Chapter 12

The most common site of metastasis for a patient diagnosed with prostate cancer is which location? a. bones. b. brain. c. bladder. d. kidney.

a. bones. The bone, especially the lumbar spine area, is the most common metastasis site for prostate cancer.

Which statements concerning aging and the occurrence of cancer are true? (select all that apply). a. decline in immunologic functions. b. predisposition to nutritional inadequacies. c. unwillingness to access health care services. d. reluctance to engage in cancer screenings. e. effects of immobility on the immune system.

a. decline in immunologic functions. b. predisposition to nutritional inadequacies. e. effects of immobility on the immune system. Many common malignancies occurs mostly in older age as a result of immunologic functions declining with age. Older persons are predisposed to nutritional deficiencies, and malnutrition impairs immunocompetence. Far-advanced cancer often results in immobility and general debility that worsens with age.

Two "hits" are required to inactivate tumor-suppressor genes because: a. each allele must be altered, and each person has two copies, or alleles, of each gene, one from each parent. b. the first hit stops tissue growth, and the second hit is needed to cause abnormal tissue growth. c. tumor-suppressor genes are larger than proto-oncogenes, requiring two hits to effect carcinogenesis. d. the first hit is insufficient to cause enough damage to cause mutation.

a. each allele must be altered, and each person has two copies, or alleles, of each gene, one from each parent. A single genetic event can activate an oncogene, acting in a dominant manner in the cell. However, each person has two copies, or alleles, of each gene, one from each parent. Therefore two hits are required to inactivate the two alleles of a tumor-suppressor gene, allowing the process to become active.

Normally, which cells are considered immortal (never die)? (select all that apply). a. germ. b. stem. c. blood. d. epithelial. e. muscle.

a. germ. b. stem. Usually, germ cells (those that generate sperm and eggs) and stem cells are the only cells in the body that are immortal.

What are tumor cell markers? a. hormones, enzymes, antigens, and antibodies that are produced by cancer cells. b. receptor sites on tumor cells that can be identified and marked. c. cytokines that are produced against cancer cells. d. identification markers that are used in administering radiation therapy.

a. hormones, enzymes, antigens, and antibodies that are produced by cancer cells. Tumor (biologic) markers are substances produced by both benign and malignant cells that are found either in or on the tumor cells or in the blood, spinal fluid, or urine. Tumor markers may include hormones, enzymes, genes, antigens, and antibodies.

What are the most common causes of nosocomial infections among patients with cancer? (select all that apply). a. indwelling medical devices. b. suppressed immune system. c. visitor-introduced microorganisms. d. poor appetite. e. inadequate wound care.

a. indwelling medical devices. c. visitor-introduced microorganisms. e. inadequate wound care. Hospital-acquired (nosocomial) infections increase because of indwelling medical devices, inadequate wound care, and the introduction of microorganisms from visitors and other individuals.

What is the skin-related health risk induced by some types of chemotherapy? a. infection. b. ultraviolet damage. c. pain. d. erythema.

a. infection. Decreased renewal rates of the epidermal layers in the skin may lead to skin breakdown and dryness, altering the normal barrier protection against infection. Radiation therapy may cause skin erythema (redness).

What is the role of caretaker genes? a. maintenance of genomic integrity. b. proliferation of cancer cells. c. secretion of growth factors. d. restoration of normal tissue structure.

a. maintenance of genomic integrity. Caretake genes are responsible for the maintenance of genomic integrity.

Apoptosis is a(n): a. normal mechanism for cells to self-destruct when growth is excessive. b. antigrowth signal activated by the tumor-suppressor gene Rb. c. mutation of cell growth stimulated by the TP53 gene. d. transformation of cells from dysplasia to anaplasia.

a. normal mechanism for cells to self-destruct when growth is excessive. Normal cells have a mechanism that causes them to self-destruct when growth is excessive and cell cycle checkpoints have been ignored. Diverse stimuli, including normal development and excessive growth, trigger this self-destruct mechanisms, called apoptosis.

Which cancer originates from connective tissue? a. osteogenic sarcoma. b. basal cell carcinoma. c. multiple myeloma. d. adenocarcinoma.

a. osteogenic sarcoma. Cancers arising from connective tissue usually have the suffix -sarcoma.

What cellular characteristics are affected by anaplasia? (select all that apply). a. size. b. ability to differentiate. c. life expectancy. d. tissue structure. e. shape.

a. size. b. ability to differentiate. d. tissue structure. e. shape. Anaplasia is defined as the loss of cellular differentiation, irregularities of the size and shape of the nucleus, and loss of normal tissue structure.

