Chapter 10: Biology, Clinical Manifestations, and Treatment of Cancer

Huether & McCance: Understanding Pathophysiology, 6th Edition

MULTIPLE CHOICE

1. A patient has a tissue growth that was diagnosed as cancer. Which of the following terms best
describes this growth?
a. Malignant tumor
b. Lipoma
c. Meningioma
d. Hypertrophy

ANS: A
Some tumors initially described as benign can progress to cancer and then are referred to as malignant
tumors. Lipomas are benign growths, while a meningioma is a benign tumor. Hypertrophy refers to
tissue overgrowth, but not cancer.

REF: p. 234

2. Which information indicates a nurse understands characteristics of malignant tumors?

a. Grows slowly
b. Has a well-defined capsule
c. Cells vary in size and shape
d. Is well differentiated

ANS: C
Malignant tumors have cells that vary in both size and shape, and they grow rapidly. They are poorly
differentiated and not encapsulated.

REF: p. 234

3. A nurse is discussing preinvasive epithelial tumors of glandular or squamous cell origin. What is the
nurse describing?
a. Tumor in differentiation
b. Dysplastic
c. Cancer in situ
d. Cancer beyond (meta) situ

ANS: C
Early-stage growths that are localized to the epithelium and have not invaded are called cancer in situ.
Cancer in situ is early-stage growth and not a tumor in differentiation but is more mature growth.
Dysplastic cells do not define cancer in situ.

REF: p. 234

4. A 25-year-old male develops a tumor of the breast glandular tissue. What type of tumor will be
documented on the chart?
 a. Carcinoma
b. Adenocarcinoma
c. Sarcoma
d. Lymphoma
ANS: B
Tumors that arise from or form ductal or glandular structures are named adenocarcinomas. Cancers
arising in epithelial tissue are called carcinomas; mesenchymal tissue (including connective tissue,
muscle, and bone) usually have the suffix sarcoma; lymphatic tissue are called lymphomas.

REF: p. 234

5. A 30-year-old female is diagnosed with cancer. Testing reveals that the cancer cells have spread to
local lymph nodes. A nurse realizes this cancer would be documented as stage:
a. 1.
b. 2.
c. 3.
d. 4.

ANS: C
Cancer that has spread to regional structures, such as lymph nodes, is stage 3. Cancer confined to the
organ of origin is stage 1. Cancer that is locally invasive is stage 2. Cancer that has spread to distant
sites, such as a liver cancer spreading to lung or a prostate cancer spreading to bone, is stage 4.

REF: p. 259, Figure 10-22

6. An oncologist is discussing when a cancer cell loses differentiation. Which of the following is the
oncologist describing?
a. Autonomy
b. Anaplasia
c. Pleomorphic
d. Metastasis

ANS: B
Anaplasia, not autonomy, is the loss of differentiation. The term pleomorphic refers to a marked
variability of size and shape. A malignant tumor has the ability to spread far beyond the tissue of
origin by the process of metastasis.

REF: p. 234

7. A primary care provider is attempting to diagnose cancer and is looking for a tumor marker. Which of
the following could be a possible marker?
a. Red blood cells
b. Apoptotic cells
c. Enzymes
d. Neurotransmitters

ANS: C
 Tumor markers include hormones, enzymes, genes, antigens, and antibodies, but not red blood cells,
apoptotic cells, or neurotransmitters.

REF: p. 258

8. A 52-year-old male with hepatitis C recently developed hepatic cancer. Which of the following
markers should be increased?
a. Alpha-fetoprotein (AFP)
b. Catecholamines
c. Prostate-specific antigen
d. Homovanillic acid

ANS: A
Liver and germ cell tumors secrete a protein known as AFP, not catecholamines. Prostate tumors
secrete prostate-specific antigen. Homovanillic acid is a catecholamine marker.

REF: p. 259, Table 10-7

9. Which information should the nurse include when teaching about angiogenic factors? In cancer,
angiogenic factors stimulate:
a. release of growth factors.
b. tumor regression.
c. apoptosis.
d. new blood vessel growth.

ANS: D
Cancers can secrete multiple factors that stimulate new blood vessel growth called angiogenesis, not
release of growth factors or tumor regression. Apoptosis is cell death.

REF: pp. 245-246

10. What is the effect of telomere caps on cancer cells?

a. Repeated divisions
b. Clonal distinction
c. Limited mitosis
d. Mutation abilities

ANS: A
The presence of telomere caps gives cancer cells the ability to divide over and over again, thus cancer
cells have unlimited mitosis. Telomere caps do not give cells clonal distinction. Mutation capability is
a characteristic of cancer cells, but this property is not related to telomeres.

