Oncology Purdue Exam 1

Which of the tissues or organs would you expect to be the brightest on an x ray/CT?

Bone

What is the main advantage of MRI over CT?

Soft tissue contrast

Which imaging modality employs radiotracers?

SPECT

Which of the following imaging modalities involve gamma rays?

PET

The MRI sensitivity for breast cancer detection is 99%. Among 1000 patients carrying breast cancer, how many cannot be detected in MRI scans?

10

Why is biopsy procedure needed when mammography detects breast cancer?

Mammography has high false positive rate

What is one of the main reasons cancer invades the stromal normal tissue?

Search for nutrients

The majority of cancer related deaths are caused by

Metastases

Paget's seed and soil theory refers to

Tumors ability to grow in a metastatic site

This form of invasion involves a multicellular sheet attached to the primary tumor

Coordinated

This step in the metastatic cascade refers to cells exiting circulation

Extravasation

What is the first step in the metastatic cascade

Localized invasion

What is the last step in the metastatic cascade

Formation of macrometastases

A mutation resulting in a loss of cellular function is an example of what type of cancer-related gene?

Tumor Suppressor gene

A mutation in a gain of cellular function is an example of what type of cancer related gene?

Oncogene

A mutation causes upregulation of a specific protein. This upregulated protein is a transcription factor for cell proliferation genes. This mutation is most likely occurring in which type of gene?

Oncogene

Without mutations in growth factor receptors, what method do cancer cells likely use for increased growth factor  signaling? 

Autocrine signaling

What is the most likely way mutations affecting growth factor receptor’s structure stimulate cancer growth?

Ligand-independent signaling

What is the most likely way repeated copies of a growth factor receptor gene stimulate cancer growth?

Receptor overexpression

Unmutated her2, ras, src, and myc are what type of genes?

Proto-oncogenes

Maintenance of the telomere length is directly related to which hallmark of cancer?

Enabling replicative immortality

Telomerase extends the length of telomeres, which enables more:

Cell proliferation

Rb and p53 are considered which types of genes?

Tumor suppressor gene

Mutations in both copies of which type of gene are usually required to support cancer formation?

Tumor suppressor gene

Mutations in a gene cause the cell to lose its functions relating to apoptosis. This gene could likely be classified as which type of gene?

Tumor suppressor gene

In the runaway car analogy of cancer the tumor suppressor genes are what?

Defective breaking system

Damaged DNA repair genes are most directly related to which hallmark of cancer?

Genome instability and mutation

What is the correct definition of dysplasia?

Disorganized cell growth

A tumor’s cell of origin (e.g., epithelial cell) is which type of classification feature?

Histologic

A tumor’s size is which type of classification feature?

Gross (macroscopic)

A tumor’s genetic mutation is which type of classification feature?

Molecular

Cancers can arise from?

Many specialized cell types

What is the likely type of cancer for a tumor originating in the epithelium?

Carcinoma

What is the difference between benign and malignant neoplasia?

Metastasizes/Invades tissues

In breast cancer, what is the most common first metastatic site?

Lymph node

In TNM staging, size of the primary tumor would be captured by:

The T in TNM

A patient with a small primary breast tumor and one metastatic tumor would be considered what TNM stage?

Stage IV

Extensive lymph node involvement with a small (invasive) primary breast tumor would likely be considered what TNM stage?

Stage III

n Hematoxylin and Eosin (H&E) staining the dark purple staining usually signifies

Cell nucleus

Prognostic breast cancer staging, in addition to TNM, incorporates other factors such as

Protein/Gene expression

Cancer staging is often performed by which department(s)?

Radiology and Pathology

Which of these early screening tests is suggested starting at an age of 21 years old?

Pap Smear

One of the main goals for this technique is the identification and removal of pre-cancerous polyps.

Colonoscopy

This technique can be used to visualize stomach ulcers.

Endoscopy

Which of these visually observable changes can apply to sarcoma?

Ulceration

Which of the following imaging modalities does not involve ionizing radiation?

MRI

What is the limitation of visual inspection?

Tissue penetration depth

Which approach is the gold standard for diagnosis?

pathology

What are the challenges for determination of cellular and tumor tissue integrin avb3 Expression?