Oncogenes are genes that are capable of: a. undergoing mutation that directs the synthesis of proteins to accelerate the rate of tissue proliferation. b. directing synthesis of proteins to regulate growth and to provide necessary replacement of tissue. c. encoding proteins that negatively regulate the synthesis of proteins to slow or halt the replacement of tissue. d. undergoing mutation that directs malignant tissue toward blood vessels and lymph nodes for metastasis.

a. undergoing mutation that directs the synthesis of proteins to accelerate the rate of tissue proliferation. Oncogenes are mutant genes that, before mutation, direct synthesis of proteins that positively regulate (accelerate) proliferation.

The survival rate of stage IV Hodgkin disease can be as high as: a. 99%. b. 70%. c. 40%. d. 20%.

b. 70%. Survival rates for Hodgkins disease is 99% for stage I and 70% for stage IV.

Which statement supports the hypothesis that intestinal polyps are benign neoplasms and the first stage in the development of colon cancer? a. cancer cells accumulate slower than non cancer cells. b. an accumulation of mutations in specific genes is required for the development of cancer. c. tumor invasion and metastasis progress more slowly in the gastrointestinal tract. d. apoptosis is triggered by diverse stimuli, including excessive growth.

b. an accumulation of mutations in specific genes is required for the development of cancer. Multiple genetic mutations are required for the evolution of full-blown cancer.

By what process do cancer cells multiply in the absence of external growth signals? a. proto-oncogene. b. autocrine stimulation. c. reliance on caretaker genes. d. pleomorphology.

b. autocrine stimulation. Cancer cells must have mutations that enable them to proliferate in the absence of external growth signals. To achieve this, some cancers acquire the ability to secrete growth factors that stimulate their own growth, a process known as autocrine stimulation.

What is the most common route for distant metastasis? (select all that apply). a. seeding. b. blood. c. lymphatic vessels. d. invasion. e. proliferation.

b. blood. c. lymphatic vessels. To transition from local to distant metastasis, the cancer cells must also be able to invade local blood and lymphatic vessels.

What is the consequence for cells when the functioning TP53 gene is lost as a result of mutation? a. cells undergo apoptosis. b. cells escape apoptosis. c. cells receive less oxygen. d. cells adhere more readily.

b. cells escape apoptosis. The most common mutations conferring resistance to apoptosis occur in the TP53 gene.

Burkitt lymphomas designate a chromosome that has a piece of chromosome 8 fused to a piece of chromosome 14. This is an example of which mutation of normal genes to oncogenes? a. point mutation. b. chromosome translocation. c. gene amplification. d. chromosome fusion.

b. chromosome translocation. Chromosome translocations, in which a piece of one chromosome is translocated to another chromosome, can activate oncogenes. One of the best examples is the t (8;14) translocation found in many Burkitt lymphomas; t (8;14) designates a chromosome that has a piece of chromosome 8 fused to a piece of chromosome 14.

Which cancers are all associated with chronic inflammation? a. brain, muscle, and endocrine. b. colon, thyroid gland, and urinary bladder. c. bone, blood cells, and liver. d. eye, tracheal, and kidney.

b. colon, thyroid gland, and urinary bladder. Some organs appear to be more susceptible to the oncogenic effects of chronic inflammation; for example, the GI tract, prostate, thyroid gland, pancreas, urinary bladder, pleura, and skin. One large study found a 66% increase in the risk of lung cancer among women with chronic asthma.

Carcinoma refers to abnormal cell proliferation originating from which tissue origin? a. blood vessels. b. epithelial cells. c. connective tissue. d. glandular tissue.

b. epithelial cells. Only cancers arising from epithelial cells are called carcinomas.

What is the most commonly reported symptom of cancer treatment? a. nausea. b. fatigue. c. hair loss. d. weight loss.

b. fatigue. Fatigue is the most frequently reported symptom of cancer and cancer treatment.

Which terms represent the correct nomenclature for benign and malignant tumors of adipose tissue, respectively? a. liposarcoma, lipoma. b. lipoma, liposarcoma. c. adisarcoma, adipoma. d. adipoma, adisarcoma.

b. lipoma, liposarcoma. In general, cancers are named according to the cell type from which they originate (e.g., lip for cancers that originate in adipose or fat tissue), whereas benign tumors use the suffix -oma. Cancers arising from connective tissue usually have the suffix -sarcoma.

What aberrant change causes the abnormal growth in retinoblastoma? a. proto-oncogenes are changed to oncogenes. b. the tumor-suppressor gene is turned off. c. genetic amplification causes the growth. d. chromosomes 9 and 32 are fused.

b. the tumor-suppressor gene is turned off. One of the first discovered tumor-suppressor genes, the retinoblastoma (Rb) gene, normally strongly inhibits the cell division cycle. When it is activated, the cell division cycle can proceed unchecked. The Rb gene is mutated in childhood retinoblastoma.

