I85PREP
⌘ K
CON(C) Oncology study materials
CON(C) Oncology study resources

CON(C) Oncology practice questions

One question at a time. Build your CON(C) Oncology understanding.

First 50 of 200 questions. Each one lists the choices, the correct answer, and an explanation. The checker at the top of this page saves progress in this browser when it is available.

Continue in the practice tool above to load more questions, 50 at a time.

Question 1Roles and Responsibilities of the Oncology Nurse

A patient is about to begin intravenous chemotherapy. Which action falls within the oncology nurse's independent scope of practice rather than requiring a new prescriber order?

  1. Verifying the regimen, calculating the dose against body surface area, and assessing pre-treatment labs Correct answer.
  2. Deciding to delay the cycle by one week without contacting the prescriber
  3. Selecting an alternative antiemetic regimen when the prescribed one fails
  4. Adjusting the chemotherapy dose downward because of a low neutrophil count

Explanation

Oncology nurses are accountable for independent verification of the prescribed regimen, dose calculation using parameters such as body surface area, and assessment of laboratory values and patient status before administration. Dose modification, regimen substitution, and schedule changes are prescriber decisions that require an order. Recognizing this boundary protects both patient safety and the nurse's license.

Question 2Roles and Responsibilities of the Oncology Nurse

Which responsibility is specifically assigned to the nurse who is certified to administer chemotherapy rather than to unlicensed assistive personnel?

  1. Performing the pre-administration verification of the chemotherapy regimen with a second qualified clinician Correct answer.
  2. Changing the bed linens after an episode of emesis
  3. Assisting the patient with ambulation to the bathroom
  4. Recording the patient's oral intake at meals

Explanation

Independent double-check of the chemotherapy regimen, including drug, dose, route, rate, and patient identity, must be performed by two qualified clinicians before administration. Tasks such as intake recording, ambulation assistance, and linen changes are within the scope of unlicensed assistive personnel under delegation. Delegation must always match the task to the training and legal scope of the delegatee.

Question 3Roles and Responsibilities of the Oncology Nurse

A patient receiving a first cycle of chemotherapy asks the nurse what the nurse's role will be over the coming months. Which description best reflects the oncology nurse's coordinating function?

  1. Acting as the consistent point of contact who assesses symptoms, educates, and links the patient to supportive services Correct answer.
  2. Serving as the single decision-maker for all treatment choices across the care trajectory
  3. Limiting involvement to the physical administration of each chemotherapy infusion
  4. Transferring all psychosocial concerns to the social worker without further nursing follow-up

Explanation

The oncology nurse functions as a care coordinator who provides continuity, performs ongoing symptom assessment, delivers patient education, and connects patients with dietitians, social workers, and other supportive services. Treatment decisions remain with the interprofessional team and the patient. Restricting the role to infusion administration or handing off psychosocial concerns entirely neglects core nursing responsibilities.

Question 4Roles and Responsibilities of the Oncology Nurse

During a chemotherapy infusion the patient reports sudden shortness of breath and chest tightness, and the infusion must be stopped. What is the nurse's priority sequence of actions?

  1. Complete the remaining infusion volume quickly so the line can be removed
  2. Wait for the next scheduled vital sign check before taking any action
  3. Stop the infusion, keep the intravenous line patent with normal saline, assess the patient, and notify the provider urgently Correct answer.
  4. Disconnect the intravenous line entirely and send the patient to the waiting room

Explanation

When an acute infusion reaction is suspected, the nurse stops the drug immediately, maintains venous access with compatible fluid so emergency medications can be given, performs a focused assessment, and escalates to the provider. Preserving the line is essential because resuscitation and antidote administration depend on it. Rapid escalation reflects the nurse's independent duty to protect the patient during an emergency.

Question 5Roles and Responsibilities of the Oncology Nurse

A patient's absolute neutrophil count is 0.4 x 10^9/L and the protocol requires holding chemotherapy at this level. What is the nurse's most appropriate action?

  1. Hold the dose, notify the prescriber for a new order, and reinforce neutropenic precautions Correct answer.
  2. Administer the chemotherapy as ordered and monitor the temperature every four hours
  3. Ask the pharmacist to authorize a reduced dose so treatment is not delayed
  4. Administer half the ordered dose and document the rationale

Explanation

The nurse cannot independently alter or proceed with a regimen that violates protocol-defined parameters; the correct action is to withhold the drug, inform the prescriber, and obtain a new order. Neutropenic precautions and infection-prevention teaching should be reinforced because the patient is severely immunocompromised. Pharmacists cannot authorize dose changes, which remain prescriber decisions.

