Principles of cancer – classification MCQs With Answer

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Introduction

Understanding the principles of cancer and its classification is essential for B. Pharm students preparing for pharmacology, pathology, and oncology modules. This focused guide on “Principles of cancer – classification MCQs With Answer” covers tumor biology, grading and staging (TNM), histologic classification, oncogenes and tumor suppressors, pathways of metastasis, tumor markers, and diagnostic techniques. These Student-friendly MCQs emphasize core concepts like carcinogenesis, angiogenesis, molecular classification, and clinical relevance to therapeutics. Each question is designed to deepen your applied knowledge and exam readiness for B. Pharm curricula. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. What is the fundamental cellular definition of cancer?

  • Programmed cell death due to DNA damage
  • Uncontrolled clonal cell proliferation
  • Normal cell differentiation into specialized tissues
  • Transient hyperplasia that resolves spontaneously

Correct Answer: Uncontrolled clonal cell proliferation

Q2. Which feature best distinguishes malignant tumors from benign tumors?

  • Slow growth rate
  • Encapsulation and well-defined borders
  • Local invasion and metastasis
  • Retention of normal tissue architecture

Correct Answer: Local invasion and metastasis

Q3. Carcinomas are malignant tumors that arise from which tissue type?

  • Connective (mesenchymal) tissue
  • Neural tissue
  • Hematopoietic tissue
  • Epithelial tissue

Correct Answer: Epithelial tissue

Q4. Sarcomas originate primarily from which of the following?

  • Lymphoid tissue
  • Mesenchymal (connective) tissue
  • Surface epithelium
  • Endocrine glands

Correct Answer: Mesenchymal (connective) tissue

Q5. Lymphomas are cancers of which origin?

  • Glandular epithelial cells
  • Lymphoid cells
  • Bone marrow stroma only
  • Squamous epithelial cells

Correct Answer: Lymphoid cells

Q6. In the TNM staging system, what does the “N” denote?

  • Number of primary tumors
  • Necrosis within the tumor
  • Regional lymph node involvement
  • Presence of distant metastasis

Correct Answer: Regional lymph node involvement

Q7. Tumor grading primarily assesses which characteristic?

  • Patient symptoms and performance status
  • Extent of lymph node spread
  • Histologic differentiation and cellular atypia
  • Presence of specific tumor markers

Correct Answer: Histologic differentiation and cellular atypia

Q8. The Gleason score in prostate cancer is determined by:

  • Serum PSA level only
  • Sum of the two most predominant architectural patterns
  • Degree of bone metastasis
  • Patient age and tumor size

Correct Answer: Sum of the two most predominant architectural patterns

Q9. Which of the following is described as a “hallmark of cancer”?

  • Increased sensitivity to growth suppressors
  • Sustained proliferative signaling
  • Enhanced DNA repair fidelity
  • Strict dependence on normal growth factors

Correct Answer: Sustained proliferative signaling

Q10. An oncogene typically results from which molecular change?

  • Loss-of-function mutation of a tumor suppressor
  • Gain-of-function mutation that promotes proliferation
  • Epigenetic silencing of proto-oncogene
  • Decreased expression of growth factors

Correct Answer: Gain-of-function mutation that promotes proliferation

Q11. The tumor suppressor p53 primarily functions in:

  • Promoting angiogenesis
  • DNA damage response and apoptosis
  • Stimulating cell cycle progression
  • Enhancing telomerase activity

Correct Answer: DNA damage response and apoptosis

Q12. Activating mutations in RAS family genes commonly involve which mechanism?

  • Chromosomal translocation with immunoglobulin loci
  • Point mutation leading to constitutive activation
  • Homozygous deletion of the gene
  • Promoter methylation and silencing

Correct Answer: Point mutation leading to constitutive activation

Q13. BRCA1 is best known for its role in which cellular process?

  • Mitotic spindle formation
  • Homologous recombination DNA repair
  • Protein glycosylation in the Golgi
  • Mitochondrial oxidative phosphorylation

Correct Answer: Homologous recombination DNA repair

Q14. High-risk human papillomavirus (HPV) types 16 and 18 are most strongly associated with:

  • Hepatocellular carcinoma
  • Cervical squamous cell carcinoma
  • Chronic lymphocytic leukemia
  • Renal cell carcinoma

Correct Answer: Cervical squamous cell carcinoma

Q15. Which of the following is a classic chemical carcinogen?

  • Ultraviolet B radiation
  • Human T-cell lymphotropic virus (HTLV)
  • Polycyclic aromatic hydrocarbons (e.g., benzopyrene)
  • Helicobacter pylori infection

Correct Answer: Polycyclic aromatic hydrocarbons (e.g., benzopyrene)

Q16. The first key step in the metastatic cascade is typically:

  • Colonization at distant organ
  • Invasion through the basement membrane
  • Angiogenesis at primary site
  • Immune-mediated tumor clearance

Correct Answer: Invasion through the basement membrane

Q17. Carcinomas most commonly spread initially by which route?

