Williams Gynecology, Second Edition (Schorge,Williams Gynecology), 2nd Edition

CHAPTER 27
Principles of Chemotherapy

27–1. Compared with normal cells within the same tissue, tumor cells have which characteristic that leaves them more vulnerable to chemotherapy?

a. Greater cell membrane permeability

b. Faster completion of the cell cycle

c. Slower completion of the cell cycle

d. A greater percentage of cells progressing through the cell cycle

27–2. Cells in which phase of the cell cycle are LEAST sensitive to chemotherapeutic agents?

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Reproduced, with permission, from Nguyen PD: Principles of Radiation Therapy. In Hoffman BL, Schorge JO, Schaffer JI, et al (eds): Williams Gynecology, 2nd ed. New York, McGraw-Hill, 2012, Figure 28-8.

a. S

b. G0

c. G1

d. G2

27–3. Which of the following tumor qualities decreases a tumor’s susceptibility to chemotherapy?

a. Metastatic lesion

b. Slow doubling time

c. High growth fraction

d. No gross residual disease after debulking surgery

27–4. Which term is used to describe drugs that can kill at several cell cycle phases?

a. Omnicyclic

b. Generational

c. Broad spectrum

d. Cell cycle nonspecific

27–5. Which term is used to describe chemotherapy used as primary treatment of advanced malignancy when no feasible alternative treatment exists?

a. Salvage

b. Adjuvant

c. Induction

d. Neoadjuvant

27–6. Which term is used to describe chemotherapy used preoperatively to decrease the extent of subsequent resection?

a. Salvage

b. Adjuvant

c. Induction

d. Neoadjuvant

27–7. Combination chemotherapy is commonly used to provide maximum cell kill. When drugs are selected, agents should have which of the following characteristics?

a. Overlapping toxicities

b. Similar mechanisms of action

c. Effectiveness as a sole agent

d. Lower dosages required when used solely

27–8. Patients with advanced endometrial cancer may receive both adjuvant chemotherapy and radiation. Which of the following is true when patients are treated with both modalities?

a. Toxicity is increased.

b. A decrease in chemotherapy dose due to toxicity is seldom required.

c. Tumor within a previously irradiated field is more sensitive to chemotherapy.

d. All of the above

27–9. Most chemotherapy drugs are typically dosed using what patient parameter?

a. Height

b. Weight

c. Body mass index

d. Body surface area

27–10. Intraperitoneal chemotherapy efficacy may be limited by all EXCEPT which of the following?

a. Ascites

b. Slower drug clearance than intravenous administration

c. Intraabdominal adhesions

d. Fibrotic tumor encapsulation

27–11. Special care should be taken if administering a chemotherapeutic agent capable of causing skin ulceration and tissue necrosis. Which term describes this group?

a. Irritant

b. Vesicant

c. Exfoliant

d. Inflammant

27–12. Which of the following chemotherapeutic agents is considered a vesicant?

a. Etoposide

b. Methotrexate

c. Dactinomycin

d. Cyclophosphamide

27–13. In defining chemotherapy response, a decrease of at least 30 percent in the sum of diameters of all target lesions is termed which of the following?

a. Progression

b. Stable disease

c. Partial response

d. Complete response

27–14. Methotrexate binds tightly to which enzyme to exert its antimetabolite effects?

a. Topoisomerase

b. RNA polymerase

c. Dihydrofolate reductase

d. Receptor tyrosine kinase

27–15. In the United States, methotrexate is commonly used as a sole primary agent to treat which of the following?

a. Partial mole

b. Complete mole

c. Gestational trophoblastic neoplasia

d. All of the above

27–16. Concurrent leucovorin administration in women treated with methotrexate achieves which of the following goals?

a. Decreases drug clearance

b. Minimizes myelosuppression

c. Expands cell-cycle specificity

d. Enhances tumor radiosensitivity

27–17. Cyclophosphamide and ifosfamide have which of the following classic side effects, which is paired with the pretreatment agent used to attenuate this problem?

a. Anemia; leucovorin

b. Neuropathy; amifostine

c. Hemorrhagic cystitis; mesna

d. Ovarian suppression; gonadotropin-releasing hormone agonist

27–18. Your patient is a 25-year-old G1P0A1 who underwent dilatation and curettage for treatment of the condition shown here. During postoperative surveillance, low-risk gestational trophoblastic neoplasia is diagnosed. Which of the following is a suitable single agent for primary treatment?

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a. Cisplatin

b. Doxorubicin

c. Gemcitabine

d. Dactinomycin

27–19. These preoperative images show a tumor-enlarged uterus and para-aortic node involvement. Which combination of agents is commonly used as adjuvant treatment of advanced endometrial cancer?

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Images contributed by Dr. Diane Twickler. Reproduced, with permission, from Miller DS, Schorge JO: Endometrial cancer. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, 2008, Figure 33-5.

a. Cisplatin, ifosfamide

b. Taxol, Adriamycin, cisplatin (TAP)

c. Bleomycin, etoposide, cisplatin (BEP)

d. Etoposide, methotrexate, Adriamycin D, cyclophosphamide, Oncovin (EMA-CO)

27–20. Which combination of agents is commonly used as adjuvant treatment of advanced epithelial ovarian cancer? Extensive omental involvement is seen here.

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Reproduced, with permission, from Schorge JO: Epithelial ovarian cancer. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, 2008, Figure 35-16.

a. Carboplatin, paclitaxel

b. Taxol, Adriamycin, cisplatin (TAP)

c. Bleomycin, etoposide, cisplatin (BEP)

d. Etoposide, methotrexate, Adriamycin D, cyclophosphamide, Oncovin (EMA-CO)

27–21. Which of the following is used commonly as a radiosensitizing agent in the primary treatment of cervical cancer such as the clinical stage 1B2 cancer shown here?

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Photograph contributed by Dr. John Schorge. Reproduced, with permission, from Lea JS: Cervical cancer. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, 2008, Figure 30-14.

a. Cisplatin

b. Doxorubicin

c. Gemcitabine

d. Dactinomycin

27–22. Risks and side effects of tamoxifen include all EXCEPT which of the following?

a. Osteoporosis

b. Thromboembolism

c. Endometrial cancer

d. Vasomotor symptoms

27–23. Which of the following biologic agents does not have VEGF as a direct or indirect target of action?

a. Sunitinib

b. Bevacizumab

c. Poly(ADP) ribose polymerase (PARP) inhibitor

d. Mammalian target of rapamycin (mTOR) inhibitor

27–24. Which of the following agents commonly used in gynecologic oncology is associated with a high risk for nausea and vomiting?

a. Bleomycin

b. Cisplatin

c. Etoposide

d. Paclitaxel

27–25. Which of the following is an agent used to stimulate granulocyte production in those with chemotherapy-induced neutropenia?

a. Leucovorin

b. Filgrastim

c. Darbepoetin alfa

d. None of the above

Chapter 27 ANSWER KEY

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