Transcript Cancer is

November 19, 2013
Janice Fairfield PGY-2
General Surgery
 ONCOLOGY OBJECTIVES
 2.1.12.2. Basic principles of neoplastic transformation






including tumor growth and spread
2.1.12.2.1. Pathology requirements for appropriate
assessments
2.1.12.2.2. Definition of common pathological terms such as
but not limited to neoplasia, malignancy, dysplasia,
metaplasia and atypia
2.1.12.3. Genetics of neoplasia
2.1.12.4. Genetics of families at risk
2.1.12.5. Role of environmental carcinogens
2.1.12.6. Paraneoplastic syndromes
Basic Principles of Neoplastic
Transformation
6 ESSENTIAL ALTERATIONS IN
CELL PHYSIOLOGY
 Self-sufficiency of growth





signals
Insensitivity to growthinhibitory signals
Evasion of apoptosis
Potential of limitless
replication
Angiogenesis
Invasion and metastasis
Schwartz’s Principles of Surgery
Cell Proliferation and
Transformation
Abnormal characteristics include:
 Contact inhibition
 Altered appearance
 Poor adherence to other cells and substratum
 Loss of anchorage dependence for growth
 Immortalization
 Gain of tumorgenicity
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Cancer Initiation
TUMORIGENESIS
 Initiation
 Promotion
 Progression
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Adenoma-Carcinoma Sequence
Tumour Suppressor
Gene Mutation
Proto-Oncogene 
Oncogene
Tumour Suppressor Gene
Mutation
Tumour Suppressor Gene
Mutation
QUESTION
Colonic adenomas are associated with
malignancy. All of the following increase the risk
of malignancy except:
a) sessile adenomas
b) multiple polyps
c) villous morphology
d) increased dysplasia
e) increasing size
QUESTION
Which of the following small bowel lesions has
the most malignant potential?
a) adenomatous polyp
b) hamartomatous polyp
c) juvenile (retention) polyp
d) leiomyoma
e) Brunner's gland adenomatous polyp
QUESTION
During histological analysis, the most specific for
malignancy is:
a) mitotic figures and prominent nucleoli
b) swollen cells
c) lymphocytic infiltration
d) bizarre shape
QUESTION
What is the most common aberration seen in
malignant cells?
a) Aneuploidy
b) Tetraploidy
c) Translocations
d) DNA cross-linking
QUESTION
Regarding the biology of malignant neoplasms, which of
the following statements is TRUE?
a) most malignant neoplasms arise from a single cell that has
undergone transformation to form a malignant clone
b) cancer cells proliferate faster than normal cells and the rate of
proliferation increases as the tumor mass increases
c) malignant cells are characterized by reversion to more
primitative cell types, cellular monomorphism, and increased
cohesion
d) tumors double in size at least every 20 days and therefore
essentially all human neoplasms are clinically detectable
within one year after the inception of neoplastic
transformation
QUESTION
All except which one of the following is associated
with papillary thyroid cancer:
a) squamous metaplasia
b) psamoma bodies
c) orphan annie
d) multicentric
e) amyloid
Cell-Cycle Dysregulation in Cancer
 Cell Cycle
vs.
 Quiescence (G0)
 Mutations in cell-cycle
regulators like INK4A,
INK4B, KIP1
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Oncogenes
 Usually designated by 3-letter
abbreviations myc or ras and
prefixes v or c
 Normal cellular genes that
contribute to cancer when
abnormal
 Normal counterpart is the protooncogene
 Proto-oncogenes can be
activated or overexpressed by
translocation, promoter
insertion, mutation, or
amplification
 Growth factors
(e.g., platelet-derived growth
factor)
 Growth factor receptors
(e.g., HER-2)
 Intracellular signal
transduction molecules
(e.g., ras)
 Nuclear transcription factors
(e.g., c-myc)
Schwartz’s Principles of Surgery
QUESTION
Oncogenes, proto-oncogenes, and tumor suppresser
genes pay a major role in carcinogenesis. Which of the
following statements is TRUE?
