Neoplasia — MCQs

Neoplasia Indian Medical PG Practice Questions and MCQs

Question 961: The most important prognostic factor for carcinoma of the breast is:

A. Stage (Correct Answer)
B. Tumor DNA content
C. Histological subtype
D. Tumor grade

Explanation: ***Stage*** - **Tumor stage** (TNM staging system) is the most critical prognostic factor for breast carcinoma because it directly reflects the extent of disease spread at diagnosis, including tumor size, nodal involvement, and distant metastases [1]. - Patients with **early-stage disease** (localized) generally have a much better prognosis than those with **late-stage disease** (regional or metastatic) [1]. *Tumor DNA content* - **Tumor DNA content**, specifically **aneuploidy**, can be an indicator of a more aggressive tumor phenotype. - While it has prognostic value, it is less important than pathological stage in clinical decision-making. *Histological subtype* - The **histological subtype** (e.g., invasive ductal carcinoma, invasive lobular carcinoma) affects prognosis, with some subtypes having more aggressive behavior [2]. - However, the overall stage, particularly lymph node involvement, overrides the prognostic impact of the specific subtype [1]. *Tumor grade* - **Tumor grade**, based on the degree of cellular differentiation, nuclear pleomorphism, and mitotic activity, is an important prognostic factor [2]. - Higher-grade tumors are generally more aggressive, but its prognostic significance is secondary to that of tumor stage, especially when considering the complete clinical picture [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1070-1072. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 457-458.

Question 962: Retinoblastoma is associated with:

A. Osteosarcoma (Correct Answer)
B. Hepatocellular carcinoma
C. Squamous cell carcinoma
D. Giant cell tumor

Explanation: ***Osteosarcoma*** - Retinoblastoma is associated with **increased risk** of secondary malignancies, particularly **osteosarcoma**. - The relationship is due to **genetic predisposition** via alterations in the RB1 gene [1]. *Hepatocellular* - Hepatocellular carcinoma is primarily linked to **risk factors** like hepatitis infection and is not directly associated with retinoblastoma. - It does not share a **common genetic pathway** with retinoblastoma, making this option incorrect. *Osteoclastoma* - Osteoclastoma (giant cell tumor of bone) typically occurs in the **metaphysis of long bones** and does not relate to retinoblastoma. - There are no documented links between **genetic mutations** in retinoblastoma and osteoclastoma development. *SCC* - Squamous cell carcinoma (SCC) is more associated with **sun exposure** and certain viral infections, rather than retinoblastoma. - It lacks any **genetic relationship** or increased incidence linked to retinoblastoma, ruling this option out. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 298-300.

Question 963: Which of the following is not a risk factor for cholangiocarcinoma?

A. Thorotrast
B. Radon
C. Dioxin
D. Aflatoxin (Correct Answer)

Explanation: ***Aflatoxin*** - **Aflatoxin** is a potent **hepatocarcinogen** produced by *Aspergillus* species that is specifically and strongly linked to **hepatocellular carcinoma (HCC)** [1], NOT cholangiocarcinoma. - This is the **most clearly unrelated** risk factor to cholangiocarcinoma among the options, as its carcinogenic mechanism targets hepatocytes specifically [1], [2]. - It contaminates crops in warm, humid regions and is a well-established cause of liver cancer in endemic areas [1]. *Thorotrast* - **Thorotrast** (thorium dioxide) was a radioactive contrast agent used until the 1950s that **IS a known risk factor** for cholangiocarcinoma. - Due to prolonged retention in the liver and biliary system, it significantly increases the risk of both **cholangiocarcinoma** and **hepatic angiosarcoma** [3]. - Its use was discontinued precisely because of its strong carcinogenic potential. *Radon* - **Radon** is a naturally occurring radioactive gas that is primarily and overwhelmingly associated with **lung cancer** from inhalation exposure. - While a potent carcinogen, it has **no established epidemiological link** to cholangiocarcinoma due to its route of exposure and target organ. *Dioxin* - **Dioxins** are environmental pollutants with documented carcinogenic effects. - While some studies have explored potential links to various cancers, dioxin is **not recognized as an established risk factor** for cholangiocarcinoma in major medical references. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, pp. 876-877. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 331-332. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 216-217.

Question 964: In Wilms' tumor, what leads to the emergence of resistance to chemotherapy?

