Tumor Markers — MCQs
Which of the following is a tumor marker associated with ovarian solid-cystic masses?
A 27-year-old man has surgery for a testicular mass. Histologic sections reveal the mass to be a testicular yolk sac tumor. Which of the substances listed below is most likely to be increased in this patient's serum?
Which of the following is true? 1. BRCA1 is an oncogene 2. HER2neu is amplified only in a fraction of breast cancer 3. EGFR (+) is seen in non-small cell lung cancer 4. N-MYC is a tumor suppressor gene
Which of the following is the platinum-based chemotherapeutic agent used as first-line treatment for ovarian carcinoma?
Okuda staging contains all except
A patient with gastric cancer shows positive CEA. What is its significance?
Alpha-fetoprotein is a marker of
AFP is a tumour marker for which of the following?
TTF-1 is a tumor marker for which of the following?
Which is an intranuclear immunohistochemistry marker for neuroendocrine tumors?
Tumor Markers Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following is a tumor marker associated with ovarian solid-cystic masses?
- A. CEA
- B. HCG
- C. HER2/neu
- D. AFP (Correct Answer)
Explanation: ***AFP (Alpha-fetoprotein)*** - **AFP** is a reliable tumor marker for differentiating **germ cell tumors**, especially **yolk sac tumors**, which often present as an ovarian solid-cystic mass. - Elevated **AFP** levels help in diagnosis, monitoring treatment response, and detecting recurrence of these specific ovarian malignancies. *CEA (Carcinoembryonic antigen)* - **CEA** is primarily associated with **gastrointestinal cancers**, such as colorectal cancer, and is less specific for ovarian masses. - While it can be elevated in some mucinous ovarian carcinomas, it's not the most specific marker for a general solid-cystic ovarian mass. *HCG (Human chorionic gonadotropin)* - **HCG** is a key marker for **gestational trophoblastic disease** and some **germ cell tumors**, such as choriocarcinoma. - It is not typically elevated in most common solid-cystic ovarian masses, especially those of epithelial origin. *HER2/neu (Human Epidermal growth factor Receptor 2)* - **HER2/neu** is primarily associated with **breast cancer** and some gastric cancers, playing a role in targeted therapy. - It is not a standard tumor marker for the general evaluation or diagnosis of ovarian solid-cystic masses.
Question 2: A 27-year-old man has surgery for a testicular mass. Histologic sections reveal the mass to be a testicular yolk sac tumor. Which of the substances listed below is most likely to be increased in this patient's serum?
- A. Acid phosphatase
- B. Human chorionic gonadotropin
- C. Alkaline phosphatase
- D. Alpha-fetoprotein (Correct Answer)
Explanation: ***Alpha-fetoprotein*** - **Yolk sac tumors**, also known as endodermal sinus tumors, are characterized by the production and elevation of **alpha-fetoprotein (AFP)** [2]. - AFP levels are crucial for both the **diagnosis** and **monitoring** of treatment response in patients with yolk sac tumors [2]. *Acid phosphatase* - **Acid phosphatase** is primarily associated with **prostatic carcinoma**, particularly in bone metastases, and would not be elevated in a testicular yolk sac tumor. - While it can be found in other tissues, it is not a specific or sensitive marker for germ cell tumors. *Human chorionic gonadotropin* - **Human chorionic gonadotropin (hCG)** is primarily elevated in **choriocarcinoma** and some **seminomas**, but not typically in pure yolk sac tumors [1]. - Mixed germ cell tumors can have elevated hCG if they contain a choriocarcinomatous component [1]. *Alkaline phosphatase* - **Alkaline phosphatase (ALP)** is a marker often elevated in conditions affecting the **liver** (e.g., cholestasis) or **bones** (e.g., Paget's disease, osteoblastic activity), but not specifically associated with testicular yolk sac tumors. - It is a general enzyme involved in various metabolic processes and not a specific tumor marker for this type of cancer. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 512-513. [2] 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. 254-255.
Question 3: Which of the following is true? 1. BRCA1 is an oncogene 2. HER2neu is amplified only in a fraction of breast cancer 3. EGFR (+) is seen in non-small cell lung cancer 4. N-MYC is a tumor suppressor gene
- A. 1,3
- B. 1,2
- C. 2,3 (Correct Answer)
- D. All of the options
Explanation: ***Correct Option: 2,3*** - **Statement 2 is TRUE**: HER2neu amplification occurs in only a fraction (~15-20%) of breast cancers, making it a specific subset requiring targeted therapy with trastuzumab (Herceptin) [1]. - **Statement 3 is TRUE**: EGFR (epidermal growth factor receptor) mutations or overexpression are commonly seen in non-small cell lung cancer (NSCLC) and serve as important therapeutic targets for tyrosine kinase inhibitors. *Incorrect Option: 1,3* - Statement 1 is **FALSE**: BRCA1 is a **tumor suppressor gene**, not an oncogene. It functions in DNA double-strand break repair, and loss-of-function mutations increase the risk of breast and ovarian cancers. - Statement 3 is TRUE, but the inclusion of the false statement about BRCA1 makes this option incorrect. *Incorrect Option: 1,2* - Statement 1 is **FALSE**: BRCA1 is a **tumor suppressor gene**, not an oncogene. - Statement 2 is TRUE [1], but the false classification of BRCA1 invalidates this option. *Incorrect Option: All of the options* - Statement 1 is **FALSE**: BRCA1 is a tumor suppressor gene, not an oncogene. - Statement 4 is **FALSE**: N-MYC is an **oncogene** that is amplified in neuroblastoma and other cancers, not a tumor suppressor gene. - Since two of the four statements are incorrect, "All of the options" cannot be true. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1059-1060.
