Clinical Oncology – Previous Examination Papers
2. List the types of surgical procedures and interventions used in the palliative setting for patients with cancer.
Give specific examples of each type including their expected outcome.
3. Health related Quality of Life (QOL) is an aspect of patient care that has received increasing attention in
recent years.
a) How does the concept of QOL relate to the management of patients with cancer?
b) What is the value of the QOL concept?
c) What difficulties are associated with QOL assessment in clinical trials and practice?
4. With regard to the use of cytotoxic chemotherapy in the treatment of carcinoma of the breast in the
neoadjuvant, adjuvant and palliative settings:
a) Discuss the evidence and rationale for treatment.
b) What are the commonly used regimens?
c) What are the expected outcomes?
5. Your advice has been sought to set up a multidisciplinary breast cancer clinic. What factors would you
consider in making your recommendations?
6. a) Discuss the justification for following up cancer patients after treatment.
b) Describe the ways in which follow up is carried out, giving examples and their intended outcomes.
August 2006
1.
Write notes on the systemic therapy options for the following clinical situations:
a. Hormone refractory metastatic prostate cancer
b. Metastatic renal cell carcinoma
2.
A 35 year old woman is diagnosed as having nodular sclerosing Hodgkin’s lymphoma involving the
mediastinum and left supraclavicular fossa (Stage IIA). A decision is made to treat her with 4 courses of
ABVD (Adriamycin, Bleomycin, Vinblastine and Dacarbazine) chemotherapy and involved field
radiotherapy (36 Gy in 20 fractions).
a. Describe the carcinogenic effects of the proposed treatment.
b. What information and advice would you provide to the patient regarding her risk of second cancers?
3.
Discuss the application of multimodality image fusion in radiotherapy treatment planning. Give
examples which demonstrate how image fusion has influenced conventional CT-based planning.
4.
A 62 year old man with a T4N3M0 squamous cell carcinoma of the oropharynx is to receive a radical
course of concurrent cisplatin based chemo-radiotherapy to a dose of 70 Gy in 35 fractions over 7
weeks.
Discuss the steps that you would put in place to reduce his risk of hospitalisation and major (RTOG
Grade 3 & 4) acute and late toxicities.
5.
A 27 year old single man presented with a 3cm right groin node. Biopsy confirmed follicular lymphoma
grade 2. Staging revealed involved external pelvic nodes, but was otherwise clear. The patient had a
left orchidectomy for undescended testis as a child, but had a normal right testis in situ in the scrotum.
He is planning to marry in the near future, and maintaining fertility is a major concern for him and his
partner.
His management is now being discussed by the multidisciplinary team, and you are asked for your
opinion.
a. Briefly describe his management options, with a detailed discussion of the fertility issues associated
with each.
b. What treatment recommendations and justification would you give to the multidisciplinary team?
c. How would you discuss your recommendations to the patient and his partner?
6.
You have been asked to lead a national committee to produce guidelines on the management of a
particular cancer.
Describe how you would proceed and the information that should be included in the guidelines
document.
February 2006
1.
Discuss your approach to facilitating a successful consultation with a new patient referred to you with a
confirmed diagnosis of cancer. How you would deal with a patient who has a distressed response to their
diagnosis such as anger, anxiety or depression?
2.
Discuss how you would manage a patient who presents with advanced non-curable malignancy and sub-
acute bowel obstruction.
3.
Outline how you would set up a radiotherapy department clinical cancer database. Discuss the data you
would collect and the practicalities of collecting it. What are the implications of implementing such a
database and how would you use the data?
4.
Discuss the symptoms and signs of spinal cord compression. Write short notes relevant to the
management of spinal cord compression for the following scenarios:
a. A man with known primary prostate cancer.
b. A previously irradiated patient with infield progression.
c. A patient with no prior history of malignancy.
