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Clin med FINAL- sem 2 > Cancers > Flashcards

Cancers Flashcards

1
Q

endometrial cancer- most common type

A

Adenocarcinoma

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2
Q

endometrial cancer- risk factors

A 
Increasing age >45
Late menopause
Early menarche
Nulliparity/ infertility 
Unopposed estrogen OCPs
Lynch syndrome
Tamoxifen- breast cancer

In general: more periods

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3
Q

endometrial cancer- what is protective?

A

combined estrogen and progesterone

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4
Q

endometrial cancer- signs and symptoms

A 
bleeding 
discharge
spotting 
cramps and pain 
POST MENOPAUSAL bleeing on exam
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5
Q

endometrial cancer screening

A

not advised if asymptomatic - there is a high % of W that are symptomatic in early stage (confined to uterus)

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6
Q

endometrial cancer- lynch syndrome risk reducing tx

A

lifetime risk of 54%

hysterectomy- risk reducing

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7
Q

endometrial cancer- diagnosis

A

bx= GOLD

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8
Q

endometrial cancer- labs and imaging

A

pap smear
pelvic us- if you see thickening or stripe >4mm–> biopsy
D&C

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9
Q

endometrial cancer- gene

A

CA125

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10
Q

endometrial cancer- treatment

A

total hysterectomy + salingo-oophorectomy

RT, chemo

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11
Q

Transition zone

A

where columnar endocervical cells transform into squamous epithelial
- junction of endocervix & ectocervix

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12
Q

cervical cancer- can obstruct what and lead to what?

A

obstruct ureters and lead to renal death

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13
Q

cervical cancer- risk factors

A 
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
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14
Q

cervical cancer- classification

A

CIS= full thickness but encapsulated

Cancer- beyond cervix to uterus to pelvic walls/vagina to lympth nodes, to bladder/ rectum to distant sites

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15
Q

cervical cancer- signs and symptoms

A

bleeding
post coidal bleeding
discharge
pelvic or lower back pain

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16
Q

cervical cancer- screening method

A

pap smear- not diagnostic test - regardless of sexual hx and HPV vaccination status

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17
Q

cervical cancer- screening age 21-29

A

cytology q 3yrs or

hrHPV starting at 25 q 5yrs in avg risk pts

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18
Q

cervical cancer- screening age 30-65

A

cytology q 3yrs or
hrHPV q 5yrs or
contesting q 5 yrs

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19
Q

cervical cancer- screening age >65

A

none after - in last 10 yrs

  • 3 (-) in a row cytology
  • 2… contesting
  • 2… hrHPV
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20
Q

cervical cancer other labs and imaging

A

colposcopy- if there are no visual lesions but high suspicion or abnormal cytology

bx- anything friable

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21
Q

cervical cancer- treatment- CIN 2 or 3

A

LEEP- loop electrosurgical excision procedure- excise tissue of interest
- increases risk of scarring or stenosis

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22
Q

cervical cancer- treatment- CIN 3 or CIS

A

Cone biopsy- goes deeper

  • used if larger neoplasia
  • more likely to lead to incompetent cervix than LEEP
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23
Q

cervical cancer other treatments besides leep or cone bx?

A

radical hysterectomy plus pelvic lymphadenectomy, rad, chemo or combo

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24
Q

why is there no screening for cervical cancer if <21?

A

Increased risk of preterm birth, low birthweight and PPROM- preterm premature rupture of membranes

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25
Q

cervical cancer- follow up

A

high risk of recurrence
high risk- q 3m to year 5
low risk- q 6 m to year 5

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26
Q

breast cancer- risk factors

A 
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

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27
Q

breast cancer- MC type

A

ductal carcinoma

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28
Q

breast cancer- signs and symptoms

A

hard (firm), immobile (fixed), single dominant mass- feels like a marble
thickening, dimpling of skin- peau d’orange

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29
Q

breast cancer- screening method

A

mammograph- soft tissue mass, speculated, high density

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30
Q

breast cancer screening- <40

A

not recommended for avg risk individuals

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31
Q

breast cancer screening- 40-49

A

q 2yrs

consider pts input

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32
Q

breast cancer screening- 50-74

A

q 2yrs

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33
Q

breast cancer screening- >75

A

q 2yrs if life expectancy >10yrs

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34
Q

breast cancer screening methods if high risk

A

also MRI and breast US

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35
Q

breast cancer- breast US

A

hypoechogenic- more dense
calcifications
shadowing
speculated

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36
Q

breast cancer treatment

A

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)

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37
Q

breast cancer- ACS screening

A

annually starting at 40
q 2 yrs starting at age 55

if high risk start at 30 yearly

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38
Q

breast cancer fine vs core needle

A 
Fine needle (localized, if too large)
Core needle bx (preferred- size of a pencil- take whole thing out)
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39
Q

what should you do once cancer is confirmed?