A) proto-oncogenes are proteins capable of inhibiting
oncogenes
B) exposure to carcinogens causes insertion of oncogenes
into the human genome
C) proto-oncogenes may be activated by mutation,
amplification, or translocation
D) tumour suppressor genes may be activated by certain
chemotherapy drugs
QUESTION
Genomic instability increases the chance of specific
gene mutations that are ultimately responsible for the
various phenotypes of cancer cells. Which of the
following statements about genomic instability is
TRUE?
A) the tumor suppressor gene p53 plays a critical role in
maintaining genomic stability
B) presence of the ras-oncogene causes genetic instability
C) local over-expression of TGF-ß may lead to genomic
instability in areas of chronic inflammation
D) DNA mismatch repair genes (MMR) can compensate
for most causes of genetic instability
Oncogenes
HER-2
RAS
 a.k.a. neu or c-erbB-2
 Small GTP-binding proteins
 Epidermal growth factor
 ~20% of all tumours have
receptor
 Tyrosine kinase
 Frequently amplified and
protein overexpressed in
breast, ovarian, lung, gastric,
and oral cancers
activating mutations in one
of the ras genes
 90% of pancreatic cancers,
but <5% breast cancers
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Tissue Homeostasis
Apoptosis
Necrosis
 Genetically regulated
 Cell injury that results in
program to dispose of cells
 “Programmed cell death” or
“suicide”
 Required for tissue
homeostasis, but can be
triggered by pathologic
stimuli
 Cell shrinks with nuclear and
cytoplasmic condensation
premature death of cells by
autolysis
 External factors: infection,
toxins, trauma
 Cells DO NOT die by apoptosis
but instead by loss of cell
membrane integrity and release
of cell death products into the
intracellular space and
interstitium
 Cell loses ability to control
osmotic pressure and explodes
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QUESTION
Apoptosis (programmed cell death) is an
important regulatory mechanism that limits
inflammatory tissue injury. Inducers of apoptosis
include all of the following, EXCEPT?
a) hyperglycemia
b) oxidant stress
c) radiation
d) cytokines
QUESTION
Which statement is not true?
a) necrosis occurs due to exogenous forces (injury)
b) apoptosis is programmed cell death
c) necrosis has minimal effect on surrounding tissues
d) necrosis involves cell swelling and protein coagulation
e) apoptosis involves cell shrinking and chromatin
condensation
Autophagy in Cancer Cells
 “Self-eating”
 Autophagy can also act as a
 Major cellular pathway for
protein and organelle
turnover
 Balance between anabolism
and catabolism
 Role in tumor suppression
 Cancer cells may have
deregulation of autophagy
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stress response to protect
cancer cells from low nutrient
supply or therapeutic insults
Alterations in Apoptosis in Cancer
Cells
 Increased expression of Fas
 Alterations of the p53
(DcR3) and TRAIL (TRID and
TRUNDD) decoy receptors
 Increased expression of
antiapoptotic BcI-2, IAPrelated protein survivin, cFLIP
 Mutations or downregulation
of proapoptotic Bax, caspase
8, APAF1, XAF1, and death
receptors CD95, TRAIL-R1,
TRAIL-R2
pathway
 Overexpression of growth
factors and growth factor
receptors
 Activation of the PI3K/Akt
survival pathway
 Heat shock proteins (HSP70
and HSP27) inhibit
downstream apoptotic
pathways
Schwartz’s Principles of Surgery
QUESTION
Following a cellular injury, cells die by a process of
necrosis or apoptosis. Which of the following
statements concerning apoptosis is NOT
CORRECT?