Question 4: Which of the following is the platinum-based chemotherapeutic agent used as first-line treatment for ovarian carcinoma?
- A. Cyclophosphamide
- B. Methotrexate
- C. Cisplatin (Correct Answer)
- D. Dacarbazine
Explanation: ***Cisplatin*** - **Cisplatin** is a platinum-based chemotherapy drug that forms **DNA cross-links**, inhibiting DNA synthesis and leading to the death of rapidly dividing cells, making it highly effective against **ovarian carcinoma**. - It is a cornerstone of chemotherapy regimens for ovarian cancer, often used in combination with other agents such as paclitaxel. *Methotrexate* - **Methotrexate** is an **antimetabolite** that inhibits dihydrofolate reductase, thereby interfering with DNA synthesis. - While it is used in various cancers like leukemia, lymphoma, and some solid tumors (e.g., breast cancer, gestational trophoblastic disease), it is **not a primary recommended drug for ovarian carcinoma**. *Cyclophosphamide* - **Cyclophosphamide** is an **alkylating agent** that causes DNA damage, leading to cell death. - It is used in many cancers, including lymphoma, breast cancer, and some leukemias, but it is **not a first-line or primary agent for ovarian carcinoma** in contemporary treatment guidelines. *Dacarbazine* - **Dacarbazine** is an **alkylating agent** primarily used in the treatment of **malignant melanoma** and Hodgkin lymphoma. - It is **not indicated for the treatment of ovarian carcinoma**.
Question 5: Okuda staging contains all except
- A. AFP (Correct Answer)
- B. Tumor size
- C. Ascites
- D. Bilirubin
Explanation: ***AFP*** - The **Okuda staging system** for hepatocellular carcinoma (HCC) uses parameters related to liver function and tumor burden, but it does **not include AFP levels**. [1] - AFP is a common **tumor marker** for HCC but is not part of the specific criteria for Okuda staging. *Tumor size* - **Tumor size greater than 50%** of the liver parenchyma is one of the four parameters used in the Okuda staging system. - This criterion is crucial for assessing the **extent of the disease**, differentiating between early and advanced cases. *Ascites* - The presence of **ascites** (related to fluid retention) is another key parameter in the Okuda staging system. - Ascites indicates **decompensated liver function**, implying a more advanced stage of disease. *Bilirubin* - **Bilirubin levels higher than 3 mg/dL** are included in the Okuda staging system. - Elevated bilirubin reflects **severe liver dysfunction**, indicating reduced hepatic synthetic capacity and usually a poorer prognosis.
Question 6: A patient with gastric cancer shows positive CEA. What is its significance?
- A. Prognostic (Correct Answer)
- B. Diagnostic
- C. Therapeutic
- D. Screening
Explanation: ***Prognostic*** - A positive **carcinoembryonic antigen (CEA)** in gastric cancer indicates **larger tumor burden** and more advanced disease [1] - Elevated preoperative CEA levels are associated with **poorer prognosis**, higher risk of recurrence, and decreased survival [1] - CEA levels can be used to **monitor treatment response** and detect early recurrence after curative resection [1] - Higher CEA values correlate with advanced stage, lymph node involvement, and distant metastases *Diagnostic* - CEA is **not specific enough** for diagnosing gastric cancer as it can be elevated in other malignancies (colorectal, pancreatic, lung) and benign conditions (smoking, cirrhosis, inflammatory bowel disease) [2] - Diagnosis of gastric cancer requires **endoscopic biopsy** with histopathological examination - CEA may be normal even in confirmed gastric cancer cases (limited sensitivity) [2] *Therapeutic* - CEA is a **tumor marker**, not a therapeutic agent or treatment modality - While CEA levels help guide treatment decisions and monitor response, the marker itself has no therapeutic role - Treatment decisions are based on staging, histology, and patient factors, not solely on CEA values *Screening* - CEA lacks sufficient **sensitivity and specificity** for population-based screening of gastric cancer [2] - Screening for gastric cancer uses **endoscopy** in high-risk populations, not serum tumor markers - CEA is primarily used for post-treatment surveillance in patients with known cancer, not for detecting occult disease in asymptomatic individuals **References:** [1] 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. 254-255. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, p. 346.
