Neoplasias: Bone, Tissue, & Skeletal Metastases (Miller)

Question 1

Which of the following is NOT a theory of cancer in the somatic model?

A. Cancer arises from a varied population of mutant cells

B. Tumors evolve by natural selection

C. Cells are able to produce tumors by differentiation/renewal

D. Individual cell populations can have chemo-resistance

E. Cells with a growth advantage propagate and mutate

Answer 1

C. The idea that cells are able to produce tumors by differentiation and continuous renewal is a theory in the stem cell model, which also includes these theories:

• tumors arise from single cell of origin
• stem cells are a small population of cells within the tumor
• stem cells are resistant to conventional treatments, which target differentiated (somatic) cells

Question 2

Which of the following statements about neoplasia is FALSE?

A. Familial genetic mutations account for the majority of cancer formation.

B. p53 deficiency is commonly associated with osteo and soft tissue sarcomas, as well as breast cancers

C. Smoking, alcohol, HPV and UV light all play a role in cancer formation

D. Changes in gene expression and post-translational modifications play a role in cancer formaiton

E. Cancer is cured with complete resection of localized disease

Answer 2

A - random mutations account for the majority of cancer formation

Question 3

Which of the following statements regarding treatment and prognosis of neoplasia is TRUE?

A. A positive margin following tumor resection gives the best prognosis

B. Tumors of the extremities tend to be worse than tumors of the pelvis and spine

C. Multiagent chemotherapy is rarely used because of the tendency for clonal populations of tumor cells to form multi-drug resistance

D. Currently, targeted therapy with monoclonal antibodies is favored because they have fewer side effects

Answer 3

D

Question 4

Which hallmark of cancer is the biggest threat to patient survival?

A. Ability of cancer cells to evade growth supressors and apoptosis

B. Ability of cancer cells to invade and metastasize

C. Loss of contact inhibition among cancer cells

D. Ability of cancer cells to sustain proliferative signalling and become immortal

E. Ability of cancer cells to induce angiogenesis

Answer 4

B

Question 5

rare cancer of mesenchymal origin affecting connective tissue, nerve sheath, and blood vessel lining

Answer 5

sarcoma

*in younger populations: osteosarcoma and Ewing sarcoma

*in older populations: chondrosarcoma

Question 6

Which of the following statements about clinical presentation of sarcoma is FALSE?

A. Smoking and personal history of cancer increase risk of sarcoma

B. Systemic symptoms include fever, weight loss, fatigue

C. Most people do not have positive findings at the time of presentation

D. Rest/night pain is the most common symptom associated with soft tissue sarcoma

E. In most cases, bone tumors are benign

Answer 6

D. Rest and night pain that is not relieved by anti-inflammatories is the most common symptom associatd with sarcomas of the bone. There may also be swelling or a mass, and sometimes a pathologic fracture.

Question 7

Which of the following imaging techniques is most appropriate for staging a bone tumor?

A. X-ray

B. MRI

C. CT

D. Bone scan

Answer 7

D

Question 8

the most common site to which osteosarcoma spreads

Answer 8

lungs (80%)

Question 9

Which of the following statements about chemotherapy is FALSE?

A. It is adriamycin-based

B. It improves survival in children with osteosarcoma and Ewing’s sarcoma

C. It is a mainstay treatment for soft tissue sarcomas in adults

D. It may cause cardiac toxicity among other side effects

Answer 9

C. It is only marginally effective in treating adult soft tissue sarcoma.

Question 10

Radiation is used to extend tumor free margins in what two specific circumstances?

Answer 10

1. when the neoplasm is close to bone, vessels or nerves
2. when there’s a high grade, large, soft tissue tumor

Question 11

Which of the following statements about metastatic bone disease is FALSE?

A. 50% of new cancer diagnoses annually in the US develop distant disease in the skeleton.

B. Metastatic carcinoma is more alarming, but less common than primary sarcoma.

C. Breast and lung are the most common carcinomas.

D. Lung cancer is the most lethal cancer in terms of annual deaths.

E. Lymphatic spread is the most common mechanism of metastasis.

Answer 11

B. Metastatic carcinoma is 100x more common than primary sarcoma.

Question 12

this receptor and its ligand are significant players in bone remodeling, secreted by osteoblasts and osteclasts

Answer 12

RANKL - osteoblasts

RANK - osteoclasts

*PTH is secreted when Ca++ is needed ► stimulates osteoblasts to secrete RANKL ► RANKL connects with RANK on osteoclast precursor ► this stiumlates osteoclast differentiation ► osteoclasts resorb bone and Ca++ enters bloodstream

Question 13

this “decoy receptor” glycoprotein binds RANKL on osteoblast cells to prevent osteoclast differentiation

Answer 13

osteoprotegerin (OPG)

Question 14

Anemia, renal failure and an SPEP/UPEP (which measures specific paraproteins in the blood and urine) all point to what neoplastic diagnosis?

Answer 14

myeloma

Question 15

Why does a bone scan sometimes give a false negative for multiple myeloma?

Answer 15

because bone scans are designed to determine areas of bone deposition (remodeling) and multiple myeloma eats away at the bone.

Question 16

Which of the following statements about treatment of bone cancer is FALSE?

A. Surgery is indicated for the prevention of fracture and/or it will give > 3 months life expectancy.

B. Radation therapy may increase tumor free margins in the patient but has not shown to effectively manage pain

C. Breast cancer and lymphoma typically are minimally responsive to radiation therapy and renal cell carcinoma is virtually unresponsive.

D. Surgery is mostly done to repair structurally signifiant lesions

Answer 16

B. Radiation provides some pain relief in up to 80% of patients, and total pain relief in 50%.

Question 17

class of medications indicated for metastatic cancer to the bone, that works by being taken up into osteoclasts where they are degradation-resistant and induce apoptosis

Answer 17

bisphosphonates (specifically, know zoledronic acid)

Question 18

major side effect of bisphosphonates

Answer 18

osteonecrosis of the jaw - causes brittle bones and atypical stress fractures

Question 19

human monoclonal antibody that binds directly to RANKL, similar to OPG, to prevent binding to the RANK receptor on osteoclasts, blocking their maturation

Answer 19

denosumab