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ACE Cancer Exercise Specialist study materials
ACE Cancer Exercise Specialist study resources

ACE Cancer Exercise Specialist practice questions

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Question 1Cancer Fundamentals: Pathology, Staging, and Medical Management

In the TNM staging system, what does the T component describe?

  1. Extent of the primary tumor Correct answer.
  2. Presence of distant metastases
  3. Histologic grade of the tumor
  4. Status of regional lymph nodes

Explanation

The TNM system combines three descriptors: T for the size and local extent of the primary tumor, N for regional lymph node involvement, and M for distant metastasis. Grade is a separate histologic measure and is not part of TNM.

Question 2Cancer Fundamentals: Pathology, Staging, and Medical Management

A cancer is classified as stage IV. What does this designation indicate?

  1. Only regional lymph nodes are affected
  2. The tumor cannot be assessed by imaging
  3. Distant organs are involved by metastasis Correct answer.
  4. The tumor is confined to its organ of origin

Explanation

Stage IV denotes metastatic disease, in which tumor cells have spread to organs or sites distant from the primary tumor, corresponding to the M1 category. It does not refer to locally advanced disease confined to the region of origin.

Question 3Cancer Fundamentals: Pathology, Staging, and Medical Management

Which finding establishes a definitive diagnosis of cancer?

  1. An elevated serum tumor marker
  2. An abnormal finding on a CT scan
  3. A palpable mass on physical exam
  4. Histopathologic exam of a tissue sample Correct answer.

Explanation

Confirmation of malignancy requires microscopic examination of tissue obtained by biopsy or resection, in which a pathologist identifies malignant cellular features. Imaging, serum markers, and palpation can raise suspicion but cannot confirm the diagnosis.

Question 4Cancer Fundamentals: Pathology, Staging, and Medical Management

Adjuvant therapy is best described as which of the following?

  1. Treatment after primary therapy to cut recurrence Correct answer.
  2. Radiation delivered during an operation
  3. Drugs given to ease pain and other symptoms
  4. Surgery that removes the entire visible tumor

Explanation

Adjuvant therapy is delivered after the primary treatment, such as surgery, when microscopic disease may remain, with the aim of reducing recurrence and improving survival. Neoadjuvant therapy, by contrast, precedes the main local treatment.

Question 5Cancer Fundamentals: Pathology, Staging, and Medical Management

Which statement describes carcinoma in situ?

  1. Benign cells growing beyond their normal boundary
  2. Malignant cells that have spread to a distant organ
  3. Malignant cells that have entered nearby lymph vessels
  4. Malignant cells above an intact basement membrane Correct answer.

Explanation

Carcinoma in situ consists of neoplastic epithelial cells that have not breached the basement membrane, so there is no access to lymphatics or blood vessels and no metastatic potential at this stage. It is regarded as a precursor lesion rather than invasive cancer.

Question 6Cancer Fundamentals: Pathology, Staging, and Medical Management

Which route accounts for most initial spread of epithelial cancers (carcinomas)?

  1. Lymphatic channels Correct answer.
  2. Hematogenous spread
  3. Direct perineural spread
  4. Seeding of body cavities

Explanation

Carcinomas typically metastasize first through lymphatic vessels to regional nodes, which is why regional node assessment is part of staging. Sarcomas more often spread hematogenously, and cavity seeding is characteristic of ovarian and some gastrointestinal cancers.

Question 7Cancer Fundamentals: Pathology, Staging, and Medical Management

Which chemotherapy class is associated with cumulative, dose-dependent cardiotoxicity?

  1. Platinum agents such as cisplatin
  2. Anthracyclines such as doxorubicin Correct answer.
  3. Antimetabolites such as methotrexate
  4. Taxanes such as paclitaxel

Explanation

Anthracyclines cause dose-dependent myocardial injury, so cumulative dose limits and baseline plus serial cardiac function monitoring are standard. Cisplatin, taxanes, and methotrexate have different dose-limiting toxicities.

Question 8Cancer Fundamentals: Pathology, Staging, and Medical Management

Tamoxifen is most appropriate for which tumor profile?

  1. Estrogen-receptor-positive breast cancer Correct answer.
  2. Estrogen-receptor-negative lung cancer
  3. Androgen-driven prostate carcinoma
  4. HER2-amplified gastric cancer

Explanation

Tamoxifen is a selective estrogen receptor modulator that blocks estrogen signaling in breast tissue and is used for hormone receptor-positive breast cancer. HER2-directed agents and androgen deprivation apply to other tumor profiles.

