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Oncology > Eugene Oncology > Flashcards

Eugene Oncology Flashcards

1
Q

increased lifetime estrogen exposure, BRCA, 1st degree relative, increased density, obesity, alcohol

A

Breast Cancer : Epi/Risk Factors

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2
Q

Most common cancer in women in US (rising), 2nd leading cause of death (falling), 1 in 8

A

Breast Cancer : Signs/Symptoms/Findings

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3
Q

sporadic>familial>hereditary(BRCA1)>BRCA2

A

Breast Cancer Etiology

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4
Q

chro 17q OR 13q mutation of dsDNA repair

A

BRCA 1 and 2

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5
Q

1:400 (1:40 Ash. Jews), 40%-60% breast, 20-40%ovarian, earlier onset, male risk of breast, prostate and pancreative cancer

A

BRCA cancer prevalence

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6
Q

> 1% of cells are ER+ or PR+ (treat with tamoxifen)

A

Breast Cancer : Good Prognosis (most have 85-100% 5 year survival

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7
Q

LN mets, more aggressive/less differentiated, HER2 gene

A

Breast Cancer, poor prognosis

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8
Q

EGFR, chro 17, amplification of cell proliferation and resistance to apoptosis, tx: trastuzumab + chemo

A

HER2 mutations

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9
Q

don’t treat with doxy. Increased risk of cardiotoxicity

A

HER2 mutation Breast Cancer (Trastuzumab)

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10
Q

lumpectomy & radiation or total mastectomy

A

Local therapy for Breast Cancer

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11
Q

antiestrogen therapy: oophorectomy, leuprolide (blocks hypo-pit axis), tamoxiphen. Post-menopuase: anastrole, letrozole, tamoxifen

A

Er+ breast tumors

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12
Q

cyclophosphamide/cytotoxan, doxorubicin/adriamycin, paclitaxel/taxol

A

general chemo for breast cancer

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13
Q

paclitaxel/taxol

A

indicated for breast cancer in young women with poorly differentiated triple negative tumors (ER-,PR-,HER-)

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14
Q

cancerous cells but no invasion

A

stage 0 breast cancer

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15
Q

tumor <2cm, no LN

A

stage 1 breast cancer

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16
Q

tumor 2-5 cm or <4 LN

A

stage 2 breast cancer

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17
Q

tumor >5 cm or >4 LN

A

stage 3 breast cancer

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18
Q

metastatic

A

stage 4 breast cancer

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19
Q

25% of breast Ca

A

Ductal Carcinoma In Situ (DCIS): Epi/Risk Factors

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20
Q

microcalcification on mamm, fills ductal lumen, nuclear atypia, stage 0

A

Ductal Carcinoma In Situ (DCIS): Signs/Symptoms/Findings

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21
Q

stage 0 neoplastic transformation of E-cadherin+ large ductal epithelial cells (noninvasive)

A

Ductal Carcinoma In Situ (DCIS): Pathophysiology/Diagnosis

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22
Q

8-10x risk of invasive carcinoma, most don’t progress, worse if younger onset, larger size, high histo grade, small margin width

A

Ductal Carcinoma In Situ (DCIS): Prognosis

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23
Q

Ipsilateral risk of invasive cancer

A

Ductal Carcinoma In Situ (DCIS): Treatment/Notes

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24
Q

Often misdiagnosed as inflammatory (e.g. eczema)

A

Paget’s Disease: Epi/Risk Factors AND Signs/Symptoms/Findings AND Picture

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25
Q

Carcinoma of ducts, nipple

A

Paget’s Disease: Pathophysiology/Diagnosis

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26
Q

High risk

A

Paget’s Disease: Prognosis

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27
Q

Ulcerated, scaling nipple lesions

A

Paget’s Disease: Treatment/Notes

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28
Q

Most common breast Ca

A

Invasive Ductal Carcinoma: Epi/Risk Factors

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29
Q

Grossly irregular; better prognosis if one of the better differentiated types

A

Invasive Ductal Carcinoma: Signs/Symptoms/Findings

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30
Q

infiltrative epithelial neoplasm resembing cells lining the ducts/lobules (E-cadherin +)

A

Invasive Ductal Carcinoma: Pathophysiology/Diagnosis

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31
Q

Prognosis: Medullary, colloid, tubular, mucinous good; inflammatory (erythematous, dermal lymphatics involved) bad

A

Invasive Ductal Carcinoma: Prognosis AND Treatment/Notes

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32
Q

invasive ductal carcinoma with abundant lyphocytes, mucin, or dilated tubules

A

medullary, colloid mucinous, or tubular carcinoma; good prognosis

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33
Q

invasive ductal carcinoma with dermal lymphocytic invasion, peau d’orange skin

A

inflammatory carcinoma; bad prognosis

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34
Q

E-cadherin(-) epithelial cells lining acini and terminal ducts

A

Lobular Carcinoma In Situ (LCIS): Signs/Symptoms/Findings

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35
Q

bilateral, multifocal small cells in lobules or ducts. Defined by cell type, not location