Question 6Roles and Responsibilities of the Oncology Nurse

A patient confides that she cannot afford the prescribed oral chemotherapy and has been skipping doses. Which nursing action best reflects the advocate role?

  1. Document the disclosure and continue with the planned teaching session
  2. Tell the patient that adherence is her responsibility and no further help is available
  3. Explore financial assistance programs with the patient and involve the pharmacist and social worker Correct answer.
  4. Advise the patient to take half doses on the days she feels unwell

Explanation

Advocacy means acting on the patient's behalf to remove barriers to effective treatment, including connecting her with financial counseling, manufacturer assistance programs, and social work support. Simply documenting the problem leaves the barrier unresolved. Suggesting self-adjusted half doses is unsafe and outside nursing or patient authority.

Question 7Roles and Responsibilities of the Oncology Nurse

Which element is essential when the oncology nurse obtains informed consent for a clinical trial from a patient who speaks limited English?

  1. Proceeding with the English consent form once the patient nods in agreement
  2. A brief verbal summary of the trial given in the patient's language by the nurse
  3. A qualified medical interpreter present throughout the discussion and a translated consent document Correct answer.
  4. Having the patient's adult child sign the consent form on the patient's behalf

Explanation

Valid informed consent requires that the patient understand the information, which obligates the team to use a qualified medical interpreter and a consent document in a language the patient can read. Family members should not serve as interpreters for consent discussions or sign in place of a competent adult. A nod of agreement does not demonstrate comprehension.

Question 8Roles and Responsibilities of the Oncology Nurse

A newly diagnosed patient asks the nurse, "How long do I have?" The patient's family has asked staff not to discuss the prognosis. What is the most appropriate nursing response?

  1. Defer all further conversation and tell the patient to ask the physician at the next visit
  2. Explore what the patient already knows and wants to know, then respond honestly within the team's agreed plan Correct answer.
  3. Tell the patient the exact survival statistics for the diagnosis
  4. Explain that the family has requested no discussion and change the subject

Explanation

The nurse should first assess the patient's existing understanding and how much information the patient wants, then provide honest information consistent with the patient's expressed preferences and the team's plan. The patient's right to information takes precedence over a family request for nondisclosure. Quoting survival statistics is not appropriate because individual prognosis cannot be predicted precisely.

Question 9Roles and Responsibilities of the Oncology Nurse

An experienced oncology nurse is asked to mentor a new graduate who will soon administer chemotherapy. Which mentoring approach best supports safe independent practice?

  1. Providing written policies only and asking the graduate to sign an attestation of competence
  2. Allowing the new graduate to administer chemotherapy alone after observing two infusions
  3. Assigning the graduate only to oral chemotherapy so intravenous skills are never needed
  4. Structuring supervised practice with competency validation, direct observation, and progressive independence Correct answer.

Explanation

Competency development requires structured supervised practice, direct observation of skills such as verification and extravasation precautions, and documented validation before independent practice. Observation alone or a signed attestation does not confirm psychomotor competence or clinical judgment. Narrowing the assignment avoids rather than resolves the learning need.

Question 10Roles and Responsibilities of the Oncology Nurse

Two nurses disagree about whether a vesicant infusion may continue through a peripheral line when the patient reports new burning at the site. What is the most appropriate professional action?

  1. Stop the infusion, follow the extravasation protocol, and escalate through the chain of command if consensus cannot be reached Correct answer.
  2. Ask the patient to decide whether the infusion should continue
  3. Restart the infusion at a faster rate to shorten the exposure time
  4. Continue the infusion and reassess the site at the end of the infusion

Explanation

New burning during a vesicant infusion is treated as a possible extravasation until proven otherwise, so the infusion must stop and the institutional extravasation protocol initiated. When clinicians disagree and patient safety is at stake, the nurse escalates through the chain of command rather than deferring. Decision-making authority for a potentially tissue-damaging event cannot be shifted to the patient.

Question 11Health Promotion and Prevention of Cancer

Which screening test is recommended for average-risk adults to detect cervical cancer?