Question 9Cancer Fundamentals: Pathology, Staging, and Medical Management

Which statement best distinguishes tumor grade from tumor stage?

  1. Grade reflects anatomic spread; stage reflects differentiation
  2. Stage is determined solely by tumor size in centimeters
  3. Grade is assigned only after metastasis has occurred
  4. Grade reflects differentiation; stage reflects anatomic spread Correct answer.

Explanation

Grade is a microscopic descriptor of how closely tumor cells resemble normal tissue and how rapidly they appear to divide, whereas stage describes the anatomic extent of disease. The two are independent and each carries prognostic information.

Question 10Cancer Fundamentals: Pathology, Staging, and Medical Management

What is the primary purpose of neoadjuvant chemotherapy?

  1. To shrink tumor before definitive local treatment Correct answer.
  2. To replace surgery in all solid tumors
  3. To palliate pain in end-stage disease
  4. To treat microscopic disease after resection

Explanation

Neoadjuvant chemotherapy is given before surgery or radiation to reduce tumor burden, which can make local treatment more feasible or less morbid and allows assessment of response in vivo. It is distinct from adjuvant therapy, which follows definitive local treatment.

Question 11Cancer Fundamentals: Pathology, Staging, and Medical Management

Trastuzumab exerts its antitumor effect by targeting which structure?

  1. The epidermal growth factor receptor
  2. The HER2 receptor Correct answer.
  3. The estrogen receptor
  4. The vascular endothelial growth factor

Explanation

Trastuzumab is a monoclonal antibody that binds the HER2 (ERBB2) receptor tyrosine kinase and blocks proliferative signaling in HER2-overexpressing cancers, chiefly breast and gastric. Baseline and serial left ventricular function monitoring is required because of cardiotoxicity.

Question 12Cancer Fundamentals: Pathology, Staging, and Medical Management

How do immune checkpoint inhibitors such as pembrolizumab act?

  1. They kill dividing tumor cells directly
  2. They block PD-1 to restore T-cell killing Correct answer.
  3. They increase blood flow to the tumor
  4. They filter tumor cells from the blood

Explanation

Checkpoint inhibitors are monoclonal antibodies that block inhibitory receptors or ligands such as PD-1 and PD-L1, releasing the brakes on cytotoxic T cells so they can attack tumor cells. They do not act through direct cytotoxicity or by altering tumor perfusion.

Question 13Cancer Fundamentals: Pathology, Staging, and Medical Management

A patient receiving chemotherapy reports a temperature of 38.5 °C with an absolute neutrophil count of 0.4 × 10⁹/L. What is the most appropriate action?

  1. Schedule the next chemotherapy cycle as planned
  2. Advise acetaminophen and continue the current cycle
  3. Reassure the patient and recheck the count in one week
  4. Arrange urgent medical evaluation and empiric antibiotics Correct answer.

Explanation

Fever with severe neutropenia constitutes febrile neutropenia, a medical emergency with risk of rapid progression to sepsis; cultures and empiric broad-spectrum antibiotics should be started promptly. Antipyretics alone or delay in evaluation can be life-threatening.

Question 14Cancer Fundamentals: Pathology, Staging, and Medical Management

What advantage does FDG-PET/CT add to conventional imaging during oncology staging?

  1. It measures tumor grade precisely
  2. It replaces the need for tissue biopsy
  3. It shows metabolic activity of lesions Correct answer.
  4. It avoids all exposure to radiation

Explanation

FDG-PET/CT detects increased glucose uptake, highlighting metabolically active tumor deposits and revealing occult nodal or distant disease that anatomic imaging may miss. It does not provide a histologic diagnosis or a grade.

Question 15Cancer Fundamentals: Pathology, Staging, and Medical Management

The sentinel lymph node is best described as which of the following?

  1. The first node draining the tumor's lymph Correct answer.
  2. The node closest to the primary tumor
  3. Any node that feels enlarged on palpation
  4. The largest node in the regional basin

Explanation

The sentinel node is the first-echelon node to receive lymphatic flow from the primary tumor; if it is free of tumor, the remainder of the basin is usually spared. Sentinel node biopsy therefore allows nodal staging with less morbidity than full dissection.

