General Medical Sciences Neoplasia practice questions
Neoplasia refers to abnormal, uncontrolled cell growth that persists even after the initial trigger is removed, producing a mass called a neoplasm (tumor). Neoplasms are classified as benign or malignant based on differentiation, growth pattern, and capacity for invasion and metastasis, and this classification underlies tumor nomenclature (e.g., -oma vs carcinoma/sarcoma). Understanding the genetic basis of carcinogenesis (oncogenes, tumor suppressor genes), grading versus staging, and the systemic effects of tumors (paraneoplastic syndromes) is central to General Medical Sciences pathology.
A 62-year-old man undergoes resection of a colonic mass found on screening colonoscopy. Histology shows cells forming irregular glandular structures that breach the muscularis mucosae and extend into the submucosa, with foci of lymphovascular invasion. Which term correctly classifies this neoplasm?
A 2-year-old girl presents with bilateral leukocoria. Her father had a similar tumor removed from one eye in early childhood. Genetic testing reveals a germline mutation in one copy of a tumor suppressor gene, with tumor tissue showing loss of the second, normal allele. Which mechanism best explains tumor development in this child?
A 50-year-old man reports fatigue and early satiety. Examination reveals massive splenomegaly. A complete blood count shows a white cell count of 250,000/microL with a full spectrum of maturing granulocytic precursors on peripheral smear. Cytogenetic testing is most likely to reveal which abnormality?
A 58-year-old woman is diagnosed with invasive ductal carcinoma of the breast. Pathology reports the tumor as moderately differentiated (grade 2), while imaging and lymph node biopsy show a 2.5 cm primary tumor with one involved axillary node and no distant metastases. Which of these findings is the strongest independent predictor of her overall prognosis?
A 68-year-old man with a 40-pack-year smoking history presents with confusion, constipation, and polyuria. Labs show a serum calcium of 13.2 mg/dL with a suppressed intact PTH and low-normal phosphate. Chest imaging reveals a central mass with hilar lymphadenopathy, and biopsy confirms squamous cell carcinoma of the lung with no evidence of bone metastases on further workup. What is the most likely mechanism of this patient's hypercalcemia?
Neoplasia, answered
What is the easiest way to remember tumor nomenclature suffixes?
Think in two axes: tissue of origin and behavior. Benign tumors generally take the '-oma' suffix (adenoma, lipoma, leiomyoma), while malignant epithelial tumors are 'carcinomas' and malignant mesenchymal tumors are 'sarcomas'. A few historical exceptions exist (lymphoma, melanoma, seminoma are malignant despite the '-oma' ending), so these are worth memorizing individually.
Do I need to memorize every specific oncogene and tumor suppressor gene for the exam?
You don't need an exhaustive list, but a small set of high-yield examples covers most questions: RB1 and TP53 as classic tumor suppressor genes (two-hit hypothesis), and RAS, MYC, and BCR-ABL as classic oncogenes. Understanding the general mechanism, dominant gain-of-function for oncogenes versus recessive loss-of-function for tumor suppressor genes, matters more than memorizing an exhaustive gene list.
What's the practical difference between grading and staging, and which one matters more?
Grading describes how differentiated the tumor cells look under the microscope (a biological feature of the tumor itself), while staging describes how far the disease has spread anatomically (local size, nodal involvement, distant metastases). For most solid tumors, stage is the stronger independent predictor of prognosis and is what most directly drives treatment decisions.
How much detail on paraneoplastic syndromes should I know for General Medical Sciences?
Focus on a handful of classic tumor-syndrome pairings rather than trying to learn every reported association: PTHrP-mediated hypercalcemia with squamous cell lung carcinoma, ectopic ACTH with small cell lung carcinoma, and SIADH also with small cell lung carcinoma. Knowing the underlying mechanism for each helps you reason through less familiar pairings on exam questions.
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