Devita, Hellman, and Rosenberg's Cancer

LWBK1006-21 LWW-Govindan-Review December 12, 2011 19:6

280 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

Question 21.3. A 55-year-old woman undergoes partial nephrectomy for clear cell car-

cinoma of the kidney, Fuhrman grade IV. The patient does well for

10 years, at which time she develops a pathologic intratrochanteric frac-

ture of her left hip. CT scanning of the chest, abdomen, pelvis, and brain

and bone scan reveals no other sites of disease. The MOST appropriate

next step is:

A. Radiation alone

B. High-dose interleukin-2 alone

C. Orthopedic resection of the tumor with reconstruction followed by

radiation

D. Temsirolimus

Questions

21.4.–21.5.

A 76-year-old man with chronic obstructive pulmonary disorder

and diabetes mellitus presents with back pain and confusion. Workup

reveals extensive metastatic disease in the lungs, bones, and liver and a

6-cm tumor in the kidney. There is no evidence of cord compression.

Laboratory studies reveal a calcium of 11.5 mg/dL and a creatinine of

2.0 mg/dL. After hydration and zoledronate, his calcium normalizes,

hemoglobin is 9.5, creatinine decreases to 1.7, and Eastern Cooperative

Oncology Group performance status is 2.

Question 21.4. The poor-risk features present in this patient include all, EXCEPT:

A. His age of>75 years

B. Hypercalcemia

C. Performance status of 2

D. Anemia

Question 21.5. The LEAST appropriate therapy in this case is:

A. Interferon-

B. Temsirolimus

C. Sunitinib

D. Sorafenib

Question 21.6. A 25-year-old Caucasian man without a medical history presents with

hematuria. Workup reveals bilateral renal cysts, at least one of them sus-

picious for malignancy. Family history is significant for a pheochromo-

cytoma in his father and a pancreatic islet cell tumor and early death

from kidney cancer in a paternal aunt. The MOST likely familial cancer

syndrome is:

A. Von Hippel-Lindau disease

B. Birt-Hogg-Dube syndrome

C. Hereditary papillary renal cancer

D. Hereditary leiomyomatosis and renal cancer