A

Lobular Carcinoma In Situ (LCIS): Pathophysiology/Diagnosis

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36
Q

6-9x risk of invasive cancer bilaterally, regardless of original side

A

Lobular Carcinoma In Situ (LCIS): Prognosis

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37
Q

general risk factor for cancer, but not a precursor, not treated surgically

A

Lobular Carcinoma In Situ (LCIS): Treatment/Notes

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38
Q

Bulls eye v. Indian file pattern of small cells with scant cytoplasm, decreased E-cadherin expression

A

Invasive Lobular Carcinoma: Signs/Symptoms/Findings

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39
Q

5-10% of breast cancers, 20% bilateral

A

Invasive Lobular Carcinoma: Epi

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40
Q

rare, advanced age, BRCA2

A

male breast cancer

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41
Q

Infiltrating carcinoma resembling cells lining lobules

A

Invasive Lobular Carcinoma: Pathophysiology/Diagnosis

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42
Q

Tends to be bilateral

A

Invasive Lobular Carcinoma: Treatment/Notes

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43
Q

40-50% of lumps

A

Fibrocystic Changes: Epi/Risk Factors

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44
Q

Fibrosis, cysts, apocrine metaplasia, expansion of periductal stroma

A

Fibrocystic Changes: Signs/Symptoms/Findings AND Picture

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45
Q

Normal part of aging process; increased risk for invasive breast cancer with atypical ductal/lobular hyperplasia, papilloma, adenosis

A

Fibrocystic Changes: Pathophysiology/Diagnosis AND Prognosis AND Treatment/Notes

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46
Q

Cookie-cutter, spherical appearance of ducts; some but not all features of in situ carcinoma

A

Atypical Ductal Hyperplasia: Signs/Symptoms/Findings

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47
Q

8-10% risk of progressing t ocarcinoma (ALH>ADH)

A

Atypical Ductal Hyperplasia: Prognosis

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48
Q

Bimodal: 20s, 40s

A

Fibroadenoma: Epi/Risk Factors

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49
Q

Lots of stroma, small mobile firm ball-like mass w/sharp edges, increased breast size and tenderness, esp. menses, pregnancy

A

Fibroadenoma: Signs/Symptoms/Findings

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50
Q

Benign fibroepithelial tumor, most common benign tumor, rarely leads to cancer

A

Fibroadenoma

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51
Q

Benign papillary neoplasm within duct, bloody discharge

A

Intraductal Papilloma: Signs/Symptoms/Findings

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52
Q

Can be peripheral or central (nipple), up to 2x risk if peripheral

A

Intraductal Papilloma: Pathophysiology/Diagnosis

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53
Q

50 yo, cured via excision

A

Cystosarcoma Phyllodes: Epi/Risk Factors

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54
Q

fibroepithelial neoplasm, Lots of stroma, invaginates into ducts

A

Cystosarcoma Phyllodes: Signs/Symptoms/Findings AND Picture

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55
Q

p53 inactivating, k-ras activating, EGFR mutation (activates k-ras), chimeric gene of EML4 & ALK

A

genetic abnormalities in lung cancer

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56
Q

chimeric gene of EML4 and ALK

A

genetic abnormality in nonsmoking lung cancer

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57
Q

k-ras activating mutation, constituitive activation of a GTPase and all downstream enzymes

A

genetic abnormality in 25% of adenocarcinoma, often in smokers

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58
Q

asbestos, ionizing radiation, benzypyrene (steel smelting), chloro-methyl ether

A

lung cancer carcinogens

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59
Q

percent of heavy smokers who get lung cancer

A

10-20%

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60
Q

risk increases greatly with exposure to multiple carcinogens (synergy)

A

lung cancer

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61
Q

highest cancer mortality, 2nd highest incidence (decreasing)

A

lunger cancer

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62
Q

Smoking causes 80-90%

A

Lung Cancer: Epi/Risk Factors

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63
Q

Cough, dyspnea, SVC syndrome, hoarseness (bad prognosis), clubbing, infxn/pneumonia, etc.

