Devita, Hellman, and Rosenberg's Cancer

LWBK1006-20 LWW-Govindan-Review December 12, 2011 19:4

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

Question 20.5.13.A 49-year-old woman noted rectal bleeding for 2 months. She denied

any pain, diarrhea, constipation, or weight loss. A colonoscopy was done

that revealed a 2-cm low-lying mass 1 cm from the anal verge. A tran-

srectal ultrasound revealed no lymph nodes. Biopsy confirmed basaloid

squamous cell carcinoma. CT scans of the abdomen and pelvis did not

reveal any metastatic disease. The BEST curative treatment option for

this patient is:

A. APR

B. Short-course (25 Gy/5 fractions) radiation followed by APR

C. Neoadjuvant chemoradiation with 5FU followed by APR

D. Chemoradiation alone with 5FU and mitomycin

Question 20.5.14.A 58-year-old man presented with a 6-month history of anorexia, fatigue,

and a vague right-sided abdominal discomfort. His physical examina-

tion was unremarkable except for mild pallor. Initial laboratory test

revealed a hemoglobin level of 10.7 g/dL with a mean corpuscular vol-

ume of 73. He also had mildly elevated alkaline phosphatase and hepatic

transaminases. Colonoscopy revealed a nonobstructing transverse colon

mass. Biopsy demonstrated moderately differentiated adenocarcinoma.

CT scan revealed a 3-cm lesion in the left lobe of the liver and two other

lesions measuring 1.5 to 2 cm in the right lobe of the liver. Positron emis-

sion tomography revealed uptake in the transverse colon and all three

known hepatic lesions. Among the following options, what would be the

best option for this patient based on current studies?

A. Curative-intent resection of the transverse colon primary and all three

hepatic lesions followed by active surveillance

B. Palliative-intent frontline chemotherapy with bevacizumab for

metastatic colon cancer until progression, followed by palliative

second-line chemotherapy

C. Curative-intent resection of the transverse colon primary and all three

hepatic lesions with chemotherapy

D. Curative-intent resection of the transverse colon primary and all three

hepatic lesions with radiotherapy

Question 20.5.15.Which of the following statements regarding colorectal cancer is correct?

A. Tumors with MSI may be resistant to treatment with 5FU.

B. Patients with DNA repair defects have poor outcomes with systemic

therapy.

C. High levels of MSI are reported in less than 10% of all colorectal

cancers.

D. MSI is the result of chromosomal instability.

Question 20.5.16.Which genetic change is associated with resistance to treatment with

cetuximab?

A. K-RAS mutation

B. EGFR over expression

C. K-RAS wild type

D. MLH1 inactivation