Oncology Flashcards
The annual age-adjusted cancer incidence rates among men and women are decreasing for all of the following EXCEPT
A. Colorectal
B. Oropharynx
C. Lung
D. Thyroid
Answer: D
Incidence rates are declining for most cancer sites, but they are increasing among both men and women for melanoma of the skin, cancers of the liver and thyroid.
Incidence rates are decreasing for all four major cancer sites except for breast cancer in women.
(See Schwartz 10th cd., p. 274.)
Which of the following is NOT a hallmark of cancer?
A. Ability to invade and metastasize
B. Ability to evade apoptosis
C. Ability to evade autophagy
D. Ability to evade immune destruction
Answer: C
There are six essential alterations in cell physiology that dictate malignant growth:
1) self-sufficiency of growth signals,
2) insensitivity to growth-inhibitory signals,
3) evasion of apoptosis (programmed cell death), 4) potential for limitless replication,
5) angiogenesis, and
6) invasion and metastasis.
Recently, two additional hallmarks have emerged—reprogramming of energy metabolism and evading immune destruction.
(See Schwartz 10th ed., p. 277.)
Characteristics of tumorigenic transformation of cells include which of the following?
A. Enhanced surface adherence
B. Monolayer confluence inhibition
C. Acquisition of chemoresistance
D. Immortalization
Answer: D
Abnormally proliferating, transformed cells outgrow normal cells in the culture dish (ie, in vitro) and commonly display several abnormal characteristics.
These include:
1) loss of contact inhibition (ie, cells continue to proliferate after a confluent monolayer is formed); 2) an altered appearance and poor adherence to other cells or to the substratum;
3) loss of anchorage dependence for growth;
4) immortalization; and
5) gain of tumorigenicity (ie, the ability to give rise to tumors when injected into an appropriate host).
(See Schwartz 10th ed., p. 277.)
The cell cycle includes all of the following phases EXCEPT
A. S phase
B. G1 phase
C. G2 phase
D. G3 phase
Answer: D
The cell cycle is divided into four phases. During the synthetic or S phase, the cell generates a single copy of its genetic material, whereas in the mitotic or M phase, the cellular components are partitioned between two daughter cells.
The G1 and G2 phases represent gap phases during which the cells prepare themselves for completion of the S and M phases, respectively.
When cells cease proliferation, they exit the cell cycle and enter the quiescent state referred to as G.
(Sec Schwartz 10th ed., p.279.)
Which of the following factors is NOT suggestive of a hereditary cancer?
A. Tumor development at a younger than normal age.
B. Presence of bilateral disease.
C. Association with paraneoplastic syndrome.
D. Presence of multiple primary malignancies.
Answer: C
The following factors may suggest the presence of a hereditary cancer:
- Tumor development at a much younger age than usual.
- Presence of bilateral disease.
- Presence of multiple primary malignancies.
- Presentation of a cancer in the less affected sex (eg, male breast cancer).
- Clustering of the same cancer type in relatives.
- Occurrence of cancer in association with other conditions such as mental retardation or pathognomonic skin lesions.
(See Schwartz 10th ed., p. 287.)
Which of the following are associated with familial adenomatous polyposis (FAP)?
A. Osteomas
B. Glioblastoma multiforme
C. Meckel diverticulum
D. Esophageal atresia
Answer: A
Familial adenomatous polyposis (FAP) is associated with benign extracolonic manifestations that may be useful in identifying new cases, including congenital hypertrophy of the retinal pigment epithelium, epidermoid cysts, and osteomas.
In addition to colorectal cancer, patients with FAP are at risk for upper intestinal neoplasms (gastric and duodenal polyps, duodenal and periampullary cancer), hepatobiliary tumors (hepatoblastoma, pancreatic cancer, and cholangiocarcinoma), thyroid carcinomas, desmoid tumors, and medulloblastomas.
(See Schwartz 10th ed., p. 291.)
Which mutated gene malignant disease association is correct
A. PTEN and Li-Fraumeni syndrome
B. RET and MEN2 syndrome
C. P16 and synovial sarcoma
D. BRCA1 and adrenocortical carcinoma
Answer: B
MEN2 syndrome is caused by gain of function mutations in the RET gene.
Li-Fraumeni syndrome is associated with mutation of TP53.
Mutations in p16 is associated with melanomas, as well as cancers of the pancreas, esophagus, head and neck, stomach, breast, and colon.
BRCA1 is associated with breast and ovarian carcinoma. (See Schwartz 10th ed., pp. 291-293.)
Risk for invasive breast cancer development is increased for each factor EXCEPT
A. Age at menarche <12.
B. Age at first live birth >30.
C. Biopsy-proven atypical hyperplasia.
D. No previous breast biopsy.
Answer: D
Risk factors for the development of breast cancer is summarized in Table 10-1.
Previous breast biopsies are associated with an increase in risk of invasive breast cancer.
No previous breast biopsy confers the baseline risk. (See Schwartz 10th ed., Table 10-8, p. 297.)