A

Lung Cancer: Signs/Symptoms/Findings

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64
Q

Dx: transbronchial biopsy, bronchoscopy, CT screening (decreases mortality 20%)

A

Lung Cancer: Picture

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65
Q

mets to brain, bones, liver, ADRENALS

A

lung cancer

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66
Q

Precursor lesions: atypical adenomatous hyperplasia, squamous, DIPNECH

A

Lung Cancer: Pathophysiology/Diagnosis

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67
Q

Screening by low-dose helical CT = 20% mortality reduction; EGFR TKIs helpful (see drug chart)

A

Lung Cancer: Treatment/Notes

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68
Q

Central, hilar, high grade poorly differentiated tumor

A

Small Cell Lung Carcinoma (aka Oat Cell): Signs/Symptoms/Findings

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69
Q

Older Age, smoking related

A

Small Cell Lung Carcinoma Epi

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70
Q

large central tumor w/necrosis, extrapulmonary disease, high N:C, nuclear molding, salt and pepper chromatin, high grade (mitoses and apoptosis), poorly differentiated (few granules)

A

Small Cell Lung Carcinoma (aka Oat Cell): Pathophysiology/Diagnosis

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71
Q

Only 5% found early

A

Small Cell Lung Carcinoma (aka Oat Cell): Prognosis

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72
Q

Poor prognosis, associated with SIADH, Cushing’s

A

Small Cell Lung Carcinoma (aka Oat Cell): Treatment/Notes

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73
Q

cell type: neuroendocrine: neurosecretory cells in airway epithelium which control smooth muscle tone

A

Carcinoid, Small Cell Lung Carcinoma

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74
Q

central, low grade, salt & pepper chromatin, nests and chords, well-differentiated w/neurosecretory granules

A

Carcinoid Lung Cancer: Signs/Symptoms/Findings

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75
Q

NE cell hyperplasia, tumorlet invades through airway wall, formation of microscopic nodule

A

Carcinoid Lung Cancer

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76
Q

Younger, nonsmoker

A

Carcinoid Lung Cancer Epi

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77
Q

Invasive, peripheral tumor can produce umbilicated lesion, may form glands (goblet cells, clara cells, type 2 pneumocytes)

A

Adenocarcinoma: Signs/Symptoms/Findings

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78
Q

most common cancer of nonsmokers

A

Adenocarcinoma: Epi

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79
Q

atypical adenomatous hyperplasia, in situ: ground glass histo, still has some functional alveoli, then forms invasive adenocarcinoma

A

Adenocarinoma

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80
Q

Disorganized, nested keratinization (pearls), central tumor with squamous differentiation, adhesions and bridges

A

Squamous Cell Carcinoma: Signs/Symptoms/Findings

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81
Q

squamous dysplasia in metaplastic bronchial cells, nuclear stratification and atypia

A

Squamous Cell Carcinoma: Signs/Symptoms/Findings

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82
Q

Early stage NSCLC: Surgery (lobectomy vs. wedge), XRT/RF ablation if nonsurgical, adjuvants: Cisplatin + Vinorelbine, Gemcitabine or Pemetrexed

A

treatment for all non-small cell carcinomas: adeno, squamous, large and giant cell

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83
Q

radiotherapy at site, LN, and brain prophylactic Etoposide and Cisplatin

A

treatment for all small-cell

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84
Q

Cisplatin and second agent, plus Erlotinib (TK inhibitor, for EGFR mutation) or Crizotinib (TKi for ALK)

A

treatment for metastatic lung cancer (e.g. of skeleton/brain)

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85
Q

High grade, non-differentiated tumor, poor prognosis, giant cell variant

A

Large Cell Carcinoma: Signs/Symptoms/Findings

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86
Q

3rd most common cancer, 10% of cancer deaths

A

Colorectal Cancer: Epi/Risk Factors

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87
Q

over 50, first degree relative, polyps(15-20%), IBD (15-40%), western diet

A

Colorectal Cancer: Epi/Risk Factors

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88
Q

AK53 leads to loss of APC/beta-catenin leads to k-ras mutation leads to p53 mutation

A

Colorectal Cancer

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89
Q

Tends to metastasize to lymphatics, liver via portal circulation

A

Colorectal Cancer: Signs/Symptoms/Findings

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90
Q

65-85% sporadic, 10-25% familial, 6% hereditary syndromes; stage I even if invades muscularis

A

Colorectal Cancer: Pathophysiology/Diagnosis

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91
Q

1 Cause of Ca death in non-smokers

A

Colorectal Cancer: Prognosis

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92
Q

Risk factors: developed nations , age, smoking, meat, decreased fiber and exercise, family history, polyps, IBD < HNPCC (~80%) < FAP (~95%)

A

Colorectal Cancer: Treatment/Notes

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93
Q

AD APC loss, 30% de novo. 1% of CRCs, 100% lifetime risk of CRC

A

Familial Adenomatous Polyposis (FAP): Epi/Risk Factors

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94
Q

100s-1000s of polyps

A

Familial Adenomatous Polyposis (FAP): Signs/Symptoms/Findings

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95
Q

blocks beta-catenin, stopping growth and proliferation via Wnt pathway

A

normal APC gene

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96
Q

APC gene sequencing, k-ras, congential hypertrophy of retinal pigment epithelium

A

Familial Adenomatous Polyposis (FAP): Pathophysiology/Diagnosis

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97
Q

desmoid tumors (benign), brain, thyroid and duodenal cancers

A

Familial Adenomatous Polyposis (FAP): Prognosis

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98
Q

Screening: Sigmoidoscopy at 10-12 yo, q2yr after for FAP (start yearly colonoscopy in 20s for Lynch) Tx: Surgery for localized, XRT for rectal; Stg. III/IV: 5-FU, Irinotecan, Oxaliplatin, Bevacizumab, Cetuximab/Panitumumab

