Clinical Oncology – Previous Examination Papers 

has been referred to you for further management. 

a) 

What investigations would you recommend for this patient? 
 
 

b) 

Histopathology review confirmed a diagnosis of poorly differentiated carcinoma (non-small cell) and 
investigations failed to identify a primary site. Staging investigations confirmed nodal disease in his left 
axilla and supraclavicular fossa, but no evidence of disease elsewhere. 
What would be your recommended management plan for this patient? 

FEBRUARY 2009 

Question 1

a) 

Describe the potential endocrine and metabolic side effects of cancer treatment in adults, giving 
examples. 
 

b) 

How would you prevent and manage these effects in a man with prostate cancer on long-term androgen 
deprivation therapy? 

Question 2

A previously well 54 year old woman presents with weakness in her right leg. She has no other symptoms and 
has not lost weight. An MRI scan demonstrates 8 cerebral metastases, measuring up to 3cm in size. A CT scan 
of the chest reveals a 3cm primary lesion in the left lower lobe. An FNA of the lung lesion shows non-small cell 
lung cancer. The cerebral lesions are not considered operable or suitable for stereotactic radiation therapy. 
 
a) 

Describe your approach to the further investigation of this patient. 

 
b) 

 
What is her prognosis and how would you convey this information to her? 

 
c) 

 Discuss the factors that impact on the decision to treat a patient with cerebral metastases    with radiation 
therapy. 

 
This woman is taking dexamethasone, 4mg every 6 hours, at the start of her radiation therapy.  
 
d) 

 
 How would you manage this medication in this woman? Justify your answer. 

 
Question 3

a) 

Discuss the causes of renal failure in patients with malignancy. 
 

b) 

What factors would you take into consideration in determining the management of renal failure in a 
cancer patient under your care? 

Question 4

A 43 year old woman finds a mass in her left breast. A mammogram shows a spiculated density measuring 2cm 
in the 2 o’clock position in the left breast, 6cm from the nipple. An FNA confirms carcinoma.  
 
a) 

Discuss her treatment options with respect to management of the breast and axilla.  
 

 
A wide local excision is performed showing a 2.1cm, grade 3 infiltrating duct carcinoma with clear margins. The 
tumour is ER and PR negative, and HER-2 positive. One of 27 lymph nodes contains cancer. A decision is 
made in the multidisciplinary team meeting to treat her with anthracycline-based chemotherapy and Herceptin. 
 
b) 

Discuss the issues associated with sequencing adjuvant therapies (both locoregional and systemic) in 
relation to this patient. Include in your answer potential interactions between treatments. 

 
Question 5

A 35 year old pregnant woman presents at 28 weeks gestation with vaginal bleeding. Investigations reveal an 
invasive squamous cell carcinoma of the cervix.