Module 7: Biology of Cancer and Tumor Spread

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The primary function of the nucleus is to:

A) control molecular movement into and out of the cell.
B) regulate cell division and control genetic information.
C) release enzymes that detoxify harmful substances.
D) form the skeletal framework for the cell.

B) regulate cell division and control genetic information.

Which of the following organelles is (are) responsible for processing and packaging proteins into secretory vesicles for transportation to intracellular or extracellular destinations?

A) Golgi apparatus
B) Nucleolus
C) Endoplasmic reticulum
D) Mitochondria

A) Golgi apparatus

Which of the following cellular structures is (are) involved in cellular communication and cell-to-cell interactions?

A) Caveolae
B) Lysosomes
C) Ribosomes
D) Plasma membrane

D) Plasma membrane

Cell surface markers are composed of:

A) phospholipids.
B) glycoproteins.
C) lactose molecules.
D) cholesterol.

B) glycoproteins.

Plasma membrane receptors are available to bind to:

A) carbon dioxide.
B) ribosomes.
C) ligands.
D) cell adhesion molecules.

C) ligands.

In the cell cycle, RNA and protein synthesis takes place during the:

A) S phase.
B) M phase.
C) G1 phase.
D) G2 phase.

D) G2 phase.

Cytokines are:

A) adhesion molecules.
B) growth factors.
C) cell junctions.
D) sequences of DNA.

B) growth factors.

In autocrine signaling:

A) a cell releases a hormone.
B) a cell signals a neighboring cell.
C) a neuron signals another neuron.
D) a cell signals itself.

D) a cell signals itself.

Which of the following cell junctions allows small ions and other molecules to pass directly from the inside of one cell to the inside of another?

A) Gap junctions
B) Tight junctions
C) Desmosomes
D) Gating channels

A) Gap junctions

Mutations can result in:

A) abnormal DNA.
B) abnormal RNA.
C) abnormal proteins.
D) all of the above.

D) all of the above.

Which of the following statements about mutations is correct?

A) Mutations always lead to genetic disease.
B) Spontaneous mutations occur as a result of exposure to a mutagen.
C) Mutations are alterations in normal DNA sequence.
D) Mutations are always inherited.

C) Mutations are alterations in normal DNA sequence.

Chronic infection of the cervix by the human papilloma virus results in cervical:

A) atrophy.
B) dysplasia.
C) metaplasia.
D) hormonal hyperplasia.

B) dysplasia.

Free radical injury can be caused by:

A) tissue damage by antioxidants.
B) radiation injury.
C) excess amounts of vitamin C and E.
D) the presence of edema.

B) radiation injury.

Free radicals cause tissue injury by all of the following mechanisms except:

A) DNA fragmentation.
B) activation of lysosomal enzymes.
C) lipid peroxidation.
D) mitochondrial damage.

B) activation of lysosomal enzymes.

Pathologic hyperplasia can lead to:

A) neoplasia (cancer).
B) dysplasia.
C) metaplasia.
D) all of the above.

D) all of the above.

Which of the following cancers arise from epithelial tissue?

A) Sarcoma
B) Leukemia
C) Glioma
D) Carcinoma

D) Carcinoma

Which of the following cancers arise from connective tissue?

A) Lymphoma
B) Sarcoma
C) Glioma
D) Adenoma

B) Sarcoma

Which of the following cancers arise from bone marrow stem cells and always originate in the bone marrow?

A) Glioma
B) Lipoma
C) Leukemia
D) Lymphoma

C) Leukemia

Which of the following is a typical characteristic of malignant tumors?

A) Cells in the malignant tumor are well differentiated.
B) Malignant tumors grow slowly.
C) Malignant tumors have a tendency to invade surrounding tissue.
D) Malignant tumors are surrounded by a capsule.

C) Malignant tumors have a tendency to invade surrounding tissue.

Tumor cell markers can be used to:

A) diagnose tumor type.
B) screen individuals for cancer.
C) follow the clinical course of tumor development.
D) accomplish all of the above.

D) accomplish all of the above.