a) it begins under the precise control of diverse
intracellular and extracelluar signals
b) it acts mainly through its effects on the mitochondria
c) its progression is regulated by a single gene
d) it follows a fixed sequence of events
QUESTION
All of the following are true except:
a) Necrosis is a non controlled process that leads to
stimulation of inflammation
b) Apoptosis is important for tissue growth
c) Both necrosis and apoptosis happen in reperfusion
injury
d) Apoptosis initiated by Golgi apparatus
QUESTION
Which of the following statements concerning
heat-shock proteins is NOT true?
a) they are expressed under conditions of compromised
oxygen delivery
b) they are both constitutively and inducibly expressed
c) they are both pro and anti inflammatory
d) they play no role in cellular apoptosis
QUESTION
Which of the following is TRUE regarding the
immune system’s response to tumour cells?
a) Humoral response decreases tumour growth
b) Cellular response decreases tumour growth
c) Cellular response increases tumour growth
d) Humoral response increases tumour growth
Cancer Invasion
 In situ = cancer cells lie
 Changes in adhesion
exclusively above basement
membrane
 Invasive = cancer cells breach
the basement membrane and
penetrate stroma
(cadherin family, integrins)
 Initiation of motility
(autocrine motility factor,
autotaxin, scatter factor, TGFalpha, EGF, insulin-like
growth factors)
 Proteolysis of extracellular
matrix (ECM)
(MMPs)
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Cancer Invasion
Other implicated factors
 Serine proteinases
(urokinase and tissue
plasminogen activators)
 Cysteine proteinases
 Aspartic proteinases
 MMPs (metal-dependent
endopeptidases)
(upregulated in almost every
type of cancer)
Schwartz’s Principles of Surgery
QUESTION
Which of the following is the most sensitive
indicator of malignancy in an incisional biopsy
for epithelial tumour?
a) aneuploidy in flow cytometry
b) positive stain for cytokeratin
c) tumour cells breaking through the basement
membrane layer
d) multiple mitotic figures and prominent nucleoli
DNA staining
QUESTION
Colon cancer metastasizes via each of these
methods EXCEPT:
a) transperitoneal
b) lymphangitic
c) hematogenous
d) peri-neural invasion
e) direct invasion
QUESTION
Which of the following cancers is not associated
with a poor prognosis if poorly differentiated:
invasive ductal breast cancer
b) sarcoma
c) astrocytoma
d) medullary breast cancer
a)
QUESTION
What is an example of a high risk for developing breast
cancer:
a) atypical ductal hyperplasia
b) squamous hyperplasia
c) papillary hyperplasia
d) sclerosing adenosis
Angiogenesis
 New vessels from an existing
 Inhibitors of angiogenesis:
vascular bed
 Ras, HER-2, p53 implicated
 Vascular endothelial growth
factors (e.g.; basic fibroblast
growth factor, insulin-like
growth factor)
 Platelet-derived growth
factors
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thrombospondin 1 and
angiostatin
QUESTION
Which factor stimulates angiogenesis?
a) Basic fibroblast growth factor
b) C5a/C3a
c) Decreased wound O2 tension
d) IL1
QUESTION
Angiogenesis is important to all of the following
conditions, EXCEPT?
a) development of cartilage
b) maintaining a chronic inflammatory state
c) ulcer healing
d) tumor growth
Metastasis
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Metastasis
 Dormancy
 Liver or bone marrow
 Preferred sites: based on blood supply
 Seed and soil theory
 HER-2 and Ras
 RhoC, osteopontin, interleukin-11, Twist
Schwartz’s Principles of Surgery
QUESTION
With regard to the spread of neoplasm, which of the
following statements is FALSE?
a) metastatic cells enter the lymph node via the subcapsular
space and later permeate the sinusoids of the node
b) carcinoma-in-situ is a lesion with histopathological
characteristics of malignancy without detectable invasion
beyond the basement membrane
c) lymphatic involvement is common with epithelial neoplasms,
whereas most sarcomas metastasize hematogenously
d) the metastatic process is highly efficient, as evidenced by the
fact that the number of circulating tumour cells correlates with
the metastatic burden
QUESTION
Which of the following primaries is least likely to
metastasize to vertebrae:
a) Lung
b) Breast
c) Prostate
d) Colon
e) Renal cell
QUESTION
Which of the following cancers has a tendency to
metastasize to bone?