A

Familial Adenomatous Polyposis & Lynch Syndrome

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99
Q

AD, early age (40s)

A

Lynch Syndrome (HNPCC): Epi/Risk Factors

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100
Q

Multiple primary cancers (endometrium, ovary, GU tract, etc.); more likely to be right-sided, MSIs

A

Lynch Syndrome (HNPCC): Signs/Symptoms/Findings

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101
Q

lifetime risk of CRC 70%, accelerated polyp to tumor timeline

A

Lynch Syndrome

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102
Q

Right v. left in CCR

A

Right bleeds, left obstructs (look for anemia, not blood)

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103
Q

IHC staining for MLH1 and 2 shows decrease, BRAF mutation

A

Lynch Syndrome (HNPCC): Diagnosis

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104
Q

DNA mismatch repair defects leads to MSIs leads to normal tumor initiation, increased progression

A

Lynch Syndrome (HNPCC): Pathophysiology

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105
Q

Bethesda guidelines for risk

A

Lynch Syndrome (HNPCC): Prognosis

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106
Q

precancerous, low surface maturation, enlarged nuclei, low mucin, purple/ble, MIB-1/Ki67 positive (proliferation)

A

Adenomatous Polyp: Signs/Symptoms/Findings

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107
Q

Malignancy risk, endoscopic resection if pedunculated, sessile if small

A

Adenomatous Polyp: Prognosis

108
Q

no risk, grossly flatter, sawtooth appearance of surface epithelium due to increased epithelium

A

Hyperplastic Polyp

109
Q

Benign except for sessile serrated adenomas (SSAs)

A

Hyperplastic Polyp

110
Q

Most lethal US cancer, average prognosis 1 y

A

Pancreatic Cancer

111
Q

M>F, >50 yo, mean age 72, smoking, DM, family history

A

Pancreatic Ductal Adenocarcinoma (90% of Pancreatic Cancers): Epi/Risk Factors

112
Q

k-ras mutation leads to p16/CDKN2a, leads to TP53 and SMAD4

A

pancreatic ductal adenocarcinoma: sporadic over time

113
Q

BRCA2 and the pancreas

A

pancreatic ductal adenocarcinoma: familial mutation

114
Q

hMLH1 and hMSH2

A

pancreatic ductal adenocarcinoma: sporadic or familial (5% of cancers)

115
Q

most arise from exocrine cells, surrounded by dense stroma/fibrosis

A

pancreatic ductal adenocarcinoma

116
Q

Sx: Painless jaundice, weight loss, linear lower back pain relieved in fetal position, malabsorption, depression. Histo: Loss of polarity and lobular architecture, atypia, neural invasion

A

Pancreatic Ductal Adenocarcinoma (90% of Pancreatic Cancers): Signs/Symptoms/Findings

117
Q

diffuse upper abdominal pain

A

tail/body pancreatic cancer

118
Q

obstructive jaundice (rare)

A

head pancreatic cancer, obstructs common bile duct

119
Q

new onset diabetes (rare)

A

pancreatic cancer, secondary to destruction of pancrease

120
Q

gastric outlet obstruction, gastric bleeding, pain and impaired motility, liver, bone, lung, CNS

A

pancreatic cancer metastasis

121
Q

Poor (most present late stage), <4% 5-yr OS; biliary obstruction = better (since in head)

A

Pancreatic Ductal Adenocarcinoma (90% of Pancreatic Cancers): Prognosis

122
Q

Tx: Whipple pancreatoduodenectomy if resectable (<20%); adjuvant chemo or radiation always, gemcitabine for palliative chemo

A

Pancreatic Ductal Adenocarcinoma (90% of Pancreatic Cancers): Treatment/Notes

123
Q

Trousseau’s syndrome (hypercoagulability) if Lewis blood group antigens are >1000; redness and tenderness on palpation of hands and feet

A

complications of pancreatic ductal adenocarcinoma

124
Q

Parenchymal necrosis, PMN infiltrate, bacterial or parasitic (amebiasis) if abscess, echinococcus if cyst