REF: p. 245

11. Which of the following indicates a nurse understands a proto-oncogene? A proto-oncogene is best
defined as a(n) _____ gene.
a. normal
b. altered
 c. inactive
d. tumor-suppressor

ANS: A
In its normal, nonmutant state, an oncogene is referred to as a proto-oncogene.
A proto-oncogene is not an altered gene, an inactive gene, or a tumor-suppressor gene.

REF: p. 240

12. Which genetic change causes alterations in only one or a few nucleotide bases?
a. Insertions
b. Deletions
c. Point mutations
d. Amplification mutations

ANS: C
Genetic changes may occur by both mutational and epigenetic mechanisms. Mutation generally
means an alteration in the DNA sequence affecting expression or function of a gene. Mutations
include small-scale changes in DNA, such as point mutations, which are the alteration of one or a few
nucleotide base pairs. The process involved with insertions, deletions, or amplification mutations is
different.

REF: p. 237

13. A 45-year-old female was recently diagnosed with cervical cancer. Which of the following is the
most likely cause of her cancer?
a. Herpes virus
b. Rubella virus
c. Human papillomavirus (HPV)
d. Hepatitis B virus

ANS: C
The presence of HPV is a factor in cervical cancer. The presence of herpes virus, rubella virus, or
hepatitis B virus is not a factor in cervical cancer.

REF: p. 250

14. A 30-year-old male with HIV is diagnosed with Epstein-Barr virus. After 2 months, the virus is still
active. Based upon the Epstein-Barr virus, which of the following cancers is most likely to develop in
this patient?
a. B-cell lymphoma
b. Kaposi sarcoma
c. T-cell leukemia
d. T-cell lipoma

ANS: A
Epstein-Barr virus is associated with B-cell lymphoma. Kaposi sarcoma is associated with HIV.
Retroviruses are associated with leukemia. Lipomas are not associated with HIV.
 REF: p. 250

15. A 45-year-old male presents with persistent, severe stomach pain. Testing reveals a peptic ulcer.
Further laboratory tests reveal the presence of Helicobacter pylori. Which of the following is of
concern for this patient?
a. Gastric cancer
b. Leukemia
c. Lung cancer
d. Adenocarcinoma of the colon

ANS: A
The presence of Helicobacter pylori is associated with gastric cancer, not leukemia, lung cancer, or
colon cancer.

REF: p. 249

16. Which statement indicates the patient has a correct understanding of metastasis? The most common
route of metastasis is through the blood vessels and:
a. lung tissue.
b. body cavities.
c. lymphatics.
d. connective tissues.

ANS: C
The most common route of metastasis is through the lymphatics, not lung tissue, body cavities, or
connective tissues.

REF: p. 253

17. A nurse is giving an example of inflammation as an etiology for cancer development. What is the best
example the nurse should give?
a. Pneumonia and lung cancer
b. Ulcerative colitis and colon cancer
c. Prostatic hypertrophy and prostate cancer
d. Hypercholesterolemia and leukemia

ANS: B
Individuals with a 10+ year history of ulcerative colitis have a 30-fold increase in developing colon
cancer. There is no relationship between pneumonia and lung cancer; between prostatic hypertrophy
and cancer of the prostate; and between hypercholesterolemia and leukemia.

REF: pp. 248-249

18. A patient asks when adjuvant chemotherapy is used. How should the nurse respond? Adjuvant
chemotherapy treatment is used:
a. as the primary treatment.
b. before radiation therapy.
 c. after surgical removal of a tumor.
d. in cancer with little risk of metastasis.

ANS: C
Adjuvant chemotherapy is given after surgical excision of a cancer with the goal of eliminating
micrometastases. Adjuvant chemotherapy is not given as the primary treatment or before radiation
therapy. Adjuvant chemotherapy is indicated in the treatment of individuals with metastasis.

REF: p. 261

MULTIPLE RESPONSE

1. Brachytherapy is being used to treat cancer in a patient. What types of cancers respond well to
brachytherapy? (select all that apply)
a. Prostate
b. Cervix
c. Head
d. Neck
e. Lung

ANS: A, B, C, D
Radiation sources can be temporarily placed into body cavities through a delivery method termed
brachytherapy. Brachytherapy is useful in the treatment of cervical, prostate, and head and neck
cancers. It is not used in the treatment of lung cancer.

REF: p. 260

Chapter 11: Cancer Epidemiology

Huether & McCance: Understanding Pathophysiology, 6th Edition

MULTIPLE CHOICE

1. The most important environmental risk factor for cancer is exposure to:
a. ultraviolet (UV) radiation.
b. radon.
c. estrogen.
d. cigarette smoke.

ANS: D
UV radiation is an important risk factor as are radon and estrogen exposure, but cigarette smoking
remains the most important cause of cancer.