a) Thyroid
b) Colon
c) Adrenal
d) Liver
QUESTION
The most likely tumor to metastasize to the brain
and cause hemorrhage is:
a) Hypernephroma
b) Malignant melanoma
c) Lung
d) Breast
e) Prostate
Cancer Stem Cells
 Small subset of cancer cells capable of extensive
proliferation
 E.g.; leukemia, multiple myeloma
 ONCOLOGY OBJECTIVES
 2.1.12.2. Basic principles of neoplastic transformation






including tumor growth and spread
2.1.12.2.1. Pathology requirements for appropriate
assessments
2.1.12.2.2. Definition of common pathological terms such as
but not limited to neoplasia, malignancy, dysplasia,
metaplasia and atypia
2.1.12.3. Genetics of neoplasia
2.1.12.4. Genetics of families at risk
2.1.12.5. Role of environmental carcinogens
2.1.12.6. Paraneoplastic syndromes
Definitions
 Neoplasia= “new growth”
 Malignancy= cancer
 “A neoplasm is an
 Implies that the neoplasm
abnormal mass of tissue,
the growth of which
exceeds and is
uncoordinated with that of
the normal tissues and
persists in the same
excessive manner after
cessation of the stimuli
which evoked the change.”
may invade and destroy
adjacent structures and
spread to distant sites
Robbins and Cotran Pathologic Basis of
Disease
QUESTION
 Cancer is:
a) clonal selection of cells with accumulated multiple
genetic mutations
b) translocation to multiple proto-oncogenes
c) imbalance between cell growth and cell death
d) replacement of one cell type with another
Definitions
 Dysplasia= disordered
growth (loss in
uniformity of individual
cells and loss in
architectural
orientation)
 Metaplasia=
replacement of one cell
type with another cell
type (can be in response
to stress)
Robbins and Cotran Pathologic Basis of Disease
Definitions
 Atypia= structural
abnormalities in a cell
Robbins and Cotran Pathologic Basis of Disease
QUESTION
Adaptive change in cells subjected to chronic
stress:
a) hyperplasia
b) hypertrophy
c) metaplasia
d) neoplasia
e) dysplasia
QUESTION
Risk of transforming Barrett’s esophagus to
adenocarcinoma is :
a) 1% per year
b) 5% per year
c) 10% per year
d) 15% per year
QUESTION
Regarding the progression of cells from normal to
cancerous, which of the following statements is
NOT true?
a) dysplasia describes cells with altered size, shape, and
organization
b) in the absence of atypia or dysplasia, hyperplasia
confirms only a modest, if any, risk of cancer in a
given tissue
c) all dysplastic tissues eventually progress to frank
carcinoma
d) metaplastic changes may be reversible
QUESTION
If a pathology report describes metaplasia, this
means:
a) invasion of basement membrane
b) increased number of cells
c) loss of polarity and nuclear atypia
d) altered architecture of cells
e) cells present which are normally located elsewhere
QUESTION
Dysplasia is best defined as:
a) atypical cells with abnormal nuclear characteristics
and abnormal growth pattern
b) normal cells in an abnormal location
c) abnormal cells invading the basement membrane
d) increased number of cells for that location
 ONCOLOGY OBJECTIVES
 2.1.12.2. Basic principles of neoplastic transformation






including tumor growth and spread
2.1.12.2.1. Pathology requirements for appropriate
assessments
2.1.12.2.2. Definition of common pathological terms such as