A

Liver Abscess or Cyst

125
Q

Young women’s Livers

A

Hemangioma, Liver Cell adenoma, focal nodular hyperplasia

126
Q

Large, painful, rarely rupture, veins > arteries, most common benign liver tumor

A

Hemangioma

127
Q

No bile ducts, benign hepatocyte tumor, central scarring, arterial malformations

A

Liver Cell Adenoma

128
Q

Too much perfusion, results in nodules resembling cirrhosis

A

Focal Nodular Hyperplasia

129
Q

Most common tumor in liver

A

Metastatic Liver Cancer: Epi/Risk Factors

130
Q

Desmoplasia, hemorrhage, central necrosis

A

Metastatic Liver Cancer: Signs/Symptoms/Findings

131
Q

Commonly from colorectal, pancreas, lung breast

A

Metastatic Liver Cancer: Pathophysiology/Diagnosis

132
Q

Elderly, M>F, cirrhosis; most common primary tumor

A

Hepatocellular Carcinoma (HCC): Epi/Risk Factors

133
Q

Microtrabecular pattern, look normal but falling apart because of decreased adhesion molecules

A

Hepatocellular Carcinoma (HCC): Signs/Symptoms/Findings

134
Q

75% have cirrhosis + serum AFP(+), HBV biggest cause worldwide, steatohepatitis is another common cause

A

Hepatocellular Carcinoma (HCC): Pathophysiology/Diagnosis

135
Q

Invades veins (portal, hepatic, IVC to lungs)

A

Hepatocellular Carcinoma (HCC): Prognosis

136
Q

Screen cirrhosis pts; Tx: transplant based on Milan criteria, resect if liver fxn good, RF ablation / chemoembolization, Sorafenib

A

Hepatocellular Carcinoma (HCC): Treatment/Notes

137
Q

Young, 20s, no risk factors

A

Fibrolamellar Carcinoma of Liver: Epi/Risk Factors

138
Q

Parallel lamellae of fibrosis + big hepatocytes

A

Fibrolamellar Carcinoma of Liver: Signs/Symptoms/Findings

139
Q

Better prognosis than HCC

A

Fibrolamellar Carcinoma of Liver: Prognosis

140
Q

Liver: Local resection

A

Fibrolamellar Carcinoma of Liver: Treatment/Notes

141
Q

Malignant glands + desmoplasia

A

Cholangiocarcinoma: Signs/Symptoms/Findings AND Picture

142
Q

Bile duct carcinoma; caused by liver flukes from fish, PSC, gallstone disease

A

Cholangiocarcinoma: Pathophysiology/Diagnosis AND Prognosis AND Treatment/Notes

143
Q

Men in 40s

A

Biliary Cancers: Epi/Risk Factors

144
Q

Caused by PSC, gallbladder dz, parasites, genetic; resect ± liver transplant

A

Biliary Cancers: Pathophysiology/Diagnosis AND Prognosis AND Treatment/Notes

145
Q

M>F, smoking, achalasia, black

A

Squamous Cell Carcinoma (SCC): Epi/Risk Factors

146
Q

Dysphagia, wt loss, dysplastic epithelium (GI/esophageal)

A

Squamous Cell Carcinoma (SCC): Signs/Symptoms/Findings

147
Q

Dx: Upper endoscopy + biopsy

A

Squamous Cell Carcinoma (SCC): Pathophysiology/Diagnosis

148
Q

Poor (37% localized, 3% met)

A

Squamous Cell Carcinoma (SCC): Prognosis

149
Q

Early: EMR; Advanced: chemoradiation ± esophagectomy; Mets: palliative

A

Squamous Cell Carcinoma (SCC): Treatment/Notes

150
Q

M>F, smoking, white, GERD

A

Esophageal Adenocarcinoma (EAC): Epi/Risk Factors

151
Q

Dysphagia, wt loss, tends to be lower 1/3

A

Esophageal Adenocarcinoma (EAC): Signs/Symptoms/Findings

152
Q

Dx: Upper endoscopy + biopsy

A

Esophageal Adenocarcinoma (EAC): Pathophysiology/Diagnosis

153
Q

Poor (37% localized, 3% met)

A

Esophageal Adenocarcinoma (EAC): Prognosis

154
Q

Early: EMR; Advanced: chemoradiation ± esophagectomy; Mets: palliative

A

Esophageal Adenocarcinoma (EAC): Treatment/Notes

155
Q

Intestinal metaplasia 2/2 GERD can lead to EAC, EMR indicated in high grade dysplasia

A

Barrett’s Esophagus

156
Q

M=F, Wt loss, Virchow’s node, Sis. Mary Joseph’s nodule, Krukenberg’s tumor, acanthosis nigricans

A

Diffuse Gastric Cancer: Signs/Symptoms/Findings

157
Q

Signet ring cells, linitis plastica

A

Diffuse Gastric Cancer: Picture

158
Q

AD inherited CDH1/E-cadherin mutations

A

Diffuse Gastric Cancer: Pathophysiology/Diagnosis

159
Q

Poor, usually late stage

A

Diffuse Gastric Cancer: Prognosis

160
Q

Prophylactic gastrectomy

A

Diffuse Gastric Cancer: Treatment/Notes

161
Q

H. Pylori, M>F, developing

A

Intestinal Pattern Gastric Cancer: Epi/Risk Factors

162
Q

Wt loss, Virchow’s node, Sis. Mary Joseph’s nodule, Krukenberg’s tumor, acanthosis nigricans

