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Section 19: Oncologic Disorders

Which of the following steps is not a part of the multistage process of carcinogenesis?

A. Initiation

B. Promotion

C. Propagation

D. Transformation

The answer is C. The first step in carcinogenesis is initiation, which requires exposure of normal cells to carcinogens. During the second step, known as promotion, carcinogens or other factors alter the environment to favor growth of the altered cell population compared to normal cells. At some point, the altered cell becomes cancerous (ie, transformation). The final stage, called progression, involves further genetic alterations that lead to increased cell proliferation. Propagation is not a step in the process of carcinogenesis.

A new genetic alteration is identified in an individual patient’s resected tumor. The normal gene product appears to inhibit inappropriate cellular growth and proliferation. Which of the following terms adequately classifies the gene?

A. Proto-angiogenic gene

B. Oncogene

C. Tumor suppressor gene

D. DNA repair gene

The answer is C. Tumor suppressor genes regulate and inhibit inappropriate cellular growth and proliferation. Mutations of tumor suppressor genes, such as TP53, are common genetic alterations associated with cancer.

A 62-year-old postmenopausal woman with newly diagnosed breast cancer has a 1-cm tumor mass in her left breast. Additional diagnostic tests show the cancer has not spread to the lymph nodes or distant sites. What is the stage of disease for this patient?

A. Stage I

B. Stage II

C. Stage III

D. Stage IV

The answer is A. Stage I usually indicates localized cancer, stages II and III typically indicate local and regional disease, and stage IV typically indicates distant metastases. Since this patient does not have local, regional, or distant cancer spread, she would be classified as having stage I breast cancer.

A 65-year-old man is recently diagnosed with locally advanced colon cancer. The cancer has spread to regional lymph nodes, but not distant sites. The patient undergoes major surgery to remove the tumor. Following surgery, the patient will receive combination chemotherapy. Which of the following best describes the chemotherapy treatment?

A. Adjuvant

B. Neoadjuvant

C. Induction


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