  1. Transvaginal ultrasound
  2. Endometrial biopsy
  3. Serum CA-125 measurement
  4. Cervical cytology (Pap) testing Correct answer.

Explanation

Cervical cancer screening relies on detecting precancerous changes in the cervix, most commonly with cytology (Pap testing) or HPV testing, alone or combined. These tests are endorsed for average-risk individuals starting around age 21 to 25 and continuing into midlife. Imaging and serum markers are not validated screening tools for cervical cancer.

Question 12Health Promotion and Prevention of Cancer

A 55-year-old with a 30 pack-year smoking history asks how to reduce lung cancer risk. Which intervention has the strongest evidence for reducing lung cancer mortality in a high-risk population?

  1. Annual chest radiography
  2. Routine sputum cytology
  3. Annual low-dose CT screening in eligible high-risk adults Correct answer.
  4. Serial serum tumor marker panels

Explanation

Low-dose computed tomography screening of high-risk adults with significant smoking exposure has been shown in large randomized trials to reduce lung cancer mortality. The benefit depends on selecting eligible high-risk individuals and pairing screening with smoking cessation. Chest radiography, sputum cytology, and serum markers have not demonstrated mortality reduction.

Question 13Health Promotion and Prevention of Cancer

Which vaccination is recommended primarily to prevent a cancer caused by a chronic viral infection?

  1. Pneumococcal conjugate vaccine
  2. Influenza vaccine
  3. Hepatitis B vaccine Correct answer.
  4. Varicella vaccine

Explanation

Chronic hepatitis B infection is a major cause of hepatocellular carcinoma, and hepatitis B vaccination reduces the risk of chronic infection and subsequent liver cancer. This is a well-established cancer-prevention strategy, especially when given at birth or before exposure. Influenza, pneumococcal, and varicella vaccines do not prevent cancers.

Question 14Health Promotion and Prevention of Cancer

A 45-year-old average-risk adult with no family history asks about colorectal cancer screening. Which statement best reflects guideline-consistent practice?

  1. Screening should be deferred until age 60 in the absence of symptoms
  2. Only colonoscopy is acceptable, and it should start at age 30
  3. Screening should begin at age 45 with either a stool-based test or a structural exam Correct answer.
  4. Screening is unnecessary unless there is visible rectal bleeding

Explanation

Major guidelines now recommend starting colorectal cancer screening at age 45 for average-risk adults, using either a stool-based test at appropriate intervals or a structural examination such as colonoscopy. The choice depends on patient preference, access, and risk factors. Waiting for symptoms or delaying to age 60 misses the opportunity for early detection and polyp removal.

Question 15Health Promotion and Prevention of Cancer

A patient with a strong family history of early-onset breast cancer is found to carry a pathogenic BRCA1 variant. Which prevention strategy is most appropriate to discuss for reducing ovarian cancer risk?

  1. Observation with no intervention until symptoms develop
  2. Risk-reducing salpingo-oophorectomy after completing childbearing Correct answer.
  3. Routine pelvic radiation prophylaxis
  4. Annual serum CA-125 alone without imaging or surgery

Explanation

For carriers of pathogenic BRCA1 or BRCA2 variants, risk-reducing salpingo-oophorectomy substantially lowers the risk of ovarian cancer and is typically discussed after childbearing is complete. Surveillance with CA-125 and ultrasound has limited sensitivity and is not a substitute for risk-reducing surgery. Prophylactic radiation is not a recognized strategy.

Question 16Health Promotion and Prevention of Cancer

Which counseling approach is most consistent with evidence-based smoking cessation support during an oncology visit?

  1. Defer cessation counseling until cancer treatment is complete
  2. Combine brief advice with pharmacotherapy and follow-up referral Correct answer.
  3. Recommend e-cigarettes as a first-line replacement therapy
  4. Advise the patient to quit abruptly without any support

Explanation

Effective cessation support combines brief clinician advice with approved pharmacotherapy and behavioral follow-up, which improves quit rates compared with advice alone. Continuing tobacco use during cancer treatment worsens outcomes, so counseling should not be deferred. Unassisted quitting and unproven replacement products are less effective and not recommended as first-line care.

Question 17Health Promotion and Prevention of Cancer

A 50-year-old with chronic hepatitis C cirrhosis is being counseled about liver cancer prevention. Which approach best reflects recommended practice?