A

Intestinal Pattern Gastric Cancer: Signs/Symptoms/Findings

163
Q

Resembles adenocarcinoma, gland-forming

A

Intestinal Pattern Gastric Cancer: Picture

164
Q

Most common histology for early gastric cancer

A

Intestinal Pattern Gastric Cancer: Pathophysiology/Diagnosis

165
Q

More likely to be caught early

A

Intestinal Pattern Gastric Cancer: Prognosis

166
Q

Surgery + adjuvant chemo, trastuzumab if Her2(+), palliative if unresectable

A

Intestinal Pattern Gastric Cancer: Treatment/Notes

167
Q

Gyn Cancer Mortality

A

ovarian>uterine>cervial>vulvar>vaginal

168
Q

Gyn Cancer Incidence

A

uterine/endo>ovarain>cervical>vulvar>vaginal

169
Q

poor middle aged female, young first intercourse, multiple partners, smoking, immunosuppression

A

Cervical Cancer: Epi/Risk Factors

170
Q

bleeding: intermenstrrual, postcoital, heavy. Cachexia, wt. loss, anemia of chronic inflammation

A

Cervical Cancer: Signs/Symptoms/Findings

171
Q

HPV16, 19 persistent infxn (10%) leads to viral encoded E6 (degrades p53) and E7 (increase DNA synth enzymes) leads to dysplasia, leads to cancer. HPV is causative agent (99.9%) along with other cofactors (OCPs, STDs, etc.)

A

Cervical Cancer: Pathophysiology/Diagnosis

172
Q

Good but very stage-dependent

A

Cervical Cancer: Prognosis

173
Q

Early: Radical surgery w/ adjuvant chemoradiation (cisplantin); Advanced: RT + brachy, chemo; Recurrent: no cure

A

Cervical Cancer: Treatment/Notes

174
Q

80% of cervical cancer, ectocervix, eosinophils cytoplasm w/multiple nucleoli, premaginancy can be IDed on Pap

A

squamous cell type cervical cancer

175
Q

10-15% of cervical cancer, arises in cervical canal

A

adenocarninoma type cervical cancer

176
Q

Gardasil (HPV 16, 18, 6, 11) for M/F 9-26. most efficacy pre-sexual activity onset

A

Cervical cancer prevention

177
Q

60 yo, post-menopausal

A

uterine cancer epi

178
Q

obesity, estrogen replacement, tamoxifen, late menopause

A

uterine cancer risks

179
Q

use of OCPs is protective

A

uterine cancer, ovarian cancer

180
Q

HNPCC/Lynch (MLH1, MSH2/6, PMS2); PTEN or p53 LOF

A

etiologies of uterine cancer

181
Q

poor prognosis in uterine cancer

A

sarcomas, arise in muscular wall of uterus

182
Q

endo cancer in uterus

A

stage 1

183
Q

endo cancer in uterus and cervix

A

stage 2

184
Q

endo cancer in local pelvis tissue

A

stage 3

185
Q

endo cancer with mets

A

stage 4

186
Q

90-95% adenocarcinomas, rest sarcomas (carcino-sarcoma, leiomyosarcoma)

A

Uterine Cancer: Pathophysiology/Diagnosis

187
Q

F, 50-70 yo, W>B, industrialized nations

A

Ovarian Cancer Epi

188
Q

Abd/pelvic mass, early satiety, pain , ascites, N/V, pleural effusion, distention

A

Ovarian Cancer: Signs/Symptoms/Findings

189
Q

increased # menstrual cycles, no OCP use, BRCA, HNPCC

A

ovarian cancer risks

190
Q

use of OPC cuts Ovarian cancer risk

A

by half

191
Q

10% from Hereditary Cancer Syndrome or HNPCC, 90% sporadic

A

Ovarian Cancer: Pathophysiology/Diagnosis

192
Q

Poor, 70% advanced

A

Ovarian Cancer: Prognosis

193
Q

Early: Surgery (TAH/BSO, lymphadenectomy / omentectomy) ± adjuvant chemo (carboplatin/paclitaxel); Advanced: Surgical cytoreduction + adjuvant chemo (IV or intraperitoneal) ± neoadjuvant; High relapse rate (80% advanced)

A

Ovarian Cancer: Treatment/Notes

194
Q

Serous (fronds of papillary tissue), mucinous (glandular, mucinous, colonic-like tissue)

A

Epithelial Ovarian Tumors: Pathophysiology/Diagnosis

195
Q

F 16-20, acute abdominal pain, fertility-conserving surgery, good prognosis, unique markers

A

Germ Cell tumor epi

196
Q

dysgerminoma, yolk sac tumor, im/mature teratomas, embryonal carcinoma, choriocarcinoma, gonadoblastoma

