4 Etiology of Cancer

Shirish M. Gadgeel

QUESTIONS

Each of the numbered items below is followed by lettered answers. Select the ONE lettered answer that is BEST in each case unless instructed otherwise.

Question 4.1 Which of the following statements regarding the relationship between cigarette smoking and lung cancer are CORRECT? (Select two correct responses)

A. The duration of smoking is a strong risk factor for developing lung cancer in smokers.

B. Smoking is only associated with a risk of developing squamous cell lung cancer and not adenocarcinoma of the lung.

C. The risk of developing lung cancer in ex-smokers drops to the level of never smokers 2 years after smoking cessation.

D. The risk of developing lung cancer increases with the number of cigarettes smoked.

Question 4.2 Which of the following statements regarding the role of specific tobacco products and tobacco related carcinogens in the development of cancer are CORRECT?

A. Polycyclic aromatic hydrocarbons in cigarette smoke are major causative factors for development of lung cancer.

B. Nicotine is an important carcinogen in the causation of laryngeal cancer.

C. Cigarettes with lower tar yields are associated with reduced risk of diseases from cigarette smoking.

D. Smokeless tobacco products don’t contain high amounts of carcinogens.

Question 4.3 Which of the following is TRUE regarding cigarette smoking causing cancer?

A. DNA adducts caused by carcinogens in cigarette smoke are responsible for mutations that can eventually cause cancer.

B. Nicotine can reduce apoptosis and promote angiogenesis.

C. Compounds that promote inflammation may play a role in cancer development

D. All of the above.

Question 4.4 The HPV vaccine Gardasil

A. Is a quadrivalent vaccine containing virus-like particles (VLPs) from four different types of HPV.

B. Protects from all HPV-causing cervical cancer.

C. Is recommended only for sexually active women.

D. Is recommended for treating cervical cancer.

Question 4.5 The role of EBV in cancer is characterized by the following:

A. EBV DNA is present in the tumor of all Burkitt lymphoma patients.

B. EBV is universally present in all CNS lymphomas in AIDS patients.

C. Nasopharyngeal carcinoma is the only nonlymphoid malignancy associated with EBV.

D. Involvement in all Hodgkin lymphoma.

Question 4.6 Association of Hepatitis C and Hepatitis B viruses with hepatocellular carcinoma (HCC) is characterized by

A. Coinfection with Hepatitis D is necessary for development of HCC in patients infected with Hepatitis B.

B. Antiviral therapy for Hepatitis C does not reduce the risk of HCC.

C. Surveillance for HCC, with ultrasound, is recommended in Hepatitis C infected individuals with cirrhosis.

D. In the United States, more than 60% of HCC cases are associated with Hepatitis B.

Question 4.7 Role of inflammation in carcinogenesis has the following feature:

A. Inflammation is involved in several steps of carcinogenesis but not in malignant transformation.

B. Inflammation and angiogenesis are two independent steps in cancer formation and progression.

C. Inflammation can cause cancer cell proliferation and cancer cell invasion.

D. None of the above.

Question 4.8 Data on markers of inflammation and prognosis of cancer patients shows

A. Glasgow Prognostic Score (GPS) is based on absolute white cell count, neutrophil to lymphocyte ratio, and platelet count.

B. Glasgow Prognostic Score predicts for higher risk of death in prostate cancer patients.

C. In a study of renal cancer patients, inflammatory markers did not correlate with overall survival.

D. Elevated C reactive protein levels are associated with higher disease free survival in breast cancer patients.

Question 4.9 Carcinogenic effects of chemicals are characterized by

A. Most chemical carcinogens undergo metabolic activation by enzymes such as cytochrome P450s.

B. Direct DNA damage leading to mutations or chromosomal alterations.

C. Induction of epigenetic changes such as altered DNA methylation.

D. All the above.

Question 4.10 Chemical carcinogenesis is characterized by

A. Individual susceptibility that varies based on genetic polymorphisms.

B. Biomarkers are available to assess cancer risk of an individual from chemical carcinogenesis.

C. Direct correlation with the chemical’s ability to cause DNA damage.

D. None of the above.

Question 4.11 Examples of chemical carcinogens include

A. Benzene has been linked to myelodysplastic syndrome and acute myeloid leukemia.

B. Heterocyclic amines are associated with breast and colon cancer.

C. Aryl aromatic amines found in tobacco smoke and in dyes have been associated with bladder cancer.

D. All of the above.

Question 4.12 Cellular response to correct and prevent damage from ionizing radiation (IR) is characterized by

