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23 BMD 430 lecture 23

front 1 Which of the following best differentiates a benign tumor from a malignant tumor? A. Benign tumors lack neoplastic cells B. Benign tumors metastasize slowly C. Malignant tumors are encapsulated D. Malignant tumors invade surrounding tissues	back 1 D. Malignant tumors invade surrounding tissues
front 2 Which hallmark of cancer is MOST associated with telomerase activation? A. Resisting cell death B. Enabling replicative immortality C. Genome instability D. Activation of invasion and metastasis	back 2 B. Enabling replicative immortality
front 3 A patient with a history of chronic tobacco exposure develops lung cancer. This is an example of which carcinogen category? A. Physical B. Chemical C. Biological D. Lifestyle	back 3 B. Chemical
front 4 Which statement best describes metastasis? A. Local expansion of a tumor B. Spread of cancer cells to distant organs C. Initial mutation triggering transformation D. A benign tumor becoming encapsulated	back 4 B. Spread of cancer cells to distant organs

front 5 Which of the following is a proto-oncogene? A. TP53 B. BCL-2 C. RAS D. BRCA1	back 5 C. RAS
front 6 A mutation causes complete loss of p53 function. This gene is classified as a: A. Oncogene B. Tumor-suppressor gene C. DNA repair gene D. Anti-apoptotic gene	back 6 B. Tumor-suppressor gene
front 7 During which stage of malignant transformation do mutated cells begin clonal expansion? A. Initiation B. Promotion C. Progression D. Metastasis	back 7 B. Promotion
front 8 Which tumor antigen group includes viral proteins expressed on tumor cells? A. TAAs B. TSAs C. Cancer-testis antigens D. Oncoviral antigens	back 8 D. Oncoviral antigens

front 9 Downregulation of MHC I by cancer cells allows them to evade: A. Neutrophils B. T regulatory cells C. CD4 T cells D. CD8 T cells	back 9 D. CD8 T cells
front 10 Which immunotherapy blocks inhibitory signals to enhance T-cell activity? A. CAR T cells B. Monoclonal antibodies C. Checkpoint blockade therapy D. DC vaccines	back 10 C. Checkpoint blockade therapy
front 11 Anti-CD20 monoclonal antibodies are used primarily for: A. Breast cancer B. B-cell lymphomas C. Melanoma D. HPV-related tumors	back 11 B. B-cell lymphomas
front 12 CAR T cells differ from adoptively transferred T cells because: A. They require MHC presentation B. They are genetically engineered to recognize antigens without MHC C. They do not expand in the patient D. They are only used for solid tumors	back 12 B. They are genetically engineered to recognize antigens without MHC

front 13 Which checkpoint molecule is blocked by Ipilimumab? A. PD-L1 B. PD-1 C. CTLA-4 D. CD28	back 13 C. CTLA-4
front 14 Which environmental factor category includes UV radiation? A. Biological B. Chemical C. Physical D. Lifestyle	back 14 C. Physical
front 15 Which phase of immunoediting reflects immune control but incomplete elimination of tumor variants? A. Elimination B. Equilibrium C. Escape D. Promotion	back 15 B. Equilibrium
front 16 Neoplasm:	back 16 uncontrolled abnormal tissue growth.

front 17 Benign:	back 17 localized, encapsulated, non-metastatic
front 18 Malignant:	back 18 invasive, fast-growing, can metastasize.
front 19 List FIVE hallmarks of cancer.	back 19 sustained proliferative signaling, avoiding growth suppressors, resisting cell death, enabling immortality, angiogenesis, invasion/metastasis, altered energetics, immune evasion, genome instability, tumor-promoting inflammation.
front 20 Describe the multi-hit model of cancer.	back 20 Multiple sequential mutations accumulate in a single cell lineage over time, eventually producing malignant transformation.

front 21 TSAs:	back 21 unique to tumor cells (mutations, viral proteins) → ideal targets.
front 22 TAAs:	back 22 normal proteins overexpressed (HER2, PSA) → not tumor-specific.
front 23 Name two ways tumor cells evade the immune system.	back 23 downregulate MHC I, secrete TGF-β/IL-10, Treg recruitment, antigen loss, PD-L1 overexpression.
front 24 Prophylactic:	back 24 prevent cancer (HPV, HBV).

