional assessment finding is most concerning for cauda equina syndrome?

  1. Hyperreflexia of the lower extremities
  2. Decreased vibratory sense in the toes
  3. Unilateral knee pain
  4. Loss of anal sphincter tone Correct answer.

Explanation

Cauda equina syndrome is a surgical emergency characterized by saddle anesthesia, bowel/bladder dysfunction, and loss of anal sphincter tone. Hyperreflexia suggests upper motor neuron lesions, while knee pain and vibratory loss are nonspecific.

Question 29Patient/Client Assessment and Diagnosis

A patient with lymphoma presents with bone pain, fatigue, and a serum calcium level of 12.8 mg/dL. Which additional laboratory finding is most consistent with hypercalcemia of malignancy?

  1. Elevated serum phosphate
  2. Suppressed parathyroid hormone (PTH) Correct answer.
  3. Elevated parathyroid hormone (PTH)
  4. Low alkaline phosphatase

Explanation

Hypercalcemia of malignancy is often mediated by PTHrP, which suppresses endogenous PTH. Elevated PTH suggests primary hyperparathyroidism. Phosphate is typically normal or low, and alkaline phosphatase may be elevated with bone involvement.

Question 30Patient/Client Assessment and Diagnosis

A patient with pancreatic cancer develops new ascites and early satiety. Which assessment parameter best indicates the need for palliative paracentesis?

  1. Serum albumin level
  2. Abdominal girth and respiratory comfort Correct answer.
  3. Liver enzyme levels
  4. Body mass index

Explanation

Paracentesis is indicated for symptomatic ascites causing respiratory compromise or discomfort. Abdominal girth and respiratory status guide timing. Albumin, BMI, and liver enzymes do not directly determine need.

Question 31Patient/Client Assessment and Diagnosis

A patient with breast cancer reports new severe back pain and is found to have a pathologic fracture of the vertebra. Which assessment finding is most important to monitor for potential spinal cord compression?

  1. Lower extremity strength and sensation Correct answer.
  2. Upper extremity strength
  3. Cranial nerve function
  4. Hand grip strength

Explanation

Spinal cord compression from vertebral fracture most commonly affects the lower extremities, causing weakness, sensory changes, and bowel/bladder dysfunction. Upper extremity and cranial nerve function are not typically affected.

Question 32Patient/Client Assessment and Diagnosis

A patient with melanoma is being assessed for suspected brain metastases. Which symptom reported by the patient most strongly suggests intracranial involvement?

  1. Anorexia
  2. Generalized fatigue
  3. Night sweats
  4. New-onset focal seizures Correct answer.

Explanation

Focal seizures suggest cortical irritation from a brain lesion. Fatigue, anorexia, and night sweats are nonspecific and can occur with many conditions.

Question 33Patient/Client Assessment and Diagnosis

A patient with ovarian cancer has a rising CA-125 level but no symptoms. Which assessment principle best guides the interpretation of this tumor marker?

  1. CA-125 levels correlate perfectly with tumor burden
  2. CA-125 lacks specificity and can be elevated in benign conditions Correct answer.
  3. CA-125 is only useful in postmenopausal women
  4. CA-125 is a screening test for ovarian cancer

Explanation

CA-125 can be elevated in many benign conditions (e.g., endometriosis, cirrhosis) and is not a reliable screening test. It is most useful for monitoring disease recurrence or treatment response. Levels do not always correlate perfectly with tumor burden.

Question 34Patient/Client Assessment and Diagnosis

A patient with colon cancer has a carcinoembryonic antigen (CEA) level that rises steadily over three months despite stable imaging. Which action is most appropriate?

  1. Refer for genetic counseling
  2. Immediately start chemotherapy
  3. Repeat imaging and consider further evaluation for occult recurrence Correct answer.
  4. Ignore the trend as CEA is nonspecific

Explanation

A rising CEA trend can indicate recurrence before imaging changes. Further evaluation with imaging (e.g., PET-CT) is warranted. CEA is not specific enough to start chemotherapy without confirmation, and genetic counseling is unrelated.

Question 35Patient/Client Assessment and Diagnosis

A patient with multiple myeloma reports new mid-back pain and is found to have a compression deformity on imaging. Which assessment finding is most important to monitor for potential spinal cord compression?