Relative Risk(%)
Risk Factor
Age at menarche (years)
>14 RR = 1.00
12-13 RR = 1.10
<12 RR = 1.21
Age at first live birth (years)
Patients with no frst-degree relatives with cancer
<20 RR = 1.00
20-24 RR = 1.24
25-29 or nulliparous RR =1.55
> 30 RR = 1.93
Patients with one first-degree-relative with cancer
<20 RR = 1.00
20-24 RR = 2.64
25-29 or nulliparous RR = 2.76
> 30 RR = 2.83
Patients with >2 first-degree relatives
with cancer
<20 RR = 6.80
20-24 RR = 5.78
25-29 or nullipatous RR = 4.91
> 30 RR = 4.17
Breast biopsies (number) Patients aged <50 at counseling 0 RR = 1.00
1 RR = 1.70
> 2 RR = 2.88
Patients aged >50 at counseling
0 RR = 1.00
1 RR = 127
> 2 RR = 1.62
Routine ongoing cancer screening is recommended for which of the following malignancies?
A. Ovary
B. Leukemia
C. Carcinoma of the kidney
D. Sarcoma
Answer: A
On the occasion of a periodic health examination, the cancer-related checkup should include examination for cancers of the thyroid, testicles, ovaries, lymph nodes, oral cavity, and skin, as well as health counseling about tobacco, sun exposure, diet and nutrition, risk factors, sexual practices, and environmental and occupational exposures. (See Schwartz 10th ed., p. 299.)
Depending on the tumor, acceptable approaches to biopsy include any of the following EXCEPT
A. Fine-needle aspiration
B. Core needle biopsy
C. Incisional biopsy
D. Morcellation
Answer: D
A sample of a lesion can be obtained with a needle or with an open incisional or excisional biopsy specimen.
Core biopsy specimen, such as fine-needle aspiration, is relatively safe and can be performed either by direct palpation (eg, a breast mass or a soft tissue mass) or can be guided by an imaging study (eg, stereotactic core biopsy specimen of the breast).
Open biopsy specimens have the advantage of providing more tissue for histologic evaluation and the disadvantage of being an operative procedure.
Incisional biopsy specimens are reserved for very large lesions in which a definitive diagnosis cannot
be made by needle biopsy specimen.
Excisional biopsy specimens are performed for lesions for which either core biopsy specimen is not possible or the results are nondiagnostic.
(See Schwartz 10th ed.,p. 300.)
Anticancer chemotherapy agents include all of the following EXCEPT
A. Alkylating agents
B. Antitumor antibiotics
C. Prometabolites
D. Plant alkaloids
Answer: C
Anticancer agents include alkylating agents, antitumor antibiotics, antimetabolites, and plant alkaloids.
Antimetabolites are cell-cycle specific agents that have their major activity in the S phase of the cell cycle.
These drugs are most effective in tumors that have a high growth fraction, and include folate antagonists, purine antagonists, and pyrimidine antagonists.
(See Schwartz 10th cd., p. 307.)
Approved strategies for cancer chemoprevention include all of the following EXCEPT
A. Neurontin for malignant peripheral nerve sheath tumor
B. Tamoxifen for breast cancer
C. Celecoxib for FAP syndrome
D. 13-cis-retinoic acid for oral leukoplakia
Answer: A
The systemic or local administration of therapeutic agents to prevent the development of cancer, called chemoprevention, is being actively explored for several cancer types.
In breast cancer, the NSABP Breast Cancer Prevention Trial demonstrated that tamoxifen administration reduces the risk of breast cancer by one-half and reduces the risk of estrogen receptor-positive tumors by 69% in high-risk patients.
Therefore, tamoxifen has been approved by the FDA for breast cancer chemoprevention.
The subsequent NSABP P-2 trial demonstrated that raloxifene is as effective as tamoxifen in reducing the risk of invasive breast cancer and is associated with a lower risk of thromboembolic events and cataracts but a non-statistically significant higher risk of noninvasive breast cancer; these findings led the FDA to approve raloxifene for prevention as well.
Several other agents are also under investigation. Celecoxib has been shown to reduce polyp number and polyp burden in patients with FAP, which led to its approval by the FDA for these patients.
In head and neck cancer, 13-cis-retinoic acid has been shown both to reverse oral leukoplakia and to reduce second primary tumor development.
(See Schwartz 10th ed., p.315.)
A recently identified cell alterations that denote malignancy:
A. Cytoplasmic degeneration
B. Reprogramming of energy metabolism and evasion of immune destruction
C. Nuclear multiplication
D. Mitochondrial fusion
B. Reprogramming of energy metabolism and evasion of immune destruction
The normal cellular genes that contribute to cancer when abnormal are:
A. Proto-oncogene
B. Oncogenes
C. Mutation factor
D. Carcinogen
B. Oncogenes
Oncogenes are normal cellular genes that contribute to cancer when abnormal.
Proto-oncogene is the precursor gene.
They can be growth factors (PDGF), growth factor receptors (HER2), intracellular signal transduction molecules (ras), nuclear transcription factors (c-myc).
Chemotherapy destroys cells by first order kinetics, meaning that with the administration of certain anticancer drug:
A. All cancer cells are killed by the drug
B. Constant percentage of cells are killed
C. Constant number of cells are killed
D. Constant percentage and number of cells are killed
B. Constant percentage of cells are killed
First-order kinetics: with administration of a drug, a CONSTANT PERCENTAGE of cells are killed, and not a constant number.
The rate of elimination is proportional to the drug concentration.
If a patient has 1kg load of tumor cells, administration of the drug results in (3-log cell kill): 1kg –> 1g
If treated with another dose (another decrease of 3-log cell kill): 1g –> 1mg rather than being eliminated totally.