but not limited to neoplasia, malignancy, dysplasia,
metaplasia and atypia
2.1.12.3. Genetics of neoplasia
2.1.12.4. Genetics of families at risk
2.1.12.5. Role of environmental carcinogens
2.1.12.6. Paraneoplastic syndromes
Cancer Genetics
Hereditary Cancers:
 Tumor development at a much younger age than usual
 Presence of bilateral disease
 Presence of multiple primary malignancies
 Presentation of a cancer in the less affected sex
 Clustering of the same cancer type in relatives
 Occurrence of cancer in association with other
conditions such as cognitive delay or pathognomonic
skin lesions
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Cancer Genetics
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Cancer Genetics
 RB1 gene and hereditary
retinoblastoma
(tumour suppressor gene)
 P53, hCHK2, and Li Fraumeni
syndrome
(early onset breast cancer, soft tissue
sarcomas, brain tumors,
adrenocortical tumors, leukemia)
 BRCA-1, BRCA-2 and hereditary
breast-ovarian cancer syndrome
(17q21 and 13q12.3)
 APC gene and Familial
Adenomatous Polyposis and
Gardner Syndrome
(tumour suppressor gene)
(FAP: colonic polyps)
(Gardner: colonic polyps, osteomas and
dental abnormalities, cutaneous
lesions, desmoid tumours, congenital
hypertrophy of retinal pigment
epithelium, adrenal adenomas, nasal
angiofibromas)
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Cancer Genetics
 Mismatch repair genes
and HNPCC
(Lynch Syndrome 1:
early onset CRC
Lynch Syndrome 2:
CRC, endometrial cancer,
transitional cell carcinoma
of ureter/renal pelvis,
stomach, small bowel,
ovary, pancreas)
 PTEN and Cowden
(hMLH1, hMSH2,
hMSH6,hPMS1, hPMS2)
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Disease
(Gliomas, breast, prostate,
renal carcinoma, thyroid
adenomas, multinodular
goiters, breast
fibroadenomas,
hamartomatous GI polyps,
trichilemmomas,benign
tumours of hair follicle
infundibulum,
mucocutaneous
papillomatosis)
(MMAC1)
Cancer Genetics
 P16 and Hereditary
Malignant Melanoma
(tumour suppressor gene,
a.k.a. INK4A, CDKN1,
CDKN2A, MTS1)
 E-Cadherin and Hereditary
Diffuse Gastric Cancer
(CDH1 gene)
 RET Proto-oncogene and
MEN Type II
(transmembrane receptor
kinase with a role in
proliferation, migration,
differentiation of cells
derived from neural crest)
(MEN2a: medullary thyroid
carcinoma,
pheochromocytoma,
parathyroid adenoma)
(MEN2b: medullary thyroid
carcinoma, marfanoid
habitus, mucosal neuromas,
ganglioneuromatosis)
Schwartz’s Principles of Surgery
QUESTION
What is the mutation found in MEN II?
a) K-Ras oncogene
b) RET oncogene
c) P53
d) CEA
QUESTION
All of the following can be malignancies
associated with von Hippel Lindau syndrome
EXCEPT:
a) pheochromocytoma
b) adenocarcinoma of the pancreas
c) cerebral hemangioblastomas
d) renal cell cancers
QUESTION
Early-onset breast cancer, sarcomas, leukemia,
and brain and adrenal cortical tumors would be
most consistent with:
a) Li-Fraumeni syndrome
b) Peutz-Jeghers syndrome
c) BRCA- 2
d) Ataxia-telangiectasia
QUESTION
Many cancers are now known to be caused by
genetic defects. Which of the following
statements concerning genetic testing for
hereditary nonpolyposis colorectal cancer is
TRUE?