  1. Hand grip strength
  2. Lower extremity strength and sensation Correct answer.
  3. Cranial nerve function
  4. Upper extremity strength

Explanation

Spinal cord compression from vertebral fracture most commonly affects the lower extremities, causing weakness, sensory changes, and bowel/bladder dysfunction. Upper extremity and cranial nerve function are not typically affected.

Question 36Patient/Client Assessment and Diagnosis

A patient with head and neck cancer treated with radiation develops trismus and reduced cervical range of motion. Which assessment tool is most appropriate to quantify these impairments?

  1. Timed up and go test
  2. Manual muscle testing of the upper extremities
  3. Six-minute walk test
  4. Goniometric measurement of mouth opening and cervical range of motion Correct answer.

Explanation

Trismus is measured by maximal interincisal opening using a ruler or goniometer, and cervical range of motion by goniometry. Other tests assess general mobility or strength, not specifically jaw and neck motion.

Question 37Patient/Client Assessment and Diagnosis

A patient with cancer reports new-onset confusion and polyuria. Serum calcium is 13.5 mg/dL. Which intervention is most appropriate initially?

  1. Intravenous fluids with normal saline Correct answer.
  2. Restriction of fluid intake
  3. Oral calcium supplements
  4. Thiazide diuretics

Explanation

Hypercalcemia is treated initially with aggressive intravenous hydration to promote renal calcium excretion. Calcium supplements and thiazides worsen hypercalcemia, and fluid restriction is contraindicated.

Question 38Patient/Client Assessment and Diagnosis

A patient with breast cancer has a new firm, immobile mass in the contralateral breast. Which finding on physical examination most suggests malignancy?

  1. Bilateral symmetry
  2. Mobility of the mass
  3. Irregular, stony-hard consistency Correct answer.
  4. Pain on palpation

Explanation

Malignant breast masses are typically hard, irregular, and fixed. Mobility and symmetry suggest benign conditions, and pain is not a reliable indicator.

Question 39Patient/Client Assessment and Diagnosis

A patient with lung cancer develops new hoarseness. Which structure is most likely affected by the tumor?

  1. Sympathetic chain
  2. Brachial plexus
  3. Recurrent laryngeal nerve Correct answer.
  4. Phrenic nerve

Explanation

Hoarseness from vocal cord paralysis is caused by recurrent laryngeal nerve involvement, often from mediastinal tumor invasion. Phrenic nerve causes diaphragmatic paralysis, sympathetic chain causes Horner's syndrome, and brachial plexus causes arm weakness.

Question 40Patient/Client Assessment and Diagnosis

A patient with cancer reports severe fatigue that is not relieved by rest and interferes with daily activities. Which assessment finding best distinguishes cancer-related fatigue from depression?

  1. Weight gain
  2. Lack of sadness or guilt Correct answer.
  3. Presence of anhedonia
  4. Insomnia

Explanation

Cancer-related fatigue is typically not accompanied by feelings of sadness or guilt, which are hallmarks of depression. Anhedonia, weight changes, and insomnia can occur in both conditions.

Question 41Prognosis, Risk Factors, and Prevention

Which histologic feature of a primary breast carcinoma is most strongly associated with an increased risk of regional lymph node metastasis?

  1. Apocrine metaplasia
  2. Sclerosing adenosis
  3. Lymphovascular invasion Correct answer.
  4. Fibrocystic change

Explanation

Lymphovascular invasion indicates tumor cells entering lymphatic or vascular channels and is a recognized predictor of nodal involvement and recurrence risk in breast cancer. Benign proliferative and metaplastic changes do not carry this prognostic implication.

Question 42Prognosis, Risk Factors, and Prevention

A patient with colorectal cancer has a tumor showing high-frequency microsatellite instability (MSI-H). Compared with microsatellite-stable tumors of similar stage, MSI-H tumors generally carry which prognosis?

  1. A worse prognosis confined to stage I disease
  2. A more favorable stage-adjusted prognosis Correct answer.
  3. A prognosis determined solely by tumor grade
  4. An identical prognosis at every stage

Explanation

MSI-H colorectal carcinomas, often arising via the mismatch repair pathway, are associated with a better stage-for-stage outcome than microsatellite-stable tumors. This association is independent of grade and is not limited to early-stage disease.