What is the role of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) in cell metastasis? a. to stimulate growth of nearby tumor cells. b. to develop new blood vessels to feed cancer cells. c. to prevent cancer cells from escaping apoptosis. d. to act as a chemical gradient to guide cells to blood vessels.

b. to develop new blood vessels to feed cancer cells. By recruiting new vascular endothelial cells and initiating the proliferation of existing blood vessel cells, the angiogenic factor, such as VEGF and growth factor bFGF, allow small cancers to become large cancers.

The ras gene converts from a proto-oncogene to an oncogene by: a. designating a chromosome that has a piece of one chromosome fused to a piece of another chromosome. b. duplicating a small piece of a chromosome, repeatedly making numerous copies. c. altering one or more nucleotide base pairs. d. promoting proliferation of growth signals by impairing tumor-suppressor genes.

c. altering one or more nucleotide base pairs. A point mutation is the alteration of one or a few nucleotide base pairs. This type of mutation can have profound effects on the activity of proteins. A point mutation in the ras gene converts it from a regulated proto-oncogene to an unregulated oncogene, an accelerator of cellular proliferation.

It has been determined that a tumor is in stage 2. What is the meaning of this finding? a. cancer is confined to the organ of origin. b. cancer has spread to regional structures. c. cancer is locally invasive. d. cancer has spread to distant sites.

c. cancer is locally invasive. Cancer confined to the organ of origin is stage 1; cancer that is locally invasive is stage 2; cancer than has spread to regional structures, such as lymph nodes, is stage 3; and cancer that has spread to distant sites, such as liver cancer spreading to the lung or a prostate cancer spreading to bone, is stage 4.

Carcinoma in situ is characterized by which changes? a. cells have broken through the local basement membrane. b. cells have invaded immediate surrounding tissue. c. cells remain localized in the glandular or squamous cells. d. cellular and tissue alterations indicate dysplasia.

c. cells remain localized in the glandular or squamous cells. Carcinoma in situ (CIS) refers to preinvasive malignant tumors of glandular or squamous cell origin. These early stage cancers are localized to the epithelium and have not broken through the local basement membrane or invaded the surrounding tissue. Dysplasia refers to changes in mature cell structure.

Which cancer may be treated with radiation delivered by brachytherapy? a. lung. b. colon. c. cervical. d. brain.

c. cervical. Radiation sources, such as small I-labeled capsules (also called seeds), can also be temporarily placed into body cavities, a delivery method termed brachytherapy. Brachytherapy is useful in the treatment of cervical, prostate, and head and neck cancers

In childhood neuroblastoma, the N-myc oncogene undergoes which type of mutation of normal gene to oncogene? a. point mutation. b. chromosome fusion. c. gene amplification. d. chromosome translocation.

c. gene amplification. Amplification are the result of the duplication of a small piece of a chromosome over and over again; consequently, instead of the normal two copies of a gene, tens or even hundreds of copies are present. The N-myc oncogene is amplified in 25% of childhood neuroblastoma.

What is the major virus involved in the development of cervical cancer? a. herpes simplex virus type 6. b. herpes simplex virus type 2. c. human papilloma virus. d. human immunodeficiency virus.

c. human papilloma virus. Infectious with specific subtypes of HPV cause virtually all cervical cancers.

Many cancers create a mutation of ras. Ras is a(n): a. tumor-suppressor gene. b. growth-promoting gene. c. intracellular-signaling protein that regulates cell growth. d. cell surface receptor that allows signaling to the nucleus concerning cell growth.

c. intracellular-signaling protein that regulates cell growth. Up to one-third of all cancers have an activating mutation in the gene for an intracellular signaling protein called ras. This mutant ras stimulates cell growth even when growth factors are missing.

Chronic inflammation causes cancer by: a. increasing vasodilation and permeability that alter cellular response to DNA damage. b. liberating lysosomal enzymes when cells are damaged that initiates mutations. c. releasing compounds such as reactive oxygen that promote mutations. d. increasing the abundance of leukotrienes that are associated with some cancers.

c. releasing compounds such as reactive oxygen that promote mutations. Inflammatory cells release compounds, such as reactive oxygen species (ROS) and other reactive molecules, that can promote mutations and block the cellular response to DNA damage.

