Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 1146 - файл
.pdf
10 Cholangiocarcinoma
https://t.me/med1917
141
25. A 62-year-old patient is diagnosed with Bismuth type III cholangiocarcinoma.
The surgical team is considering the approach for resection. Which of the following statements regarding Bismuth type III and IV CC is incorrect?
A. IIIa: The tumor involves the conuence and extends into the right
hepatic duct.
B. IIIb: The tumor involves the conuence and extends into the left hepatic duct.
C. IV: There is tumor involvement of bilateral intrahepatic secondary bile ducts.
D. There is no difference in survival between patients undergoing total caudate
lobectomy (TCL) and those who do not.
E. TCL has an acceptable safety prole and high rates of curative resectability.
Answer: D
Explanation: TCL provides higher survival rates for Bismuth type III and IV
cholangiocarcinoma, with signicant curative resection potential and safety
prole.
26. During a multidisciplinary team meeting, the resectability of a patient with
PCC is being discussed. Which of the following is incorrect regarding factors
that render CC unresectable?
A. Distant LN metastases.
B. T2b perihilar tumor.
C. Peritoneal metastases.
D. Intrahepatic metastases.
E. Vascular encasement.
Answer: B
Explanation: A T2b perihilar tumor does not necessarily preclude
resectability.
27. A patient with inoperable ICC is being evaluated for palliative treatment
options. Which of the following is not a liver-directed therapy for inoperable
cholangiocarcinoma?
A. TACE.
B. Hepatic arterial infusion.
C. ERCP.
D. Percutaneous ablation.
E. Radioembolization.
Answer: C
Explanation: ERCP is not a liver-directed therapy for ICC.
28. A patient with cholangiocarcinoma, post-surgical resection with positive lymph
nodes, is being considered for adjuvant therapy. Which of the following statements about adjuvant therapy in CC is incorrect?
A. Patients receiving chemotherapy or CRT show greater benet than those
receiving radiation therapy alone.
142
https://t.me/med1917
A. S. Mahmood et al.
B. The most signicant benet of adjuvant therapy is seen in patients with
positive LN disease.
C. Patients with R1 resection status derive the greatest benet from adjuvant
therapies.
D. Unselected patients, regardless of node and margin status, show no signi-
cant benet from adjuvant therapy.
E. Radiation therapy has no role in the management of patients with R1
resections.
Answer: E
Explanation: Radiation therapy can be benecial for patients with R1 resec-
tions, with potential harm in R0 resection patients.
29. In discussing the case of a patient with perihilar bile duct cancer, the team is
reviewing the TNM staging. Which statement about T3N1 staging for perihilar
bile duct cancer is incorrect?
A. Involvement of one to three positive lymph nodes.
B. Lymph nodes involved may include hilar, posterior pancreaticoduodenal,
common bile duct, hepatic artery, cystic duct, and portal vein lymph nodes.
C. The tumor invades the main portal vein or its branches bilaterally.
D. The tumor invades unilateral branches of the portal vein.
E. The tumor invades unilateral branches of the hepatic artery.
Answer: C
Explanation: T4, not T3N1, is characterized by invasion of the main portal
vein or its branches bilaterally.
30. A patient with advanced CC is being evaluated for chemotherapy options.
Which of the following is incorrect chemotherapy regimen for
cholangiocarcinoma?
A. Combination of gemcitabine with S-1.
B. Mitomycin-C and 5-uorouracil.
C. Cytarabine.
D. Gemcitabine alone.
E. Gemcitabine combined with oxaliplatin.
Answer: C
Explanation: Cytarabine is not commonly used in the chemotherapy regi-
men for cholangiocarcinoma.
31. In a case conference, a patient with unresectable ECC is discussed for palliative
treatment options. Which statement about the treatment of unresectable ECC is
incorrect?
A. Biliary drainage is achieved through stent placement.
B. PDT and RFA can prolong survival.
C. One-month mortality with PDT is signicantly higher than with RFA and
stent placement alone.
10 Cholangiocarcinoma
https://t.me/med1917
143
D. Survival is longer in patients using photothermal therapy (PTU) compared
to RFA and stent placement.
