The patient is a 63-year-old woman with a history (10 years ago) of squamous cell carcinoma in situ of the cervix, which was treated with a total abdominal hysterectomy. Three years ago a pelvic mass was palpated, and exploratory laparotomy revealed a multinodular solid cystic mass of 10 to 12 cm. The mass arose from the right ovary and was adherent to the right pelvic wall. The patient underwent resection of the mass, and the pathology revealed squamous cell carcinoma of the ovary. She subsequently had combined modality treatment with chemotherapy (cisplatin and 5-fluorouracil) and radiation therapy to the pelvis. The latest CT scan of the abdomen revealed a new

right retroperitoneal lymph node. CT-guided fine needle aspiration was consistent with metastatic ovarian squamous cell carcinoma.

1. What best describes the patient's original diagnosis? ..............................

A. Endometrial and cervical carcinoma

B. Localized cancer of the lower portion of the uterus

C. Cervical cancer that spread to the abdomen

D. Ovarian cancer

2. What was the initial primary treatment? ..........................................

A. Drug treatment

B. Radiation treatment

C. Drug and radiation treatment

D. Surgical removal of the entire uterus

3. What procedure identified the new pelvic mass? .......................................

A. Incision of the abdomen

B. Radiation therapy

C. Total abdominal hysterectomy

D. CT scan of the abdomen

4. Which treatment modalities were used for the patient's ovarian carcinoma? .........................................

A. Computed tomography of the abdomen

B. Fine-needle aspiration of the ovary

C. Drug and radiation therapy in addition to surgical removal

D. Surgical resection of the mass

5. How would you characterize the disease in the patient's retroperitoneal lymph node? .......................................

A. Cancer of the lymphatic system

B. Cervical cancer that had spread

C. Primary ovarian cancer

D. Ovarian cancer that had spread

B.Research Report

In a recent trial comparing the antiemetics ondansetron (Zofran) and metoclopramide (Reglan), ondansetron was more effective and produced less severe side effects. The trial involved 24 medical centers and 307 cancer patients receiving high doses of cisplatin.

1. What type of drug is ondansetron? ......................................

A. Chemotherapeutic

B. Antipsychotic medication

C. Antibiotic

D. Antinauseant

2. When is ondansetron prescribed? .........................................

A. After cancer surgery

B. In conjunction with metoclopramide

C. When patients are receiving high-dose chemotherapy for cancer

D. Before cancer surgery

C.Chart Note

Pt with metastatic squamous cell carcinoma of the tongue. Toward the end of XRT, the pt complained of some intermittent costal and low vertebral pain. The pt presented to the ER when pain control was no longer achieved using Percocet. CT scan and MRI were performed, revealing a number of vertebral bodies involved with tumor in the upper lumbar and lower thoracic regions. Preliminary reading suggests no evidence of cord compression, yet there is evidence of disk protrusion at T6-T7.We are consulted for palliative XRT of the spine lesions for purpose of pain control.

1. What was probably causing the patient's pain? ....................................

A. Tuberculosis of the spine

B. Pressure on the spinal cord

C. Tumor of the oral cavity

D. Metastatic tumor in the backbones

2. What does costal mean? ................................................

A. Pertaining to ribs

B. Pertaining to spinal cord

C. Pertaining to the back

D. Pertaining to the breast bone

3. What is palliative XRT? ..................................................

A. Diagnostic workup for malignancy

B. Chemotherapy for painful cancer treatment

C. Radiotherapy to relieve symptoms but not to cure

D. Surgery to relieve pain

4. What type of doctor wrote this report? ........................................

A. Radiologist

B. Radiation oncologist

C. Nuclear medicine specialist

D. Orthopedist