Question 16Cancer Fundamentals: Pathology, Staging, and Medical Management

What is the normal function of the TP53 gene product?

  1. It speeds the cell cycle after DNA damage
  2. It amplifies growth factor signaling
  3. It arrests the cell cycle after DNA damage Correct answer.
  4. It directly repairs broken DNA strands

Explanation

p53 is a tumor suppressor that senses DNA damage and induces cell cycle arrest, DNA repair, or apoptosis, earning it the label guardian of the genome. Loss of function, most often by mutation, permits survival and proliferation of genetically damaged cells.

Question 17Cancer Fundamentals: Pathology, Staging, and Medical Management

Which change is characteristic of an activated oncogene?

  1. A loss-of-function mutation in a DNA repair gene
  2. Deletion of both alleles of a suppressor gene
  3. Silencing of a gene by promoter methylation
  4. A gain-of-function mutation driving proliferation Correct answer.

Explanation

Oncogenes arise from proto-oncogenes through activating alterations such as mutation, amplification, or translocation that increase growth-promoting activity, and a single altered allele can suffice. Loss-of-function events instead define tumor suppressor gene inactivation.

Question 18Cancer Fundamentals: Pathology, Staging, and Medical Management

Which laboratory abnormality is a hallmark of tumor lysis syndrome?

  1. Hyperuricemia Correct answer.
  2. Hypokalemia
  3. Hypophosphatemia
  4. Hypercalcemia

Explanation

Tumor lysis releases intracellular contents, producing hyperkalemia, hyperphosphatemia, hyperuricemia, and secondary hypocalcemia, which together can cause acute kidney injury and arrhythmias. Hypercalcemia and hypokalemia are not features of the syndrome.

Question 19Cancer Fundamentals: Pathology, Staging, and Medical Management

A patient with breast cancer metastatic to bone develops confusion, constipation, and polyuria. Which cause should be suspected?

  1. Hypercalcemia from bone destruction Correct answer.
  2. Hypoglycemia from hepatic metastases
  3. Hypocalcemia from tumor lysis
  4. Hyponatremia from inappropriate ADH

Explanation

Osteolytic metastases release calcium into the circulation, and the classic symptom cluster includes confusion, constipation, polyuria, and dehydration. Serum calcium measurement confirms the diagnosis and guides bisphosphonate or denosumab therapy.

Question 20Cancer Fundamentals: Pathology, Staging, and Medical Management

The ECOG performance status score is used mainly to do which of the following?

  1. Describe how independently a patient functions Correct answer.
  2. Grade the malignancy of a tumor specimen
  3. Estimate the size of a solid tumor
  4. Predict response to a specific drug

Explanation

Performance status scales such as ECOG and Karnofsky summarize a patient's functional independence and are used for prognosis, trial eligibility, and decisions about treatment intensity. They are not measures of tumor biology or drug sensitivity.

Question 21Cancer Fundamentals: Pathology, Staging, and Medical Management

In RECIST 1.1, how is tumor response assessed in solid tumors?

  1. By change in the sum of target lesion diameters Correct answer.
  2. By change in tumor metabolic activity
  3. By the number of circulating tumor cells
  4. By the pathologist's grading of a biopsy

Explanation

RECIST uses unidimensional measurements: the diameters of selected target lesions are summed and compared with baseline, with thresholds defining partial response, stable disease, and progression. Functional imaging and biomarkers are not the basis of RECIST categories.

Question 22Cancer Fundamentals: Pathology, Staging, and Medical Management

What is the goal of cytoreductive (debulking) surgery in advanced ovarian cancer?

  1. To bypass an obstructed bowel segment
  2. To remove only involved lymph nodes
  3. To obtain tissue for genomic testing
  4. To reduce tumor bulk as much as possible Correct answer.

Explanation

Cytoreductive surgery aims to reduce residual tumor volume to minimal or no visible disease, which improves the effectiveness of subsequent platinum-based chemotherapy and survival. It is distinct from palliative bypass procedures and from purely diagnostic biopsy.

Question 23Cancer Fundamentals: Pathology, Staging, and Medical Management

A patient on oxaliplatin reports numbness and unsteadiness when standing in the dark. Which exercise-related approach is most appropriate?

