Neoplasia — MCQs
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CA-19-9 is typically elevated in all of the following cancers except:
Which enzymatic activity is primarily responsible for the immortality of cancer cells?
Which of the following tumors is known for its potential for spontaneous regression?
Clear cell variety of renal cell carcinoma is related to a gene located on which chromosome?
All are features of hypernephroma except:
Neoplasia Indian Medical PG Practice Questions and MCQs
Question 991: CA-19-9 is typically elevated in all of the following cancers except:
- A. Breast carcinoma (Correct Answer)
- B. Ovarian carcinoma
- C. Colonic carcinoma
- D. Pancreatic carcinoma
Explanation: ***Breast carcinoma*** - CA-19-9 is a **tumor marker** primarily associated with **gastrointestinal cancers** and is not typically elevated in breast carcinoma. - While other markers like **CA 15-3** or **CA 27.29** are used for monitoring breast cancer, CA-19-9 is not clinically useful in this context. *Ovarian carcinoma* - Although **CA-125** is the primary marker for ovarian cancer, CA-19-9 can be elevated in a subset of cases, particularly with **mucinous ovarian tumors**. - Its presence can indicate a **different histological subtype** or more advanced disease, but it's not the primary diagnostic marker. *Colonic carcinoma* - CA-19-9 can be elevated in **colorectal cancer**, although **CEA (carcinoembryonic antigen)** is more commonly used for monitoring this type of cancer. - High levels of CA-19-9 in colorectal cancer may suggest **advanced disease** or specific tumor characteristics. *Pancreatic carcinoma* - CA-19-9 is the **most widely used and validated tumor marker** for **pancreatic adenocarcinoma**, helping in diagnosis, prognosis, and monitoring treatment response. - Elevated levels are found in a majority of patients with pancreatic cancer and correlate with **tumor burden** and **disease progression**.
Question 992: Which enzymatic activity is primarily responsible for the immortality of cancer cells?
- A. RNA polymerase
- B. Telomerase (Correct Answer)
- C. DNA polymerase
- D. DNA reverse transcriptase
Explanation: ***Telomerase*** - **Telomerase** is an enzyme that adds repetitive nucleotide sequences to the ends of chromosomes (**telomeres**), preventing their shortening during DNA replication [1]. - In normal somatic cells, **telomerase** activity is low or absent, leading to progressive telomere shortening and eventual cellular senescence or apoptosis; however, in cancer cells, **telomerase** is highly active, maintaining telomere length and enabling indefinite cell division, contributing to their **immortality** [1]. *DNA reverse transcriptase* - **DNA reverse transcriptase** synthesizes DNA from an RNA template, a process characteristic of retroviruses (e.g., HIV) and not typically involved in the immortality of human cancer cells. - While some endogenous retroelements exist in the human genome, this enzyme's primary role is not in maintaining the replicative potential of cancer cells. *RNA polymerase* - **RNA polymerase** is responsible for synthesizing RNA from a DNA template (**transcription**), a fundamental process in gene expression. - While critical for cell growth and division, **RNA polymerase** does not directly prevent telomere shortening or contribute to cellular immortality. *DNA polymerase* - **DNA polymerase** is involved in DNA replication and repair, synthesizing new DNA strands and ensuring genetic fidelity. - While essential for cell proliferation, it does not directly address the issue of **telomere shortening**, which is key to cellular aging and immortality. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 311-312.
Question 993: Which of the following tumors is known for its potential for spontaneous regression?
- A. Osteogenic sarcoma
- B. Malignant melanoma (Correct Answer)
- C. Retinoblastoma
- D. Cholangiocarcinoma
Explanation: ***Osteogenic sarcoma*** - Osteogenic sarcoma, or **osteosarcoma**, is a **malignant bone tumor** that typically does not resolve spontaneously and often requires aggressive treatment [1]. - It commonly presents with **pain and swelling** in long bones, and its prognosis is poor without intervention. *Retinoblastoma* - Retinoblastoma can exhibit **spontaneous regression**, especially in bilateral cases, where the tumor may shrink without treatment over time. - It primarily affects the **retina** in children, ideally diagnosed early to preserve vision and life. *Cholangio carcinoma* - Cholangio carcinoma is an aggressive form of **bile duct cancer** that does not resolve spontaneously and usually has a poor prognosis. - Symptoms typically include **jaundice** and bile duct obstruction, requiring surgical intervention. *Malignant melanoma* - Malignant melanoma is a highly aggressive skin cancer that does not undergo spontaneous resolution and often metastasizes quickly. - Early recognition is crucial for treatment, as it is associated with significant **morbidity and mortality**. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 673-674.
Question 994: Clear cell variety of renal cell carcinoma is related to a gene located on which chromosome?
- A. X
- B. 22
- C. 20
- D. 3 (Correct Answer)
Explanation: ***3*** - The **clear cell variety of renal cell carcinoma** (RCC) is associated with **mutations in the VHL gene**, which is located on chromosome **3** [1]. - This gene plays a crucial role in the **regulation of angiogenesis**, and its inactivation leads to tumor development. *22* - Chromosome **22** is associated with other disorders but not specifically with clear cell RCC or its genetic mutations. - Renal cell carcinoma primarily relates to **chromosome 3**, not chromosome 22 [1]. *X* - The **X chromosome** has other oncogenes and tumor suppressor genes but is not linked to clear cell RCC specifically. - Mutations in the **VHL gene** on chromosome 3 are the key factors, not those found on the X chromosome. *20* - Chromosome **20** does not contain significant genes linked to clear cell renal cell carcinoma. - The notable genetic association is with chromosome **3**, specifically the VHL gene [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 958-959.
Question 995: All are features of hypernephroma except:
- A. Cannon ball secondaries are seen
- B. More common in males
- C. May invade renal vein
- D. Lower pole involvement (Correct Answer)
Explanation: ***Lower pole involvement*** - Renal cell carcinoma (hypernephroma) characteristically shows a **predilection for the upper pole** of the kidney, occurring in approximately **70-75% of cases** [1]. - **Lower pole involvement is NOT a typical feature** and occurs less frequently. - This upper pole predilection is an important distinguishing characteristic of RCC. *Cannon ball secondaries are seen* - **Cannonball metastases** (large, round, well-circumscribed lesions) are a characteristic radiographic finding when renal cell carcinoma metastasizes to the **lungs**. - This appearance is highly suggestive of advanced renal cell carcinoma. *More common in males* - Renal cell carcinoma consistently shows a higher incidence in **males than females**, with a male-to-female ratio of approximately **2:1** [1]. - This **gender predisposition** is well-established in epidemiological studies. *May invade renal vein* - **Renal vein invasion** is a classic and critical feature of renal cell carcinoma, which can extend into the **inferior vena cava** [1]. - This venous invasion is a significant factor in **staging and prognosis** [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 959-961.
Practice by Chapter
Nomenclature and Classification of Tumors
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Characteristics of Benign and Malignant Neoplasms
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Molecular Basis of Cancer
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Carcinogenesis and Carcinogens
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Tumor Progression and Metastasis
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Tumor Markers
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Paraneoplastic Syndromes
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Genetic Basis of Cancer
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Tumor Immunity
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Cancer Epidemiology and Prevention
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