front 25 Therapeutic:	back 25 treat existing tumors (dendritic cell vaccines).
front 26 Describe how CAR T-cell therapy works.	back 26 T cells are engineered with a chimeric antigen receptor that recognizes tumor antigens independently of MHC, allowing strong targeted killing
front 27 List the four generations of CAR T cells.	back 27 1st: CD3ζ 2nd: CD3ζ + one co-stimulatory domain 3rd: CD3ζ + two co-stimulatory domains 4th: TRUCKs (secrete IL-12)
front 28 A 62-year-old man presents with weight loss, anemia, and a rapidly growing mass. Biopsy shows invasive cells with loss of p53. Q: What type of gene was lost, and what is the consequence?	back 28 Tumor-suppressor gene; loss allows uncontrolled proliferation and reduced DNA damage response.

front 29 A patient with melanoma is treated with a therapy that blocks PD-1, resulting in an enhanced T-cell response. Q: Which therapy is being used?	back 29 Checkpoint blockade therapy (anti–PD-1 antibody).
front 30 A young woman with leukemia receives her own dendritic cells loaded with leukemia antigens. Q: Is this prophylactic or therapeutic?	back 30 Therapeutic cancer vaccine.
front 31 A child with B-cell leukemia receives CAR T cells targeting CD19. Q: Why do these T cells not require MHC I to function?	back 31 CARs recognize antigen independently of MHC presentation.
front 32 A tumor sample shows high PD-L1 expression. Q: How does this help the tumor escape immunity?	back 32 PD-L1 binds PD-1 on T cells → inhibits T-cell activation.

front 33 Which of the following best distinguishes a malignant tumor from a benign tumor? A. Slow growth rate B. Encapsulated mass C. Ability to invade and metastasize D. Originates from epithelial cells	back 33 C. Ability to invade and metastasize
front 34 *A patient has a mutation that causes overexpression of BCL-2. What hallmark of cancer does this best represent?* A. Sustained proliferative signaling B. Evading growth suppressors C. Resisting cell death D. Enabling replicative immortality	back 34 C. Resisting cell death
front 35 Which type of cancer originates in plasma cells? A. Leukemia B. Lymphoma C. Multiple myeloma D. Sarcoma	back 35 C. Multiple myeloma
front 36 A mutation in the TP53 gene contributes to cancer development mainly because: A. It increases angiogenesis B. It removes a key tumor suppressor C. It activates oncogenes D. It increases metastasis	back 36 B. It removes a key tumor suppressor

front 37 Which phase of immunoediting involves the immune system controlling but not eliminating the tumor? A. Elimination B. Equilibrium C. Escape	back 37 B. Equilibrium
front 38 HER2 overexpression in breast cancer is an example of: A. Tumor-specific antigen B. Tumor-associated antigen C. Cancer-testis antigen D. Oncoviral antigen	back 38 B. Tumor-associated antigen
front 39 Which immunotherapy works by blocking inhibitory signals on T cells? A. CAR T cells B. Cancer vaccines C. Checkpoint blockade therapy D. Monoclonal antibodies targeting HER2	back 39 C. Checkpoint blockade therapy
front 40 *Which environmental factor is most strongly associated with biological carcinogenesis?* A. UV radiation B. Tobacco smoke C. HPV infection D. Asbestos exposure	back 40 C. HPV infection

front 41 Which CAR T-cell generation includes cytokine release (e.g., IL-12) to enhance local immunity? A. First B. Second C. Third D. Fourth (TRUCKs)	back 41 C. Third
front 42 A 62-year-old smoker presents with rapidly growing lung cancer that has spread to the liver. Which features describe this cancer?	back 42 Malignant tumor; invasive and metastatic.
front 43 A patient with B-cell lymphoma receives rituximab (anti-CD20). This therapy works by…	back 43 Binding CD20 on B cells → triggers ADCC, complement activation, and direct killing.
front 44 A patient with melanoma undergoes treatment with anti-PD-1. What is the mechanism?	back 44 Blocks PD-1 inhibitory receptor → restores T-cell activation → tumor killing.

front 45

A patient’s dendritic cells are taken, loaded with tumor antigens, and reinfused. This is an example of:

back 45

Therapeutic cancer vaccine using adoptively transferred DCs.