Question 43Prognosis, Risk Factors, and Prevention

Which inherited syndrome carries the highest lifetime risk of colorectal and endometrial carcinoma due to germline mismatch repair gene mutations?

  1. Lynch syndrome Correct answer.
  2. Familial adenomatous polyposis
  3. Li-Fraumeni syndrome
  4. Peutz-Jeghers syndrome

Explanation

Lynch syndrome results from germline mutations in mismatch repair genes (such as MLH1, MSH2, MSH6, PMS2) and confers high lifetime risks of colorectal and endometrial cancer. The other syndromes involve different genes and tumor spectra.

Question 44Prognosis, Risk Factors, and Prevention

Which environmental exposure is the strongest established risk factor for developing malignant mesothelioma?

  1. Asbestos exposure Correct answer.
  2. High dietary fat intake
  3. Chronic hepatitis B infection
  4. Tobacco smoking alone

Explanation

Asbestos exposure is the principal established cause of malignant mesothelioma, with risk related to cumulative exposure and fiber type. Smoking and diet are not primary causes of mesothelioma.

Question 45Prognosis, Risk Factors, and Prevention

Which of the following is a recognized modifiable risk factor for the development of type 2 endometrial carcinoma?

  1. Early menarche alone
  2. Nulliparity alone
  3. Obesity Correct answer.
  4. Low body mass index

Explanation

Obesity, through excess peripheral estrogen production and metabolic effects, is a major modifiable risk factor for endometrial carcinoma, particularly the type 1 estrogen-driven pathway. Low BMI is protective rather than a risk factor.

Question 46Prognosis, Risk Factors, and Prevention

A 55-year-old with a 30 pack-year smoking history asks about lung cancer risk reduction. Which statement best reflects current evidence?

  1. Risk returns to that of a never-smoker within one year of quitting
  2. Pack-years no longer matter once symptoms are absent
  3. Smoking cessation lowers subsequent lung cancer risk relative to continued smoking Correct answer.
  4. Screening eliminates the need for cessation

Explanation

Smoking cessation reduces lung cancer risk compared with continued smoking, although risk does not fully return to never-smoker levels. Screening complements but does not replace cessation.

Question 47Prognosis, Risk Factors, and Prevention

Infection with which virus is most strongly associated with the development of hepatocellular carcinoma?

  1. Cytomegalovirus
  2. Hepatitis C virus Correct answer.
  3. Epstein-Barr virus
  4. Human papillomavirus

Explanation

Chronic hepatitis C infection, like chronic hepatitis B, is a major cause of cirrhosis and hepatocellular carcinoma. The other viruses are associated with different malignancies.

Question 48Prognosis, Risk Factors, and Prevention

Which tumor marker is most useful for monitoring disease burden in a patient with a known germ cell tumor?

  1. Carcinoembryonic antigen
  2. CA 19-9
  3. Alpha-fetoprotein Correct answer.
  4. CA 125

Explanation

Alpha-fetoprotein, along with beta-hCG and LDH, is a standard serum marker for germ cell tumors and correlates with disease burden and response. CA 19-9, CA 125, and CEA are used for other tumor types.

Question 49Prognosis, Risk Factors, and Prevention

Which of the following best describes the relationship between tumor stage at diagnosis and prognosis for most solid tumors?

  1. Higher stage at diagnosis generally predicts shorter survival Correct answer.
  2. Lower stage predicts worse survival
  3. Stage predicts survival only in hematologic malignancies
  4. Stage has no consistent relationship with survival

Explanation

For most solid tumors, more advanced stage at diagnosis is associated with worse prognosis because of greater tumor burden and metastatic spread. Stage is a core prognostic factor across solid and hematologic malignancies.

Question 50Prognosis, Risk Factors, and Prevention

A patient with early-stage breast cancer is found to have a tumor that overexpresses HER2. Before the advent of HER2-targeted therapy, this feature was associated with which prognostic pattern?

  1. No effect on recurrence risk
  2. Protection against distant metastasis
  3. Improved prognosis independent of treatment
  4. Poorer prognosis with more aggressive behavior Correct answer.

Explanation

HER2 overexpression historically marked a more aggressive phenotype with higher recurrence and mortality risk. This prognostic effect is substantially modified by HER2-targeted therapy, which is why receptor status guides treatment.