Neoplasms Flashcards
What is the MC malignancy in women and 2nd leading cause of death
MC malignancy in women and 2nd leading cause of death = BCA
What type of BCA is MC
MC type of BCA = Invasive ductal carcinoma
2 types of non-invasive BCA
Non-invasive BCA (in situ)
- DCIS - ductal
- LCIS - lobular
What is the biggest RF for BCA
biggest RF for BCA = incr age
What 2 mutations a/w incr risk of developing BCA
BRCA1/2 mutations = incr risk of BCA
BRCA mutations/genetic testing
- how many 1st degree rel needed for testing to be indicated
- pts w/ what ancestry = incr risk
- BRCA mutations = what type of inheritance pattern
BRCA mutation genetic testing
- need 2 1st deg rel for testing to be indicated
- incr risk mutations w/ Ashkenazi Jewish pts
- Autosomal dominant
Pt presents w/ single, NT, firm, fixed, immobile mass w/bloody d/c that is poorly circumscribed and located in the upper outer quadrant of the breast. Mammogram reveals microcalcifications and a spiculated mass
What are you concerned about based on this presentation?
Concerned about BCA
- NT, firm, fixed, immobile mass w/bloody d/c that is poorly circumscribed
- upper outer quadrant
- Mammo –> microcalcifications and a spiculated mass
Types of BCA
- what type a/w tumor cells that cause lymphatic obstruction, redness,
- what type a/w chronic ezcematous rash (nipple + areola)
- what type a/w peau de orange appearance of the breast
Types of BCA
- A/w tumor cells that cause lymphatic obstruction = Inflam BCA
- A/w chronic ezcematous rash (nipple + areola) = Paget’s Dz
- A/w peau de orange appearance of breast = Inflam
Why is radiation and adjuvant chemo done after breast CA surg?
Radiation and adjuvant chemo done after breast CA surg to prevent recurrence
What types of BCA respond to hormonal Tx
ER+/PR+ (estrogen/progesterone receptor +) BCA responds to hormonal Tx
ER/PR+ BCA - what class of drugs can treat these types of BCA
ER/PR+ BCA
- SERMs (Selective Estrogen Rec Modulators) Tx it
Pt is found have ER+ BCA. What 2 drugs in the SERM class could you give her that would be effective against it
ER + (or PR+) BCA drugs
- Tamoxifen
- AIs (Aromatase Inhibitors) -ozoles
If a pt has HER2+ BCA what is the only type of hormonal therapy that will work against it
HER2+ BCA –> monoclonal Ab (Trastuzumab/Herceptin)
1st LNs impacted by BCA called
1st LNs impacted by BCA = sentinel LNs
Pt determined to have BCA –> you perform a sentinel lymph node Bx that is (+). What is the next appropriate step?
SLN Bx (+) –> ALND (full axillary LN Dissection)
What is the most important/favorable prognostic factor for BCA
most important/favorable prognostic factor for BCA = (-) LN status
What is the minimum BIRADS score that indicates the mass is suspicious for malignancy therefore CNBx must be obtained
BIRADS score 4 –> suspicious for malignancy, CNBx must be obtained
Workup/Methods of Sampling for solid mass
- < 30 y/o –>
- > 30 y/o –>
- FNA non-Dx –>
Workup/Methods of Sampling for solid mass
- < 30 y/o –> FNA
- > 30 y/o –> CNBx
- FNA non-Dx –> excisional Bx
What other breast d/o can mimic BCA on mammogram
Fat necrosis can mimic BCA on mammogram
What is the typical cause of fat necrosis
Cause of fat necrosis –> trauma to breast
40 y/o women presents for BCA screening, mammogram reveals ill-defined mass w/ cluster of calcifications in L breast. About 1 yr pt states she was in an MVA, and seatbelt bruised her L breast
Dx?
Dx = Fat necrosis
40 y/o women presents for BCA screening, mammogram reveals ill-defined mass w/ cluster of calcifications in L breast. About 1 yr pt states she was in an MVA, and seatbelt bruised her L breast
Dx?
Dx = Fat necrosis
What types of HPV cause Vulvar Cancer (3)
HPV types 16, 18, 31 cause vulvar cancer
What is MC histology for Vulvar and Vaginal CA
MC histology for Vulvar and Vaginal CA = SCC
MC Sx a/w vulvar CA
MC Sx a/w vulvar CA = vulvar pruritus/irritation
62 y/o pt postmenopausal pts w/ PMH of lichen sclerosus and HIV presents w/ vulvar pruritus, pain, and bleeding x 2 yrs that a/w lesion on labia majora. Also c/o of dysuria and perianal burning. 1 mo ago she was treated w/ for fungal infxn but Sxs persisted.
Most likely Dx?
