6 Cancer Prevention

Lingling Du, Richard Chen, Daniel Morgensztern, and Rebecca Aft

QUESTIONS

Each of the numbered items below is followed by lettered answers. Select the ONE lettered answer that is BEST in each case unless instructed otherwise.

Question 6.1 Which of the following statements regarding nicotine replacement therapy (NRT) is TRUE?

A. NRT increases the odds of quitting smoking compared to placebo.

B. NRT is associated with increased risk of carcinogenesis in the general population.

C. a and b

D. None of the above

Question 6.2 Which of the following statement is TRUE?

A. Continued smoking after the diagnosis of localized prostate cancer does not increase the risk of recurrence.

B. The adverse effect of smoking is not acutely reversible. Therefore smoking cessation is not recommended before surgical resection for esophageal cancer.

C. Current smoking does not increase the risk of postoperative death in lung cancer patients undergoing surgery.

D. Current smoking increases the toxicities associated with radiotherapy in patients with head and neck cancer.

Question 6.3 Varenicline (Chantix) is associated with which of the following side effects?

A. Hypertension

B. Anorexia

C. Suicidal ideation

D. Elevated liver enzymes

Question 6.4 Which of the following is recommended as second-line pharmacotherapy for tobacco dependence?

A. Clonidine

B. Nortriptyline

C. Both a and b

D. None of the above

Question 6.5 Which of the following neoplasias is an intraepithelial marker for invasive cancer?

A. Cervical ectropion

B. Junctional nevus

C. Seborrheic keratosis

D. Leukoplakia

Question 6.6 In clinical trials, systemic retinoids and beta carotene were shown to reduce cancer incidence in this group of high-risk individuals

A. Skin cancer in patients with xeroderma pigmentosum

B. Lung cancer in heavy smokers

C. Cervical cancer in patients with cervical dysplasia

D. Colorectal cancer in patients with adenoma

Question 6.7 Which of the following was associated with selenium supplementation in randomized clinical trials?

A. Decreased risk of squamous cell skin cancer

B. Reduced incidence of prostate cancer

C. Increased incidence of nonmelanoma skin cancer

D. Increased risk of prostate cancer

Question 6.8 Which of the following statements is/are TRUE regarding calcium and vitamin D?

A. Calcium reduces the risk of recurrent colorectal adenoma.

B. The combination of vitamin D and calcium decreased the risk of developing colon cancer in postmenopausal women in the Women’s Health Initiative (WHI) trial.

C. The combination of vitamin D and calcium reduced the risk of breast cancer in postmenopausal women in the WHI trial.

D. High serum level of vitamin D is associated with decreased risk of pancreatic cancer.

Question 6.9 Which of the statements is/are TRUE regarding nonsteroidal anti-inflammatory drugs (NSAIDs) in the prevention of colorectal cancer?

A. Chemopreventive effects of low-dose aspirin on colorectal cancer development were demonstrated in clinical trials, and its overall benefits outweigh the risks in adults at average risks of developing colorectal cancer.

B. High-dose sulindac prevents the development of new polyps, although it does not cause the regression of established polyps.

C. In randomized trials, both rofecoxib and celecoxib were shown to reduce the risk of metachronous colorectal adenomas and colorectal cancer.

D. Considering the risks associated with these agents, screening strategy alone is recommended in average-risk adults.

Question 6.10 Which of the statement is TRUE regarding tamoxifen and raloxifene?

A. Tamoxifen reduces the risk of ER-negative breast cancer.

B. Raloxifene reduces breast cancer-specific mortality rates.

C. Tamoxifen is more effective than raloxifene in reducing breast cancer incidence.

D. Both tamoxifen and raloxifene decrease the risk of in situ breast neoplasms.

Question 6.11 The risk of which of the following toxicities is increased in patients treated with raloxifene?

A. Endometrial cancer

B. Vertebral fracture

C. Stroke

D. Coronary artery heart disease

Question 6.12 Which of the following statement is TRUE regarding the role of 5-alpha-steroid reductase inhibitors in preventing prostate cancer?

A. Finasteride does not reduce the incidence of prostate cancer.

B. Patients treated with finasteride or dutasteride who develop prostate cancer are more likely to have tumors of a high Gleason score compared to patients treated with placebo.

C. Finasteride decreases the survival after prostate cancer diagnosis compared to placebo.

D. Dutasteride increases the risk of prostate cancer.

Question 6.13 Which of the following is TRUE regarding statins?

A. Simvastatin was shown to decrease the overall cancer risk in several large randomized trials.

B. Statins reduces the risk of breast cancer and colon cancer in randomized studies.

C. Both a and b.

D. None of the above.

Question 6.14 Which of the following is TRUE?

A. Bisphosphonates reduces the risk of recurrent breast cancer in postmenopausal women with breast cancer.

B. Metformin decreases the risk of invasive breast cancer in patients with type 2 diabetes mellitus in large randomized studies.

C. Both a and b.

D. None of the above.

Question 6.15 Which of the following is TRUE regarding diet-derived natural products?

A. There have been no large prospective trials demonstrating the efficacy of natural products in reducing cancer risk.

B. Berry formulations reduce esophageal dysplasia and oral leukoplakia in phase II studies.

C. Both a and b.

D. None of the above.

Question 6.16 Helicobacter pylori infection is associated with increased risk of which of the following?

A. Esophageal adenocarcinoma

B. Gastric cardia carcinoma

C. Esophageal squamous cell carcinoma

D. Intestinal-type gastric adenocarcinoma

Question 6.17 In performing risk-reducing salpingo-oophorectomy for high-risk patients:

A. An open approach is required to perform an en-bloc resection of ovaries, uterus, and nearby pelvic lymph nodes.

B. BRCA mutation confers a high risk of uterine cancer.

C. Patients may be subsequently protected from all breast cancers.

D. Patients with Lynch syndrome should undergo simultaneous hysterectomy.

Question 6.18 In patients with medullary thyroid carcinoma (MTC), which of the following preoperative basal calcitonin levels is an indication for ipsilateral central and lateral neck dissection?

A. 15 to 20 pg/mL

B. 20 to 50 pg/mL

C. 50 to 200 pg/mL

D. 200 to 500 pg/mL

Question 6.19 What is TRUE regarding the risk of endometrial cancer for patients with Lynch syndrome?

A. The risk for women with Lynch syndrome varies from 20% to 60% and is higher than development of ovarian cancer.

B. Clinically, these cancers are frequently poorly differentiated, present at an advanced stage, and associated with poor prognosis.

C. Risk reducing hysterectomy should be performed shortly after menarche.

D. Estrogen replacement is contraindicated in women with Lynch syndrome undergoing bilateral salpingo-oophorectomy.

Question 6.20 What is the best treatment of a patient with FAP presenting with approximately 300 colorectal polyps and 15 rectal adenomas?

A. Observation

B. Total proctocolectomy with permanent ileostomy (TPC)

C. Proctocolectomy with ileal pouch-anal anastomosis (IPAA)

D. Total colectomy with ileorectal anastomosis (IRA)

Question 6.21 Which of the following malignancies are associated with germ line mutations in the RET protooncogene?

A. Multiple endocrine neoplasia (MEN) 2A

B. MEN 2B

C. Sporadic medullary thyroid carcinoma

D. All the above

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