ONCOLOGY ACTUAL PRACTICE EXAM QUESTIONS AND
ANSWERS MARKED A+
✔✔Explain the grading system for malignant tumors (Gx-G4). - ✔✔Gx - cannot be
determined
G1 - well differentiated; closely resemble parent cells; *low-grade*; malignant but *slow*
growing
G2- moderately differentiated; still retain some normal cell characteristics but are more
malignant than G1
G3- poorly differentiated; tissue of origin can usually be established; *few* normal
characteristics
G4- poorly differentiated; *no* normal characteristics; difficult/impossible to determine
tissue of origin (*high grade*)
✔✔What determines the exact location of the cancer and its degree of metastasis at
diagnosis to aid in the selection of therapy? - ✔✔staging (clinical, surgical, & pathologic)
*clinical:* assesses pt's clinical manifestations & evaluates them for tumor size/possible
spread
*surgical:* assesses tumor size, number, sites, and spread by inspection at surgery
*pathologic:* MOST DEFINITIVE - determines tumor size, number, sites, & spread by
pathologic examination of tissues obtained at surgery
✔✔What is the staging system used to describe the anatomic extent of cancers? -
✔✔*TNM Classification* (not useful for leukemia or lymphomas)
*Primary Tumor (T)*:
*Tx*- primary tumor cannot be assessed
*T0*- no evidence of primary tumor
*Tis* - carcinoma in situ
*T1, T2, T3, T4* - increasing size and/or local extent of primary tumor
*Regional Lymph Nodes (N)*:
*Nx*- regional lymph nodes cannot be assessed
*N0*- no regional lymph node metastasis
*N1, N2, N3*- increasing involvement of regional lymph nodes
*Distant Metastasis (M)*:
*Mx*- presence of metastasis cannot be assessed
*M0*- no distant metastasis
,*M1*- distant metastasis
*higher numbers = later stages = decreased chance for cure/long-term survival*
✔✔What is tumor growth assessed in terms of? - ✔✔doubling time (amount of time it
takes a tumor to double in size)
mitotic index (percentage of actively dividing cells within a tumor) (<10% = slow
growing, > 85% = fast growing)
✔✔What is the size of the smallest detectable tumor? - ✔✔1 cm (contains 1 billion cells)
(to reach this size it must undergo at least *30 doublings*)
✔✔What three factors influence cancer development & account for variation in cancer
development from one person to another, even when exposed to the same hazards? -
✔✔1. exposure to carcinogens
2. genetic predisposition
3. immune function
✔✔What is the main mechanism of carcinogenesis? - ✔✔oncogene activation =
excessive cylcin production = uncontrolled cell division
(overexpressed due to mutations damaging suppressor genes and preventing them
from producing the proteins that control cellular regulation)
✔✔What two chemical substances act as *co-carcinogens*, enhancing each other's
carcinogenic activity when taken together? - ✔✔alcohol & tobacco (only mildly
carcinogenic when separate, cancer development requires chronic, long-term exposure
to large amounts)
*30% of cancer in US RT to tobacco use*
✔✔What is the single most preventable source of carcinogenesis? - ✔✔tobacco (long
term tobacco use first initiates, then promotes cancer)
✔✔Tissues with the greatest risk for tobacco-induced cancer are those that have direct
contact with tobacco or tobacco smoke, but tobacco use & cigarette smoking also
promote the development of other cancers. What are the common cancer types
associated with tobacco use? - ✔✔-*lung*
-*oral cavity*
-pharynx/larynx
-esophagus
-pancreas
-uterine cervix
,-kidney
-bladder
-liver
-stomach
-myeloid leukemia
✔✔What are the *7 warning signs of cancer*? - ✔✔*C*-changes in bowel/bladder habits
*A*- a sore throat that doesn't heal
*U*- unusual bleeding/discharge
*T*- thickening or lump in breast or elsewhere
*I*- Indigestion or difficulty swallowing
*O*- obvious change in wart or mole
*N*-nagging cough or hoarseness
✔✔What are the two *physical* agents known to cause cancer? - ✔✔radiation & chronic
irritation
✔✔What are the two different types of radiation that can cause cancer? - ✔✔ionizing -
found in elements in rocks/soil, x-rays, cosmic radiation
UV- sun, tanning beds, germicidal lights (*skin cancer*)
*can cause cancer in non-dividing cells as well as dividing cells*
✔✔True or False:
The incidence of skin cancer is higher in the scars of people with burn scars or other
types of severe skin injuries - ✔✔true (chronically irritated tissues undergo frequent cell
division & are at an increased risk for DNA mutation)
✔✔How do viruses influence cancer development (*oncoviruses*)? - ✔✔virus infects
body cells & insert their own genetic material into human DNA while breaking the