  • Direct intra-arterial embolism
  • Lymphatic spread
  • Transcoelomic spread exclusively
  • Neural invasion only

Correct Answer: Lymphatic spread

Q18. Which organ is the most frequent site of hematogenous metastasis for many tumors?

  • Spleen
  • Heart
  • Lungs
  • Thyroid

Correct Answer: Lungs

Q19. Prostate-specific antigen (PSA) is primarily used as a marker for which organ’s cancer?

  • Breast
  • Prostate
  • Liver
  • Pancreas

Correct Answer: Prostate

Q20. Tumor markers are most clinically useful for which of the following?

  • Definitive initial diagnosis in isolation
  • Screening general asymptomatic populations routinely
  • Monitoring therapy response and detecting recurrence
  • Replacing histopathology for tumor typing

Correct Answer: Monitoring therapy response and detecting recurrence

Q21. Immunohistochemical detection of cytokeratins helps identify tumors of which origin?

  • Neural origin
  • Epithelial origin
  • Hematopoietic origin
  • Endothelial origin

Correct Answer: Epithelial origin

Q22. Ki-67 labeling index in a tumor is a measure of:

  • Apoptotic cell fraction
  • Cell proliferation
  • Vascular density
  • Immune cell infiltration

Correct Answer: Cell proliferation

Q23. A high mitotic index generally correlates with which tumor characteristic?

  • Low grade and better prognosis
  • High grade and aggressive behavior
  • Benign nature of the lesion
  • Decreased sensitivity to radiation always

Correct Answer: High grade and aggressive behavior

Q24. “Differentiation” in tumor pathology refers to:

  • The tumor’s ability to metastasize
  • The resemblance of tumor cells to the normal tissue of origin
  • The number of chromosomes in cancer cells
  • The presence of necrosis within tumor

Correct Answer: The resemblance of tumor cells to the normal tissue of origin

Q25. Syndrome of inappropriate ADH secretion (SIADH) is a paraneoplastic feature commonly associated with:

  • Small cell lung carcinoma
  • Basal cell carcinoma
  • Renal cell carcinoma only
  • Colon adenocarcinoma exclusively

Correct Answer: Small cell lung carcinoma

Q26. Cancer cachexia is mediated primarily by which of the following?

  • Local tumor compression effects only
  • Systemic inflammatory cytokines such as TNF-α and IL-6
  • Excess caloric intake
  • Purely endocrine failure of pancreas

Correct Answer: Systemic inflammatory cytokines such as TNF-α and IL-6

Q27. Vascular endothelial growth factor (VEGF) is best known for its role in:

  • Inducing tumor cell apoptosis
  • Promoting angiogenesis
  • Repairing DNA double-strand breaks
  • Activating T-cell mediated immunity

Correct Answer: Promoting angiogenesis

Q28. Anti-angiogenic cancer therapies most commonly target which molecule or pathway?

  • Estrogen receptor signaling
  • VEGF signaling pathway
  • Topoisomerase II inhibition
  • Glucose transporters

Correct Answer: VEGF signaling pathway

Q29. The sequence “initiation, promotion, progression” describes which concept?

  • Steps in tumor metastasis only
  • Stages of wound healing
  • Phases of multistep carcinogenesis
  • Phases of cell cycle regulation exclusively

Correct Answer: Phases of multistep carcinogenesis

Q30. The Ames test is used to assess:

  • Cytotoxic effects on mammalian cells
  • Mutagenicity of chemical agents using bacteria
  • Viral oncogenic potential in humans
  • In vivo carcinogenicity in rodents only

Correct Answer: Mutagenicity of chemical agents using bacteria

Q31. Xeroderma pigmentosum patients are predisposed to skin cancer due to a defect in:

  • Homologous recombination repair
  • Nucleotide excision repair of UV-induced DNA damage
  • Mismatch repair only
  • Base excision repair of oxidative lesions

Correct Answer: Nucleotide excision repair of UV-induced DNA damage

Q32. An example of an epigenetic alteration in cancer is:

  • Point mutation in an oncogene
  • Chromosomal translocation
  • Promoter hypermethylation leading to gene silencing
  • Gain of extra chromosome copies only

Correct Answer: Promoter hypermethylation leading to gene silencing

Q33. MicroRNAs in cancer can function as:

  • Only tumor suppressors
  • Only structural proteins
  • Either oncogenes (oncomiRs) or tumor suppressors
  • Enzymes in DNA replication

Correct Answer: Either oncogenes (oncomiRs) or tumor suppressors

Q34. Flow cytometric analysis of tumor cells for DNA ploidy provides information about:

  • Specific gene mutations present
  • Prognostic significance related to aneuploidy
  • Exact tissue of origin in all tumors
  • Serum tumor marker concentrations

Correct Answer: Prognostic significance related to aneuploidy

Q35. Fine-needle aspiration cytology (FNAC) is most useful for:

  • Detailed tumor grading in all cancers
  • Initial minimally invasive sampling of palpable masses
  • Replacing core biopsy for definitive diagnosis always
  • Evaluating distant metastases by PET imaging

Correct Answer: Initial minimally invasive sampling of palpable masses

Q36. Sentinel lymph node biopsy in cancer surgery is performed to:

  • Identify systemic metastasis in bone marrow
  • Determine the first draining lymph node for accurate staging
  • Replace the need for any imaging tests
  • Assess tumor grade histologically

Correct Answer: Determine the first draining lymph node for accurate staging

Q37. Chemotherapy is often curative in which of the following cancers?