What is next best step to confirm Dx
Dx = Vulvar CA
Next –> Bx
Vulvar CA Dx + Tx
- What is commonly seen on Bx
- What type of surgical Tx is usually done
Vulvar CA Dx + Tx
- Bx –> red/acetowhite ulcerative lesions
- surgical Tx = wide local excision
What is the MC site for Vaginal CA
MC site of Vaginal CA = upper 1/3 of vagina
DES exposure in utero/ < age 20 increases the risk of what
DES exposure in utero/ < age 20 increases the risk of Clear Cell Adenocarcinoma
DES exposure in utero/ < age 20 increases the risk of what
DES exposure in utero/ < age 20 increases the risk of Clear Cell Adenocarcinoma
75 y/o pt w/ h/o cervical CA, HPV infxn, smoking, and DES exposure presents w/ painless vaginal bleeding/pruritus/ watery blood tinged d/c. Last pap was abnormal so colposcopy and Bx performed.
Dx?
Dx = Vaginal CA
Tx of Vaginal CA
- Tx for Stage I/small lesions
- Tx for Stage III/IV/large lesions
Tx of Vaginal CA
- Stage I/small –> surgical excision
- Stage III/IV/larger –> radiation
What is the biggest RF for HPV
biggest RF for HPV= # of lifetime partners
About HPV
- What type of CA does high risk strains cause (gen + histological)
- Is it MC latent or expressed + transient or persistent
About HPV
- high risk strains cause cervical CA, SCC
- MC latent + transient (most ppl clear it)
Pap Smear Recommendations
- what age must you begin testing
- HIV+ when do you begin testing, how often after
- After what age can you stop pap smears if no h/o high grade dysplasia in past 20 yrs
- If only Paps are done as screening how often must pts get it done (ages 21+)
- If Pap + HPV testing done together how often must pts get it done (ages 30+)
Pap Smear Recommendations
- Must you begin testing at age 21
- HIV+ –> begin testing when sexually active, then anually
- After age 65 can stop pap smears if no h/o high grade dysplasia in past 20 yrs
- Only Paps are done –> repeat Q3 yrs (ages 21+)
- Pap + HPV testing done together–> repeat Q5 yrs (ages 30+)
Pap Results
- (+) ASCUS –> next step
- (+) ASC-H, LSIL, HSIL, or AGC –> next step
Pap Results
- (+) ASCUS –>HPV test
- (+) ASC-H, LSIL, HSIL, or AGC –> colposcopy
Pap results: (+) ASCUS
- if HPV test (-) –>
- if HPV test (+) –>
Pap results: (+) ASCUS –> HPV test
- HPV test (-) –> repeat cotesting in 3 yrs
- HPV test (+) –> colposcopy
Colposcopy
- what 2 things are applied to highlight changes in cervix
- what results are concerning (6, 3 main)
Colposcopy
- App acetic acid or lugol’s iodine to highlight changes in cervix
- Concerning results
- acetowhite changes (brighter = bad)
- lugol’s –> areas that dont take up the iodine
- squamous changes at transformation zone
- mosaicism, punctuations and atypical vessels
Cervical Intraepithelial Neoplasia/Dysplasia (CIN 1-3)
- which type is considered low risk
- how much of the epithelium is involved w/ CIN-2
- Another name for CIN III that is full thickness
- What types is tx recommended for
- What are the 2 types of excisional methods for Txting CIN, which usu done
Cervical Intraepithelial Neoplasia/Dysplasia (CIN 1-3)
- CIN 1 = low risk
- CIN 2 –> 2/3 of epithelium involved
- CIN III that is full thickness = carcinoma in situ
4 tx recommended for CIN II/III (high risk)
- Excisional methods
- LEEP (Loop Electrosurgical Excision Procedure) = electrocautery, usu done
- Cold Knife Conization = scalpel
Note: CIN 1 = lower 1/3
What is the MC GYN CA in women
MC GYN CA in women = cervical CA
Cervical CA
- what 7 types of HPV is it a/w
- what type is a/w skip lesions/sprinkler effect
- MC presenting Sx
- What is usu seen on PE
- What location = MC
Cervical CA
- a/w HPV types 16, 18, 31, 33, 45, 52, 58
- skip lesions/sprinkler effect –> adenocarcinoma
- MC presenting Sx = post coital bleeding
- PE –> friable transformation zone
- MC location = transformation zone (sq. columnar junction)
52 y/o women, G5P5 c/o of postcoital bleeding. She has had 15 sexual partners, began having sex at age 15, has a h/o of STIs and smokes. She also c/o watery vaginal d/c, vaginal bleeding, and pelvic pain/pressure. Speculum exam reveals friable transformation zone
Dx?
Best way to confirm Dx?
Dx = Cervical CA
Dx w/ colposcopy + Bx
Tx of Cervical CA
- What is unique about how it is staged
- What stages can surgery be done to Tx it
- What is the tx for stages above #2
Tx of Cervical CA
- staged clincially!