a) seeks to identify the responsible oncogene
b) can predict the risk of desmoid tumour
development
c) is useful for at-risk family members when no
mutation is detected in the proband
d) can be performed on peripheral white blood cells
 ONCOLOGY OBJECTIVES
 2.1.12.2. Basic principles of neoplastic transformation






including tumor growth and spread
2.1.12.2.1. Pathology requirements for appropriate
assessments
2.1.12.2.2. Definition of common pathological terms such as
but not limited to neoplasia, malignancy, dysplasia,
metaplasia and atypia
2.1.12.3. Genetics of neoplasia
2.1.12.4. Genetics of families at risk
2.1.12.5. Role of environmental carcinogens
2.1.12.6. Paraneoplastic syndromes
Genetic Modifiers of Risk
CARCINOGENS
 Chemical
 Physical
 Viral
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Chemical Carcinogens
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Physical Carcinogens
 Chronic inflammation and irritation
(chronic non-healing wounds, burns, IBD)
 Infection
(H. pylori, liver fluke)
 Asbestos, silica
 Radiation
(non-ionizing: UV)
( ionizing: xrays, gamma rays, alpha and beta particles)
Schwartz’s Principles of Surgery
QUESTION
All of the following are associated with
mesothelioma except:
a) Asbestos
b) hypoglycemia
c) dyspnea
d) pulmonary osteoarthropathy
QUESTION
Which is not a risk factor for skin cancer:
a) nevus sebaceum
b) HPV
c) xeroderma pigmentosum
d) immunosuppression
e) none of the above
QUESTION
All are associated with increased risk of basal cell
carcinoma (BCC) except:
a) UV
b) nevus sebaceous
c) keratoacanthosis
d) actinic keratosis
QUESTION
Bowen’s Disease is:
a) Basal cell carcinoma (BCC) in situ
b) Squamous cell carcinoma (SCC) in situ
c) Melanoma in situ
d) Pyoderma gangranosum in situ
QUESTION
The most common cause of tongue cancer is:
a) adenocarcinoma
b) squamous cell carcinoma
c) lymphoma
d) adenoid cystic carcinoma
e) mucoepidermoid carcinoma
QUESTION
Esophageal squamous cell carcinoma (SCC) is
not associated with:
a) Barrett’s esophagus
b) achalasia
c) upper esophageal web
d) smoking
QUESTION
What is the most sensitive way to detect squamou
cell carcinoma on pathology?
a) invasion of the basement membrane
b) altered polarity of the basal cells
c) cellular atypia
d) nest cells
QUESTION
A chronic leg osteomyelitis developed chronic
ulcer and discharge. What is the most common
cancer that will develop in this ulcer:
a) Basal cell carcinoma (BCC)
b) Squamous cell carcinoma (SCC)
c) Ewing’s sarcoma
d) Non-Ewing’s osteosarcoma
Viral Carcinogens
Schwartz’s Principles of Surgery
QUESTION
Hepatocellular carcinoma is epidemiologically
associated with all of the following, EXCEPT:
a) Hepatitis A
b) Hepatitis B
c) Hepatitis C
d) alcoholic cirrhosis
QUESTION
Viruses that relate to cancer include all except:
a) Hepatitis B
b) Hepatitis C
c) EBV
d) CMV
QUESTION
Epstein-Barr virus is associated with which of the
following:
a) Cervical cancer
b) Nasopharyngeal cancer
c) Kaposi’s Sarcoma
d) Hepatocellular carcinoma
QUESTION
What is the most common presentation of a
nasopharyngeal carcinoma:
a) neck mass
b) decreased hearing
c) nasal obstruction
d) sore throat
e) new onset of cough
QUESTION
What is the most common tumour in HIVinfected patients:
a) B-cell lymphoma
b) Kaposi sarcoma
c) Cervical cancer in females
d) Anal squamous cell carcinoma
QUESTION
All of the following neoplasms have been
associated with AIDS, EXCEPT:
a) non-Hodgkin’s lymphoma
b) Kaposi’s sarcoma
c) gastrointestinal stromal tumor (GIST)
d) CNS lymphoma
QUESTION
Which of the following malignancies IS NOT
increased in AIDS patients?
