Neoplasia — Past Paper OmpathStudy

Neoplasia — Questions and Answers Complete review bank: 60 questions recovered from all 39 source pages. 1. A 44-year-old woman notes a lump in her left breast while taking a shower. The nurse practitioner palpates a 3 cm firm, irregular, non-movable mass in the upper outer quadrant of her left breast on physical examination. A fine needle aspiration of this mass is performed, and cytologically the cells are consistent with infiltrating ductal carcinoma. The mass is removed with lumpectomy along with an axillary sentinel lymph node sampling. Which of the following findings will best predict a better prognosis for this patient? A. Tumor cells strongly estrogen receptor positive B. No metastases in the sampled lymph nodes C. Flow cytometric analysis with aneuploidy and a high S-phase D. One relative who had a similar type of breast cancer E. High cytologic tumor grade Answer: B. The lack of metastases suggests a lower stage and a better prognosis. In general, stage is a better indicator of prognosis than grade. In general, low stage cancers are more amenable to surgical resection and chance for cure. 2. A change in bowel habits prompts a 53-year-old woman to see her physician. On physical examination there are no lesions noted on digital rectal examination, but her stool is positive for occult blood. A colonoscopy is performed and reveals a 6 cm friable exophytyic mass in the cecum. A biopsy of this mass is performed and microscopic examination shows a moderately differentiated adenocarcinoma. Which of the following laboratory findings is most likely to be present in this patient? A. K-RAS mutation in the neoplastic cells B. Neoplastic cells positive for vimentin C. Stool culture with Shigella flexneri D. Presence of HIV-1 RNA E. DNA topoisomerase I autoantibody Answer: A. Many human carcinomas are associated with RAS mutations that contribute to oncogenesis. Many types of mutations can be present, and in general multiple mutations are present. Sporadic cancers in adults can have many of the same mutations, such as APC and mismatch repair, that are found in familial cancers, but they are aquired and not inherited. 3. An experiment is conducted in which proliferating cells are subjected to ionizing radiation. The ionizing radiation leads to arrest in a checkpoint that monitors completion of DNA replication. It is observed that there are increased numbers of chromosomal abnormalities in these cells. Which of the following is the checkpoint affected by the ionizing radiation? A. G0/G1 B. G1/S C. S/G2 D. G2/M E. M/G0 Answer: D. This is the second checkpoint in the cell cycle; ionizing radiation activates this checkpoint, resulting in chromosomal abnormalities in mitosis. 4. A clinical study is performed to determine the incidence of cancers in different countries. The data show that persons born in Japan and continuing to reside there have an increased risk for a certain type of cancer. A risk factor of Helicobacter pylori infection is postulated. Which of the following cancers is most likely seen with increased frequency in this population? A. Breast B. Colon C. Lung D. Stomach E. Uterus Answer: D. Gastric cancers are more prevalent in Japan. Is this genetics or environment? The risk goes down with emigration and subsequent generations living outside of Japan. The prevlance of H. pylori infection may play a role. with progression of chronic gastritis to gastric atrophy, intestinal metaplasia, then dysplasia evolving to carcinoma. Incidence of gastric cancer has diminished in the U.S. The health care system in Japan has effective screening programs that diagnose many cases at the curable early gastric cancer stage. 5. A 48-year-old woman has a routine physical examination. A 4 cm diameter non-tender mass is palpated in her right breast. The mass appears fixed to the chest wall. Another 2 cm non-tender mass is palpable in the left axilla. A chest radiograph reveals multiple 0.5 to 2 cm nodules in both lungs. Which of the following TNM classifications best indicates the stage of her disease? A. T1 N1 M0 B. T1 N0 M1 C. T2 N1 M0 D. T3 N0 M0 E. T4 N1 M1 Answer: E. She has a large invasive (high T) primary tumor mass with axillary node (N 0) and lung (distant) metastases (M1). 6. A study is performed to analyze characteristics of malignant neoplasms in biopsy specimens. The biopsies were performed on patients who had palpable mass lesions on digital rectal examination. Of the following microscopic findings, which is most likely to indicate that the neoplasm is malignant? A. Pleomorphism B. Atypia C. Invasion D. Increased nuclear/cytoplasmic ratio E. Necrosis Answer: C. Metastasis would be an even better indicator, but invasion of adjacent tissues suggests malignancy more than the other items listed here. Size increasing beyond 1 cm is also a risk for malignancy in a colonic polypoid lesion. 7. A 61-year-old man has a screening colonoscopy performed. A 2.7 cm polypoid mass in the rectum is biopsied and diagnosed as grad