Cancers Flashcards
endometrial cancer- most common type
Adenocarcinoma
endometrial cancer- risk factors
Increasing age >45 Late menopause Early menarche Nulliparity/ infertility Unopposed estrogen OCPs Lynch syndrome Tamoxifen- breast cancer
In general: more periods
endometrial cancer- what is protective?
combined estrogen and progesterone
endometrial cancer- signs and symptoms
bleeding discharge spotting cramps and pain POST MENOPAUSAL bleeing on exam
endometrial cancer screening
not advised if asymptomatic - there is a high % of W that are symptomatic in early stage (confined to uterus)
endometrial cancer- lynch syndrome risk reducing tx
lifetime risk of 54%
hysterectomy- risk reducing
endometrial cancer- diagnosis
bx= GOLD
endometrial cancer- labs and imaging
pap smear
pelvic us- if you see thickening or stripe >4mm–> biopsy
D&C
endometrial cancer- gene
CA125
endometrial cancer- treatment
total hysterectomy + salingo-oophorectomy
RT, chemo
Transition zone
where columnar endocervical cells transform into squamous epithelial
- junction of endocervix & ectocervix
cervical cancer- can obstruct what and lead to what?
obstruct ureters and lead to renal death
cervical cancer- risk factors
HPV- 16&18 & other STIs - HPV present for avg of 15yrs to become cancer Early onset of intercourse Multiple sex partners- partners w multiple partners Smoking OCPs >5yrs Multiple vaginal births- >3 Immunosuppresion DES exposure
cervical cancer- classification
CIS= full thickness but encapsulated
Cancer- beyond cervix to uterus to pelvic walls/vagina to lympth nodes, to bladder/ rectum to distant sites
cervical cancer- signs and symptoms
bleeding
post coidal bleeding
discharge
pelvic or lower back pain
cervical cancer- screening method
pap smear- not diagnostic test - regardless of sexual hx and HPV vaccination status
cervical cancer- screening age 21-29
cytology q 3yrs or
hrHPV starting at 25 q 5yrs in avg risk pts
cervical cancer- screening age 30-65
cytology q 3yrs or
hrHPV q 5yrs or
contesting q 5 yrs
cervical cancer- screening age >65
none after - in last 10 yrs
- 3 (-) in a row cytology
- 2… contesting
- 2… hrHPV
cervical cancer other labs and imaging
colposcopy- if there are no visual lesions but high suspicion or abnormal cytology
bx- anything friable
cervical cancer- treatment- CIN 2 or 3
LEEP- loop electrosurgical excision procedure- excise tissue of interest
- increases risk of scarring or stenosis
cervical cancer- treatment- CIN 3 or CIS
Cone biopsy- goes deeper
- used if larger neoplasia
- more likely to lead to incompetent cervix than LEEP
cervical cancer other treatments besides leep or cone bx?
radical hysterectomy plus pelvic lymphadenectomy, rad, chemo or combo
why is there no screening for cervical cancer if <21?
Increased risk of preterm birth, low birthweight and PPROM- preterm premature rupture of membranes
cervical cancer- follow up
high risk of recurrence
high risk- q 3m to year 5
low risk- q 6 m to year 5
breast cancer- risk factors
hx of ovarian, endometrial or breast cancer BRCA 1 & 2 radiation between ages 10-30 nulliparity delayed childbearing early menarche late menopause estrogen
in general- more menses- estrogen exposures
breast cancer- MC type
ductal carcinoma
breast cancer- signs and symptoms
hard (firm), immobile (fixed), single dominant mass- feels like a marble
thickening, dimpling of skin- peau d’orange
breast cancer- screening method
mammograph- soft tissue mass, speculated, high density
breast cancer screening- <40
not recommended for avg risk individuals
breast cancer screening- 40-49
q 2yrs
consider pts input
breast cancer screening- 50-74
q 2yrs
breast cancer screening- >75
q 2yrs if life expectancy >10yrs
breast cancer screening methods if high risk
also MRI and breast US
breast cancer- breast US
hypoechogenic- more dense
calcifications
shadowing
speculated
breast cancer treatment
Lumpetomy w sentinel bx preferred w early-stage cancer
OR
Mastectomy- Both same outcomes
Radiation therapy
Adjuvant chemo or hormonal therapy
Palliative (if widely metastatic)
breast cancer- ACS screening
annually starting at 40
q 2 yrs starting at age 55
if high risk start at 30 yearly
breast cancer fine vs core needle
Fine needle (localized, if too large) Core needle bx (preferred- size of a pencil- take whole thing out)
what should you do once cancer is confirmed?