  1. Complete rest until chemotherapy is finished
  2. High-intensity plyometric jump training
  3. Single-leg balance work without any support
  4. Supervised balance training with support available Correct answer.

Explanation

Oxaliplatin causes cumulative sensory peripheral neuropathy that impairs proprioception and increases fall risk, particularly in low light. Balance training with supervision and nearby support is safe and effective, whereas unsupervised single-leg work or plyometrics raises injury risk and total rest worsens deconditioning.

Question 24Cancer Fundamentals: Pathology, Staging, and Medical Management

Why is chemotherapy often given concurrently with radiation therapy?

  1. To sensitize tumor cells to radiation damage Correct answer.
  2. To replace surgery for local control
  3. To reduce radiation injury to normal tissue
  4. To shorten the total radiation course

Explanation

Certain agents act as radiosensitizers, making tumor cells less able to repair radiation-induced DNA damage and thereby improving local control, as in concurrent chemoradiation for head and neck or cervical cancer. The combination also increases toxicity, so patient selection matters.

Question 25Cancer Fundamentals: Pathology, Staging, and Medical Management

Which statement about cancer cachexia is most accurate?

  1. It is caused solely by reduced food intake
  2. Extra calories alone do not reverse it Correct answer.
  3. It resolves with a high-protein diet alone
  4. It occurs only in gastrointestinal cancers

Explanation

Cachexia involves systemic inflammation, altered metabolism, and muscle proteolysis driven by tumor and host factors, so hypercaloric feeding alone does not restore lean mass. Management is multimodal, combining nutrition support, exercise, and anti-inflammatory or appetite-directed therapy where appropriate.

Question 26Cancer Fundamentals: Pathology, Staging, and Medical Management

Which description best defines carcinoma in situ?

  1. Malignant cells that have breached the basement membrane
  2. Malignant cells present in regional lymph nodes with no visible primary mass
  3. A benign overgrowth of epithelial cells with no malignant potential
  4. Malignant cells confined by an intact basement membrane Correct answer.

Explanation

Carcinoma in situ consists of cytologically malignant epithelial cells that have not crossed the basement membrane, so they have no access to lymphatics or blood vessels. Because the lesion is non-invasive (stage 0), it cannot metastasize and is generally cured by local treatment such as excision.

Question 27Cancer Fundamentals: Pathology, Staging, and Medical Management

In the TNM staging system, the N category describes which of the following?

  1. The degree of histologic differentiation of the tumor
  2. The size and local extent of the primary tumor
  3. Whether regional lymph nodes contain tumor Correct answer.
  4. The presence or absence of distant metastases

Explanation

TNM assigns T to the primary tumor's size and local extent, N to regional lymph node involvement, and M to distant metastasis, and the three components are then combined into a stage group. Nodal status strongly influences prognosis and often determines whether nodal surgery or radiation is added to treatment.

Question 28Cancer Fundamentals: Pathology, Staging, and Medical Management

Adjuvant chemotherapy is best described as treatment given in which setting?

  1. Instead of surgery for patients who decline an operation
  2. After definitive local treatment to eradicate occult micrometastases Correct answer.
  3. Only to relieve symptoms in patients with far-advanced disease
  4. Before surgery to shrink a tumor and make resection easier

Explanation

Adjuvant therapy follows definitive local treatment such as surgery when micrometastases are suspected but not detectable by imaging. Its purpose is to reduce recurrence risk and improve survival, which distinguishes it from neoadjuvant therapy given before local treatment.

Question 29Cancer Fundamentals: Pathology, Staging, and Medical Management

A 62-year-old with newly diagnosed small cell lung cancer has a serum sodium of 124 mmol/L, low serum osmolality, and an inappropriately high urine osmolality while appearing euvolemic. Which paraneoplastic syndrome is most likely?

  1. Syndrome of inappropriate antidiuretic hormone secretion Correct answer.
  2. Ectopic ACTH production causing Cushing syndrome
  3. Carcinoid syndrome from ectopic serotonin release
  4. Ectopic secretion of parathyroid hormone-related peptide

Explanation

Small cell lung cancer can ectopically secrete antidiuretic hormone, producing euvolemic hyponatremia with concentrated urine and low serum osmolality. Volume depletion and diuretic use must be excluded, but the euvolemic presentation points to SIADH.

Question 30Cancer Fundamentals: Pathology, Staging, and Medical Management

In a postmenopausal woman with hormone receptor-positive breast cancer, letrozole lowers estrogen levels mainly by doing which of the following?

