MOD 3 Flashcards
What is the MoM?
measure of how far an individual result deviates from the median, used to report results of medical screning tests esp if indiv tests are highly variable (avoids multiple reference ranges), such as AFP
What is B-hCG, and what is it generally a marker for?
a hormone produced by trophoblasts of dev placenta 9 days after ovulation, good early marker for preg
What other conditions besides pregnancy can bHCG be used to evaaluate?
ectopic preg
spont abortion
gestational tumor
What does postiive bHCG indicate
Preg!
OR non-invasive molar tumors
OR testicular cancer
When does hyperglycosylated bHCG appear?
implantation phase of preg at a few weeks, and prevents CL regression and allows continued estro/prog synth
-major form of bHCG in choriocarcinoma
Free bHCG?
Nicked BHCG?
free- marker for DOWNS
nicked- present after removal of hydatiform mole
What might it mean if bhCG levels off early?
may indicate that preg is in trouble
What are some thigns that can produce false positive on b-hCG preg tests?
- hbcg-producing tumors
- pts that have heterophilic ab’s against mouse ab’s used in test
- have bhcg like material but usually too low for + result
- urine tests and renal failure can give incorrect results
Spontaneous abortions, and what they show with bhcg levels
first trim, v common
slowing in the rate of hcg incr means impending abortion, and drops during abortion
what is ultrasound used for in preg
not always that helpful, but helps estimate gest age, ID cause of vag bleeding, uterine size, confirms preg, or ectopic preg etc
Ectopic preg
timing
hcg levels
sx
common, usu in fallopian tube, sx start 4-6 wk after conception
- bhcg increase then level off, then the rate of increase slows
- sx: abnormal uterine bleeding, decreased hct, shock (can cause death)
Gestational tumors- Hydatidiform mole
HCG levels
HPL levels
trophoblastic dis where non viable fert egg is implanted, needs to be removed, produces v high levels of hCG and decreased HPL (hcg should decr a few months after removal, but if still there, may be residual mole or choriocarcinoma)
What is amniocentesis for?
chrom analysis (excludes Downs) or abnormal AFP follow up (can exclude spina bifida)
Chorionic villi sampling- what is it for? Adv? Disadv?
- collects cell from placenta villi to test genetic makeup of fetus
- ADV: QUICKER results (a week) than amniocentesis
- DISADV: RISK for miscarraige over amniocentesis, and chance of placental mosacisism (placenta has weird chroms but fetus is actually normal)
What are common prenatal tests?
Triple test
Prenatal US
What is the triple test?
-what is it used with? what does it test for?
prenatal test that tests maternal serum AFP, hCG, and UE3 (estriol) in the second trimester to screen for DOWNS and open NTDs at 16-18wk gest, 70% sens with 5% false +
-used in conjuction with prenatal ultrasound for gest age and fetal abnormalities and nuchal translucency or guiding needle placement etc
What might high AFP on triple test but low other vals mean?
NTD!
(spina bifidia if aceytlcholinesterase in amnio fluid)
or omphalocele, gastoschisis, multiple gest
What does high hCG but low other vals mean on triple test?
DOWN!
What does all low vals mean on triple test?
Trisomy 18! (edwards)
What does incr vs decr AFP indicate
incr- open NTD
decr- down, tirsomy 18, T1DM, endocrine pseudopreg
uE3 (estriol) in triple test does what?
What does leveling off mean?
What does decr level inearly 2nd tirmester mean?
MOST ACCURATE unconj serum estriol, in both fetus and plac, increase steadily throughout preg in serum
- leveling off means impendign fetal demise
- decr in 2nd trim means NTD
biomarker of down?
decreased maternal serum/aniotic AFP
triple test
Possible anatomic issues in down
heart, GI, choroid plexus cysts, hydronephrosis, echogenic bowel
biomarker for NTD
triple test
high AFP andddd high acetylcholinesterase, US helps with both conditions but isnt diagnostic
What may leakage between CSF with incr AFP and amniotic fluid indicate? (MoM>2)
spina bifida!
What can ultrasound identify in spina bifida?
meningomyelocele aka spina bifida has hydrocephalus, ultrasound can find frontal bones, and spalying of spinal bones behind vertebra (spinal defect)
What might IVF increase in a screen?
false positive screen rate in 2nd trim Downs
what is FISH Inhibin A Quad test Integrated Test
- FISH- put cells on slide to see chrom
- Inhibin A- if fetus has Downs, may be elev as early as 11 weeks. normally an inhibitor of FSH secretion
- Quad- adds inhibin A to triple test, 81% sens when take at 15-18 weeks gest, if positive means high risk of chrom abnormaliteis or NTDs
- Integrated- screening method for downs, higher detection rates and lower false positive rates
Tests to detect risk for neonatal RDS
- L:S ratio (lecithin) <2
- PG (phosphatidylglycerol) test via latex aggl which is detectable at lung maturity, much faster than L/S (but not as accurate?)