E. Stent patency duration is longer in patients using PTU compared to RFA
and stent placement.
Answer: C
Explanation: One-month mortality with PDT is actually lower than with
RFA and stent placement alone.
32. In a tumor board meeting, the team discusses the risk factors for recurrence in
a patient with recently resected ICC.Which of the following is incorrect predictor for ICC recurrence?
A. Tumor size ≥5cm.
B. Presence of perineural invasion.
C. Evidence of vascular invasion.
D. The tumor is solitary.
E. Nodal status.
Answer: D
Explanation: The presence of multiple tumors, not a solitary tumor, is a pre-
dictor for earlier recurrence of ICC.
33. In discussing the risks of PTCp for a patient with suspected biliary obstruction,
which statement about PTCp complications is incorrect?
A. Bile leakage is a potential complication.
B. Severe blood loss requiring transfusion may occur.
C. Hemobilia can be a complication of the procedure.
D. Formation of a biloma is a possible complication.
E. Pneumoperitoneum is a recognized complication.
Answer: B
Explanation: Severe blood loss requiring transfusion is not a typical complication of PTCp; hemobilia is usually temporary and does not generally require
emergency intervention or blood transfusion.
34. A patient with hilar CC is being evaluated for diagnostic and palliative options.
Which statement about the roles of PTCp and ERCP is incorrect?
A. PTCp is more frequently used as it better outlines tumor involvement in the
proximal biliary tree than ERCP.
B. Both ERCP and PTCp are often needed to assess the feasibility of major
liver resection.
C. PTCp can be used to decompress bile ducts before surgical excision as a
palliative approach for jaundice.
D. ERCP can be used for stent placement as palliative therapy in unresectable
hilar cholangiocarcinoma.
E. PTCp is the preferred test in the majority of cases and offers a greater over-
all survival benet compared to ERCP.
144
https://t.me/med1917
A. S. Mahmood et al.
Answer: E
Explanation: The choice between PTCp and ERCP depends on expertise
availability and tumor anatomy, not on one providing a greater overall survival
benet.
35. During a multidisciplinary discussion about a patient with unresectable ECC,
RFA is considered. Which of the following statements about RFA is incorrect?
A. Overall survival is signicantly longer in patients treated with RFA and
stenting compared to stenting alone.
B. Stent patency period is longer in patients treated with RFA and stenting than
in stent-only patients.
C. There is a signicant difference in the incidence of postoperative adverse
events between the RFA and stent-only groups.
D. RFA is a safe and effective palliative treatment option for these patients.
E. RFA can be applied either endoscopically or percutaneously.
Answer: C
Explanation: There is no signicant difference in the incidence of postopera-
tive adverse events between the RFA and stent-only groups.
36. The team evaluates a patient with unresectable CC for brachytherapy in con-
junction with stenting. Which statement about this combined treatment approach
is incorrect?
A. Brachytherapy increases the duration of stent patency compared with stent-
ing alone.
B. Brachytherapy offers an average survival of 10 months, compared to
4–6months without it.
C. Brachytherapy improves localized control, enhancing complete and partial
response rates, with or without external beam radiation.
D. Overall survival is better with brachytherapy.
E. There are no signicant side effects when comparing brachytherapy with
stenting alone.
Answer: E
Explanation: Radiation-associated complications, such as duodenal ulcers
and later duodenal stenosis, can occur with brachytherapy.
37. A patient with unresectable hilar CC is being evaluated for biliary drainage.
Which statement about the drainage of this type of cancer is incorrect?
A. Effective drainage is often achieved when more than 50% of the liver vol-
ume, especially in Bismuth 3 strictures, is drained.
B. Unilateral stent placement is usually sufcient.
C. Pre-ERCP assessment of hepatic volume distribution on CT imaging can
optimize endoscopic procedures.
D. Intubation of an atrophic liver segment (30%) is not useful and may increase
cholangitis cases.
E. Drainage of 50% of liver volume is associated with longer survival.
10 Cholangiocarcinoma
https://t.me/med1917
145
Answer: B
Explanation: Bilateral stent placement is often needed to drain more than
50% of the liver volume in these cases.