Do hormone testing
ER
PR
HER2
Parget disease of the breast- palpable mass vs none
Palpable mass- usually invasive infiltrating ductal carcinoma
No palpable mass- usually DCIS or noninvasive breast cancer
Eczematous or ulcerated lesion of the nipple
May be pruritic, burning, or painful
Paget disease of the breast- symptoms
Eczematous or ulcerated lesion of the nipple
May be pruritic, burning, or painful
Parget disease of the breast- treatment
mastectomy
Lobular carcinoma- dx
Lucky find!
found early, no spread, no invasion
Lobular carcinoma treatment
excise lesion- can become invasive- risk of developing breast cancer
chemoprevention
Invasive carcinoma- mc area
upper outer quadrant
Invasive carcinoma signs and symptoms
Fixed, Firm nodule Non-tender but can have breast pain Dimpling of skin Retraction of nipple Breast size changes- nl but sudden change Skin thickening- peau d'orange Eczematous changes Axillary node enlargement Arm edema= lymphatic blockage Palpable supraclavicular/ infraclavicular nodes
Breast cancer in men- risk factor
increased incidence in M w prostate cancer
Breast cancer in men- signs and symptoms
Painless lump beneath areola
Nipple discharge
Retraction
Ulceration
Ovarian cancer- risk factors
Age (avg age 63)
BRCA
Lynch syndrome
Infertility- release more eggs (ovulation)
Nulliparity- release more eggs
Others- endometriosis, PCOS, postmenopausal hormone therapy, obesity, smoking, asbestos
More periods- releasing more eggs
Ovarian cancer- protective factors
Multiparity Breastfeeding Oral contraceptives Salpingo-oophorectomy Tubal ligation Hysterectomy
Less periods
Ovarian cancer- MC type
epithelial carcinoma
Ovarian cancer- signs and symptoms
Asymptomatic until advanced disease (distant metastases)
Subacute presentation
- adenxal mass
- pelvic/ abdominal symptoms (bloating, urinary urgency or frequency, etc.)