A. DNA damage induced by IR can be repaired by mechanisms such as homologous recombination repair pathway and nonhomologous end joining pathway.

B. If the DNA is damaged by IR, there are no mechanisms in place to prevent cells with DNA damage from entering into critical phases of cell cycle.

C. All cells in the body are equally sensitive to radiation-induced cell killing.

D. IR-induces cell death through apoptosis alone.

Question 4.13 Risk of cancer from ionizing radiation (IR) is characterized by

A. Most cancers in areas of atomic bomb explosion occurred within 20 years of the exposure.

B. Older individuals are at the highest risk of developing cancer in areas of massive IR exposure.

C. The largest source of IR exposure to the population in the US is exposure from radiology studies.

D. The most sensitive tissues for development of cancer from IR are thyroid, lung, breast, and bone marrow.

Question 4.14 The following is TRUE about ultraviolet (UV) light:

A. UVA light induces reactive oxygen species which in turn causes DNA damage.

B. Risk of melanoma appears to be linked to cumulative lifetime exposure to UV light.

C. UV light initiates carcinogenesis only by inducing DNA lesions.

D. Melanoma occurs only in sun exposed areas of the skin.

Question 4.15 Alcohol consumption and risk of cancer (Select two correct responses)

A. Alcohol is not a carcinogen since it only induces cancer indirectly by causing inflammation.

B. Types of alcoholic drinks can influence the risk of cancer.

C. Mechanisms of inducing cancers include direct damage to cells, modulation of DNA methylation, and causing DNA adducts.

D. Alcohol can increase the risk of breast cancer.

Question 4.16 Which statement is CORRECT concerning dietary influence on risk of cancer

A. Dietary fat intake is an important contributor to breast cancer incidence.

B. Cancer risk is more related to the types of foods consumed than the total caloric intake.

C. Data supports a link between consumption of fat-containing animal products and incidence of prostate cancer.

D. A higher intake of vegetable fat was associated with greater risk of breast cancer in premenopausal women.

Question 4.17 Fruit and vegetable consumption and risk of cancer are characterized by

A. There is an inverse relationship between consumption of fruits and vegetables and risk of colon cancer.

B. An inverse relationship between intake of fruits and vegetables and risk of estrogen receptor negative breast cancer has been shown by the Nurse’s Health Study.

C. Consumption of fruit and vegetables reduces total cancer incidence.

D. None of the above.

Question 4.18 Data on the influence of specific nutrients and risk of cancer shows

A. Individuals with higher 25 (OH) D levels have a lower risk of colorectal cancer.

B. Higher intake of beta carotene reduces the risk of lung cancer.

C. In the Selenium and Vitamin E Cancer Prevention Trial (SELECT) trial selenium was found to protect from development of prostate cancer.

D. High intake of calcium protects development of prostate cancer.

Question 4.19 Obesity and physical activity as risk factors for breast cancer is characterized by

A. Low level of physical activity is a risk factor for breast cancer in postmenopausal women but not premenopausal women.

B. Obesity is associated with reduced risk of breast cancer in postmenopausal women.

C. Obesity is associated with reduced risk of breast cancer in premenopausal women.

D. None of the above.

Question 4.20 Obesity and physical activity are associated with following cancers:

A. Obesity but not low physical activity is associated with risk of colon cancer.

B. Obesity is not a risk factor for endometrial cancer.

C. Higher lifetime physical activity is associated with lower risk for pancreatic cancer.

D. Obesity lowers the risk of gallbladder cancer.

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