1. Fluorescence-labeled monoclonal antibodies (e.g. LM609) have limited solution stability.

2. Large variability in performance of integrin a_vb₃ antibodies from different commercial sources.

3. Cellular and tissue staining with fluorescence-labeled monoclonal antibodies is complicated.

Which of the following statement is correct about circulating DNA?

1. Tumor cells naturally release DNA fragments to surrounding fluids.

2. They have a half-life of 0.25-3 hours.

3. They are best for evaluating disease progression rather than diagnosis.

Personalized cancer medicine focuses on the tumors:

genetics/mutation profile

Why would we want better blood tests for cancer?

more people can be screened

Which is a diagnostic test for prostate cancer?

PSA

Which of the following statements is correct about circulating tumor cells?

1. Presence of cancer cells in the bloodstream is a predictor of metastasis.

2. Circulating tumor cell correlate with poor outcomes

the process in which molecules are broken down to produce energy

catabolism

the process in which molecules are combined to produce macromolecules

anabolism

T/F tumors have up to 200 times the glycolytic activity of normal tissues and therefore have the increased uptake of 18F-FDG

true

the clinical applications of 18F-FDG include:

1. Diagnosis and staging

2. Treatment planning

3. Noninvasive monitoring

18F-FDG PET is also clinically useful for:

1. Evaluating disease response to chemotherapy or radiotherapy

2. Selecting tumor region for biopsy guidance

3. Radiotherapy planning with therapeutic and palliative intent

18F-FDG is a PET radiotracer, which

1. Will accumulate in tissues with high glycolytic activity

2. Most commonly used radiotracer for diagnosis of cancer and related metastasis.

3. Mimics glucose

Which of the following tissues will have a high 18F-FDG background

brain

Which of the components of tumor microenvironment is acellular?

extracellular matrix

Which cell type is part of adaptive immunity

T cells

In angiogenesis, blood vessels are made by?

extending new capillaries from nearby small blood vessels

At what minimum tumor size is angiogenesis required?

1.5-2 mm3

Which of the following can be used as a CT contrast agent

Iodinated compounds

T/F Integrin avb3 plays a significant role in tumor angiogenesis. It is a receptor for the extracellular matrix proteins with the exposed arginine-glycine-aspartic (RGD) tripeptide sequence. Therefore, biomolecules containing RGD tripeptide sequence can be used as targeting biomolecules for the development of avb3-targeted radiotracers.

True

Which of these can be used as an MRI contrast agent?

Gadolinium complexes

Which of the following statement about tumor hypoxia is true?

1. Tumor cells that outgrow their blood supply become hypoxic.

2. The effectiveness of chemotherapy depends on the degree of tumor hypoxia.

3. Tumor hypoxia also has significant effect on the success of radiotherapy.

Which of the following statement is correct about 18F-FMISO?

1. ¹⁸F-FMISO is the most widely used agents for imaging regional hypoxia.

2. ¹⁸F-FMISO is retained and trapped inside hypoxic cells.

3. ¹⁸F-FMISO PET can help identify hypoxic tumor, which will help facilitate the image-guided radiotherapy.

T/F: One of the key characteristics of the tumor cell is its capacity for proliferation without dependence on external growth factors. Tumor cells may proliferate by either internal production of growth factors or by responding to levels of external growth factors.

True

T/F: 18F-FLT is a biomarker of cellular proliferation but does not measure DNA synthesis

True

T/F: Since 18F-ISO shows all of the proliferating cells, it might be a better agent for detecting proliferating cells.

True

Which of the following statement is true about integrin avb3-targeted radiotracer?

1. Integrin a_vb₃-targeted radiotracers are useful for imaging tumor necrosis, caused by natural process or chemotherapy.

2. Integrin a_vb₃-targeted radiotracers are also useful for noninvasive monitoring of chemotherapy.

Which of the following statement is true about 64Cu-ATSM?

1. ⁶⁴Cu-ATSM PET provide prognostic information.

2. The tumor uptake ⁶⁴Cu-ATSM correlate well with the response of therapy and overall survival rate of cancer patients.