Ovarian cancer- screening
none, rapidly progressive- poor prognosis
Ovarian cancer- diagnosis
full surgical removal vs bx
Ovarian cancer- imaging
CT abdomen/ pelvis and or pelvic US
Ovarian cancer- gene
CA-125
Vulvar cancer is
superficial
Vulvar cancer risk factors
Vulvar or cervical intraepithelial neoplasia (VIN) Prior hx of cervical cancer Smoking Vulvar lichen sclerosus Immunodeficiency syndromes HPV infection- 16, 33, 18
Vulvar cancer- MC type
squamous cell carcinoma
Vulvar cancer - signs and symptoms
Abnl finding on the labia majora= MC Local discomfort Unifocal vulvar plaque, ulcer or mass- cauliflower lesion - can be fleshy, nodular, or warty Pruritus Bleeding (including rectal) Pain- Dysuria or Dyschezia Enlarged lymph node in groin Lower extremity edema
Vulvar cancer- diagnosis
bx anything abnl
penile cancer- risk factors
HPV HIV Age 60 Phimosis- uncircumcised Smoking
penile cancer- MC type
squamous cell carcinoma
penile cancer- signs and symptoms
Lump, mass or ulceration on penis- most commonly on glans
Inguinal lymphadenopathy
Infection- erythema, swelling, drainage
penile cancer- diagnosis
bx
penile cancer- treatment - abx
If infection suspected
OR for excision of lesion
penile cancer treatment- low risk of recurrence
Low risk of recurrence (Tis, Ta glans and T1a/T1b glans & shaft)
- Partial penectomy - goal 1-2 cm of (-) margins
- radiation
- laser ablation, glans resurfacing (Tis)
- mohs micrographic surgery
- topical tx- fluorouracil, imiquimod
penile cancer- high risk or recurrence treatment
High risk of recurrence (bulky, T2-T4)
- Penectomy
penile cancer- treatment if sx refusal
interstitial brachytherapy (radioactive seeds)
bladder cancer - MC type
urothelial (transitional cell) carcinoma
bladder cancer - signs and symptoms
Gross hematuria - microscopic >3 RBC/hpf - in kids blood in urine= US - @ beginning = urethra source - Terminal= bladder neck - Throughout= kidney, ureter, bladder Voiding symptoms - frequency, urgency, hesitancy Pain Usually always symptomatic
bladder cancer- imaging
Cystoscopy
Cytology
CT abdomen and pelvis
Imaging of upper tract collecting system
bladder cancer - how to determine invasive vs noninvasive
if tumor visualized on office cystoscopy and/or (+) cytology- go to OR- exam under anesthesia
TURBT- go deep enough to get muscle, not deep enough to penetrate
- Pathologic evaluation will help differential muscle invasive vs non-invasive
bladder cancer- treatment- non-invasive
Non-invasive-
- low risk: 1 dose of intravesical chemo
- interm: extended course
- high: extended +/- systemic chemo, consider cystectomy
bladder cancer- treatment- invasive
Muscle invasive-
- radical cystectomy
bladder cancer treatment- metastatic
Metastatic disease
- platinum based- chemo
prostate cancer- psa abnl level… when is it falsely low?
Abnl >4ng/ml
Falsely low if take 5-alpha reductase inhibitors (Proscar and Avodart) for BPH
- double the #
prostate cancer- why is PSA debatable?
go through colon to get bx- get septic and can die
prostate cancer- DRE exam
DRE- normal= symmetric and smooth
If elevated PSA or abnl DRE- repeat PSA or Prostate biopsy- TRUS - 12 cores taken - (+) = consider tx - (-) = observation, if still high or rising- 18-24 core biopsy
Enema prep & 2d abx prophylaxix
prostate cancer- treatment is based on what?
Tx based on many things like:
- histologic grade (gleason score)
- – 2 most prevalent tissue types from biopsy- added together (range from 6-10)
- PSA level
- etc. slide 22
prostate cancer- treatment- localized, very low risk
- PSA <10, normal DRE, GS <6, <3 (+) cores
- Active surveillance
prostate cancer- treatment- low risk
- PSA <10, normal DRE, GS <6, >3 (+) cores
- surveillance, radiation, radical prostatectomy
prostate cancer- treatment- localized interm risk
- PSA >10, GS >7, larger, and/or in both lobes
- RT, radical prostatectomy
prostate cancer- treatment- localized high risk
- PSA >20, GS 8+
- RT, radical prostatectomy
prostate cancer- treatment- stage IV
- lymph node involvement/distant mets
- RT +/- ADT (chemotherapy)
prostate cancer- after treatment
- serial PSA for recurrence
- serial CT- depending on risk level
Testicular cancer- mc population?