  1. Destroying the estrogen receptor through irreversible covalent binding
  2. Suppressing ovarian estrogen synthesis through gonadotropin inhibition
  3. Competing directly with estrogen at the estrogen receptor
  4. Inhibiting the enzyme that converts androgens into estrogens Correct answer.

Explanation

After menopause, peripheral tissues such as adipose and adrenal tissue become the main source of estrogen through aromatase-mediated conversion of androgens. Letrozole inhibits aromatase, sharply reducing circulating estrogen in hormone receptor-positive disease.

Question 31Cancer Fundamentals: Pathology, Staging, and Medical Management

Six months after curative resection of stage III colon cancer, which serum test is most appropriate for surveillance of recurrence?

  1. Cancer antigen 19-9 (CA 19-9)
  2. Carcinoembryonic antigen (CEA) Correct answer.
  3. Alpha-fetoprotein (AFP)
  4. Cancer antigen 125 (CA-125)

Explanation

CEA is the standard serum marker used to monitor colorectal cancer after resection, and a rising level can precede radiologic evidence of recurrence. Serial measurement is paired with imaging and clinical assessment rather than used alone.

Question 32Cancer Fundamentals: Pathology, Staging, and Medical Management

A man with prostate cancer and multiple bone metastases is started on denosumab. Which mechanism best describes the drug's effect?

  1. It stimulates osteoblast-mediated bone formation to outpace tumor resorption
  2. It directly induces apoptosis of metastatic tumor cells within bone
  3. It blocks RANK ligand, reducing osteoclast formation and activity Correct answer.
  4. It binds circulating calcium and prevents its deposition in bone

Explanation

Denosumab is a monoclonal antibody that binds RANK ligand, thereby blocking osteoclast differentiation, function, and survival. Reducing osteoclast activity limits tumor-driven bone destruction and lowers the risk of skeletal-related events; the drug is not cytotoxic to cancer cells.

Question 33Cancer Fundamentals: Pathology, Staging, and Medical Management

An ovarian tumor carrying a BRCA1 mutation is unusually sensitive to PARP inhibitors. Which explanation best accounts for this sensitivity?

  1. Homologous recombination repair is lost, leaving PARP-mediated repair as the main pathway Correct answer.
  2. PARP inhibitors restore the function of the mutated BRCA1 protein
  3. PARP inhibitors speed up tumor cell division so that cells become more vulnerable to damage
  4. BRCA1 mutations make tumor cells impermeable to standard alkylating agents

Explanation

BRCA1 and BRCA2 proteins are required for homologous recombination repair of DNA double-strand breaks. When that pathway is defective, cells depend on PARP-mediated repair of single-strand breaks, so PARP inhibition causes unrepaired damage and cell death, a concept termed synthetic lethality. Normal cells retain one functional BRCA allele and tolerate the drug better.

Question 34Cancer Fundamentals: Pathology, Staging, and Medical Management

A tumor shrinks markedly during initial chemotherapy but regrows several months later while the same regimen continues. Which explanation is most consistent with this course?

  1. Resistant subclones present at low frequency survived and expanded under drug selection Correct answer.
  2. The tumor became more differentiated, which increased its sensitivity to the regimen
  3. The original cancer was fully eradicated and the new mass is an unrelated second primary
  4. Chemotherapy caused the tumor to lose its blood supply, which permanently halted drug delivery

Explanation

Solid tumors are genetically heterogeneous, and a small subpopulation may already carry resistance mechanisms before treatment begins. Chemotherapy eliminates sensitive cells and gives resistant clones a growth advantage, so regrowth on an ongoing regimen is best explained by selection of resistant subpopulations rather than by a change in drug potency. This pattern usually prompts a change of regimen.

Question 35Effects of Cancer and Cancer Treatments on Physiological and Functional Capacity

Which statement best characterizes cancer-related fatigue (CRF)?

  1. It is always directly proportional to the amount of physical work the patient has performed.
  2. It occurs only during the weeks of active chemotherapy infusion.
  3. It resolves completely with a single night of uninterrupted sleep.
  4. It is disproportionate to recent activity and not fully relieved by rest. Correct answer.