A. Nephrogenic rests associated with Wilms' tumor
B. Anaplastic features in tumor cells (Correct Answer)
C. Tumor capsular infiltration
D. Monophasic tumor morphology

Explanation: ***Anaplasia*** - Anaplasia in Wilms' tumor is associated with **poor differentiation**, leading to increased **resistance to chemotherapy** due to altered cell growth and survival pathways. - Tumors exhibiting anaplastic features often have a more aggressive behavior, resulting in **treatment failure** and **recurrence** despite chemotherapy. *Capsular infiltration* - While capsular infiltration indicates **tumor aggressiveness**, it does not directly contribute to **chemotherapy resistance** mechanisms. - It primarily reflects **advanced stage** or local spread rather than alterations in drug response. *Nephrogenic rests* - Nephrogenic rests are **pre-existing lesions** that can predispose to Wilms' tumor [1] but are not directly tied to **chemotherapy resistance**. - They are typically changes related to **developmental anomalies** rather than mechanisms of drug resistance. *Monophasic morphology* - Monophasic morphology refers to the **uniform appearance** of tumor cells, which typically indicates less heterogeneity and does not imply **resistance to chemotherapy**. - This characteristic may affect prognosis but is not a mechanism contributing to **chemotherapy failure**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 486-490.

Question 965: Which of the following is NOT classified as a small round cell tumor?

A. Ewing's sarcoma
B. Rhabdomyosarcoma
C. Wilm's tumor (Correct Answer)
D. Retinoblastoma

Explanation: ***All of the above*** - Small round cell tumors encompass a variety of neoplasms including **retinoblastoma** and **rhabdomyosarcoma** [1]. - They are characterized by **primitive, undifferentiated cells**, making this classification broad and inclusive of all mentioned tumors. *Retinoblastoma (a small round cell tumor)* - While retinoblastoma is indeed a **small round cell tumor** [1], this option fails to recognize the broader classification of tumors in the question. - It doesn't encompass other key tumors that can also be categorized under the **small round cell tumor** umbrella. *Wilm's tumor (not a small round cell tumor)* - Wilm's tumor is classified as a **nephroblastoma**, featuring a distinct morphology that does not fit into the small round cell category. - Typically presents as a **pediatric abdominal mass** with **triphasic pathology**, unlike small round cell tumors which have a more uniform appearance. *Rhabdomyosarcoma (a small round cell tumor)* - Although rhabdomyosarcoma is considered a **small round cell tumor** [1][2], this option too does not cover all tumors classified under this term. - It features **mesenchymal differentiation** and uniform round cells with little cytoplasm [2] rather than presenting a broad view, as requested by the question. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 483-484. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1224-1225.

Question 966: Radiation exposure can lead to which type of thyroid carcinoma?

A. Lymphoma
B. Papillary carcinoma (Correct Answer)
C. Medullary carcinoma
D. Follicular carcinoma

Explanation: ***Papillary carcinoma*** - Papillary thyroid carcinoma is strongly associated with **radiation exposure**, particularly during childhood [1]. - It is the most prevalent type of thyroid cancer and typically has a **good prognosis** [1]. *Lymphoma* - Thyroid lymphoma is rare and generally not linked to **radiation exposure**; it often presents as a **rapidly enlarging goiter**. - It is more commonly associated with **autoimmune thyroiditis**, not primary radiation effects. *Follicular carcinoma* - Follicular carcinoma shows a correlation with **iodine deficiency** rather than radiation exposure [1]. - Its presentation is more subtle, compared to the classical association of **radiation with papillary carcinoma**. *Medullary carcinoma* - Medullary thyroid carcinoma is primarily linked to **familial syndromes** like MEN 2 and not radiation exposure. - It arises from **parafollicular C cells**, making it clinically distinct from radiation-related types. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1098-1099.

Question 967: Which of the following statements about borderline tumors is false?

A. Absence of stromal invasion
B. Metastases are common (Correct Answer)
C. 10% of all epithelial tumours are borderline
D. They have a good prognosis

Explanation: ***Metastases are common*** - This statement is **false** because **metastases are rare** in borderline ovarian tumors [1]. - While they can have intra-abdominal implants, these are usually non-invasive and do not typically metastasize to distant sites like invasive carcinomas [2]. *10% of all epithelial tumours are borderline* - Borderline ovarian tumors, also known as **tumors of low malignant potential**, account for approximately **10-15% of all epithelial ovarian tumors**. - This percentage indicates they are a significant, but not predominant, subtype of ovarian epithelial neoplasms. *they have a good prognosis* - Patients with borderline ovarian tumors generally have an **excellent prognosis**, with a 5-year survival rate typically over 90% [1], [2]. - This is due to their non-invasive nature and low potential for aggressive spread. *Absence of stromal invasion* - A key defining characteristic of borderline ovarian tumors is the **absence of destructive stromal invasion** [2]. - They exhibit epithelial proliferation beyond that seen in benign tumors, but without invading the underlying stroma, which differentiates them from invasive carcinomas. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 478-480. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1029-1032.

