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CHAPTER 16
Cancer and Its Interaction with the Immune System
The Immune System, Third Edition
 2009 Garland Science Publishing
Questions
16–1
A benign tumor of glandular tissue is known as a(n) _____.
a.
sarcoma
b.
myeloma
c.
adenoma
d.
adenocarcinoma
e.
lymphoma.
16–2
A malignant tumor is characterized by which of the following features? (Select all that apply.)
a.
encapsulation
b.
localized
c.
restricted in size
d.
metastasizes to distant sites
e.
results from multiple mutations affecting cell division or survival.
16–3
Which of the following pairs are matched correctly? (Select all that apply.)
a.
myeloma: bone marrow
b.
benign tumor: encapsulation
c.
lymphoma: bone marrow
d.
tumor-associated antigens: proteins expressed only by tumor cells
e.
sarcoma: epithelial cell.
16–4
Examples of tumor suppressor genes include _____. (Select all that apply.)
a.
APC
b.
RAS
c.
p53
d.
ABL
e.
DCC.
16–5
_____ describes the condition in which a cell becomes able to cause cancer.
a.
Malignant mutation
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b.
c.
d.
e.
Malignant recombination
Malignant neoplasm
Malignant transformation
Malignant suppression.
16–6
A protein expressed in response to damage to DNA that results in death to the cell is _____.
a.
Ras
b.
p53
c.
Rb
d.
Abl
e.
MAGEA1.
16–7
Human herpes virus 8 (HHV8) is associated with the development of _____ in
immunocompromised patients.
a.
Burkitt’s lymphoma
b.
chronic myeloid leukemia
c.
melanoma
d.
myeloma
e.
Kaposi’s sarcoma.
16–8
Li–Fraumeni syndrome is linked to a greater risk of cancer as a result of the inheritance of a
germline mutation in one copy of _____.
a.
TLR-9
b.
p53
c.
CTLA4
d.
heat-shock protein
e.
Rb.
16–9
Chemical and physical agents that increase mutation rates by damaging DNA and increase the
likelihood of developing cancer are known as _____.
a.
oncogens
b.
malignant transformers
c.
antitumor suppressor agents
d.
carcinogens
e.
tumor-associated agents.
16–10
_____ agents usually cause single nucleotide substitutions in DNA, whereas _____ agents
produce more significant damage to DNA.
a.
mutagenic; carcinogenic
b.
chemical; physical
c.
benign; malignant
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d.
e.
tumor-associated; tumor-specific
benign; oncogenic.
16–11
An example of a physical agent that increases an individual’s predisposition to developing
cancer is_____. (Select all that apply.)
a.
cigarette smoke
b.
X-rays
c.
ultraviolet radiation
d.
asbestos
e.
exposure to radioactive sources.
16–12
Burkitt’s lymphoma is a tumor associated with _____ infection, which causes _____ to divide
uncontrollably.
a.
Epstein–Barr virus; B cells
b.
hepatitis B virus; epithelial
c.
human T-cell leukemia; hepatocytes
d.
human herpes virus; T cells
e.
papillomavirus; uterine cells.
16–13
DNA viruses associated with cancer development include _____. (Select all that apply.)
a.
human papillomavirus (HPV)
b.
human immunodeficiency virus (HIV-1)
c.
human herpes virus 8 (HHV8)
d.
Epstein–Barr virus (EBV)
e.
malignant transformation.
16–14
Cancers develop their own blood supply and become vascularized through _____.
a.
apoptosis
b.
neoplasia
c.
angiogenesis
d.
metastasis
e.
malignant transformation.
16–15
Systemic distribution of cancer cells to other sites of the body through the bloodstream or lymph
is a process known as _____.
a.
apoptosis
b.
neoplasia
c.
angiogenesis
d.
metastasis
e.
malignant transformation.