38. The oncology team is considering chemotherapy options for a patient with
advanced, unresectable cholangiocarcinoma. Which statement about chemotherapy in this setting is incorrect?
A. Gemcitabine plus cisplatin has been proven effective.
B. Gemcitabine plus cisplatin is superior to gemcitabine alone in patients with
advanced disease.
C. Patients receiving combined therapy may experience a signicant increase
in lethargy.
D. Chemotherapy does not play a role in prolonging survival in advanced unre-
sectable tumors.
E. Combining S-1 with gemcitabine is a treatment option.
Answer: D
Explanation: Chemotherapy, including regimens like gemcitabine plus cisplatin, plays a role in prolonging survival in advanced unresectable
cholangiocarcinoma.
39. A patient with unresectable stage IVa/IVb ICC is being evaluated for treatment
options. Which statement about the management of this condition is incorrect?
A. Capecitabine plus cisplatin (XP) chemotherapy with external radiotherapy
(XP-CCRT) is well-tolerated.
B. XP-CCRT patients have a longer overall survival than those receiving XP
chemotherapy alone.
C. Neutropenia as a side effect is more common in XP-CCRT than in the XP
group alone.
D. Neoadjuvant concurrent CRT offers more advantages than locoregional RT
alone for patients with advanced and unresectable ICC, including those
with distant metastases.
E. Chemotherapy alone is the standard treatment of choice for most patients
with advanced unresectable ICC.
Answer: E
Explanation: Better overall survival has been noted in XP-CCRT patients
compared to XP chemotherapy alone.
40. In a multidisciplinary team meeting, the treatment plan for a patient with locally
advanced, unresectable ICC is discussed. Which of the following statements is
incorrect?
A. Chemotherapy alone is superior to locoregional treatment for these types
of tumors.
B. Locoregional treatment benets patients with locally advanced, unresect-
able ICC.
C. Locoregional treatment is superior to systemic chemotherapy alone.
146
https://t.me/med1917
A. S. Mahmood et al.
D. Locoregional therapy reduces the occurrence of death by decreasing liver
failure cases.
E. Locoregional therapy maintains control of intrahepatic disease, thereby
increasing overall survival.
Answer: A
Explanation: Locoregional treatment, not chemotherapy alone, is superior
for these types of tumors.
41. A patient with an incurable biliary tract tumor is being considered for stenting.
Which statement about biliary tract stenting is incorrect?
A. Stenting can be used as a palliative procedure in incurable tumors.
B. Preoperative stent placement is advised if serum bilirubin is >10mg/dL and
surgery is deferred until serum bilirubin is <3mg/dL.
C. Complications include obstruction due to tumor ingrowth or overgrowth
and cholangitis.
D. The placement of a stent is best done transcutaneously.
E. Self-expandable metallic stents (SEMS) are more effective than plastic
stents for both proximal and distal obstructions.
Answer: D
Explanation: The placement of stents is typically best performed using
ERCP, not transcutaneously.
42. In evaluating a patient with risk factors for gallbladder malignancy, the surgical
team discusses the associated risks. Which statement about risk factors for gallbladder malignancy is incorrect?
A. Stones larger than 3cm carry a tenfold increased risk of malignancy.
B. Symptomatic stone disease carries a lower risk of developing malignancy
than asymptomatic stones.
C. Gallbladder polyps larger than 10mm have a 25% risk of malignancy.
D. Porcelain gallbladders are malignant in 10% of cases.
E. Prophylactic cholecystectomy is advised when risk factors for gallbladder
malignancy are present.
Answer: B
Explanation: Symptomatic gallstones carry a higher risk of developing
malignancy compared to asymptomatic gallstones.
Bibliography
1. DeOliveira ML, Cunningham SC, Cameron JL, Kamangar F, Winter JM, Lillemoe KD, etal.
Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution. Ann
Surg. 2007;245(5):755–62.
10 Cholangiocarcinoma
https://t.me/med1917
2. Palmer WC, Patel T. Are common factors involved in the pathogenesis of primary liver
cancers? A meta-analysis of risk factors for intrahepatic cholangiocarcinoma. J Hepatol.