Explanation

Cancer-related fatigue is a persistent, distressing sense of tiredness tied to cancer or its treatment that is disproportionate to recent activity and is not fully relieved by rest. It differs from ordinary fatigue and can persist during and after treatment.

Question 36Effects of Cancer and Cancer Treatments on Physiological and Functional Capacity

Cancer cachexia is best described as which of the following?

  1. Ongoing loss of skeletal muscle with systemic inflammation and metabolic dysregulation Correct answer.
  2. Weight loss caused only by reduced food intake that reliably reverses with aggressive feeding
  3. Fluid retention that masks lean mass but does not affect function
  4. A temporary decrease in appetite that resolves when chemotherapy ends

Explanation

Cancer cachexia is a multifactorial syndrome driven by systemic inflammation and metabolic dysregulation, with ongoing skeletal muscle loss that is not fully reversed by feeding alone. It is not simply reduced intake.

Question 37Effects of Cancer and Cancer Treatments on Physiological and Functional Capacity

Which chemotherapy class is most associated with dose-dependent cardiomyopathy?

  1. Antimetabolites
  2. Anthracyclines Correct answer.
  3. Taxanes
  4. Platinum agents

Explanation

Anthracyclines cause dose-dependent cardiotoxicity through oxidative stress and topoisomerase II beta-mediated injury, so cumulative dose matters. Taxanes, platinum agents, and antimetabolites have other toxicity profiles.

Question 38Effects of Cancer and Cancer Treatments on Physiological and Functional Capacity

Which treatment class commonly causes a length-dependent sensory peripheral neuropathy?

  1. Taxanes Correct answer.
  2. Anthracyclines
  3. Corticosteroids
  4. Aromatase inhibitors

Explanation

Taxanes and platinum agents commonly produce a length-dependent sensory peripheral neuropathy with numbness, tingling, and altered proprioception. This can impair balance and increase fall risk.

Question 39Effects of Cancer and Cancer Treatments on Physiological and Functional Capacity

Which precaution is most important during exercise for a patient with known lytic bone metastases?

  1. Progress quickly to maximal axial loading
  2. Avoid high-impact loading over affected bone Correct answer.
  3. Use ballistic stretching to preserve joint range
  4. Perform deep spinal twists to maintain axial mobility

Explanation

Lytic bone metastases weaken bone, so high-impact and torsional loading over affected areas raises pathologic fracture risk. Exercise should emphasize safe, controlled loading and medical clearance.

Question 40Effects of Cancer and Cancer Treatments on Physiological and Functional Capacity

Androgen deprivation therapy for prostate cancer most commonly causes which change?

  1. Improved insulin sensitivity and lipid profile
  2. Isolated increase in hemoglobin and aerobic capacity
  3. Selective gain of appendicular skeletal muscle
  4. Loss of lean mass and bone density Correct answer.

Explanation

Androgen deprivation therapy lowers testosterone, causing loss of lean mass, increased fat mass, and reduced bone mineral density. These changes impair strength and raise fracture risk.

Question 41Effects of Cancer and Cancer Treatments on Physiological and Functional Capacity

Which statement about resistance training in breast cancer-related lymphedema is best supported?

  1. Heavy overhead lifting should begin immediately
  2. Limb compression should be avoided during all exercise
  3. Only aerobic exercise is safe for the affected arm
  4. Gradual progressive resistance training is generally safe Correct answer.

Explanation

Gradual progressive resistance training is generally safe in breast cancer-related lymphedema and may improve strength and symptoms when introduced carefully. Compression and monitoring are often used.

Question 42Effects of Cancer and Cancer Treatments on Physiological and Functional Capacity

After axillary lymph node dissection, which shoulder problem is most common?

  1. Isolated loss of elbow flexion strength
  2. Restricted shoulder motion and cording Correct answer.
  3. Painless full range of motion without limitation
  4. Immediate fixed abduction contracture at the shoulder

Explanation

Axillary lymph node dissection can injure lymphatics and nerves, leading to shoulder stiffness, restricted range of motion, and axillary cording. Early mobility and rehabilitation help preserve function.

Question 43Effects of Cancer and Cancer Treatments on Physiological and Functional Capacity

Which physiologic mechanism contributes to cancer-related fatigue?

  1. Increased oxygen-carrying capacity of the blood
  2. Suppression of systemic inflammatory signaling
  3. Enhanced mitochondrial biogenesis in skeletal muscle
  4. Cytokine-driven inflammation and HPA-axis dysregulation Correct answer.