- Stages I + IIA –> surgery
- Stages IIB+ –> chemoradiation
What is prevention for Cervical CA
Prevention for Cervical CA = Gardasil Vaccine
Gardasil Vaccine
- what age range can it be given, how many doses usu
- ideally given before _____
- how many types of HPV does it target
Gardasil Vaccine
- Given to BOYS + girls age 9-26, usu 2 doses
- ideally given before sexual activity
- Targets 9 types of HPV (all 7 high risk types + 6, 11)
Pap Smears: additional info
- need to do routine cervical cytology for women w/ hysterectomy for benign reasons
- what type of Pap done for women w/ hysterectomy for CIN
Pap Smears: additional info
- DONT need routine cervical cytology for women w/ hysterectomy for benign reasons
- women w/ hysterectomy for CIN –> pap w/ vaginal cuff
What GYN cancer is the MC cause of mortality + why (2)
GYN cancer MC cause of mortality = Ovarian Cancer
- b/c lack of good screening test and vague Sxs
What is the likely cause of ovarian CA (Exs)
Likely cause of ovarian CA = chronic uninterrupted ovulation
Exs: early menarche, late menopause, nulliparity, infertile, late age of childbearing
What factors are protective for ovarian CA (6)
Things that decr risk of ovarian CA: anything that interupts/suppresses ovulation
- breastfeeding
- multiparity
- late menarche
- early menopause
- OCPs
- BTL/hysterectomy
What 2 genetic conditions incr risk of ovarian CA
Genetic conditions: incr risk ovarian CA
- Lynch Syndrome
- BRCA 1/2 mutations
60 y/o obese pt has h/o of endometriosis, BCA and has be on estrogen replacement therapy for 7 yrs presents w/ Sxs of abd pain/fullness, bloating, early satiety, N/V, and fatigue. On PE you feel mass that is solid, fixed and irreg in abd.
Best way to Dx?
Most likely Dx?
Best way Dx = US
Dx = Ovarian Cancer
What is the PE finding called that is a/w METs to the umbilical LNs in Ovarian CA
Sister Mary Joseph’s node = METs to the umbilical LNs in Ovarian CA
What is the MC type of ovarian CA
MC type of ovarian CA = epithelial call
1) Epithelial Cell Ovarian CA
- what type MC and usu bilat
- what type is usu very large
Epithelial Cell Ovarian CA
- MC and usu bilat = Serous
- Very large = Mucinous
2) Stromal Cell Ovarian CA
- Are they cystic, complex or solid
- what are the two types
2) Stromal Cell Ovarian CA
1. Solid tumors
- Two types
- Granulosa-Theca Cell
- Sertoli-Leydig
2) Stromal Cell Ovarian CA: Granulosa-Theca Cell
vs Sertoli-Leydig
- Which a/w estrogen production, precocious puberty and vaginal bleeding
- Which a/w androgen production, masculinization and hirsutism
2) Stromal Cell Ovarian CA: Granulosa-Theca Cell
vs Sertoli-Leydig
- Granulosa-Theca Cell a/w estrogen production, precocious puberty and vaginal bleeding
- Sertoli-Leydig a/w androgen production, masculinization and hirsutism
3) Germ Cell Tumors
- What type is MC and usually benign/mature
- what age group are these MC in
- why are these usu Dx early (unique)
3) Germ Cell Tumors
1. MC type = dermoid cyst/teratoma (usually benign/mature)
2. MC in kids, young women (20-30s)
3. Usu Dx early b/c grow fast –> pain
What type of Ovarian Tumor:
- teratoma w/ thyroid tissue –> may cause Sxs of hyperthyroid
- usu unilat
- multilobulated mass w/thick septa on MRI
- tx is cystectomy
What type of Ovarian Tumor:
- teratoma w/ thyroid tissue –> may cause Sxs of hyperthyroid
- usu unilat
- multilobulated mass w/thick septa on MRI
- tx is cystectomy
Stuma Ovarii
What 4 labs are used to monitor ovarian CA
Labs for monitoring Ovarian CA
- CA 125
- AFP
- LDH
- hCG
Ovarian CA staging/Tx
What is the type of surgery done for primary staging and Tx for early stage dz
Ovarian CA staging/Tx
TAH-BSO (w/LAD) done for primary staging and Tx for early stage dz
54 y/o presents w/vaginal bleeding. Pt is obese, has a h/o PCOS and DM and currently is on tamoxifen to control postmenopausal Sxs. abn Pap smear results.
What is next best step?
likely Dx?
Next step –> EMB
Likely Dx –> Endometrial CA (AUB = hallmark)
Name 2 types of Endometrial CA
- which type is estrogen dependent
Types of Endometrial CA
- Type 1 = Endometroid (estrogen dep)
- Type 2 = Serous/Clear Cell (estrogen indep)
Types of Endometrial CA: Type I vs II
- which is well differentiated, good prognosis, ER+
- which is MC in thin, PMP pts and worse prognosis
Types of Endometrial CA: Type I vs II
- Type I = well differentiated, good prognosis, ER+
- Type II = MC in thin, PMP pts and worse prognosis
Endometrial CA Tx
- What type of surg done (regardless of stage)
- What additional Txs used for higher stages
- What is 1st line Tx for adv + recurrent dz
Endometrial CA Tx
- TAH-BSO done (regardless of stage)
- Additional Txs used for higher stages = chemo + radiation
- 1st line Tx for adv + recurrent dz = high dose progestins