2012;57(1):69–76.
3. Bismuth H, Nakache R, Diamond T.Management strategies in resection for hilar cholangiocarcinoma. Ann Surg. 1992;215(1):31–8.
4. Clements O, Eliahoo J, Kim JU, Taylor-Robinson SD, Khan SA. Risk factors for intrahepatic and extrahepatic cholangiocarcinoma: a systematic review and meta-analysis. J Hepatol.
2020;72(1):95–103.
5. Burak K, Angulo P, Pasha TM, Egan K, Petz J, Lindor KD. Incidence and risk factors for
cholangiocarcinoma in primary sclerosing cholangitis. Am J Gastroenterol. 2004;99(3):523–6.
6. Burkhart RA, Pawlik TM.Staging and prognostic models for hepatocellular carcinoma and
intrahepatic cholangiocarcinoma. Cancer Control. 2017;24(3):1073274817729235.
7. Akiba J, Nakashima O, Hattori S, Tanikawa K, Takenaka M, Nakayama M, et al.
Clinicopathologic analysis of combined hepatocellular-cholangiocarcinoma according to the
latest WHO classication. Am J Surg Pathol. 2013;37(4):496–505.
8. Madhusudhan KS, Gamanagatti S, Gupta AK.Imaging and interventions in hilar cholangiocarcinoma: a review. World J Radiol. 2015;7(2):28–44.
9. Brandi G, Venturi M, Pantaleo MA, Ercolani G. Cholangiocarcinoma: current opinion on
clinical practice diagnostic and therapeutic algorithms: a review of the literature and a longstanding experience of a referral center. Dig Liver Dis. 2016;48(3):231–41.
10. Malaguarnera G, Paladina I, Giordano M, Malaguarnera M, Bertino G, Berretta M.Serum
markers of intrahepatic cholangiocarcinoma. Dis Markers. 2013;34(4):219–28.
11. Oseini AM, Chaiteerakij R, Shire AM, Ghazale A, Kaiya J, Moser CD, etal. Utility of serum
immunoglobulin G4in distinguishing immunoglobulin G4-associated cholangitis from cholangiocarcinoma. Hepatology. 2011;54(3):940–8.
12. Liao P, Cao L, Chen H, Pang SZ.Analysis of metastasis and survival between extrahepatic
and intrahepatic cholangiocarcinoma: a large population-based study. Medicine (Baltimore).
2021;100(16):e25635.
13. Bagante F, Spolverato G, Weiss M, Alexandrescu S, Marques HP, Aldrighetti L, et al.
Assessment of the lymph node status in patients undergoing liver resection for intrahepatic
cholangiocarcinoma: the new eighth edition AJCC staging system. J Gastrointest Surg.
2018;22(1):52–9.
14. Boerner T, Drill E, Pak LM, Nguyen B, Sigel CS, Doussot A, etal. Genetic determinants of
outcome in intrahepatic cholangiocarcinoma. Hepatology. 2021;74(3):1429–44.
15. Olthof SC, Othman A, Clasen S, Schraml C, Nikolaou K, Bongers M.Imaging of cholangiocarcinoma. Visc Med. 2016;32(6):402–10.
16. You Y, Shin YC, Choi DW, Heo JS, Shin SH, Kim N, etal. Proposed modication of staging
for distal cholangiocarcinoma based on the lymph node ratio using Korean multicenter database. Cancers (Basel). 2020;12(3):762.
17. Bird N, Elmasry M, Jones R, Elniel M, Kelly M, Palmer D, etal. Role of staging laparoscopy in
the stratication of patients with perihilar cholangiocarcinoma. Br J Surg. 2016;104(4):418–25.
18. Pelsang RE, Johlin FC.A percutaneous biopsy technique for patients with suspected biliary or
pancreatic cancer without a radiographic mass. Abdom Imaging. 1997;22(3):307–10.
19. Park JY, Kim SY, Shin DH, Choi KU, Kim JY, Sol MY, etal. Validation of the T category for
distal cholangiocarcinoma: measuring the depth of invasion is complex but correlates with
survival. Ann Diagn Pathol. 2020;46:151489.