  1. Treat the hepatitis C infection and continue periodic liver imaging surveillance Correct answer.
  2. Use alpha-fetoprotein testing as the sole screening method
  3. Discontinue surveillance once viral load becomes undetectable
  4. Rely on annual liver enzyme testing alone

Explanation

Curative antiviral therapy lowers but does not eliminate hepatocellular carcinoma risk in patients with established cirrhosis, so periodic imaging surveillance should continue. Liver enzyme testing and alpha-fetoprotein alone are insufficiently sensitive. Surveillance should not stop simply because the virus is suppressed.

Question 18Health Promotion and Prevention of Cancer

Which statement best explains why HPV vaccination is most effective when given before sexual debut?

  1. It provides cross-protection against all known HPV types
  2. It generates immunity before exposure to the covered HPV types Correct answer.
  3. It replaces the need for cervical screening at all ages
  4. It cures existing HPV infections at the time of injection

Explanation

HPV vaccines are prophylactic, inducing neutralizing antibodies that prevent new infection with covered types; they do not clear established infections. Administering the vaccine before exposure therefore maximizes benefit. Vaccinated individuals still require cervical screening, and coverage does not extend to every HPV type.

Question 19Health Promotion and Prevention of Cancer

A 62-year-old with Barrett esophagus and confirmed low-grade dysplasia is being managed. Which strategy best reflects accepted practice for reducing progression to esophageal adenocarcinoma?

  1. Observation without intervention until high-grade dysplasia appears
  2. Endoscopic eradication therapy with continued surveillance Correct answer.
  3. Annual barium swallow imaging alone
  4. Prophylactic esophagectomy at the time of diagnosis

Explanation

Endoscopic eradication therapy, such as radiofrequency ablation with or without endoscopic resection, is recommended for confirmed low-grade dysplasia in Barrett esophagus because it reduces progression to cancer. Surveillance continues afterward to detect recurrence. Barium swallow is insensitive, and esophagectomy is far too morbid for this indication.

Question 20Health Promotion and Prevention of Cancer

Which combination of modifiable lifestyle factors is most consistently associated with reduced overall cancer risk in epidemiologic studies?

  1. High-dose antioxidant supplementation and low sun exposure
  2. High-protein diet with prolonged caloric restriction cycles
  3. Maintaining healthy weight, regular physical activity, and a plant-rich diet Correct answer.
  4. Frequent whole-body imaging and routine tumor marker panels

Explanation

Maintaining a healthy body weight, engaging in regular physical activity, and eating a diet rich in vegetables and fruits are consistently linked to lower risk of several cancers. These recommendations underpin major prevention guidelines. Supplementation, frequent imaging, and unproven dietary cycles are not established prevention strategies.

Question 21Cancer Biology, Diagnosis, Staging and Treatment Modalities

Which cellular process is the direct target of imatinib in chronic myeloid leukemia?

  1. Bcr-Abl tyrosine kinase activity Correct answer.
  2. Dihydrofolate reductase
  3. Topoisomerase II DNA cleavage
  4. Microtubule polymerization

Explanation

Imatinib is a small-molecule inhibitor that binds the ATP pocket of the Bcr-Abl fusion tyrosine kinase, blocking autophosphorylation and downstream proliferation signals. This targeted action explains its high activity in CML, which is driven by the Philadelphia chromosome translocation.

Question 22Cancer Biology, Diagnosis, Staging and Treatment Modalities

A tumor is described as having invaded through the muscularis propria into pericolorectal tissues. Which T category does this correspond to in colorectal cancer staging?

  1. T4a
  2. T3 Correct answer.
  3. T1
  4. T2

Explanation

In colorectal TNM staging, T3 denotes tumor invasion through the muscularis propria into the subserosa or non-peritonealized pericolic or perirectal tissues. T2 is limited to the muscularis propria, and T4 requires invasion of the visceral peritoneum or adjacent organs.

Question 23Cancer Biology, Diagnosis, Staging and Treatment Modalities

Which mechanism best explains why tumors with homologous recombination deficiency respond to PARP inhibitors?

