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1. What is the initial step in the metastatic process?
 A. Angiogenesis
 B. Intravasation
 C. Adhesion
 D. Invasion
 Answer: D. Invasion is the initial step where cancer cells break through
the local tissue barriers.
2. During metastasis, how do cancer cells travel to distant sites?
 A. Through the bloodstream only
 B. Through lymphatic vessels only
 C. Either through bloodstream or lymphatic vessels
 D. Via transcellular migration
 Answer: C. Cancer cells can travel to distant sites either through the
bloodstream or lymphatic vessels.
3. Which of the following is a key feature of metastatic cancer cells?
 A. High differentiation
 B. Low mitotic index
 C. Evasion of apoptosis
 D. Limited angiogenesis
 Answer: C. Evasion of apoptosis is a key feature that allows metastatic
cancer cells to survive and proliferate.
4. What role does the extracellular matrix (ECM) play in metastasis?
 A. It supports angiogenesis.
 B. It prevents cancer cell migration.
 C. It provides structural support for tumor growth.
 D. It facilitates invasion and dissemination of cancer cells.
 Answer: D. The ECM facilitates invasion and dissemination of cancer
cells by providing pathways for movement.
5. Which process involves the formation of new blood vessels to supply
nutrients to tumors?
 A. Oncogenesis
 B. Angiogenesis
 C. Lymphogenesis
 D. Carcinogenesis
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