Tumor grading is performed to determine:

A) the type of cancer-causing gene.
B) the degree of differentiation in the tumor cells.
C) the level of autonomy a cancer has.
D) the extent of metastasis present.

B) the degree of differentiation in the tumor cells.

Cancer cells stimulate blood vessel growth toward the tumor by releasing:

A) autocrine growth factors.
B) angiogenic factors.
C) lysosomal enzymes.
D) telomerase.

B) angiogenic factors.

Cancer-causing mutations to proto-oncogenes result in:

A) apoptosis.
B) increased cell division.
C) production of monoclonal antibodies.
D) decreased cell responsiveness to growth factors.

B) increased cell division.

Which of the following mutational routes is necessary to cause cancer with a tumor suppressor gene mutation?

A) Point deletion on one chromosome
B) Chromosomal translocation
C) Deletion of both copies of a tumor suppressor gene
D) Gene amplification

C) Deletion of both copies of a tumor suppressor gene

Exposure to ionizing radiation is linked to all of the following cancers except:

A) thyroid cancer.
B) leukemia.
C) melanoma.
D) breast cancer.

C) melanoma.

Obesity is an important risk factor for all of the following cancers except:

A) breast cancer.
B) leukemia.
C) colon cancer.
D) esophageal cancer.

B) leukemia.

A tumor that has regional lymph node involvement only is classified as:

A) Stage I.
B) Stage II.
C) Stage III.
D) Stage IV.

B) Stage II.

The less differentiated a cancer cell is, the more:

A) benign it will be.
B) embryonic it will appear.
C) similar it will appear to its tissue of origin.
D) all of the above.

B) embryonic it will appear.

Which of the following is a typical characteristic of benign tumors?

A) Cells in the tumor are undifferentiated.
B) Benign tumors are surrounded by a capsule.
C) Benign tumors have a tendency to invade surrounding tissue.
D) Cells in the tumor occasionally metastasize to lymph nodes.

B) Benign tumors are surrounded by a capsule.

Malignant tumors have a tendency to:
A) grow rapidly.
B) metastasize to distant tissues.
C) invade surrounding tissues.
D) all of the above.

D) all of the above.

Sarcomas are cancers that arise from:

A) connective tissues.
B) glandular tissues.
C) epithelial tissues.
D) germ cells.

A) connective tissues.

Which of the following cancers always arises from an initial mutation in the blood-forming cells of the bone marrow?

A) Lymphoma
B) Carcinoma
C) Leukemia
D) Sarcoma

C) Leukemia

Cervical carcinoma in situ:

A) usually progresses to cervical cancer even after treatment.
B) contains cancer cells that have not invaded the surrounding tissue.
C) refers to cervical cancer that has metastasized to the liver.
D) cannot be detected using available medical tests.

B) contains cancer cells that have not invaded the surrounding tissue.

Referring to cancer, the term anaplasia means:

A) loss of cellular differentiation.
B) rapid growth of cells.
C) independence from normal cellular controls.
D) ectopic production of hormones.

A) loss of cellular differentiation.

Tumor markers can be found in:

A) blood.
B) cerebrospinal fluid.
C) urine.
D) all of the above.

D) all of the above.

Tumor cell markers can be used to:

A) screen individuals for cancer.
B) diagnose tumor type.
C) follow the clinical course of tumor development.
D) all of the above.

D) all of the above.

A tumor that has distant lymph node involvement but no evidence of distant metastasis to other tissues is classified as:

A) Stage I.
B) Stage II.
C) Stage III.
D) Stage IV.

C) Stage III.

The term used to describe an aggregation of cancer cells that accumulates faster than its non-mutant neighbors is clonal:

A) selection.
B) stimulation.
C) expansion.
D) reunification.

C) expansion.

Which of the following is not a typical characteristic of cancer cells?

A) Loss of cellular self-destruct mechanisms
B) Unlimited replication
C) Autocrine stimulation
D) Decreased responsiveness to growth signals

D) Decreased responsiveness to growth signals

Cancer cells ensure adequate supply of oxygen and nutrients by releasing:

A) autocrine growth factors.
B) lysosomal enzymes.
C) telomerase.
D) angiogenic factors.