REF: p. 274

2. When an oncologist is discussing the degree to which an organism’s development is contingent on its
environment, which of the following is the oncologist explaining?
a. Transgenerational inheritance
 b. Epigenetics
c. Histone modification
d. Developmental plasticity

ANS: D
Developmental plasticity is the degree to which an organism’s development is contingent on its
environment. Transgenerational inheritance is the heritable transmission to future generations of
environmentally caused phenotypes. Epigenetics is the role of genes in development and disease.
Histone modifications are changes in genetic acetylation.

REF: p. 272

3. Chromosome aberrations and mutations in cells that were not directly irradiated are referred to as:
a. bystander effects.
b. lethal mutation.
c. delayed reproductive death.
d. genetic instability.

ANS: A
The directly irradiated cells can lead to genetic effects in the so-called bystander cells or innocent
cells. This is termed bystander effects. Lethal mutation and delayed reproductive death are similar
phenomenons and are not related to bystander effects. Genetic instability is related to chromosomal
instability.

REF: p. 286

4. A patient develops skin cancer on the head and neck following years of sunbathing. Which of the
following cancers is most likely?
a. Lymphoma
b. Adenoma
c. Basal cell carcinoma
d. Leukemia

ANS: C
Basal cell carcinoma is related to UV radiation primarily from the sun. Neither lymphoma, adenoma,
nor leukemia is related to sunbathing.

REF: p. 287

5. A nurse recalls physical activity was shown to definitely reduce the risk of which of the following
types of cancer?
a. Prostate
b. Lung
c. Bone
d. Colon

ANS: D
 Physical activity has been proven to reduce the risk for breast and colon cancers, but its effect in
reducing prostate, lung, or bone cancer is not as strong.

REF: p. 276

6. A 65-year-old patient recently diagnosed with cancer retired from construction work. Which cancer is
likely to develop secondarily to occupational hazards?
a. Mesothelioma
b. Bladder cancer
c. Prostate cancer
d. Bone cancer

ANS: A
One notable occupational factor is asbestos, which increases the risk of mesothelioma, lung cancer,
and possibly others. The same risk of bladder, prostate, or bone cancer does not exist.

REF: p. 293

7. A patient asks why indoor pollution is worse than outdoor pollution. How should the nurse respond?
Indoor pollution is considered worse than outdoor pollution because of cigarette smoke and:
a. fireplace wood smoke.
b. radon.
c. benzene.
d. chlorine.

ANS: B
Indoor pollution is related to cigarette smoke and radon. Indoor pollution is not related to fireplace
smoke, benzene, or chlorine.

REF: pp. 292-293

8. A water test recently revealed arsenic levels above 200 mcg/L. Which of the following cancers would
be most likely to develop in those who consistently drank the water?
a. Liver
b. Skin
c. Colon
d. Kidney

ANS: B
Evidence indicates an increased risk of bladder, skin, and lung cancers following consumption of
water with high levels of arsenic. Evidence for cancers of the liver, colon, and kidney is weaker
following consumption of water with high levels of arsenic.

REF: p. 293

9. When an oncologist is teaching about how radiation induces genomic instability, which topic should
the oncologist discuss?
a. Increasing hypersensitivity
 b. Facilitating new mutations
c. Promoting cell death
d. Enhancing mitosis

ANS: B
Radiation induces genomic instability because it facilitates new mutations but it does not promote
hypersensitivity. Radiation may promote cell death, but this is not its role in inducing genomic
instability. Radiation does not enhance mitosis but halts it.

REF: p. 286

10. Which of the following patients would be at greatest risk for basal cell carcinoma?
a. Dark complexion, light eyes, underweight
b. Light complexion, dark eyes, overweight
c. Medium complexion, light eyes, smoker
d. Light complexion, light eyes, fair hair

ANS: D
Individuals at risk for basal cell carcinoma have light complexions, light eyes, and fair hair.

REF: p. 287

11. The role of physical activity in the prevention of colon cancer is identified by which of the following?
a. It increases fluid loss, leading to thirst and increased fluid intake, hydrating the colon.
b. It increases blood supply, thereby increasing oxygen to the colon.
c. It increases gut motility, thereby decreasing the time the bowel is exposed to
mutagens.
d. It increases the secretion of hydrochloric acid, thereby killing mutants.

ANS: C
Physical activity increases gut motility, thereby decreasing exposure to mutagens. Physical activity
does increase fluid loss and blood supply, but neither effect prevents mutagens. Physical activity does
not increase hydrochloric acid.

REF: p. 283

MULTIPLE RESPONSE

1. A 50-year-old female confirms chronic alcohol intake. This practice places the patient at risk for
cancer in which organs? (select all that apply)
a. Larynx
b. Esophagus
c. Liver
d. Lung
e. Brain
f. Breast
 ANS: A, B, C, F
Chronic alcohol consumption is a strong risk factor for colorectal cancer and cancer of the oral
cavity, pharynx, hypopharynx, larynx, esophagus, liver, and breast. It is not associated with lung or
brain cancer.

