Neoplasia: invasion and metastasis: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Neoplasia: invasion and metastasis

Sample item

In the invasion-metastasis cascade, carcinoma cells must cross the extracellular matrix to reach vessels. Which sequence correctly describes the steps of local invasion?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Loosening of intercellular junctions, degradation of the basement membrane, attachment to new matrix components, migration

Invasion proceeds in four steps: loosening of cell-to-cell junctions (for example loss of E-cadherin), proteolytic degradation of basement membrane and stroma by matrix metalloproteinases, attachment to newly exposed matrix components through integrins, and locomotion of the cell. Cells then enter vessels, travel, arrest and extravasate.

Option by option

  • A. Attachment to matrix components, loosening of intercellular junctions, migration, degradation of the basement membrane

    Attachment cannot precede loosening, because tumour cells are held together until cadherin function is lost.

  • B. Degradation of the basement membrane, attachment to matrix components, loosening of junctions, migration

    Degradation before loosening is out of sequence, as cells must first detach from neighbours.

  • C. Loosening of intercellular junctions, degradation of the basement membrane, attachment to new matrix components, migration (correct)

    Junction loosening, matrix degradation, attachment and migration is the standard order.

  • D. Migration, loosening of intercellular junctions, attachment to matrix components, degradation of the basement membrane

    Migration is the final step and cannot occur before the cell has detached, cleared a path and attached.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is C, Loosening of intercellular junctions, degradation of the basement membrane, attachment to new matrix components, migration. Invasion proceeds in four steps: loosening of cell-to-cell junctions (for example loss of E-cadherin), proteolytic degradation of basement membrane and stroma by matrix metalloproteinases, attachment to newly exposed matrix components through integrins, and locomotion of the cell.

Why is "Attachment to matrix components, loosening of intercellular junctions…" not the answer?

Attachment cannot precede loosening, because tumour cells are held together until cadherin function is lost.

Why is "Degradation of the basement membrane, attachment to matrix components…" not the answer?

Degradation before loosening is out of sequence, as cells must first detach from neighbours.

Why is "Migration, loosening of intercellular junctions, attachment to matrix…" not the answer?

Migration is the final step and cannot occur before the cell has detached, cleared a path and attached.

What concept does this question test?

It tests Neoplasia: invasion and metastasis in Pathology. Cells then enter vessels, travel, arrest and extravasate.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neoplasia: invasion and metastasis?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.