D) angiogenic factors.

A proto-oncogene is best defined as:

A) a normal gene.
B) a frameshift mutation.
C) an inactive gene.
D) a tumor-suppressor gene.

A) a normal gene.

Cancer-causing mutations of a proto-oncogene result in:

A) apoptosis.
B) increased cell division.
C) production of monoclonal antibodies.
D) decreased cell responsiveness to growth factors.

B) increased cell division.

Immortality in cancer cells is obtained through the production of:

A) growth factors.
B) apoptosis signals.
C) telomerase.
D) tumor markers.

C) telomerase.

The normal function of tumor suppressor genes in an individual without cancer is to:

A) prevent apoptosis.
B) control production of anti-growth signals.
C) stimulate cell replication.
D) prevent cancer-causing mutations.

B) control production of anti-growth signals.

Which of the following mutational routes is necessary to cause cancer with a tumor suppressor gene mutation?

A) Point deletion on one chromosome
B) Chromosomal translocation
C) Gene amplification
D) Deletion of both copies of a tumor suppressor gene

D) Deletion of both copies of a tumor suppressor gene

Normally, the tumor suppressor gene p53 induces:

A) apoptosis.
B) secretion of anti-growth factors.
C) the formation of oncogenes.
D) telomere activity.

A) apoptosis.

One way that a tumor suppressor gene can become inactivated in the absence of mutation or deletion is through gene:

A) silencing.
B) splicing.
C) amplification.
D) translocation.

A) silencing.

Which of the following genetic events is capable of activating oncogenes?

A) Deletion
B) Loss of heterozygosity
C) Amplification
D) All of the above

C) Amplification

Which of the following factors plays a role in the development of cancer from viral and bacterial infections?

A) Inflammatory chemicals cause damage to DNA.
B) Growth factors are released during the resulting inflammation.
C) Cells divide more frequently to replace damaged tissue.
D) All of the above factors play a role.

D) All of the above factors play a role.

Viruses are associated with all of the following cancers except:

A) lung cancer.
B) Kaposi sarcoma.
C) lymphoma.
D) liver cancer.

A) lung cancer.

Chronic active hepatitis B infection is a risk factor for developing which of the following types of cancer?

A) Lung
B) Leukemia
C) Pancreas
D) Liver

D) Liver

Which of the following viruses has been implicated in the development of cervical cancer?

A) Herpes virus
B) HIV
C) Epstein-Barr virus
D) Human papilloma virus

D) Human papilloma virus

Helicobacter pylori infection is a bacterial cause of:

A) lymphoma.
B) colon cancer.
C) gastric cancer.
D) bladder cancer.

C) gastric cancer.

Which of the following risk factors is associated with the development of lung, bladder, pancreatic, renal, laryngeal, pharyngeal, and esophageal cancer?

A) Ultraviolet (UV) radiation
B) Radon
C) Tobacco use
D) Asbestos

C) Tobacco use

Exposure to ionizing radiation is linked to all of the following cancers except:

A) leukemia.
B) thyroid cancer.
C) breast cancer.
D) skin cancer.

D) skin cancer.

Obesity is an important risk factor for all of the following cancers except:

A) breast cancer.
B) leukemia.
C) colon cancer.
D) esophageal cancer.

B) leukemia.

All of the following dietary substances are known carcinogens except:

A) fiber.
B) polyunsaturated fats.
C) charbroiled beef.
D) nitrates (nitrosamines).

A) fiber.

Which of the following statements about alcohol intake and cancer risk is true?

A) Alcohol intake is linked to the development of liver cancer only.
B) Alcohol intake increases the development of smoking-related cancers.
C) Moderate amounts of alcohol intake protect against breast and colon cancer.
D) Alcohol acts as an antioxidant, resulting in liver cancer.

B) Alcohol intake increases the development of smoking-related cancers.

Radon exposure increases an individual's risk for which of the following cancers?

