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DIRECTIONS: Choose the one best response to each question.

Which of the following is the most significant risk factor for cancer?

A. Age

B. Family history

C. Obesity

D. Tobacco

The answer is A. (Chaps. 65, 66, and 67) The most significant risk factor for cancer overall is age; two-thirds of all cases were in those aged >65 years. Only a small fraction of cancers occurs in patients with a genetic predisposition. Risk of certain cancers appears to increase modestly (relative risks generally in the 1.0–2.0 range) as body mass index (BMI) increases beyond 25 kg/m2. A cohort study of >5 million adults included in the UK. Clinical Practice Research Datalink (a primary care database) found that each 5 kg/m2 increase in BMI was linearly associated with leukemia and cancers of the uterus, gallbladder, kidney, cervix, and thyroid. Positive associations were also noted between BMI and colon, liver, ovarian, and postmenopausal breast cancers, but these associations were not linear and the effect varied by individual characteristics. However, obesity is not the most significant risk factor and high BMI appears to have an inverse association with prostate and premenopausal breast cancer. Tobacco smoking is a strong, modifiable risk factor for cardiovascular disease, pulmonary disease, and cancer. Smokers have an approximately one in three lifetime risk of dying prematurely from a tobacco-related cancer or cardiovascular or pulmonary disease.

Mr. Borr is a 66-year-old man, recently diagnosed with multiple myeloma after presenting with fatigue from anemia and lower back pain. Further evaluation found malignant bone lesions in his thoracic and lumbar spine. He was started on multi-agent treatment 6 weeks ago and comes in for follow-up. He has been feeling well with decreased pain and denies any new side effects from treatment. He wants to know if his disease is responding to the current therapy. Which test would be the most helpful in assessing his response to treatment?

A. Complete blood count

B. Fluorodeoxyglucose-positron emission tomography scan

C. Flow cytometry

D. Lactate dehydrogenase

E. Monoclonal immunoglobulin

The answer is E. (Chap. 65) Tumor markers may be useful in patient management in certain tumors. Response to therapy may be difficult to gauge with certainty. However, some tumors produce or elicit the production of markers that can be measured in the serum or urine, and in a particular patient, rising and falling levels of the marker are usually associated with ...

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