A

Germ cell tumors

197
Q

unique marker: LDH

A

germ cell tumor: dysgerminoma

198
Q

unique marker: AFP, Schiller-Duval bodies (cleared out spaces around vessels)

A

germ cell tumor: yolk sac tumor

199
Q

unique marker: hCG

A

germ cell tumor: choriocarcinoma

200
Q

Sex cord stromal tumors arise from ovarian mesenchyme, leads to early sexual development, secrete estrogen, inhibin

A

Granulosa Cell Ovarian Tumors, Sertoli-Leydig Tumors

201
Q

Call-Exner bodies, coffee-bean nuclei, secrete estrogen, inhibin

A

Granulosa Cell Ovarian Tumors

202
Q

95% adult type, Tx: Surg

A

Granulosa Cell Ovarian Tumors: Pathophysiology/Diagnosis

203
Q

Good prognosis gyn cancers

A

Granulosa Cell Ovarian Tumors, Germ cell tumors

204
Q

Secrete androgen, poorly differentiated

A

Sertoli-Leydig Cell Tumors: Signs/Symptoms/Findings

205
Q

Dysgerminoma (50%), yolk-sac tumors (20%)

A

Germ Cell Tumors: Pathophysiology/Diagnosis

206
Q

smokers, obese, HTN

A

Renal Cell Carcinoma: Epi/Risk Factors

207
Q

Nearly 50% found incidentally on CT, 1/3 met@dx; paraneoplastic syndromes

A

Renal Cell Carcinoma: Signs/Symptoms/Findings

208
Q

Triad of hematuria, flank pain, abdominal mass only seen in 10%

A

Renal Cell Carcinoma: Picture

209
Q

fever w/o infxn, hypercalcemia (due to PTHrP or prostaglandins), Erythrocytosis (Epo), cachexia, weight loss, anemia

A

Renal Cell carcinoma: pareneoplastic syndrome

210
Q

HIF almost always involved: 75% clear cell (VHL gene mut), papillary (HPRC (MET pathway) or HLRCC), chromophobe or oncocytoma (Birt-Hogg Dube)

A

Renal Cell Carcinoma: Pathophysiology/Diagnosis AND Prognosis

211
Q

Tx: nephrectomy (even if mets), sorafenib and sunitinib only decent treatments, mTOR inhibitors also approved

A

Renal Cell Carcinoma: Treatment/Notes

212
Q

Hemangioblastomas in CNS, retina; pheochromocytoma

A

extrarenal renal cell carinoma presentation

213
Q

loss of chro 3p (VHL)’ nests of clear cells, separated by delicate vascularture, most common

A

Clear Cell RCC, worst prognosis

214
Q

chro 7 & 17 trisomy, cuboid to columnar epithelial cells lining fibrovascular cores, papillary architecture, 10-20%

A

Papillary RCC, more favorable prognosis than clear cell

215
Q

loss of chro 1,6,10; sheets of eosinophils w/prominent PM and raisinoid nuclie, 5-10%

A

Chromophobe RCC, ver ygood prognosis

216
Q

oncocytoma, collecting duct carcinoma, urothelial carcinoma

A

very rare RCC variants

217
Q

limited to kidney, excellent 5y survival

A

stage 1 & 2 RCC

218
Q

extrarenal invasion of veins, (renal vein to IVC), LN, or peri-renal tissue

A

stage 3 RCC

219
Q

metastatic spread with relatively poor five year survival

A

stage 4 RCC

220
Q

most common peds kidney cancer, 2-5 yo

A

Wilms Tumor (nephroblastoma)

221
Q

LOF in Wt1 (11p13), from hereditary syndrome (denys-drash) or sporadic mutation

A

Wilms Tumor (nephroblastoma)

222
Q

huge flank mass, grossly hemorrhagic with blastemal, stromal and epithelial (triphasic) elements

A

Wilms Tumor (nephroblastoma)

223
Q

7-8% of renal cancers, arise from renal pelvis

A

epithelial carcinoma

224
Q

Most common Ca and Ca death cause in 20-34yo

A

Testicular Cancer: Epi/Risk Factors

225
Q

Most are germ cell tumors (95%)

A

testicular cancers (other: gonadal stromal and mesenchyme of supporting stroma)

226
Q

15-35 y/o male, low mortality, white>black, asian

A

testicular cancer epi

227
Q

most are malignant (95%)

A

Testicular tumors

228
Q

cryptorchidism, HIV, estrogen/DES exposure in utero

A

Testicular Cancer: Risks

229
Q

Choriocarcinoma - increased HCG; yolk sac + embryonal - increased AFP

A

Testicular Cancer: Picture

230
Q

painless mass, dull ache or heavy sensation in lower abdomen, perianal area or scrotum, or acute pain

A

Testicular Cancer Presentation

231
Q

40% seminoma, 30% NSGCT (choriocarcinoma, yolk sac, teratoma, embryonal)