A) Pancreatic
B) Esophageal
C) Lung
D) Skin

C) Lung

Autotoxin release by cancer cells stimulates:

A) cell division.
B) apoptosis of normal cells.
C) motility.
D) release of lysosomal enzymes.

C) motility.

As a tumor grows, it exerts mechanical pressure on surrounding tissues, which results in:

A) cellular swelling.
B) ischemia.
C) metastasis.
D) extravasation.

B) ischemia.

Local tissue invasion by a tumor is accomplished by which of the following mechanisms?

A) Release of cytokines by the tumor cells, which kills surrounding cells
B) Release of lytic enzymes by the tumor cells, which causes tissue degradation
C) Release of antibodies by the tumor cells, which enhances phagocytosis of surrounding tissue
D) Release of free radicals by the tumor cells, which damages surrounding tissue

B) Release of lytic enzymes by the tumor cells, which causes tissue degradation

In normal cells, the glycoprotein fibronectin:

A) is a self vs. non-self antigenic marker.
B) acts as a receptor for growth factors.
C) activates the conversion of fibrinogen to fibrin.
D) helps adhere neighboring cells to each other.

D) helps adhere neighboring cells to each other.

In order for a tumor cell to invade tissues, it must attach to laminin in the:

A) basement membrane.
B) endothelium.
C) collagenous matrix.
D) blood.

A) basement membrane.

The process of triggering new blood vessel formation in a tumor is called:

A) erythropoiesis.
B) atherosclerosis.
C) angiogenesis.
D) seeding.

C) angiogenesis.

The extension of cancer to distant tissues and organs is called:

A) apoptosis.
B) tropism.
C) metastasis.
D) malignancy.

C) metastasis.

Seeding involves the spread of cancer cells to:

A) blood vessels.
B) serous membranes of body cavities.
C) fascia surrounding muscles and bones.
D) dermis and subcutaneum of the skin.

B) serous membranes of body cavities.

After cancer cells metastasize into lymphatic vessels, which of the following events occurs?

A) Cancer cells are killed by immune cells in the lymph nodes.
B) Cancer cells lodge in the lymph node and proliferate.
C) Cancer cells continue past the lymph nodes to distant organ sites.
D) All of the above can occur.

D) All of the above can occur.

The process of cancer cells entering into blood vessels is called:

A) tropism.
B) embolism.
C) intravasation.
D) angiogenesis.

C) intravasation.

Determining the size of the tumor, the degree of node involvement, and the extent of distant metastasis is called:

A) categorization.
B) staging.
C) factoring.
D) processing.

B) staging.

Which of the following factors is necessary for metastasis to occur?

A) Decreased cellular motility
B) Decreased cell adhesions
C) Temporary cessation of cell division
D) Proximity to body cavities

B) Decreased cell adhesions

Survival from breast cancer is directly correlated to the:

A) number of involved lymph nodes.
B) amount of seeding in the peritoneal cavity.
C) amount of pain an individual incurs.
D) degree of nausea and vomiting side effects from chemotherapy. ji

A) number of involved lymph nodes.

Which of the following factors plays a role in organ tropism?

A) Preferential adherence to the surface of certain target cells
B) Presence of certain growth factors or hormones
C) Presence of chemotactic factors
D) All of the above

D) All of the above

Cancers in the abdominopelvic cavity, such as ovarian and colorectal cancers, tend to first metastasize to the:

A) liver.
B) bladder.
C) brain.
D) axillary lymph nodes.

A) liver.

The most commonly reported symptom in individuals with cancer is:

A) fatigue.
B) anorexia.
C) nausea.
D) depression.

A) fatigue.

Mechanisms that cause cancer pain include all of the following except:

A) Pressure on tissues and nerve endings
B) Metastases to bone
C) Cancer cells residing in lymph nodes
D) Release of pain-inducing chemicals

C) Cancer cells residing in lymph nodes

Individual response to pain depends on which of the following factors?

A) Cultural
B) Psychologic
C) Physiologic
D) All of the above

D) All of the above

Pharmacologic therapies for pain management include all of the following except:

A) local anesthesia.
B) beta receptor blockers.
C) anti-inflammatory agents.
D) opioids.