Question 7: Alpha-fetoprotein is a marker of
- A. Yolk sac carcinoma (Correct Answer)
- B. Choriocarcinoma
- C. Embryonal carcinoma
- D. Dysgerminoma
Explanation: ***Yolk sac carcinoma*** - **Alpha-fetoprotein (AFP)** is a **glycoprotein** normally produced by the fetal liver and yolk sac. - In adults, elevated AFP levels are a key tumor marker for **yolk sac tumors (endodermal sinus tumors)**, hepatocellular carcinoma, and some germ cell tumors [1]. *Choriocarcinoma* - **Choriocarcinoma** is primarily associated with elevated levels of **human chorionic gonadotropin (hCG)**, not AFP [2]. - hCG is a hormone produced by the placenta and is a marker for various germ cell tumors, especially those with syncytiotrophoblastic differentiation [3]. *Embryonal carcinoma* - **Embryonal carcinoma** can produce various tumor markers, including **hCG** and sometimes **AFP**, but it is generally less consistently associated with high AFP compared to yolk sac tumors [2]. - Its histological features are more primitive and undifferentiated than yolk sac carcinoma [1]. *Dysgerminoma* - **Dysgerminoma** is associated with elevated levels of **lactate dehydrogenase (LDH)** and, occasionally, mildly elevated hCG. - It is histologically analogous to seminoma in males and typically does not produce AFP [4]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 979-980. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1035-1036. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 512-513. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1140-1141.
Question 8: AFP is a tumour marker for which of the following?
- A. Chordoma
- B. RCC
- C. HCC (Correct Answer)
- D. Oncocytoma
Explanation: ***Correct Option: HCC*** - **Alpha-fetoprotein (AFP)** is the most widely recognized tumor marker for **Hepatocellular Carcinoma (HCC)**, the most common primary liver cancer [1] - Elevated AFP levels (>400 ng/mL) are highly suggestive of HCC and are used for **diagnosis, monitoring treatment response, and surveillance for recurrence** [1] - AFP is also elevated in **yolk sac tumors** and some **non-seminomatous germ cell tumors**, but HCC remains the primary clinical association [1] *Incorrect: Chordoma* - **Chordomas** are rare malignant bone tumors arising from notochord remnants, typically in the skull base or sacrum - **No specific tumor marker** is routinely used; brachyury (transcription factor) may be used as an immunohistochemical marker for diagnosis - AFP is not associated with chordomas *Incorrect: RCC* - **Renal Cell Carcinoma (RCC)** is the most common kidney malignancy - No highly specific tumor markers exist for RCC; occasionally **elevated LDH, alkaline phosphatase, or calcium** may be seen - AFP is not a marker for RCC *Incorrect: Oncocytoma* - **Renal oncocytoma** is a **benign** renal tumor composed of oncocytes (cells with abundant mitochondria) - Diagnosed primarily by **imaging and histology**, not serum markers - AFP has no role in oncocytoma diagnosis or monitoring **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 399-400.
Question 9: TTF-1 is a tumor marker for which of the following?
- A. Adenocarcinoma
- B. Small cell carcinoma (Correct Answer)
- C. Thymoma
- D. Melanoma
Explanation: ***Small cell carcinoma*** - **Thyroid transcription factor 1 (TTF-1)** is a nuclear transcription protein expressed in lung and thyroid neoplasms - It is positive in **85-90% of small cell lung carcinomas**, making it a key immunohistochemical marker [1] - TTF-1 helps differentiate small cell carcinoma from other neuroendocrine tumors and extrapulmonary small cell carcinomas [1] *Adenocarcinoma* - TTF-1 is also **strongly positive in 75-80% of lung adenocarcinomas** - It is a primary marker for lung adenocarcinoma, often used with **Napsin A** and **Cytokeratin 7 (CK7)** *Thymoma* - Thymomas are neoplasms of the **thymus gland** and typically express **cytokeratins** but **not TTF-1** - Characteristic markers include **CD5**, **CD117**, and epithelial markers *Melanoma* - Melanomas are cancers of **melanocytes** and express melanocytic markers like **S-100**, **HMB-45**, **Melan-A**, and **SOX10** - **TTF-1** is not expressed in melanoma and helps exclude lung primary when evaluating metastatic disease **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 337-338.
Question 10: Which is an intranuclear immunohistochemistry marker for neuroendocrine tumors?
- A. NCAM1/CD56
- B. Chromogranin
- C. Synaptophysin
- D. INSM (Correct Answer)
Explanation: ***INSM*** - **INSM1 (Insulinoma-associated protein 1)** is a highly sensitive and specific **transcription factor** expressed in neuroendocrine cells. - It exhibits **intranuclear staining** in immunohistochemistry, making it a reliable marker for neuroendocrine differentiation in tumors. *NCAM1/CD56* - **NCAM1/CD56** is a **cell surface adhesion molecule** - It shows **membranous or cytoplasmic staining** in immunohistochemistry, not intranuclear. *Chromogranin* - **Chromogranin A** is a **storage protein** found in dense core granules of neuroendocrine cells. [1] - It demonstrates **cytoplasmic staining** in immunohistochemistry and is a general neuroendocrine marker. [1] *Synaptophysin* - **Synaptophysin** is a **transmembrane glycoprotein** associated with synaptic vesicles. - It exhibits **cytoplasmic or membranous staining** in immunohistochemistry and is also a general neuroendocrine marker. [2] **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 419-420. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 780-781.
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