present DNA (activates oncogenes or damages suppressor genes)
✔✔True or False:
Low fiber intake & high intake of red meat or animal fat is suspected to be related to
cancer development - ✔✔true
✔✔What are some common dietary habits that reduce cancer risk? - ✔✔-avoid
excessive intake of animal fat
-avoid nitrites (prepared lunch meats, sausage, bacon)
-minimize intake of red meat
-limit alcohol intake to no more than *2 drinks/day*
-eat more *bran*
, -eat more cruciferous veggies (broccoli, cauliflower, brussels sprouts, cabbage)
-eat foods high in *vitamin A & C* (apricots, carrots, leafy green/yellow veggies// fresh
fruits & veggies, especially citrus fruits)
✔✔Which of the following are *primary* prevention efforts? (SATA)
a) demonstrating breast self-exam methods to women
b) instructing people on the use of chemoprevention
c) providing vaccinations against certain cancers
d) screening teenage girls for cervical cancer
e) teaching teens the dangers of tanning booths - ✔✔b, c, e (primary prevention of
cancer involves avoiding exposure to *known causes* of cancer)
✔✔True or False:
Benign tumors grow by *expansion* whereas malignant tumors grow by *invasion* -
✔✔true
✔✔What are the *personal factors* that affect whether a person is likely to develop
cancer or not? - ✔✔-*immune function* (NK & T-cells provide immune surveillance from
non-self cells -- higher risk if older than 60 due to reduced immunity)
-*age* (immunity decreases and carcinogen exposure accumulates
-*genetic risk*
✔✔True or False:
Organ transplant recipients taking immunosuppressive drugs to prevent organ rejection
are at a higher risk for developing cancer - ✔✔true
✔✔True or False:
In patients with AIDS, cancer incidence may be as high as 70% - ✔✔true
✔✔A 65 yo client tells the nurse she does not have mammograms b/c there is no
history of breast cancer in her family. What is the nurse's best response?
a) "You are correct. Breast cancer is an inherited type of malignancy & your family
history indicates a low risk for you."
b) "Performing breast self-exams monthly at home is sufficient screening for someone
with your family history."
c) "B/c your breasts are no longer as dense as they were when you were younger, your
risk for breast cancer is now decreased."
ANSWERS MARKED A+
✔✔Explain the grading system for malignant tumors (Gx-G4). - ✔✔Gx - cannot be
determined
G1 - well differentiated; closely resemble parent cells; *low-grade*; malignant but *slow*
growing
G2- moderately differentiated; still retain some normal cell characteristics but are more
malignant than G1
G3- poorly differentiated; tissue of origin can usually be established; *few* normal
characteristics
G4- poorly differentiated; *no* normal characteristics; difficult/impossible to determine
tissue of origin (*high grade*)
✔✔What determines the exact location of the cancer and its degree of metastasis at
diagnosis to aid in the selection of therapy? - ✔✔staging (clinical, surgical, & pathologic)
*clinical:* assesses pt's clinical manifestations & evaluates them for tumor size/possible
spread
*surgical:* assesses tumor size, number, sites, and spread by inspection at surgery
*pathologic:* MOST DEFINITIVE - determines tumor size, number, sites, & spread by
pathologic examination of tissues obtained at surgery
✔✔What is the staging system used to describe the anatomic extent of cancers? -
✔✔*TNM Classification* (not useful for leukemia or lymphomas)
*Primary Tumor (T)*:
*Tx*- primary tumor cannot be assessed
*T0*- no evidence of primary tumor
*Tis* - carcinoma in situ
*T1, T2, T3, T4* - increasing size and/or local extent of primary tumor
*Regional Lymph Nodes (N)*:
*Nx*- regional lymph nodes cannot be assessed
*N0*- no regional lymph node metastasis
*N1, N2, N3*- increasing involvement of regional lymph nodes
*Distant Metastasis (M)*:
*Mx*- presence of metastasis cannot be assessed
*M0*- no distant metastasis
,*M1*- distant metastasis
*higher numbers = later stages = decreased chance for cure/long-term survival*
✔✔What is tumor growth assessed in terms of? - ✔✔doubling time (amount of time it
takes a tumor to double in size)
mitotic index (percentage of actively dividing cells within a tumor) (<10% = slow
growing, > 85% = fast growing)
✔✔What is the size of the smallest detectable tumor? - ✔✔1 cm (contains 1 billion cells)
(to reach this size it must undergo at least *30 doublings*)
✔✔What three factors influence cancer development & account for variation in cancer
development from one person to another, even when exposed to the same hazards? -