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16–16
The efficacy of treating bladder cancer is increased by introducing the BCG vaccine. The
vaccine component attributing this antitumor effect is _____, which induces a state of chronic
inflammation.
a.
mycolic acid
b.
unmethylated CpG-containing DNA
c.
lipopolysaccharide
d.
teichoic acid
e.
peptidoglycan.
16–17
Which of the following are true for cancer stem cells? (Select all that apply.)
a.
They are self-renewing.
b.
They are highly susceptible to radiation.
c.
They are resistant to toxins used in chemotherapy.
d.
They may be present in low numbers without causing relapse.
e.
They may cause cancer if donated in organ transplants.
16–18
Proteins not expressed on normal cells but found on tumor cells are called _____.
a.
cancer stem cell antigens
b.
oncogenic antigens
c.
tumor-associated antigens
d.
tumor-specific antigens
e.
proto-oncogene products.
16–19
Tumor-specific antigens are derived from _____. (Select all that apply.)
a.
peptide antigens encoded by fused portions of recombined genes
b.
peptide antigens containing point mutations
c.
proteins modified by abnormal posttranslational processes
d.
reactivated embryonic genes
e.
viral proteins
f.
overexpression of normal genes
g.
non-contiguous peptides spliced together by peptide bonds in the proteasome.
16–20
Which of the following describe types of tumor-associated antigens? (Select all that apply.)
a.
They are derived from self proteins to which the immune system is not tolerant.
b.
They are derived from proteins encoded by mRNAs that have undergone abnormal
posttranscriptional splicing.
c.
They are proteins normally expressed in immunologically privileged sites.
d.
They are proteins expressed at unusually high levels.
e.
They are derived from viral proteins to which the immune system is not tolerant.
16–21
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A tumor-associated antigen normally expressed only in the testes is called a _____ antigen.
a.
MIC
b.
CT
c.
male-specific
d.
sex chromosome-encoded
e.
privileged.
16–22
A mechanism by which cancer cells can evade an immune response involves an alteration in the
amount of MIC on the cell surface by
a.
decreasing the level of MIC transcription
b.
cleavage of MIC at the cell surface by a protease
c.
switching from a transmembrane form of MIC to a secreted form
d.
cytosolic degradation of MIC in proteasomes
e.
alternative mRNA splicing resulting in a truncated form of MIC that is no longer able to
bind to NKG2D.
16–23
Which of the following is a mechanism by which tumors can evade immune detection? (Select
all that apply.)
a.
reduction in levels of HLA class I
b.
recruitment of regulatory T cells
c.
enhancement of inflammatory responses
d.
lowering of levels of MIC on cell surface
e.
increase in levels of CT antigens.
16–24
Which cytokines are associated with tumor-induced suppression of the immune response?
(Select all that apply.)
a.
IL-12
b.
IL-2
c.
TGF-
d.
IL-4
e.
IL-10.
16–25
One of the side effects of treating tumor patients with anti-CTLA4 monoclonal antibodies is
_____.
a.
the development of autoimmune disease
b.
lymphoproliferative disorder
c.
increased levels of mutation in tumor cells
d.
upregulation of CT antigens
e.
reactivation of embryonic genes.
16–26
6
Monoclonal antibodies are used in cancer treatment because of their ability to _____. (Select all
that apply.)
a.
target tumor cells for immune responses such as ADCC or opsonization
b.
suppress regulatory cells
c.
deliver radioactive molecules to track the status of metastasis
d.
enhance expression of tumor-specific antigens
e.
be conjugated to cytotoxic drugs to kill tumor cells.
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Answers
16–1: c
16–2: d, e
16–3: a, b
16–4: a, c, e
16–5: d
16–6: b
16–7: e
16–8: b
16–9: d
16–10: b
16–11: b, c, e
16–12: a
16–13: a, d
16–14: c
16–15: d
16–16: b
16–17: a, c, d, e
16–18: d
16–19: a, b, c, e, g
16–20: a, c, d
16–21: b
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16–22: b
16–23: a, b, d
16–24: c, e
16–25: a
16–26: a, c, e