A 65-Year-Old Woman Is Being Evaluated Following an Episode of Syncope

question 446

Multiple Choice

A 65-year-old woman is being evaluated following an episode of syncope that occurred after prolonged standing.  She used to exercise in the local gym but has become easily fatigued recently.  The patient has had occasional dark stools.  She has lost 5 kg (11 lb) in the past few weeks due to "poor appetite."  She does not smoke, drink alcohol, or use illicit drugs.  Family history is negative for cancers.  Vital signs reveal mild orthostatic hypotension.  Physical examination is unremarkable, but stool is positive for occult blood.  Colonoscopy reveals 2 polyps.  The pathology report shows advanced adenomatous changes in one polyp and adenocarcinoma in the other.  A mutation in which of the following genes is most likely responsible for the transformation from advanced adenoma to adenocarcinoma in this patient?

• A)BRCA1
• B)CCND1
• C)KRAS
• D)NMYC
• E)TP53
• F)WT1