  • Hodgkin lymphoma
  • Pancreatic adenocarcinoma
  • Glioblastoma multiforme
  • Advanced metastatic melanoma primarily

Correct Answer: Hodgkin lymphoma

Q38. Which provides better overall prognostic information for many solid tumors?

  • Tumor grade only
  • Tumor stage (extent of disease)
  • Serum cholesterol level
  • Patient gender exclusively

Correct Answer: Tumor stage (extent of disease)

Q39. Intratumoral heterogeneity primarily arises from:

  • Uniform gene expression across clones
  • Genetic instability and clonal evolution
  • Single mutation present in all tumor cells
  • Lack of selective pressures in microenvironment

Correct Answer: Genetic instability and clonal evolution

Q40. Knudson’s “two-hit” hypothesis explains the inactivation of which type of gene?

  • Oncogenes requiring only one activated allele
  • Tumor suppressor genes requiring both alleles lost or inactivated
  • Housekeeping genes not related to cancer
  • Genes involved exclusively in metabolism

Correct Answer: Tumor suppressor genes requiring both alleles lost or inactivated

Q41. The c-MYC oncogene is commonly activated in Burkitt lymphoma by which mechanism?

  • Point mutation in coding region
  • Chromosomal translocation t(8;14) placing c-MYC under immunoglobulin promoter
  • Promoter hypermethylation
  • Homozygous deletion of chromosome 8

Correct Answer: Chromosomal translocation t(8;14) placing c-MYC under immunoglobulin promoter

Q42. Cachexia in cancer patients is best characterized by:

  • Reversible weight gain and fluid retention
  • Systemic inflammation, muscle wasting, and weight loss despite nutrition
  • Purely psychological anorexia with no metabolic change
  • Localized fat loss only at tumor site

Correct Answer: Systemic inflammation, muscle wasting, and weight loss despite nutrition

Q43. A “high-grade” tumor typically shows which histologic feature?

  • Well-differentiated cells resembling normal tissue
  • Poor differentiation and marked cellular atypia
  • Complete encapsulation and slow behavior
  • Absence of mitoses

Correct Answer: Poor differentiation and marked cellular atypia

Q44. Barrett’s esophagus is an example of metaplasia that predisposes to which cancer?

  • Squamous cell carcinoma of the esophagus
  • Esophageal adenocarcinoma
  • Gastric lymphoma
  • Small intestinal stromal tumor

Correct Answer: Esophageal adenocarcinoma

Q45. Epstein-Barr virus (EBV) infection is associated with which malignancy?

  • Basal cell carcinoma
  • Burkitt lymphoma and nasopharyngeal carcinoma
  • Chronic myeloid leukemia only
  • Hepatocellular carcinoma only

Correct Answer: Burkitt lymphoma and nasopharyngeal carcinoma

Q46. Germline RET mutations are commonly linked to which endocrine malignancy?

  • Medullary thyroid carcinoma
  • Adrenal cortical carcinoma only
  • Follicular thyroid adenoma
  • Pheochromocytoma exclusively

Correct Answer: Medullary thyroid carcinoma

Q47. The tumor microenvironment includes which of the following components?

  • Only the malignant epithelial cells
  • Stroma, immune cells, extracellular matrix, and vasculature
  • Serum proteins unrelated to the tumor
  • Only bacterial flora adjacent to tumor

Correct Answer: Stroma, immune cells, extracellular matrix, and vasculature

Q48. Compared to simple starvation, cancer cachexia is uniquely associated with:

  • Reversible loss of fat only
  • Reduced resting energy expenditure always
  • Systemic inflammation and metabolic alterations leading to muscle loss
  • Improved appetite and weight gain

Correct Answer: Systemic inflammation and metabolic alterations leading to muscle loss

Q49. The Nottingham histologic score for breast carcinoma includes all of the following EXCEPT:

  • Tubule formation
  • Nuclear pleomorphism
  • Mitotic count
  • Serum calcium level

Correct Answer: Serum calcium level

Q50. Which molecular subtype of breast cancer is generally associated with the best prognosis?

  • Triple-negative (ER-/PR-/HER2-)
  • HER2-enriched (HER2+) without hormone receptors
  • Luminal A (ER+/PR+, HER2-, low proliferation)
  • Basal-like with high proliferation

Correct Answer: Luminal A (ER+/PR+, HER2-, low proliferation)

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