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

D. Malignant tumors invade surrounding tissues

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

B. Enabling replicative immortality

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

B. Chemical

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

B. Spread of cancer cells to distant organs

Which of the following is a proto-oncogene?

A. TP53
B. BCL-2
C. RAS
D. BRCA1

C. RAS

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

B. Tumor-suppressor gene

During which stage of malignant transformation do mutated cells begin clonal expansion?

A. Initiation
B. Promotion
C. Progression
D. Metastasis

B. Promotion

Which tumor antigen group includes viral proteins expressed on tumor cells?

A. TAAs
B. TSAs
C. Cancer-testis antigens
D. Oncoviral antigens

D. Oncoviral antigens

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

D. CD8 T cells

Which immunotherapy blocks inhibitory signals to enhance T-cell activity?

A. CAR T cells
B. Monoclonal antibodies
C. Checkpoint blockade therapy
D. DC vaccines

C. Checkpoint blockade therapy

Anti-CD20 monoclonal antibodies are used primarily for:

A. Breast cancer
B. B-cell lymphomas
C. Melanoma
D. HPV-related tumors

B. B-cell lymphomas

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

B. They are genetically engineered to recognize antigens without MHC

Which checkpoint molecule is blocked by Ipilimumab?

A. PD-L1
B. PD-1
C. CTLA-4
D. CD28

C. CTLA-4

Which environmental factor category includes UV radiation?

A. Biological
B. Chemical
C. Physical
D. Lifestyle

C. Physical

Which phase of immunoediting reflects immune control but incomplete elimination of tumor variants?

A. Elimination
B. Equilibrium
C. Escape
D. Promotion

B. Equilibrium

Neoplasm:

uncontrolled abnormal tissue growth.

Benign:

localized, encapsulated, non-metastatic

Malignant:

invasive, fast-growing, can metastasize.

List FIVE hallmarks of cancer.

sustained proliferative signaling, avoiding growth suppressors, resisting cell death, enabling immortality, angiogenesis, invasion/metastasis, altered energetics, immune evasion, genome instability, tumor-promoting inflammation.

Describe the multi-hit model of cancer.

Multiple sequential mutations accumulate in a single cell lineage over time, eventually producing malignant transformation.

TSAs:

unique to tumor cells (mutations, viral proteins) → ideal targets.

TAAs:

normal proteins overexpressed (HER2, PSA) → not tumor-specific.

Name two ways tumor cells evade the immune system.

downregulate MHC I, secrete TGF-β/IL-10, Treg recruitment, antigen loss, PD-L1 overexpression.

Prophylactic:

prevent cancer (HPV, HBV).

Therapeutic:

treat existing tumors (dendritic cell vaccines).

Describe how CAR T-cell therapy works.

T cells are engineered with a chimeric antigen receptor that recognizes tumor antigens independently of MHC, allowing strong targeted killing

List the four generations of CAR T cells.

1st: CD3ζ
2nd: CD3ζ + one co-stimulatory domain
3rd: CD3ζ + two co-stimulatory domains
4th: TRUCKs (secrete IL-12)

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?

Tumor-suppressor gene; loss allows uncontrolled proliferation and reduced DNA damage response.

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?

Checkpoint blockade therapy (anti–PD-1 antibody).

A young woman with leukemia receives her own dendritic cells loaded with leukemia antigens.
Q: Is this prophylactic or therapeutic?

Therapeutic cancer vaccine.

A child with B-cell leukemia receives CAR T cells targeting CD19.
Q: Why do these T cells not require MHC I to function?

CARs recognize antigen independently of MHC presentation.

A tumor sample shows high PD-L1 expression.
Q: How does this help the tumor escape immunity?

PD-L1 binds PD-1 on T cells → inhibits T-cell activation.

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

C. Ability to invade and metastasize

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

C. Resisting cell death

Which type of cancer originates in plasma cells?

A. Leukemia
B. Lymphoma
C. Multiple myeloma
D. Sarcoma

C. Multiple myeloma

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

B. It removes a key tumor suppressor

Which phase of immunoediting involves the immune system controlling but not eliminating the tumor?

A. Elimination
B. Equilibrium
C. Escape

B. Equilibrium

HER2 overexpression in breast cancer is an example of:

A. Tumor-specific antigen
B. Tumor-associated antigen
C. Cancer-testis antigen
D. Oncoviral antigen

B. Tumor-associated antigen

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

C. Checkpoint blockade therapy

Which environmental factor is most strongly associated with biological carcinogenesis?

A. UV radiation
B. Tobacco smoke
C. HPV infection
D. Asbestos exposure

C. HPV infection

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)

C. Third

A 62-year-old smoker presents with rapidly growing lung cancer that has spread to the liver. Which features describe this cancer?

Malignant tumor; invasive and metastatic.

A patient with B-cell lymphoma receives rituximab (anti-CD20). This therapy works by…

Binding CD20 on B cells → triggers ADCC, complement activation, and direct killing.

A patient with melanoma undergoes treatment with anti-PD-1. What is the mechanism?

Blocks PD-1 inhibitory receptor → restores T-cell activation → tumor killing.

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

Therapeutic cancer vaccine using adoptively transferred DCs.