  1. Synthetic lethality from unrepaired single-strand breaks converting to double-strand breaks Correct answer.
  2. Blockade of the PD-1 immune checkpoint
  3. Direct inhibition of the mitotic spindle checkpoint
  4. Enhanced antibody-dependent cellular cytotoxicity

Explanation

PARP inhibition traps single-strand break repair intermediates that collapse into double-strand breaks at replication forks. Cells lacking homologous recombination, such as BRCA-mutated tumors, cannot repair these lesions and die, a concept termed synthetic lethality.

Question 24Cancer Biology, Diagnosis, Staging and Treatment Modalities

Which serum tumor marker is most useful for monitoring treatment response in nonseminomatous germ cell tumors?

  1. CA 19-9
  2. Calcitonin
  3. Alpha-fetoprotein Correct answer.
  4. CA 125

Explanation

Alpha-fetoprotein and beta-hCG are the standard serum markers for nonseminomatous germ cell tumors and correlate with disease burden and response. CA 19-9, CA 125, and calcitonin are markers for other malignancies.

Question 25Cancer Biology, Diagnosis, Staging and Treatment Modalities

A patient has a breast tumor that is estrogen receptor positive and HER2 negative. Which systemic approach is most appropriate as initial endocrine therapy in the absence of visceral crisis?

  1. Bleomycin-based chemotherapy
  2. Aromatase inhibitor Correct answer.
  3. High-dose methotrexate
  4. Trastuzumab plus pertuzumab

Explanation

Hormone receptor-positive, HER2-negative breast cancer without visceral crisis is managed with endocrine therapy, and aromatase inhibitors are standard in postmenopausal patients. HER2-directed antibodies require HER2 overexpression, and cytotoxic regimens are reserved for endocrine resistance or aggressive disease.

Question 26Cancer Biology, Diagnosis, Staging and Treatment Modalities

Which feature defines a malignant tumor at the histologic level?

  1. Slow growth over many years
  2. Infiltrative growth with cellular atypia and mitoses Correct answer.
  3. Encapsulation by fibrous tissue
  4. Uniform cell size and preserved polarity

Explanation

Malignancy is characterized by invasive growth, loss of normal tissue architecture, cellular pleomorphism, and increased mitotic activity. Benign tumors tend to be well circumscribed with uniform cells and preserved polarity.

Question 27Cancer Biology, Diagnosis, Staging and Treatment Modalities

Which pathway is most commonly dysregulated in clear cell renal cell carcinoma?

  1. Von Hippel-Lindau pathway with HIF accumulation Correct answer.
  2. APC-beta-catenin pathway
  3. BRCA1 homologous recombination
  4. RET proto-oncogene rearrangement

Explanation

Loss of the VHL tumor suppressor leads to accumulation of hypoxia-inducible factors, driving angiogenesis and the clear cell phenotype. This biology underlies the sensitivity of clear cell renal carcinoma to VEGF-pathway inhibitors.

Question 28Cancer Biology, Diagnosis, Staging and Treatment Modalities

Which imaging modality is standard for initial local staging of rectal cancer to assess depth of invasion and nodal status?

  1. Positron emission tomography
  2. Bone scintigraphy
  3. Plain radiography
  4. Pelvic magnetic resonance imaging Correct answer.

Explanation

High-resolution pelvic MRI is the preferred modality for local staging of rectal cancer because it delineates the mesorectal fascia and depth of wall invasion. This information guides the decision for neoadjuvant chemoradiation.

Question 29Cancer Biology, Diagnosis, Staging and Treatment Modalities

Which class of chemotherapy agents acts by alkylating DNA and is associated with dose-limiting hemorrhagic cystitis?

  1. Vincristine
  2. Irinotecan
  3. Cyclophosphamide Correct answer.
  4. Methotrexate

Explanation

Cyclophosphamide is an alkylating agent whose metabolite acrolein causes hemorrhagic cystitis, prevented by hydration and mesna. Vinca alkaloids, antifolates, and topoisomerase inhibitors have distinct mechanisms and toxicities.

Question 30Cancer Biology, Diagnosis, Staging and Treatment Modalities

A 60-year-old with newly diagnosed multiple myeloma has renal impairment and a lytic bone lesion. Which feature is part of the diagnostic CRAB criteria?

  1. Splenomegaly
  2. Anemia Correct answer.
  3. Thrombocytosis
  4. Hyperviscosity

Explanation

The CRAB criteria for myeloma-related organ damage are hypercalcemia, renal insufficiency, anemia, and bone lesions. Hyperviscosity, thrombocytosis, and splenomegaly are not part of these criteria.