adolescents and young adults 15-35
Testicular cancer- risk factors
Cryptochidism
Fhx
Prior personal hx
Intra-tubular germ cell neoplasia (ITGCN)
Testicular cancer- germ cell tumors vs stromal tumors
Germ cell tumors: AFP- bHCG
- seminoma- originate from seminiferous tubules
- non-seminoma- originate from sperm/ova cells
Stromal tumors: inhibin
- Leydig cell tumors (testosterone)
- Sertoli cell tumors (estradiol)
Testicular cancer seminoma- description
- local (limited to testicle)
- usually no elevated b-hCG and never AFP
- sensitive to radiation tx
Testicular cancer non-seminoma- description
- present w distant metastatic disease
- elevated b-hCG & AFP
- less sensitive to radiation tx
Testicular cancer- signs and symptoms
Painless, unilateral mass in scrotum
Back and flank pain
Testicular cancer- treatment
Inguinal surgery- radical orchiectomy is indicated if (+) markers or concern on frozen section
- Exception- pt w massive pulmonary metastatic disease w fatal potential
If markers are (-), <2cm mass, and suspected benign disease or a stromal tumor
- testicular sparing surgery (TSS) may be reasonable
- have pathology available for immediate frozen section analysis
Chemotherapy and RT based on clinical/pathologic staging
Testicular cancer- staging imaging
- pre op CXR before orchiectomy to R/O massive pulmonary mets
- consideration of pre-op CT chest/abd/pelvis
Testicular cancer imaging and labs
Scrotal US Serum tumor markers - bHCG, AFP, LDH - if (-) concern for stromal tumor - based on levels AFTER orchiectomy
Testicular cancer- what is something usually recommended?
sperm banking
Renal cell carcinoma in children is called?
Wilm’s tumor and nephroblastoma
Renal cell carcinoma- risk factors
Tabacco smoking
Leather tanners, shoe workers, asbestos workers
Obesity, HTN
Long-term dialysis develop acquired polycystic kidney disease –> RCC
Renal cell carcinoma- cause
Majority sporadically
Pseudo-hypoxia–> angiogenesis
Renal cell carcinoma- signs and symptoms
Slow growing
Occult most of its course
TRIAD- flank pain, hematuria, palpable abdominal mass
Hematuria
Systemic- fatigue, weight loss, hypercalcemia, hepatic dysfunction
Renal cell carcinoma- labs and imaging
Labs- CBC, BMP, LFTs, alkaline phosphatase, urinalysis
Radiographic studies- cross sectional imaging
- CT or MRI of abd/pel
- CT chest once confirmed RCC- to look for metastatic disease
Renal cell carcinoma treatment- localized (I-III)
surgical excision is curative
- 20-30% relapse within 2-3yrs
- metastases to lung common
Renal cell carcinoma- metastatic (IV) treatment
nephrectomy + metastasectomy OR cytoreductive RN (if unresectable proceed to first line systemic therapy)
Renal cell carcinoma- why is conventional chemo rarely used?
Intrinsic resistance
Anal cancer- risk factors
Similar to genital malignancy: HPV- lower incidence if vaccinated HIV Multiple partners Receptive anal intercourse Smoking
Anal cancer- MC type
squamous cell carcinoma
colon cancer- adenocarcinoma
Anal cancer- signs and symptoms
Rectal bleeding
Anorectal pain
Sensation of mass/fullness- pressure that turns to pain
Anal cancer- screening
Colonoscopy- age 45
Anal cancer- in women
Need thorough GYN evaluation due to higher incidence of cervical cancer if dx w anal cancer
Anal cancer- DRE and imaging
DRE- most are felt Inguinal lymph node eval Bx CT chest, abdomen and pelvis \+/- PET scan Anoscopy HIV testing
Anal cancer- treatment
Primary treatment:
- combo therapy of rad and chemo
- may achieve cure wo surgery
- preserve anal sphincter
- restage and proceed w sx resection if needed:
- APR= removal of anus- colostomy required
- local incision
If metastatic:
- RT and chemo focus
Perianal cancer location
skin/hair containing surface
Perianal cancer treatment
Similar to anal cancer
Can consider local excision