REF: p. 281

Chapter 12: Cancer in Children

Huether & McCance: Understanding Pathophysiology, 6th Edition

MULTIPLE CHOICE

1. What is the origin of most childhood cancers?

a. Placenta
b. Environment
c. Mesodermal germ layer
d. Neural tube

ANS: C
Most childhood cancers originate from the mesodermal germ layer that gives rise to connective
tissue, bone, cartilage, muscle, blood, blood vessels, the gonads, the kidney, and the lymphatic
system. Most childhood cancers do not originate from the placenta or the environment. Neural tubes
are generally not associated with cancer.

REF: p. 301

2. Which characterizes an embryonic cancer tumor?

a. Commonly occurring
b. Often seen in adults
c. Composed of mature, differentiated cells
d. Usually manifested around age 5

ANS: D
These types of cancers usually manifest around age 5. These types of cancers are not commonly
occurring, seen in adults, or composed of undifferentiated cells.

REF: p. 301

3. A nurse is preparing to teach the most common malignancy in children. Which malignancy should
the nurse discuss?
a. Leukemia
b. Neuroblastoma
c. Wilms tumor
d. Retinoblastoma

ANS: A
 The most common malignancy in children is leukemia. Tumors of the nervous system, Wilms tumors,
and retinoblastoma occur less frequently.

REF: p. 302, Table 12-1

4. A 3-year-old female was diagnosed with Wilms tumor. This disease is a tumor of the:
a. kidney.
b. brain.
c. bone marrow.
d. liver.

ANS: A
Wilms tumor is a tumor found in the kidney, not the brain, the bone marrow, or the liver.

REF: p. 303

5. The nurse explains to a parent that young children diagnosed with Down syndrome are at higher risk
for developing:
a. nephroblastoma.
b. rhabdomyosarcoma.
c. leukemia.
d. retinoblastoma.

ANS: C
One of the more recognized syndromes is the association of trisomy 21 and Down syndrome, with an
increased susceptibility to acute leukemia, not nephroblastoma, rhabdomyosarcoma, or
retinoblastoma.

REF: p. 303

6. What event occurs in about 70% of the cases of childhood cancers?

a. Cured
b. Required only chemotherapy
c. Participated in clinical trails
d. Developed a secondary malignancy

ANS: A
More than 70% of children diagnosed with cancer are cured. Some of the factors leading to improved
cure rates in pediatric oncology include the use of combination chemotherapy or multimodal
treatment for solid childhood tumors and improvements in nursing and supportive care. A partial
explanation for the relative lack of progress in curing the adolescent population at the same rate as
that realized in the younger pediatric population is the lack of participation in clinical trials. While
survivors of childhood cancer are at increased risk of developing a second malignancy later in life, it
is not as frequent as 70%.

REF: p. 305
 7. A 40-year-old female developed adenocarcinoma of the vagina. Which prenatal event is the most
likely cause of her cancer?
a. Rb gene mutation
b. Exposure to diethylstilbestrol (DES)
c. Exposure to solvents
d. Exposure to radiation

ANS: B
The patient with adenocarcinoma of the vagina most likely experienced prenatal exposure to DES,
not an Rb gene mutation or exposure to solvents or radiation.

REF: pp. 303-304

8. A 16-year-old with aspirations of becoming a bodybuilder spends 3 hours a day in the gym. Five
years later a hepatocellular carcinoma is discovered. Which of the following is the most likely cause
of the cancer?
a. Immunosuppressive agents
b. Cytotoxic agents
c. Anabolic steroids
d. A viral infection

ANS: C
A history of anabolic steroids, not immunosuppressive or cytotoxic agents, places the patient at risk
for hepatocellular carcinoma. A viral infection does not place the patient at risk for hepatocellular
carcinoma.

REF: p. 305, Table 12-5

9. The most common type of tissue cancer occurring between ages 15 and 19 is:
a. sarcoma.
b. squamous cell.
c. carcinoma.
d. neuroma.

ANS: C
The most common type of tissue cancer after adolescence is carcinoma, not sarcoma, squamous cell,
or neuroma.

REF: p. 301

MULTIPLE RESPONSE

1. When an aide asks why carcinomas rarely occur in childhood, how should the nurse respond? (select
all that apply)
a. Carcinomas cannot develop in an immunosuppressed environment.
b. Carcinomas need a long time from exposure to occurrence.
c. Carcinomas are due to environmental exposures.
d. Carcinomas occur primarily in secondary sexual organs.
e. Carcinomas are mesodermal.

ANS: B, C
Carcinomas rarely occur in children because these cancers most commonly result from environmental
carcinogens and require a long period from exposure to the appearance of the carcinoma.

REF: p. 301