High risk preganancies that should be tested for viability?
maternal diabetes, HTN, substance abuse, etc
What does HPL measure and what is an adv? What does declining value indicate?
What does it mean if low but high hcg?
rises then flattens in thrid trim, measures placental fxn in third trim
- short half life of 30 min for rapid assessment of placenta
- declining vals indicate fetal jeaopardy
- low hpl but high hcg indicates trophoblastic molar disease
Fetal fibronectin test
shows up in cervicovaginal secretions up to 21 wk then disappears, then reappears at 37 and leaks into vagina before labor
what does presence of ffN in secretions between 21 and 37 weeks mean?
-what might negative ffn test mean?
- ffn means preterm delivery
- negative ffn means wont deliver in next 2 weeks
which testing chemicals are located in the
- urine
- placental tissue
- cervicovag secretions
- materal serum at third trim
- amn fluid only
- urine is hcG (and blood)
- placental is chorionic villus sampling
- cervico is fFM for preterm labor
- serum at third trim is HPL and UE3 for fetal loss
- amn fluid only is acetylcholinesterase and LS/PG
- Estriol is serum only
Comedo DCIS
High grade DCIS, generally localized, may be ER/PR neg but HER2/p53+ (other 3 micropap cribiform and solid are low grade and ER/PR+ with rest neg)
DCIS pathway
prolif>atypical hyerplasia>low grade DCIS>invasive carc
High grade DCIS has a higer likelihood of becoming..
triple negative BC!
Which grade DCIS has higher multifocality?
low grade! so can spread, complicating surgery
Std of care for DCIS?
Lumpectomy! bc complete mast doesnt incr survival rate with DCIS. has 2mm margin. then after do chemo or radiation
- no axillary removal bc DCIS is noninvasive
- can tx with tamox if estrogenic
Invasive ductal carcinoma NOS occurs when….
DCIS invades stroma and can travel to lymph nodes
- most common
- diff types of inv ductal carc such as tubular, mucinous, medulllary, papillary and inflamm, and NOS
4 types of invasive ductal carcinoma NOS
Luminal A
Luminal B
HER2/ERBB2
Basal-like
Luminal A and B inv duct carc NOS
er/pr/her2 lvls
tx
ER/PR+ strong
- use anti estr TAMOX
- her2 neg
- low prolif and grade, excellent px
- Luminal B is same but ER/PR weakly +, antriestro with other tx, HER2 CAN be +, moderate prolif/grade, fair px
HER2 (ERBB2) inv ductal carci NOS
er/pr/her2 lvls
tx
ER/PR-
HER2 strongly +
give DOXORUBICIN & TRASTUZUMAB (herceptin) (her2 R blockade)
Basal like invasive ductal carc NOS
lvls?
tx?
- triple neg tumor
- above 3 drugs dont work, can defy mammography
- high grade, larger, necrosis, can be sys, poor px
- related to BRCA, AA women
- Tx with NEOADJUVANT TX (means give radiation or homrones to shrink tumor for surg), give chemo first (but doesnt change survival rate)
Tx based on ER/PR/HER2 lvls
ER/PR + =tamox!
HER2+ =DOXO+TRASTU
triple neg= NEOADJUVANT tx
What does removing axillary lymph nodes do?
sxe?
decr recurrence, but doesnt change survival much
-sxe of peipheral edema
How is it decided which lymph nodes (eg ax) are removed?
inject a sulfur based dye to see which lymph nodes it will go to (sentinel lymph nodes, which can be biopsied to see if they need to be removed)
What can sx of thickened skin with rapid onset erythema/ red swollen breast and peua de’orange mean?
Can mean inflammatory BC!
or also mastitis
(possibly even paget’s if just nipple or dermatitis)
What is a locally advanced breast carcinoma?
tumors >5cm with regional lymphadeno, direct extension to chest walll or skin, cancers such as inflammatory breast cancer (red and swollen)
What is inflammatory breast cancer?
tx?
- type of locally advanced BC, very aggro
- orange peel caused by tumors embolizing dermal lymphatics (bc lymph cant drain)
- tx: mastectomy if advanced (if spread to lymph nodes), give radiation to decr recurrence regardless
which levels respond better to tx?
ER/PR+