a) Non-Hodgkin's lymphoma
b) Squamous cell carcinoma
c) Myelogenous leukemias
d) Kaposi's sarcoma
e) None of the above
Tumour Markers
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Carcinoembryonic Antigen (CEA)
 Elevated in primary colorectal cancer, breast, lung,
ovarian, prostate, liver, thyroid, and pancreatic cancer
 Also elevated in diverticulitis, IBD, PUD, bronchitis,
pancreatitis, pulmonary infections, liver abscess,
alcoholic cirrhosis, cholecystitis, smokers, elderly
persons
 Controversial in its use for colorectal cancer
(better for evaluating metastases)
Schwartz’s Principles of Surgery
Tumor Markers
 PSA (can be elevated in prostate
cancer, BPH, prostatitis)
 AFP (primary liver cancer, germ
cell tumour of ovary or testicle,
gastric cancer)
(benign conditions: pregnancy,
cirrhosis, hepatic necrosis,
hepatitis)
 CA 19-9 (can be elevated in
pancreatic, stomach, colorectal,
esophageal, liver cancers)
 CA 15-3 (can be elevated in early
breast cancer, lung, ovarian,
endometrial, GI cancers )
(benign conditions: chronic
hepatitis, TB, sarcoidosis, PID,
endometriosis, SLE, pregnancy,
lactation)
 CA 27-29 (can be elevated in
breast cancer, colon, stomach,
kidney, lung, ovary, pancreas,
uterus, liver)
Schwartz’s Principles of Surgery
QUESTION
All are true of carcinoembryonic antigen (CEA)
except:
a) high level associated with poor prognosis
b) level is increased in smokers
c) when level in increased after surgery, it indicates
recurrence
d) the increase in CEA level in asymptomatic patient
indicates malignancy
QUESTION
All except which of the following are poor
prognostic indicators for colon cancer:
a)
b)
c)
d)
e)
perforation
obstruction
poorly differentiated
elevated CEA
venous and perineural invasion
QUESTION
Which of the following has the highest specificity
for the diagnosis of related disease:
a) PSA- prostate
b) Beta-HCG-choriocarcinoma
c) CA19-9 – pancreatic cancer
d) Calcitonin- medullary carcinoma
QUESTION
What is the best marker for melanoma?
a) Tyrosinase
b) HMB-45
c) S-100
d) MART-1
QUESTION
How to best differentiate primary skin melanoma
lesion from a metastatic melanoma deposit:
a) junctional activity
b) dermal invasion
c) ulceration
d) margins
QUESTION
Most common cause of death in women from
cancer:
a) breast
b) lung
c) colon
d) ovarian
e) endometrial
QUESTION
Which of the following is the MOST common
human cancer?
a) breast
b) prostate
c) lung
d) basal cell carcinoma of the integument
e) adenocarcinoma of the bowel
QUESTION
What is the most common cancer among men?
a) lung
b) prostate
c) colon
d) brain
e) renal
QUESTION
a)
b)
c)
d)
Renal transplant patients have an increased
incidence of:
nonmelanoma skin cancer
lobular breast cancer
colonic carcinoid
lung cancer
QUESTION
Immunosuppression to facilitate organ transplant
may result in many complications. Malignant
lymphoma may occur years after the transplant.
Which of the following statements about
transplantation associated lymphomas is NOT true:
a) they are usually non-Hodgkin’s B-cell lymphomas
b) the malignant transformation may be caused by the
Epstein-Barr virus
c) the incidence of lymphoma is directly related to the
amount of immunosuppression received over time
d) upon diagnosis of the lymphoma, withdrawal of
immunosuppression is rarely successful in eradicating
the tumour
References
 Schwartz’s Principles of Surgery
 Up-to-Date
 Robbins and Cotran Pathologic Basis of Disease
 Indian J Dermatol. 2008; 53(4): 212–214.doi: 10.4103/0019-
5154.44803PMCID: PMC2763751MALIGNANT
MELANOMA – CUTANEOUS METASTASESL
Padmavathy, L Lakshmana Rao,1 N Ethirajan, and B
Krishna Swamy1
 UBC and U of T Principles of Surgery Websites (Old Exams)
 Multiple Old Exam Questions