Hereditary cancer syndromes Flashcards
VHL associated malignancies
- clear cell RCC
- Hemangioblastoma
- pheochromocytomas
- retinal angiomas
Birt-hogg-dube syndrome gene mutation
folliculin (FLCN) gene
Birt-hogg-dube syndrome associated malignancies
- clear cell RCC
- chromophobe RCC
- spontaneous PTX
Tuberous sclerosis gene mutations
TSC1, TSC2
Tuberous sclerosis associated malignancies
- clear cell RCC
- angiomyolipomas
Hereditary papillary RCC gene mutation
CMET
BAP1 associations
- clear cell RCC
- cutaneous and uveal melanoma
- mesothelioma (often peritoneal)
Gene mutation and pathologies associated with hereditary paraganglioma and pheocromocytoma syndrome
succinate dehydrogenase
- clear cell RCC + pheochromocytomas
MEN1 associated
3ps
pituitary adenomas
parathyroid adenomas
pancreatic islet cell tumors (VIPomas, Gastrinomas, insulinomas)
*Also carcinoid and adrenal tumors
MEN2 mutations
RET mutations
MEN2A malignancies
- medullary thyroid
- pheos
- primary parathyroid hyperplasia
MEN2B
- medullary thyroid
- pheos
- mucosal neuromas
MEN2B management
thyroidectomy before age 6
screen for pheos and hyperparathyroidism
MUTYH polyposis associated malignancy
Increased risk of CRC
Peutz jeghers syndrome gene mutation
STK11
Peutz jeghers associated malignancies
- breast
- CRC
- gastric
- pancreatic
- ovarian
- lung
- *GI hamartomas
- mucutaneous pigmentation (SEE PHOTO online, will prob show photo)
NF1 associated malignancies
- GIST
- peripheral nerve sheath tumors
- breast cancer
PALB2 associated malignancies
- pancreatic
- Male breast cancer
Which ovarian pts need germline testing?
universal
Li fraumeni associated maligancies
- breast
- sarcoma
- brain tumors
- adrenocortical
- leukemia
- multiple primaries
- radiation induced malignancies
- aggressive prostate cancer
Li fraumeni screening
- NO XRT
- MRI over CT to avoid radiation exposure
- Breast
- annual brain MRI
- ***annual whole body MRI annually
- endoscopy
- routine skin checks
MSI pattern associated with hypermethylation pathway AND significance of BRAF in association
- loss of MLH1
- loss of PMS2
*BRAF mutant indicates sporadic
Lynch associated malignancies
- colon
- *endometrial
- ovarian
- prostate
- gastric
- small bowel
- CNS (glioma)
- bladder (UTUC)
- pancreatic
- sebaceous skin tumors
- rarely breast
Lynch screening for colon and uterine
- colonoscopy q1-2 yrs starting at age 20-25
- salipingo-oophorectomy once child bearing complete
FAP gene mutation
APC
FAP associated malignancies
- early onset CRC
- small bowel cancer
- gastric
- pancreatic
- desmoid
FAP mgmt
- annual c-scope starting at age 10-15
- total colectomy
- CT or MRI looking at desmoid tumors
BRCA1 chromosome
chromosome 17
BRCA2 chromosome
chromosome 13
BRCA subtype associated with higher risk of breast and ovarian and with TNBC
BRCA2
BRCA2 other malignancies
- gastric
- biliary
- melanoma
BRCA screening for breast cancer
- mammos starting at age 30
- MRI breast at age 25
- NO routine vaginal US or CA125
BRCA2 mgmt for prostate cancer
- prostate cancer screening at age 40
Cowden syndrome gene mutation
PTEN
Cowden syndrome malignancies
- mucocutaneous lesions
- macrocephaly
- breast tumors
- endometrial
- thyroid
- CRC
- RCC
- Melanoma
Cowden syndrome screening
- MRI and mammos starting at age 30
- annual thyroid US starting at age 7
- Colonoscopy starting at age 35
Alternative name for Lynch
Hereditary nonpolyposis colorectal cancer syndrome
Gardner syndrome is a subtype of what disorder
FAP
ATM associated malignancies
- pancreatic cancer
- prostate cancer
- stomach cancer
- invasive ductal carcinoma of the breast
Radiation in prostate cancer SE’s
- bowel dysfunction
- urinary frequency, incontinence, nocturia
Radical prostatectomy in prostate cancer SE’s
- urinary incontinence
- *erectile dysfunction
degarelix, relugolix mechanism
GnRH antagonists
ADT duration for high risk disease
2 years
Goserelin, triptorelin mechanism
GNHR/LHRH agonists
Malignancy patients with fanconi anemia are at increased risk of
- head and neck cancer
Answer to next step up after diagnosis of cancer in patient with Fanconi Anemia clinical features
- chromosome breakage test (severe toxicities from chemo)
Additional screening required for CDKN2A mutant patients
MRCP + EUS for pancreatic cancer
When germline testing is indicated for CRC
age <50
High risk breast cancer screening - age + screening
Starting at age 30 - MRI and mammogram annually but staggered by 6 months so get imaging every 6 months
Role of chemoprevention in high risk breast cancer patients
IF BRCA wildtype, tamoxifen
IF BRCA1, no chemoprevention
IF BRCA2, tamoxifen (reduces breast cancer by 50% but only prevents hormone receptor)
Indications for germline testing in breast
Given metastatic disease OR triple negative any age OR diagnosis at age <50 OR multiple primary BC OR male OR Ashkenazi Jewish ancestry OR lobular with personal or FH h/o diffuse gastric OR >1 first degree relative with breast cancer <50/male breast/ovarian/pancreatic/high risk prostate OR >3 diagnosis of breast/prostate on same side of family (first and second degree) including the pt w/ breast cancer
Screening required for FAP patients
- colonoscopy starting in teenage years
- colectomy as polyps arise
- Following colectomy, EGD
- annual thyroid exams
- annual abdominal exam for desmoid tumors
CDH1 mutation 1) management 2) associated malignancies
Poppy sitting on steps/prostate cancer. CD’s all over floor/CDH1. Prophylactic gastrectomy recommended/T on the operating table in middle of room and surgeon cutting stomach out. BDSM chick with whip in front of doorway/autosomal dominant.
CHEK2 associated malignancies
Coded character: Dr. Cerny
Location: Josh’s room
Scene: He has huge tits + gastric cancer patietn sitting at Josh’s desk + bill roebuck standing in wall + poppy + bones covering floor + Kathleen laying naked on floor /associated malignancies = breast + stomach + prostate + kidney + sarcoma + plasma cell neoplasms.
Risk of ovarian cancer in BRCA1 and 2
1 = 40-60% (much higher)
2 = 13-29%
Risk of contralateral breast cancer in BRCA1 and 2 pts
1 = 30-40%
2 = 25%
RAD51c associated malignancies
Breast (especially triple negative)
Ovarian
RAD51c management
- annual mammo starting at age 40
- BSO at age 45