CHAPTER 17: Tumor Immunology

Question 1

How can normal cells become malignant?
a. Overexpression of oncogenes
b. Underexpression of tumor suppressor genes
c. Viral infection
d. All of the above

Answer 1

d. All of the above

Question 2

Which of the following best summarizes the concept of tumor development via immunoediting?
a. Tumor cells produce cytokines that are toxic to T cells.
b. Tumor cells that can escape the immune system have a growth advantage over tumor cells that are destroyed during immunosurveillance.
c. T-cell activity causes an increase in MHC expression on tumor cells that allows them to escape the immune system.
d. Secreted tumor-associated antigen saturates T-cell receptors and makes T cells incapable of binding to tumor cells.

Answer 2

b. Tumor cells that can escape the immune system have a growth advantage over tumor cells that are destroyed during immunosurveillance.

Question 3

Which of the following is an example of a tumor-specific antigen?
a. BCR/ABL fusion protein
b. CEA
c. CA 125
d. PSA

Answer 3

a. BCR/ABL fusion protein

Question 4

Most tumor markers are not used to screen the general population because they
a. cannot be inexpensively quantified.
b. do not rise to high enough levels in the presence of cancer.
c. can also be elevated in conditions other than the cancer.
d. vary too much between patients belonging to different ethnic populations.

Answer 4

c. can also be elevated in conditions other than the cancer.

Question 5

Both AFP and hCG exhibit serum elevations in
a. pregnancy.
b. ovarian germ cell carcinoma.
c. nonseminomatous testicular cancer.
d. all of the above.

Answer 5

d. all of the above.

Question 6

Suppose a patient with ovarian cancer had a serum CA 125 level of 50 kU/L at initial diagnosis. After her tumor was surgically removed, her CA 125 level declined to 25 kU/L. She received chemotherapy drug #1; after 1 year, her CA 125 level was 40 kU/L. She was then given chemotherapy drug #2 and her CA 125 level rose to 60 kU/L. These results indicate that
a. surgery was effective in removing the patient’s tumor.
b. chemotherapy drug #1 was more effective than chemotherapy drug #2.
c. both chemotherapy drug #1 and chemotherapy drug #2 were effective.
d. neither chemotherapy drug #1 nor chemotherapy drug #2 were effective.

Answer 6

d. neither chemotherapy drug #1 nor chemotherapy drug #2 were effective.

Question 7

All of the following are recommended for cancer screening in the groups indicated except
a. CA 125/women of reproductive age.
b. AFP/subjects at high risk for liver cancer.
c. PSA/men over 50 with at least 10 years of life expectancy.
d. none of the above.

Answer 7

a. CA 125/women of reproductive age.

Question 8

The best use of serum tumor markers is considered to be in
a. screening for cancer.
b. initial diagnosis of cancer.
c. monitoring patients undergoing cancer treatment.
d. determining patient prognosis.

Answer 8

c. monitoring patients undergoing cancer treatment.

Question 9

In order to use a tumor marker to monitor the course of the disease, which of the following must be true?
a. The laboratory measures the marker with the same method over the entire course of the patient’s treatment.
b. The marker must be released from the tumor or, because of the tumor, into a body fluid that can be obtained and tested.
c. The marker’s half-life is such that the marker persists long enough to reflect tumor burden but clears fast enough to identify successful therapy.
d. All of the above.

Answer 9

d. All of the above.

Question 10

Which of the following markers could be elevated in nonmalignant liver disease?
a. AFP
b. CEA
c. CA 15-3
d. All of the above

Answer 10

d. All of the above

Question 11

Each of the following markers is correctly paired with a disease in which it can be used for patient monitoring except
a. CEA/choriocarcinoma.
b. CA 15-3/breast adenocarcinoma.
c. CA 125/ovarian adenocarcinoma.
d. CA 19-9/pancreatic adenocarcinoma.

Answer 11

a. CEA/choriocarcinoma.

Question 12

Which of the following is a marker used in immunohistochemical staining to identify tumors of epithelial origin?
a. Cytokeratins
b. Vimentin
c. CD45
d. CD10

Answer 12

a. Cytokeratins

Question 13

Which of the following assays would you recommend to test for chromosomal rearrangements such as the BCR/ABL translocation seen in CML?
a. PCR
b. FISH
c. Microarray
d. Next generation sequencing

Answer 13

b. FISH

Question 14

Innate immune responses thought to be involved in defense against tumors include
a. NK cell-mediated apoptosis.
b. MHC I-restricted T-cell-mediated destruction.
c. ADCC.
d. all of the above.
a. NK cell-mediated apoptosis.

Answer 14

a. NK cell-mediated apoptosis.

Question 15

A woman with breast cancer is treated with a monoclonal antibody to HER2. This is an example of
a. a cancer vaccine.
b. an immunotoxin.
c. passive immunotherapy.
d. active immunotherapy.

Answer 15

c. passive immunotherapy.