Question 31Cancer Biology, Diagnosis, Staging and Treatment Modalities

Which type of radiation delivery concentrates a high dose in a small target volume with steep dose fall-off, making it suitable for small brain metastases?

  1. Electron beam therapy
  2. Conventional whole-brain radiotherapy
  3. Total body irradiation
  4. Stereotactic radiosurgery Correct answer.

Explanation

Stereotactic radiosurgery delivers highly conformal, ablative doses with rapid dose fall-off, sparing adjacent normal tissue. It is used for limited numbers of small brain metastases and other small intracranial lesions.

Question 32Cancer Biology, Diagnosis, Staging and Treatment Modalities

Which immune checkpoint molecule on T cells is targeted by pembrolizumab?

  1. CTLA-4
  2. PD-1 Correct answer.
  3. CD20
  4. HER2

Explanation

Pembrolizumab is an anti-PD-1 monoclonal antibody that blocks interaction with PD-L1 and PD-L2, restoring T-cell effector function. CTLA-4 is targeted by ipilimumab, while CD20 and HER2 are targets on B cells and breast cancer cells respectively.

Question 33Cancer Biology, Diagnosis, Staging and Treatment Modalities

Which paraneoplastic syndrome is classically associated with small cell lung cancer due to ectopic hormone production?

  1. Hypoglycemia from insulin-like growth factor
  2. Syndrome of inappropriate antidiuretic hormone secretion Correct answer.
  3. Cushing syndrome from ectopic ACTH
  4. Hypercalcemia from parathyroid hormone-related peptide

Explanation

Small cell lung cancer commonly secretes antidiuretic hormone ectopically, producing hyponatremia through SIADH. Squamous cell carcinoma is more typically linked to PTHrP-mediated hypercalcemia, and carcinoid tumors to ectopic ACTH.

Question 34Cancer Biology, Diagnosis, Staging and Treatment Modalities

Which molecular test is required before administering trastuzumab in gastric adenocarcinoma?

  1. HER2 immunohistochemistry with in situ hybridization when equivocal Correct answer.
  2. BRAF V600E sequencing
  3. EGFR mutation analysis
  4. MSI testing

Explanation

Trastuzumab is indicated only for HER2-positive gastroesophageal adenocarcinoma, so HER2 status must be established by immunohistochemistry, with in situ hybridization for equivocal results. EGFR, BRAF, and MSI testing guide other therapies.

Question 35Cancer Biology, Diagnosis, Staging and Treatment Modalities

Which mechanism underlies resistance to imatinib in some patients with chronic myeloid leukemia?

  1. Loss of the Philadelphia chromosome
  2. Increased expression of topoisomerase II
  3. Upregulation of dihydrofolate reductase
  4. Acquisition of BCR-ABL kinase domain mutations Correct answer.

Explanation

Point mutations in the BCR-ABL kinase domain can impair drug binding and cause resistance, prompting use of second-generation inhibitors such as dasatinib or nilotinib. Loss of the Philadelphia chromosome would reduce the target rather than cause resistance.

Question 36Cancer Biology, Diagnosis, Staging and Treatment Modalities

Which histologic finding is characteristic of Hodgkin lymphoma?

  1. Psammoma bodies
  2. Reed-Sternberg cells in an inflammatory background Correct answer.
  3. Sheets of small cleaved lymphocytes
  4. Signet ring cells

Explanation

Classic Hodgkin lymphoma features binucleate Reed-Sternberg cells within a reactive inflammatory infiltrate. Signet ring cells indicate mucinous adenocarcinoma, and psammoma bodies are seen in papillary thyroid and serous ovarian carcinomas.

Question 37Cancer Biology, Diagnosis, Staging and Treatment Modalities

Which screening test is recommended for average-risk adults to detect colorectal cancer?

  1. Serum alpha-fetoprotein every 5 years
  2. Colonoscopy every 10 years Correct answer.
  3. Annual chest radiograph
  4. Annual serum CA 19-9

Explanation

Colonoscopy every 10 years is one accepted strategy for average-risk colorectal cancer screening, alongside stool-based tests and flexible sigmoidoscopy. CA 19-9, chest radiography, and alpha-fetoprotein have no role in colorectal screening.