20. Lee AJ, Chun YS.Intrahepatic cholangiocarcinoma: the AJCC/UICC 8th edition updates. Chin
Clin Oncol. 2018;7(5):52.
21. Yamamoto Y, Sugiura T, Okamura Y, Ito T, Ashida R, Ohgi K, Nakanuma Y, Uesaka K.The
evaluation of the eighth edition of the AJCC/UICC staging system for intrahepatic cholangiocarcinoma: a proposal of a modied new staging system. J Gastrointest Surg.
2020;24(4):786–95.
147
148
https://t.me/med1917
22. Hau HM, Meyer F, Jahn N, Rademacher S, Sucher R, Seehofer D.Prognostic relevance of the
eighth edition of TNM classication for resected perihilar cholangiocarcinoma. J Clin Med.
2020;9(10):3152.
23. Valle J, Wasan H, Palmer DH, Cunningham D, Anthoney A, Maraveyas A, etal. Cisplatin plus
gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med. 2010;362(14):1273–81.
24. Rea DJ, Heimbach JK, Rosen CB, Haddock MG, Alberts SR, Kremers WK, etal. Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma. Ann Surg. 2005;242(3):451–8; discussion 8–61, 461.
25. Cheng QB, Yi B, Wang JH, Jiang XQ, Luo XJ, Liu C, etal. Resection with total caudate lobectomy confers survival benet in hilar cholangiocarcinoma of Bismuth type III and IV. Eur J
Surg Oncol. 2012;38(12):1197–203.
26. Liu P, Song Y, Shakoor K, Peng C, Liu S. The pros and cons of the PCC staging system to
guide surgical resectability and prognosis. J Cancer. 2022;13(13):3444–51.
27. Koay EJ, Odisio BC, Javle M, Vauthey JN, Crane CH.Management of unresectable intrahepatic cholangiocarcinoma: how do we decide among the various liver-directed treatments?
Hepatobiliary Surg Nutr. 2017;6(2):105–16.
28. Horgan AM, Amir E, Walter T, Knox JJ.Adjuvant therapy in the treatment of biliary tract cancer: a systematic review and meta-analysis. J Clin Oncol. 2012;30(16):1934–40.
29. Ueno M, Morizane C, Ikeda M, Okusaka T, Ishii H, Furuse J.A review of changes to and clinical implications of the eighth TNM classication of hepatobiliary and pancreatic cancers. Jpn
J Clin Oncol. 2019;49(12):1073–82.
30. Luvira V, Satitkarnmanee E, Pugkhem A, Kietpeerakool C, Lumbiganon P, Pattanittum
P. Postoperative adjuvant chemotherapy for resectable cholangiocarcinoma. Cochrane
Database Syst Rev. 2021;9(9):Cd012814.
31. Mohan BP, Chandan S, Khan SR, Kassab LL, Ponnada S, Artifon ELA, etal. Photodynamic
therapy (PDT), radiofrequency ablation (RFA) with biliary stents in palliative treatment of
unresectable extrahepatic cholangiocarcinoma: a systematic review and meta-analysis. J Clin
Gastroenterol. 2022;56(2):e153–e60.
32. Hyder O, Hatzaras I, Sotiropoulos GC, Paul A, Alexandrescu S, Marques H, etal. Recurrence
after operative management of intrahepatic cholangiocarcinoma. Surgery. 2013;153(6):811–8.
33. Chang HY, Liu B, Wang YZ, Wang WJ, Wang W, Li D, etal. Percutaneous transhepatic cholangiography versus endoscopic retrograde cholangiography for the pathological diagnosis of
suspected malignant bile duct strictures. Medicine (Baltimore). 2020;99(11):e19545.
34. Zhimin G, Noor H, Jian-Bo Z, Lin W, Jha RK.Advances in diagnosis and treatment of hilar
cholangiocarcinoma—a review. Med Sci Monit. 2013;19:648–56.