Autocrine stimulation is the ability of cancer cells to: a. stimulate angiogenesis to create their own blood supply. b. encourage secretions that turn off normal growth inhibitors. c. secrete growth factors that stimulate their own growth. d. divert nutrients away from normal tissue for their own use.

c. secrete growth factors that stimulate their own growth. Cancer cells must have mutations that enable them to proliferate in the absence of external growth signals. To achieve this, some cancers acquire the ability to secrete growth factors that stimulate their own growth, a process known as autocrine stimulation.

Which gastrointestinal tract condition can be an outcome of both chemotherapy and radiation therapy? a. increased cell turnover. b. constipation. c. stomatitis. d. blood stool.

c. stomatitis. Chemotherapy and radiation therapy may cause a decreased cell turnover, thereby leading to oral ulcers (stomatitis), malabsorption, and diarrhea.

Which statement is true regarding pleomorphic cells? a. pleomorphic cells are similar in size. b. they share a common shape. c. they are a result of anaplasia. d. pleomorphic cells differentiate uniformly.

c. they are a result of anaplasia. In contrast to normal cells, which are uniform in size and shape, anaplastic cells are of variable size and shape and abnormally differentiate, making them pleomorphic.

Inherited mutations that predispose to cancer are almost invariably what kind of gene? a. proto-oncogenes. b. oncogenes. c. tumor-suppressor genes. d. growth-promoting genes.

c. tumor-suppressor genes. Inherited mutations that predispose to cancer are almost invariably in tumor-suppressor genes.

Which term is used to describe a muscle cell showing a reduced ability to form new muscle while appearing highly disorganized? a. dysplasia. b. hyperplasia. c. myopliasia. d. anaplasia.

d. anaplasia. Anaplasia is defined as the loss of cellular differentiation, irregularities of the size and shape of the nucleus, and the loss of normal tissue structure. In clinical specimens, anaplasia is recognized by a loss of organization and a significant increase in nuclear size with evidence of ongoing proliferation.

What are characteristics of benign tumors? a. benign tumors invade local tissues. b. benign tumors spread through the lymph nodes. c. benign tumors cause systemic symptoms. d. benign tumors include the suffix -oma.

d. benign tumors include the suffix -oma. Benign tumors are usually encapsulated and well-differentiated. They retain some normal tissue structure and do not invade the capsules surrounding them or spread to regional lymph nodes or distant locations. Benign tumors are generally named according to the tissues from which they arise and include the suffix -oma. Benign tumors do not cause systemic symptoms.

What is the cause of anemia in a patient diagnosed with pancreatic cancer? a. impaired pancreatic function. b. malnutrition. c. chronic bleeding. d. malabsorption of iron.

d. malabsorption of iron. Iron is malabsorbed in individuals with gastric, pancreatic, or upper intestinal cancer. Commonly associated with malignancy, mechanism of anemia include chronic bleeding (resulting in iron deficiency), severe malnutrition, cytotoxic chemotherapy, and malignancy in blood-forming organs.

Which statement is true regarding pain and cancer? a. pain is primarily a result of pressure caused by the tumor. b. pain indicates the metastasis of a cancer. c. pain is usually the initial symptom of cancer. d. pain is generally associated with late-stage cancer.

d. pain is generally associated with late-stage cancer. Pain is generally associated with the late stages of cancer. Pressure, obstruction, invasion of a structure sensitive to pain, stretching, tissue destruction, and inflammation can cause pain.

In a normal, nonmutant state, an oncogene is referred to as a: a. basal cell. b. target cell. c. caretaker gene. d. proto-oncogene.

d. proto-oncogene. In its normal non mutant state, an oncogene is referred to as a proto-oncogene.

The function of the tumor cell marker is to: a. provide a definitive diagnosis of cancer. b. treat certain types of cancer. c. predict where cancers will develop. d. screen individuals at high risk for cancer.

d. screen individuals at high risk for cancer. Screening and identifying individuals at high risk for cancer are ways tumor markers can be used. These markers are not used to definitively diagnose or treat cancer and are not useful in predicting specific sites of cancer development.

Which statement concerning benign tumors is true? a. the resulting pain is severe. b. benign tumors are not encapsulated. c. benign tumors are fast growing. d. the cells are well-differentiated.

d. the cells are well-differentiated. A benign tumor is well-differentiated with its tissue appearing similar to the tissue from which it arose.

How do cancer cells use the enzyme telomerase? a. to repair the telomeres to restore somatic cell growth. b. as an intracellular signaling chemical to stimulate cell division. c. to switch off the telomerase to enable cells to divide indefinitely. d. to switch on the telomerase to enable cells to divide indefinitely.

d. to switch on the telomerase to enable cells to divide indefinitely. Cancer cells, when they reach a critical age, somehow activate telomerase to restore and maintain their telomeres and thereby make it possible for cells to divide over and over again.