Carcinogenesis, Paraneoplastic Syndromes and Tumor Markers MCQs

Ans. is 'a' i.e., CEA Carcinoembryonic antigen is a marker in cancer of colon, pancreas, lung, breast, and ovary.

Explanation: Cancers with increased incidence in obesity due to: Hyperinsulinemia, increased IGF-1 , Chronic inflammation , Increased estrogen (from aromatization in adipose tissue) . Cancers associated with obesity include : Adenocarcinomas of the esophagus, gastric(Option C ruled out), colon , rectum , liver , gallbladder , pancreas(Option D ruled out) , kidney , thyroid . In women: endometrium, ovary, breast (postmenopausal) . In men: prostate . Meningioma (Option A ruled out)

It is suspected that TNF and other cytokines produced by macrophages in response to tumour cells or by the tumour cells themselves mediate cachexia. TNF suppresses appetite and inhibits the action of lipoprotein lipase, preventing the release of free fatty acids from lipoproteins. TNF-α is chiefly secreted by macrophages in response to stimuli for the induction of systemic inflammation. The binding of the ligand TNF-α to the TNF receptor(TNFR1) initiates the pro-inflammatory and pro-apoptotic signaling cascades. Reference: Robbins and Cotran Pathologic Basis of Diseases, 10 th ed, Pg: 236.

Acanthosis nigricans can occur as paraneoplastic syndrome caused by growth factors released from tumors. RCC is rarely associated with acanthosis nigricans. Most common associations are with obesity and diabetes. Reference: Robbins & Cotran Pathologic Basis of Diseases 10 th edition Chapter 25, pg 1143

Hypoglycemia as Paraneoplastic syndrome in some tumors: Mesenchymal tumors, sarcomas, adrenal, hepatic, gastrointestinal, kidney, prostate, Cervix (small-cell carcinoma) The first association of hyperglycemia was made by Glicksman and Rawson who noted a 25% incidence of "diabetes" in patients with sarcomas of bone. Marcove and Francis found hyperglycemia in 85% of their chondrosarcoma patient and Turner and Horne reported similar abnormalities associated with fibrosarcoma Reference: Cancer 42:603-610, 1978;

Pure red cell aplasia can either be inherited or acquired. Congenital PRCA Diamond-Blackfan or Blackfan-Diamond syndrome Acquired PRCA Autoimmune/Collagen disorders - systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease. Leukemias Lymphoproliferative disorders Chronic lymphocytic leukemia (CLL) (common) Large granular lymphocytic leukemia (LGL)(common) ABO-incompatible stem cell transplant Solid tumors Thymoma is strongly associated Virus Parvovirus B19 (most common) - can lead to transient aplastic crises Human immunodeficiency virus (HIV) T-cell leukemia-lymphoma virus, Epstein-Barr virus (EBV) Hepatitis A, B, C, and E Cytomegalovirus Bacterial infections - group C streptococcus, tuberculosis, bacterial sepsis Drugs - recombinant erythropoietin (rhEPO) is most common. Reference: Robbins, 10 th edition, page number 384

The neoplastic diseases considered to be AIDS-defining conditions are Kaposi's sarcoma, non-Hodgkin's lymphoma and invasive cervical carcinoma. In addition, there is also an increase in the incidence of a variety of non- AIDS-defining malignancies: Hodgkin's disease; Multiple myeloma; Leukemia; Melanoma; and Cervical, brain, testicular, oral, lung, gastric, liver, renal and anal cancers. Reference: Robbins, 9th ed, Pg: 253.

Both initiators and promotors are required for cancer to occur. Reference: Robbins and Cotran Pathologic Basis of Diseases, 10 th ed, Pg: 321.