35. Yang J, Wang J, Zhou H, Zhou Y, Wang Y, Jin H, et al. Efcacy and safety of endoscopic
radiofrequency ablation for unresectable extrahepatic cholangiocarcinoma: a randomized trial.
Endoscopy. 2018;50(8):751–60.
36. Taggar AS, Mann P, Folkert MR, Aliakbari S, Myrehaug SD, Dawson LA.A systematic review
of intraluminal high dose rate brachytherapy in the management of malignant biliary tract
obstruction and cholangiocarcinoma. Radiother Oncol. 2021;165:60–74.
37. Vienne A, Hobeika E, Gouya H, Lapidus N, Fritsch J, Choury AD, etal. Prediction of drainage
effectiveness during endoscopic stenting of malignant hilar strictures: the role of liver volume
assessment. Gastrointest Endosc. 2010;72(4):728–35.
38. Valle JW, Wasan H, Johnson P, Jones E, Dixon L, Swindell R, etal. Gemcitabine alone or in
combination with cisplatin in patients with advanced or metastatic cholangiocarcinomas or
other biliary tract tumours: a multicentre randomised phase II study—the UK ABC-01 study.
Br J Cancer. 2009;101(4):621–7.
39. Kim YI, Park JW, Kim BH, Woo SM, Kim TH, Koh YH, etal. Outcomes of concurrent chemoradiotherapy versus chemotherapy alone for advanced-stage unresectable intrahepatic cholangiocarcinoma. Radiat Oncol. 2013;8:292.
A. S. Mahmood et al.
10 Cholangiocarcinoma
https://t.me/med1917
40. Yamashita S, Koay EJ, Passot G, Shroff R, Raghav KP, Conrad C, etal. Local therapy reduces
the risk of liver failure and improves survival in patients with intrahepatic cholangiocarcinoma: a comprehensive analysis of 362 consecutive patients. Cancer. 2017;123(8):1354–62.
41. Machairas N, Lang H, Jayant K, Raptis DA, Sotiropoulos GC.Intrahepatic cholangiocarcinoma: limitations for resectability, current surgical concepts and future perspectives. Eur J
Surg Oncol. 2020;46(5):740–6.
42. Yu MH, Kim YJ, Park HS, Jung SI.Benign gallbladder diseases: imaging techniques and tips for
differentiating with malignant gallbladder diseases. World J Gastroenterol. 2020;26(22):2967.
149
Chapter 11
https://t.me/med1917
Anal Cancers
SalihAhmedAljiburi, AqeelShakirMahmood, SalehAbdulkareemSaleh,
andMustafaIsmail
1. A 67-year-old male presented with hematochezia; further evaluation revealed
SCC.In epidemiology of anal cancer, the incorrect statement is:
A. Less than 1000 new cases are diagnosed annually in the United States.
B. Anal cancer incidence and mortality have increased dramatically in the
recent decades in the United States.
C. Anal cancer is more common in men.
D. Anal cancer accounts for 1–2% of digestive tract tumors.
E. SCC constitutes 80–90% of all malignant anal tumors.
Answer: C
Explanation: Anal cancer is more common in females, potentially attributed to sexual behavior or the prevalence of human papillomavirus (HPV)
infection in females. This demographic difference is a key point to
remember.
2. A 77-year-old male presented with fresh bleeding and pain during defecation;
further evaluation exhibits SCC in the anus. In risk factors for anal cancer, the
incorrect statement is:
A. Autoimmune diseases are associated with an increased prevalence of
anal cancer.
S. A. Aljiburi
Baghdad Teaching Hospital, Baghdad, Iraq
A. S. Mahmood
Department of General Surgery, University of Baghdad, Baghdad, Iraq
S. A. Saleh
College of Medicine University of Baghdad, Baghdad, Iraq
M. Ismail (*)
Department of Surgery, College of Medicine, University of Baghdad, Baghdad, Iraq
Switzerland AG 2024
A. S. Mahmood, A. Koulouris (eds.), MCQs in General Surgical Oncology,
https://doi.org/10.1007/978-3-031-65738-2_11
151© The Author(s), under exclusive license to Springer Nature
Соседние файлы в папке @xirurgi_2025