A

Do hormone testing
ER
PR
HER2

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40
Q

Parget disease of the breast- palpable mass vs none

A

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

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41
Q

Paget disease of the breast- symptoms

A

Eczematous or ulcerated lesion of the nipple

May be pruritic, burning, or painful

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42
Q

Parget disease of the breast- treatment

A

mastectomy

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43
Q

Lobular carcinoma- dx

A

Lucky find!

found early, no spread, no invasion

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44
Q

Lobular carcinoma treatment

A

excise lesion- can become invasive- risk of developing breast cancer
chemoprevention

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45
Q

Invasive carcinoma- mc area

A

upper outer quadrant

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46
Q

Invasive carcinoma signs and symptoms

A 
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
47
Q

Breast cancer in men- risk factor

A

increased incidence in M w prostate cancer

48
Q

Breast cancer in men- signs and symptoms

A

Painless lump beneath areola
Nipple discharge
Retraction
Ulceration

49
Q

Ovarian cancer- risk factors

A

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

50
Q

Ovarian cancer- protective factors

A 
Multiparity
Breastfeeding
Oral contraceptives
Salpingo-oophorectomy
Tubal ligation
Hysterectomy

Less periods

51
Q

Ovarian cancer- MC type

A

epithelial carcinoma

52
Q

Ovarian cancer- signs and symptoms

A

Asymptomatic until advanced disease (distant metastases)

Subacute presentation

  • adenxal mass
  • pelvic/ abdominal symptoms (bloating, urinary urgency or frequency, etc.)
53
Q

Ovarian cancer- screening

A

none, rapidly progressive- poor prognosis

54
Q

Ovarian cancer- diagnosis

A

full surgical removal vs bx

55
Q

Ovarian cancer- imaging

A

CT abdomen/ pelvis and or pelvic US

56
Q

Ovarian cancer- gene

A

CA-125

57
Q

Vulvar cancer is

A

superficial

58
Q

Vulvar cancer risk factors

A 
Vulvar or cervical intraepithelial neoplasia (VIN)
Prior hx of cervical cancer
Smoking
Vulvar lichen sclerosus
Immunodeficiency syndromes
HPV infection- 16, 33, 18
59
Q

Vulvar cancer- MC type

A

squamous cell carcinoma

60
Q

Vulvar cancer - signs and symptoms

A 
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
61
Q

Vulvar cancer- diagnosis

A

bx anything abnl

62
Q

penile cancer- risk factors

A 
HPV
HIV
Age 60 
Phimosis- uncircumcised
Smoking
63
Q

penile cancer- MC type

A

squamous cell carcinoma

64
Q

penile cancer- signs and symptoms

A

Lump, mass or ulceration on penis- most commonly on glans
Inguinal lymphadenopathy
Infection- erythema, swelling, drainage

65
Q

penile cancer- diagnosis

A

bx

66
Q

penile cancer- treatment - abx

A

If infection suspected

OR for excision of lesion

67
Q

penile cancer treatment- low risk of recurrence

A

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
68
Q

penile cancer- high risk or recurrence treatment

A

High risk of recurrence (bulky, T2-T4)

- Penectomy

69
Q

penile cancer- treatment if sx refusal

A

interstitial brachytherapy (radioactive seeds)

70
Q

bladder cancer - MC type

A

urothelial (transitional cell) carcinoma

71
Q

bladder cancer - signs and symptoms

A 
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
72
Q

bladder cancer- imaging

A

Cystoscopy
Cytology
CT abdomen and pelvis
Imaging of upper tract collecting system

73
Q

bladder cancer - how to determine invasive vs noninvasive

A

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

74
Q

bladder cancer- treatment- non-invasive

A

Non-invasive-

  • low risk: 1 dose of intravesical chemo
  • interm: extended course
  • high: extended +/- systemic chemo, consider cystectomy
75
Q

bladder cancer- treatment- invasive

A

Muscle invasive-

- radical cystectomy

76
Q

bladder cancer treatment- metastatic

A

Metastatic disease

- platinum based- chemo

77
Q

prostate cancer- psa abnl level… when is it falsely low?

A

Abnl >4ng/ml
Falsely low if take 5-alpha reductase inhibitors (Proscar and Avodart) for BPH
- double the #

78
Q

prostate cancer- why is PSA debatable?

A

go through colon to get bx- get septic and can die

79
Q

prostate cancer- DRE exam

A

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

80
Q

prostate cancer- treatment is based on what?