Question 38Cancer Biology, Diagnosis, Staging and Treatment Modalities

Which feature best distinguishes a benign from a malignant lymph node on imaging?

  1. Uniform small size
  2. Preserved reniform shape
  3. Smooth thin capsule
  4. Loss of fatty hilum with irregular cortical thickening Correct answer.

Explanation

Malignant nodes typically lose the fatty hilum and show irregular cortical thickening, rounded shape, and abnormal vascularity. Preserved reniform architecture and a thin capsule favor benignity.

Question 39Cancer Biology, Diagnosis, Staging and Treatment Modalities

Which tumor suppressor gene is most frequently mutated in human cancers and regulates cell cycle arrest and apoptosis?

  1. MYC
  2. ABL1
  3. KRAS
  4. TP53 Correct answer.

Explanation

TP53 encodes p53, which induces cell cycle arrest or apoptosis in response to DNA damage, and is the most commonly mutated tumor suppressor in human cancer. KRAS, MYC, and ABL1 are proto-oncogenes activated by mutation or translocation.

Question 40Cancer Biology, Diagnosis, Staging and Treatment Modalities

A patient with metastatic melanoma harboring a BRAF V600E mutation is considered for targeted therapy. Which agent class directly inhibits the mutant kinase?

  1. Anti-CTLA-4 antibodies
  2. Aromatase inhibitors
  3. Proteasome inhibitors
  4. BRAF inhibitors such as vemurafenib Correct answer.

Explanation

Vemurafenib and dabrafenib selectively inhibit mutant BRAF kinase, producing rapid tumor regression in BRAF V600E melanoma. They are often combined with MEK inhibitors to delay resistance.

Question 41Cancer Biology, Diagnosis, Staging and Treatment Modalities

Which concept describes the ability of a tumor to stimulate new blood vessel formation to support growth?

  1. Apoptosis
  2. Anaplasia
  3. Angiogenesis Correct answer.
  4. Metaplasia

Explanation

Angiogenesis is the formation of new blood vessels from existing vasculature, driven by factors such as VEGF, and is a hallmark of tumor growth and metastasis. Apoptosis, anaplasia, and metaplasia describe different cellular processes.

Question 42Cancer Biology, Diagnosis, Staging and Treatment Modalities

Which staging system is used for most solid tumors to describe anatomic extent of disease?

  1. Durie-Salmon classification
  2. Child-Pugh classification
  3. TNM classification Correct answer.
  4. Ann Arbor classification

Explanation

The TNM system describes tumor size and invasion (T), regional nodal involvement (N), and distant metastasis (M) and is applied to most solid tumors. Ann Arbor, Durie-Salmon, and Child-Pugh are used for lymphoma, myeloma, and liver disease respectively.

Question 43Cancer Biology, Diagnosis, Staging and Treatment Modalities

Which mechanism explains the cardiotoxicity of doxorubicin?

  1. Blockade of beta-adrenergic receptors
  2. Iron-dependent free radical generation in cardiomyocytes Correct answer.
  3. Direct inhibition of cardiac sodium channels
  4. Antibody-mediated myocardial injury

Explanation

Doxorubicin generates reactive oxygen species and forms iron complexes in cardiomyocytes, which are relatively deficient in antioxidant defenses, leading to cumulative dose-related cardiomyopathy. Monitoring with echocardiography and use of dexrazoxane reduce this risk.

Question 44Cancer Biology, Diagnosis, Staging and Treatment Modalities

Which feature is characteristic of tumor lysis syndrome after initiation of cytotoxic therapy for a bulky hematologic malignancy?

  1. Hyperkalemia, hypophosphatemia, hypouricemia, and hypercalcemia
  2. Hypokalemia, hypercalcemia, and hyperuricemia
  3. Hypernatremia and hyperchloremia
  4. Hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia Correct answer.

Explanation

Rapid lysis of tumor cells releases intracellular potassium and phosphate and generates uric acid from nucleic acid breakdown. Phosphate binds calcium, producing hypocalcemia, and the combination can cause renal failure and arrhythmias.

Question 45Cancer Biology, Diagnosis, Staging and Treatment Modalities

Which approach describes the use of chemotherapy before surgery to shrink a locally advanced tumor?