A

Testicular Cancer: Pathophysiology/Diagnosis

232
Q

Cure rate 95% but risk of 2° malig w/ Tx

A

Testicular Cancer: Prognosis

233
Q

Seminoma Tx: surg + prophylactic XRT, chemo if fail; NSGCT: cisplatin, etoposide, bleomycin

A

Testicular Cancer: Treatment/Notes

234
Q

increased APF and/or betaHCG +/- LDH

A

non-seminomatous testicular cancer

235
Q

increased betaHCG +/- LDH

A

seminomatous testicular cancer

236
Q

stromal tumor, benign, excess androgen leads to precocious puberty, gynecomastia

A

leydig cell tumor

237
Q

bright yellow lipidy tumor with pink granular cytoplasm, Reinke crystals

A

leydig cell tumor

238
Q

benign tumor from tunica mesothelium

A

adenomatoid tumor

239
Q

most common testicular tumor in males over 50

A

malignant lymphoma

240
Q

M>F, smoking, urine cytology

A

Bladder Cancer: Epi/Risk Factors/Dx

241
Q

90-95% Transitional cell; localized (80%) and invasive cancers very different

A

Bladder Cancer: Pathophysiology/Diagnosis

242
Q

Low invasion risk but field effects

A

Bladder Cancer: Prognosis

243
Q

Early Tx: intravesical BCG; Invasive: radical cystectomy ± neoadjuvant chemo Mets: cisplatin combos

A

Bladder Cancer: Treatment/Notes

244
Q

increased Age biggest factor, family Hx, black>white

A

Prostate Cancer: Epi/Risk Factors

245
Q

Prevention hasn’t really panned out. PSA screening no longer recommended

A

Prostate Cancer: Signs/Symptoms/Findings

246
Q

Loss of GSTP1 starts down road towards PTEN/p53/Rb/Myc loss

A

Prostate Cancer: Pathophysiology/Diagnosis

247
Q

Localized Tx: brachytherapy, radical surg, fancy radiotherapy; Locally advanced: radiotherapy + neoadjuvant hormonal therapy; Mets: androgen ablation if high grade, hormonal tx if resistant

A

Prostate Cancer: Prognosis AND Treatment/Notes

248
Q

M>F, 60-70yo, poor prognosis

A

Conventional Squamous Cell Carcinoma (SCC): Epi/Risk Factors

249
Q

Histo: keratin pearls

A

Conventional Squamous Cell Carcinoma (SCC)

250
Q

hoarseness: throat, nasal fullness and bleeding: nose; mass or ulcer: tongue

A

Conventional Squamous Cell Carcinoma (SCC)

251
Q

Tobacco + EtOH are risk factors, loss of p16

A

Conventional Squamous Cell Carcinoma (SCC): Pathophysiology/Diagnosis

252
Q

I&II: unimodal radiation. III (LN involvement): ? IV (mets or below clavicle): palliative

A

Conventional Squamous Cell Carcinoma (SCC): Treatment/Notes

253
Q

M>F, oral sex, oropharynx, younger pt

A

HPV-Related SCC: Epi/Risk Factors

254
Q

p16 overexpression, Generally non-keratinizing, better prognosis

A

HPV-Related SCC: Pathophysiology/Diagnosis

255
Q

Geographic necrosis, perineural, bone, vascular invasion, infiltrative growth

A

Salivary Gland Cancer: Signs/Symptoms/Findings

256
Q

Mucoepidermoid most common, adenoid cystic common in minor glands

A

Salivary Gland Cancer: Pathophysiology/Diagnosis

257
Q

Peds, Embryonal good, alveolar (PAX-FKHR) bad

A

Rhabdomyosarcoma: Pathophysiology/Diagnosis AND Prognosis

258
Q

Peds, Painless mass, sclerosis, Codman’s triangle, lace-like osteoid deposition on histology

A

Osteosarcoma: Epi/Risk Factors AND Signs/Symptoms/Findings

259
Q

Peds: Small, round blue cell tumor, with anemia, permeating appearance on XR, increased ESR

A

Ewing’s Sarcoma

260
Q

EWS-FLI1 gene product, responsive to chemo

A

Ewing’s Sarcoma

261
Q

Lipid vesicles, adults

A

Liposarcoma: Signs/Symptoms/Findings AND Pathophysiology/Diagnosis

262
Q

adultss, fibrous tissue, Spindled cells, uniform features

A

Fibrosarcoma: Signs/Symptoms/Findings AND Picture

263
Q

adults: Malaligned smooth muscle fibers

A

Leiomyosarcoma: Signs/Symptoms/Findings AND Picture

264
Q

aka Malignant fibrous histiocytoma, Not good prognosis

A

High Grade Undifferentiated Pleomorphic Sarcoma: Pathophysiology/Diagnosis

265
Q

c-KIT mutation leads to sarcoma, treat w/Imatinib

A

GI Stromal Tumor (GIST)

Oncology (5 decks)

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