A

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
81
Q

prostate cancer- treatment- localized, very low risk

A
  • PSA <10, normal DRE, GS <6, <3 (+) cores

- Active surveillance

82
Q

prostate cancer- treatment- low risk

A
  • PSA <10, normal DRE, GS <6, >3 (+) cores

- surveillance, radiation, radical prostatectomy

83
Q

prostate cancer- treatment- localized interm risk

A
  • PSA >10, GS >7, larger, and/or in both lobes

- RT, radical prostatectomy

84
Q

prostate cancer- treatment- localized high risk

A
  • PSA >20, GS 8+

- RT, radical prostatectomy

85
Q

prostate cancer- treatment- stage IV

A
  • lymph node involvement/distant mets

- RT +/- ADT (chemotherapy)

86
Q

prostate cancer- after treatment

A
  • serial PSA for recurrence

- serial CT- depending on risk level

87
Q

Testicular cancer- mc population?

A

adolescents and young adults 15-35

88
Q

Testicular cancer- risk factors

A

Cryptochidism
Fhx
Prior personal hx
Intra-tubular germ cell neoplasia (ITGCN)

89
Q

Testicular cancer- germ cell tumors vs stromal tumors

A

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)
90
Q

Testicular cancer seminoma- description

A
  • local (limited to testicle)
  • usually no elevated b-hCG and never AFP
  • sensitive to radiation tx
91
Q

Testicular cancer non-seminoma- description

A
  • present w distant metastatic disease
  • elevated b-hCG & AFP
  • less sensitive to radiation tx
92
Q

Testicular cancer- signs and symptoms

A

Painless, unilateral mass in scrotum

Back and flank pain

93
Q

Testicular cancer- treatment

A

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

94
Q

Testicular cancer- staging imaging

A
  • pre op CXR before orchiectomy to R/O massive pulmonary mets
  • consideration of pre-op CT chest/abd/pelvis
95
Q

Testicular cancer imaging and labs

A 
Scrotal US 
Serum tumor markers
- bHCG, AFP, LDH
- if (-) concern for stromal tumor
- based on levels AFTER orchiectomy
96
Q

Testicular cancer- what is something usually recommended?

A

sperm banking

97
Q

Renal cell carcinoma in children is called?

A

Wilm’s tumor and nephroblastoma

98
Q

Renal cell carcinoma- risk factors

A

Tabacco smoking
Leather tanners, shoe workers, asbestos workers
Obesity, HTN
Long-term dialysis develop acquired polycystic kidney disease –> RCC

99
Q

Renal cell carcinoma- cause

A

Majority sporadically

Pseudo-hypoxia–> angiogenesis

100
Q

Renal cell carcinoma- signs and symptoms

A

Slow growing
Occult most of its course
TRIAD- flank pain, hematuria, palpable abdominal mass
Hematuria
Systemic- fatigue, weight loss, hypercalcemia, hepatic dysfunction

101
Q

Renal cell carcinoma- labs and imaging

A

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
102
Q

Renal cell carcinoma treatment- localized (I-III)

A

surgical excision is curative

  • 20-30% relapse within 2-3yrs
  • metastases to lung common
103
Q

Renal cell carcinoma- metastatic (IV) treatment

A

nephrectomy + metastasectomy OR cytoreductive RN (if unresectable proceed to first line systemic therapy)

104
Q

Renal cell carcinoma- why is conventional chemo rarely used?

A

Intrinsic resistance

105
Q

Anal cancer- risk factors

A 
Similar to genital malignancy:
HPV- lower incidence if vaccinated
HIV
Multiple partners
Receptive anal intercourse
Smoking
106
Q

Anal cancer- MC type

A

squamous cell carcinoma

colon cancer- adenocarcinoma

107
Q

Anal cancer- signs and symptoms

A

Rectal bleeding
Anorectal pain
Sensation of mass/fullness- pressure that turns to pain

108
Q

Anal cancer- screening

A

Colonoscopy- age 45

109
Q

Anal cancer- in women

A

Need thorough GYN evaluation due to higher incidence of cervical cancer if dx w anal cancer

110
Q

Anal cancer- DRE and imaging

A 
DRE- most are felt 
Inguinal lymph node eval
Bx
CT chest, abdomen and pelvis
\+/- PET scan
Anoscopy
HIV testing
111
Q

Anal cancer- treatment

A

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

112
Q

Perianal cancer location

A

skin/hair containing surface

113
Q

Perianal cancer treatment

A

Similar to anal cancer

Can consider local excision

Clin med FINAL- sem 2 (5 decks)

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