Question 968: Chordoma commonly involves which of the following locations?

A. Clivus and sacrum (Correct Answer)
B. Dorsal spine
C. Lumbar spine
D. Cervical spine

Explanation: ***Clivus and sacrum*** - Chordomas are rare malignant bone tumors derived from remnants of the **notochord**, which primarily occur at the ends of the axial skeleton. - The most common sites are the **sacrococcygeal region (lower spine)** and the **clivus (base of the skull)**, accounting for approximately 50-60% and 30-40% of cases, respectively. *Dorsal spine* - While chordomas can occur anywhere along the axial skeleton, involvement of the **dorsal (thoracic) spine** is much less common compared to the clivus and sacrum. - This region represents a smaller percentage of overall chordoma cases. *Lumbar spine* - Similar to the dorsal spine, the **lumbar spine** is an atypical location for chordomas, with a lower incidence than the sacrum and clivus. - Although it is part of the axial skeleton, it is not one of the predilection sites for these tumors. *Cervical spine* - **Cervical spine** involvement in chordomas is rare, occurring in less than 10% of cases. - Its incidence is significantly lower compared to the clival or sacrococcygeal regions.

Question 969: Which type of cancer is most commonly associated with perineural invasion in the head and neck region?

A. Adenocarcinoma
B. Adenoid cystic carcinoma (Correct Answer)
C. Basal cell adenoma
D. Squamous cell carcinoma

Explanation: ***Adenoid cystic carcinoma*** - Perineural invasion is a hallmark feature of **adenoid cystic carcinoma**, particularly in the **head and neck region** [1]. - This cancer tends to infiltrate along nerve sheaths, which can lead to **pain and neurological symptoms** due to local invasion. *Adenocarcinoma* - While adenocarcinoma can exhibit invasiveness, it is not specifically characterized by **perineural invasion** as a consistent feature. - These tumors usually arise from **glandular tissues** and do not have the same propensity for nerve invasion. *Basal cell adenoma* - Basal cell adenoma is generally a **benign tumor**, which does not exhibit aggressive features like perineural invasion. - Most frequently, they present as localized masses without significant invasion into surrounding structures. *Squamous cell carcinoma* - Although squamous cell carcinoma can be aggressive, **perineural invasion** is less commonly identified compared to other malignancies like adenoid cystic carcinoma. - It primarily involves **keratinizing epithelial cells** and tends to invade adjacent tissues rather than along nerve pathways. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 753-755.

Question 970: What is Askin's tumor?

A. Primitive neuroectodermal tumor in chest (Correct Answer)
B. Cholangiocarcinoma arising from bifurcation of bile duct
C. Lung adenocarcinoma involving apical region
D. Enterochromaffin cell tumor

Explanation: ***Primitive neuroectodermal tumor in chest*** - Askin's tumor is a rare, highly **malignant tumor** that arises from neuroectodermal cells, typically found in the **thoracopulmonary region**. - It is classified as a type of **peripheral primitive neuroectodermal tumor (pPNET)**, sharing genetic similarities with Ewing's sarcoma. *Cholangiocarcinoma arising from bifurcation of bile duct* - This describes a **Klatskin tumor**, which is a specific type of cholangiocarcinoma that originates at the confluence of the right and left hepatic ducts. - Klatskin tumors are **biliary tract cancers** and are distinct from neuroectodermal tumors of the chest wall. *Lung adenocarcinoma involving apical region* - This description refers to a **Pancoast tumor**, which is a type of lung cancer (most often non-small cell lung cancer, including adenocarcinoma) located in the apex of the lung. - Pancoast tumors are characterized by symptoms related to invasion of surrounding structures, such as **brachial plexus** involvement. *Enterochromaffin cell tumor* - Sometimes referred to as a **carcinoid tumor**, these are neuroendocrine tumors that arise from enterochromaffin cells primarily in the gastrointestinal tract or lungs. - They produce **amines and peptides** that can cause carcinoid syndrome but are histologically and clinically distinct from Askin's tumor.

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Neoplasia — MCQs

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