  1. Maintenance chemotherapy
  2. Adjuvant chemotherapy
  3. Neoadjuvant chemotherapy Correct answer.
  4. Palliative chemotherapy

Explanation

Neoadjuvant chemotherapy is given before definitive local treatment to reduce tumor burden and improve resectability, and it can also assess tumor response. Adjuvant therapy is given after surgery, palliative therapy treats symptoms, and maintenance continues therapy after response.

Question 46Cancer Biology, Diagnosis, Staging and Treatment Modalities

Which process describes the spread of tumor cells through the bloodstream to distant organs?

  1. Hematogenous metastasis Correct answer.
  2. Transcoelomic seeding
  3. Perineural invasion
  4. Lymphatic spread

Explanation

Hematogenous metastasis occurs when tumor cells invade blood vessels and travel through the circulation to colonize distant organs such as the liver, lungs, or bone. It is distinguished from lymphatic spread, which follows lymphatic channels to regional nodes, and from transcoelomic seeding, which involves shedding into body cavities.

Question 47Cancer Biology, Diagnosis, Staging and Treatment Modalities

A 55-year-old with newly diagnosed acute myeloid leukemia has a peripheral blast count of 40,000/µL and is starting induction chemotherapy. Which laboratory abnormality is most consistent with spontaneous tumor lysis syndrome before treatment?

  1. Hypercalcemia with hyperphosphatemia
  2. Hyperkalemia with hyperuricemia and hyperphosphatemia Correct answer.
  3. Hypokalemia with hypouricemia and hypophosphatemia
  4. Isolated hypernatremia

Explanation

Tumor lysis syndrome results from rapid breakdown of tumor cells, releasing intracellular potassium, phosphate, and nucleic acids that are metabolized to uric acid. The classic biochemical triad is hyperkalemia, hyperphosphatemia, and hyperuricemia, often with acute kidney injury, and it can occur spontaneously in bulky, high-turnover leukemia.

Question 48Cancer Biology, Diagnosis, Staging and Treatment Modalities

Which mechanism best explains why some patients with chronic myeloid leukemia develop resistance to imatinib despite initial response?

  1. Amplification of the HER2 gene
  2. Acquired kinase domain mutations in BCR-ABL1 Correct answer.
  3. Loss of the Philadelphia chromosome
  4. Increased expression of topoisomerase II

Explanation

Resistance to imatinib in chronic myeloid leukemia commonly arises from acquired point mutations in the BCR-ABL1 kinase domain that impair drug binding while preserving kinase activity. These mutations allow the leukemic clone to proliferate despite continued targeted therapy, prompting consideration of alternative tyrosine kinase inhibitors.

Question 49Cancer Biology, Diagnosis, Staging and Treatment Modalities

A 62-year-old with resected stage III colon cancer is being considered for adjuvant chemotherapy. Which biomarker is used to guide the duration and intensity of oxaliplatin-based therapy?

  1. KRAS mutation status
  2. HER2 amplification
  3. Mismatch repair status Correct answer.
  4. PD-L1 expression

Explanation

Mismatch repair deficiency or high microsatellite instability identifies tumors with a strong immune microenvironment and a better prognosis, and it influences decisions about adjuvant oxaliplatin-based chemotherapy, which may be omitted or shortened in some patients. Mismatch repair status also predicts benefit from immune checkpoint blockade in metastatic disease.

Question 50Cancer Biology, Diagnosis, Staging and Treatment Modalities

A 58-year-old woman with metastatic breast cancer has a bone scan showing multiple focal uptake areas in the ribs and spine. Her serum alkaline phosphatase is elevated, but serum calcium and phosphorus are normal. Which mechanism best explains the bone scan findings in this setting?

  1. Osteoclastic resorption stimulated by tumor-secreted factors, with reactive new bone formation Correct answer.
  2. Diffuse marrow infiltration causing expansion of the medullary cavity without bone remodeling
  3. Deposition of calcium pyrophosphate crystals within the joint spaces
  4. Direct bacterial infection of the bone marrow space with inflammatory uptake

Explanation

Bone metastases typically disrupt normal bone remodeling; tumor cells secrete factors such as parathyroid hormone-related peptide that stimulate osteoclasts, and the resulting osteoblastic repair activity is what takes up the radiotracer on a bone scan. This osteolytic-with-reactive-osteoblastic remodeling explains the focal uptake and the elevated alkaline phosphatase even when serum calcium remains normal.