B) beta receptor blockers.

Which of the following statements about cancer pain is false?

A) Non-pharmacologic therapies such as meditation and relaxation are ineffective for cancer pain management.
B) Most patients with cancer experience pain early in the disease process.
C) Cancer pain management requires a multimodal and multidisciplinary approach.
D) When first diagnosed with cancer, many individuals say that severe pain is their biggest fear.

B) Most patients with cancer experience pain early in the disease process.

Apart from diminished physical energy, cancer-related fatigue can manifest in which of the following ways?

A) Diminished intellectual performance
B) Muscle weakness
C) Mood changes
D) All of the above

D) All of the above

Major causes of fatigue related to cancer and cancer therapy listed by the National Cancer Institute include all of the following except:

A) chronic stress.
B) disordered sleep.
C) immunosuppression.
D) metabolic disturbances.

C) immunosuppression.

The wasting syndrome associated with cancer and cancer treatment is called:

A) cachexia.
B) anemia.
C) Cushing syndrome.
D) anabolism.

A) cachexia.

Cachexia is a syndrome that includes all of the following symptoms except:

A) anorexia.
B) weight loss.
C) dyspnea.
D) weakness and fatigue.

C) dyspnea.

Kwashiorkor is a form of malnutrition arising from a diet poor in:

A) calories.
B) fat.
C) carbohydrate.
D) protein.

D) protein.

Alterations in carbohydrate metabolism in people with cancer causes:

A) hypoglycemia.
B) depressed carbohydrate absorption.
C) weight gain.
D) a diabetes-like syndrome.

D) a diabetes-like syndrome.

Neuromuscular dysfunction and the release of inflammatory mediators such as tumor necrosis factor and interleukin-1 are thought to be responsible for which of the following manifestations of cancer?

A) Cachexia
B) Thrombocytopenia
C) Metastasis
D) Fatigue

D) Fatigue

Which of the following alterations in metabolism is often present in people with cancer?

A) Increased basic metabolic rate
B) Decreased fat breakdown
C) Increased anabolism
D) Overproduction of protein

A) Increased basic metabolic rate

Anemia in individuals with cancer can be the result of all of the following except:

A) decreased erythropoietin.
B) chronic bleeding.
C) fatigue.
D) malignant cells in the bone marrow.

C) fatigue.

Which of the following is an effective treatment for cancer-related or chemotherapy-related anemia?

A) Exercise
B) Chemotherapy
C) Erythropoietin
D) Calcium and magnesium supplements

C) Erythropoietin

Leukopenia from cancer or chemotherapy treatment increases an individual's risk for:

A) allergic reactions.
B) autoimmune disease.
C) bleeding.
D) infection.

D) infection.

Which of the following cell populations do chemotherapeutic agents primarily target?

A) All cells
B) Cancer cells only
C) Cells that are incapable of mitosis
D) All rapidly dividing cells

D) All rapidly dividing cells

How does radiation therapy provide an effective means for treating some forms of cancer?

A) Ionizing radiation damages the cancer cell's DNA.
B) Heat generated by radiation is thermally toxic to cancer cells.
C) The resulting inflammatory response destroys the tumor.
D) High-energy waves cause cell membrane injury.

A) Ionizing radiation damages the cancer cell's DNA.

Which of the following modes of treatment is not used to eradicate cancer?

A) Immunotherapy
B) Blood transfusions
C) Hormone therapy
D) Surgery

B) Blood transfusions

Oral ulcers caused by chemotherapy or radiation therapy is a condition known as:

A) stomatitis.
B) candidiasis.
C) impetigo.
D) decubitus ulceration.

A) stomatitis.

Hair loss from chemotherapy treatment is condition known as:

A) folliculitis.
B) alopecia.
C) erythema.
D) sterility.

B) alopecia.

Anticipatory nausea related to cancer treatment is caused by:

A) fear of impending chemotherapy treatment.
B) central nervous system effects of chemotherapeutic drugs.
C) gastrointestinal tract toxicity.
D) constipation and diarrhea.

A) fear of impending chemotherapy treatment.

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