Explanation

Cancer-related fatigue involves cytokine-driven inflammation, HPA-axis dysregulation, altered muscle metabolism, and impaired oxygen delivery. These changes reduce exercise tolerance and functional capacity.

Question 44Effects of Cancer and Cancer Treatments on Physiological and Functional Capacity

A patient with chemotherapy-induced anemia and hemoglobin 8.5 g/dL reports exertional dyspnea. What is the best exercise adjustment?

  1. Delay all activity until hemoglobin normalizes
  2. Begin interval training at maximal predicted workload
  3. Reduce intensity and monitor symptoms with oncology input Correct answer.
  4. Maintain the planned intensity and use a target heart rate

Explanation

With symptomatic chemotherapy-induced anemia, exercise intensity should be reduced and symptoms monitored in coordination with the oncology team. Pushing through dyspnea at a fixed target heart rate is unsafe.

Question 45Effects of Cancer and Cancer Treatments on Physiological and Functional Capacity

A patient receiving trastuzumab has a 10-point drop in left ventricular ejection fraction to 48%. What is the most appropriate exercise response?

  1. Use high-intensity plyometrics to improve output
  2. Start heavy overhead resistance training
  3. Continue vigorous aerobic intervals without change
  4. Pause vigorous exercise and contact oncology Correct answer.

Explanation

Trastuzumab can cause left ventricular ejection fraction decline, so a significant drop with or without symptoms warrants oncology contact and avoidance of vigorous exercise until cleared. Cardiac function should be reassessed.

Question 46Effects of Cancer and Cancer Treatments on Physiological and Functional Capacity

Which exercise modification best addresses fall risk from chemotherapy-induced sensory neuropathy in the feet?

  1. Train barefoot on a smooth treadmill
  2. Avoid all weight-bearing and balance practice
  3. Perform rapid direction changes on uneven turf
  4. Use stable support and protective footwear Correct answer.

Explanation

Sensory neuropathy reduces proprioception and protective sensation, so balance training with stable support and protective footwear is appropriate. This reduces fall risk while training stability.

Question 47Effects of Cancer and Cancer Treatments on Physiological and Functional Capacity

Late radiation fibrosis of the chest wall most likely produces which change?

  1. Increased elastic recoil of irradiated muscle
  2. Selective hypertrophy of irradiated fibroblasts
  3. Enhanced lymphatic clearance in the chest wall
  4. Reduced tissue extensibility and shoulder mobility Correct answer.

Explanation

Late radiation fibrosis reduces tissue extensibility and can restrict shoulder and chest wall mobility. Stretching and mobility work should respect irradiated tissue limits.

Question 48Effects of Cancer and Cancer Treatments on Physiological and Functional Capacity

Prolonged corticosteroid use during cancer treatment most directly causes which functional limitation?

  1. Sudden improvement in lean body mass
  2. Proximal muscle weakness and bone loss Correct answer.
  3. Isolated hyperpigmentation of the skin
  4. Distal sensory neuropathy confined to the feet

Explanation

Prolonged corticosteroid exposure causes proximal myopathy, especially in hip and shoulder girdle muscles, and accelerates bone loss. This impairs strength, mobility, and fracture risk.

Question 49Effects of Cancer and Cancer Treatments on Physiological and Functional Capacity

Which new symptom in a patient receiving immune checkpoint inhibitors should prompt medical review before exercise?

  1. Predictable hair loss after infusion
  2. Mild injection-site pain lasting minutes
  3. Stable chronic fatigue present for years
  4. New exertional dyspnea or colitis symptoms Correct answer.

Explanation

Immune checkpoint inhibitors can cause immune-related adverse events such as pneumonitis, myocarditis, and colitis. New exertional dyspnea or colitis symptoms should prompt medical review before exercise.

Question 50Effects of Cancer and Cancer Treatments on Physiological and Functional Capacity

Which strategy best reduces nausea during exercise for a patient receiving chemotherapy?

  1. Time activity around antiemetics and meals Correct answer.
  2. Skip prescribed antiemetics before activity
  3. Exercise immediately after a large fatty meal
  4. Use vigorous supine exercise right after eating

Explanation

Timing exercise around antiemetics and light meals can reduce nausea and improve tolerance. Avoiding heavy meals immediately before activity also helps.