✔✔1. exposure to carcinogens
2. genetic predisposition
3. immune function
✔✔What is the main mechanism of carcinogenesis? - ✔✔oncogene activation =
excessive cylcin production = uncontrolled cell division
(overexpressed due to mutations damaging suppressor genes and preventing them
from producing the proteins that control cellular regulation)
✔✔What two chemical substances act as *co-carcinogens*, enhancing each other's
carcinogenic activity when taken together? - ✔✔alcohol & tobacco (only mildly
carcinogenic when separate, cancer development requires chronic, long-term exposure
to large amounts)
*30% of cancer in US RT to tobacco use*
✔✔What is the single most preventable source of carcinogenesis? - ✔✔tobacco (long
term tobacco use first initiates, then promotes cancer)
✔✔Tissues with the greatest risk for tobacco-induced cancer are those that have direct
contact with tobacco or tobacco smoke, but tobacco use & cigarette smoking also
promote the development of other cancers. What are the common cancer types
associated with tobacco use? - ✔✔-*lung*
-*oral cavity*
-pharynx/larynx
-esophagus
-pancreas
-uterine cervix
,-kidney
-bladder
-liver
-stomach
-myeloid leukemia
✔✔What are the *7 warning signs of cancer*? - ✔✔*C*-changes in bowel/bladder habits
*A*- a sore throat that doesn't heal
*U*- unusual bleeding/discharge
*T*- thickening or lump in breast or elsewhere
*I*- Indigestion or difficulty swallowing
*O*- obvious change in wart or mole
*N*-nagging cough or hoarseness
✔✔What are the two *physical* agents known to cause cancer? - ✔✔radiation & chronic
irritation
✔✔What are the two different types of radiation that can cause cancer? - ✔✔ionizing -
found in elements in rocks/soil, x-rays, cosmic radiation
UV- sun, tanning beds, germicidal lights (*skin cancer*)
*can cause cancer in non-dividing cells as well as dividing cells*
✔✔True or False:
The incidence of skin cancer is higher in the scars of people with burn scars or other
types of severe skin injuries - ✔✔true (chronically irritated tissues undergo frequent cell
division & are at an increased risk for DNA mutation)
✔✔How do viruses influence cancer development (*oncoviruses*)? - ✔✔virus infects
body cells & insert their own genetic material into human DNA while breaking the
present DNA (activates oncogenes or damages suppressor genes)
✔✔True or False:
Low fiber intake & high intake of red meat or animal fat is suspected to be related to
cancer development - ✔✔true
✔✔What are some common dietary habits that reduce cancer risk? - ✔✔-avoid
excessive intake of animal fat
-avoid nitrites (prepared lunch meats, sausage, bacon)
-minimize intake of red meat
-limit alcohol intake to no more than *2 drinks/day*
-eat more *bran*
, -eat more cruciferous veggies (broccoli, cauliflower, brussels sprouts, cabbage)
-eat foods high in *vitamin A & C* (apricots, carrots, leafy green/yellow veggies// fresh
fruits & veggies, especially citrus fruits)
✔✔Which of the following are *primary* prevention efforts? (SATA)
a) demonstrating breast self-exam methods to women
b) instructing people on the use of chemoprevention
c) providing vaccinations against certain cancers
d) screening teenage girls for cervical cancer
e) teaching teens the dangers of tanning booths - ✔✔b, c, e (primary prevention of
cancer involves avoiding exposure to *known causes* of cancer)
✔✔True or False:
Benign tumors grow by *expansion* whereas malignant tumors grow by *invasion* -
✔✔true
✔✔What are the *personal factors* that affect whether a person is likely to develop
cancer or not? - ✔✔-*immune function* (NK & T-cells provide immune surveillance from
non-self cells -- higher risk if older than 60 due to reduced immunity)
-*age* (immunity decreases and carcinogen exposure accumulates
-*genetic risk*
✔✔True or False:
Organ transplant recipients taking immunosuppressive drugs to prevent organ rejection
are at a higher risk for developing cancer - ✔✔true
✔✔True or False:
In patients with AIDS, cancer incidence may be as high as 70% - ✔✔true
✔✔A 65 yo client tells the nurse she does not have mammograms b/c there is no
history of breast cancer in her family. What is the nurse's best response?
a) "You are correct. Breast cancer is an inherited type of malignancy & your family
history indicates a low risk for you."
b) "Performing breast self-exams monthly at home is sufficient screening for someone
with your family history."
c) "B/c your breasts are no longer as dense as they were when you were younger, your
risk for breast cancer is now decreased."
