The American Board of Surgery Complex General Surgical Oncology (CGSO) qualifying and certifying examinations demand mastery across every solid-organ malignancy. Practise with thousands of CGSO-mapped clinical vignettes written by practising surgical oncologists, each answer referenced to NCCN, AJCC 8th Edition and the landmark trials examiners expect you to know.
Content reviewed 26 August 2026 against current guidelines.
Start practising freeTaken from the bank, not written for this page. Answer it in your head, then open the explanation.
A 70-year-old woman with multiple comorbidities (diabetes, moderate CKD stage 3b, ECOG PS 2) is diagnosed with a 20 mm, grade 2, ER-positive, HER2-negative invasive carcinoma. She has clinically node-negative disease. She strongly wishes to avoid chemotherapy. Oncotype DX is requested and returns RS 8. According to NCCN 2025, TAILORx data, and geriatric oncology principles, what is the most appropriate recommendation?
Correct answer: C
TAILORx (Sparano et al., NEJM 2018) showed that in patients with RS 0–10, endocrine therapy alone was non-inferior to chemoendocrine therapy in node-negative HR-positive, HER2-negative breast cancer. The 9-year distant recurrence rate in the RS 0–10 group was 3%, with no chemotherapy benefit across all age subgroups including younger women. For this 70-year-old with RS 8, chemotherapy adds no proven benefit and would carry significant risk given her ECOG PS 2, CKD, and diabetes. Aromatase inhibitors are the preferred endocrine therapy for postmenopausal women — CKD stage 3b is not a contraindication to AIs (dose adjustment not required; AIs are hepatically metabolised and minimally renally excreted). Tamoxifen increases thromboembolic risk. Withholding all systemic therapy would undertreat her — endocrine therapy reduces recurrence by approximately 40% in RS ≤10 disease. MammaPrint adds no clinical utility when Oncotype DX RS is already available and clearly in the low-risk range.
Teaching point. RS ≤10 (TAILORx): endocrine therapy alone, no chemotherapy regardless of age or comorbidity. AIs are safe in CKD — hepatic metabolism, no renal dose adjustment.
Referenced to NCCN Breast Cancer 2025; TAILORx (Sparano, NEJM 2018)
Every question is explained like this — start with 50 free ›Every question is written by Pablo Lozano Lominchar, MD, PhD, and mapped to this board’s published syllabus. Before it enters the bank it has to pass an automated check: five options, a written explanation, and a citation — a named society guideline or a named trial. Benign and functional topics cannot be published without a society guideline; oncological ones cite NCCN, ESMO or AJCC, and the classification systems that govern a topic — Bethesda, TIRADS, Atlanta, Prague, Chicago — have to appear where they apply. The author has audited the full active bank against current guideline versions: what fails is re-cited, rewritten or withdrawn. 650 questions are currently withdrawn and are served to nobody.
The most efficient preparation combines high-volume, board-style question practice with guideline cross-referencing. Focus first on the highest-yield tumour sites (GI, breast, endocrine, HPB, sarcoma, melanoma), practise timed multiple-choice sessions to build recall speed, and confirm every answer against the cited NCCN or AJCC reference so the reasoning transfers to the certifying exam.
SurgBoardsQ&A provides more than 7,400 Complex General Surgical Oncology practice questions covering the full ABS CGSO content outline, each with a detailed explanation and guideline citation.
The CGSO exam spans gastrointestinal oncology, breast, endocrine (thyroid, parathyroid, adrenal), hepatopancreatobiliary tumours, soft-tissue sarcoma, melanoma and skin cancer, peritoneal surface malignancy, and the principles of staging, surgical margins and multidisciplinary decision-making.
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