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ABOG Written Exam > ONC > Flashcards

ONC Flashcards

1
Q

cervical cancer- what number most common for USA, worldwide

A

third most common gyn cancer US, third most common gyn cancer death US, 2nd most common cancer worldwide

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2
Q

natural h/o hpv infection- natural clearance

A

70% resolve by 12 mo, 90% by 24 mo

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3
Q

advantages/disadvantages of HPV only screening

A

+: sens and NPV 99-100% when combined

-: increased colpos, lowever PPV

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4
Q

ASCUS 21-65 yo, what next?

A

reflex cotest: if + colpo, if - routine screen

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5
Q

negative HPV, ASCUS 30-65 yo

A

rpt screen 3-5 yr

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6
Q

negative HPV, LSIL pap 30-65

A

pap/cotest one year, colpo also ok

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7
Q

negative HPV, HSIL pap 30-65

A

colpo

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8
Q

any abnormal pap, pos HPV 30-65

A

colpo

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9
Q

When is ECC indicated during colpo?

A
  1. inadequate colpo 2. concern for endocervical extension
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10
Q

what percentage of excisional procedures are curative? what if there are pos margins?

A

95% cure rate

of those w/ pos margins, 67% resolve spontaneously; rpt pap/ECC in 6 mos would be next step

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11
Q

endometrial cells on pap- pre vs post menop

A

pre-men: if asx, routine, if pos sx (AUB) then EMB TVUS

post-men: EMB TVUS

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12
Q

AGC (AGUS) on pap

A

HPV, ECC, colpo + EMB if greater than 35 and/or endometrial cells

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13
Q

AIS on excisional procedure?

A

hyst preferred, reexcise is pos and desire fertility

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14
Q

pap screening in HIV pt, when start how often?

A

w/in one year sexual activity no later than 21, pap q 60 then q year if first two are normal; if three consecutive normal can do q3yr

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15
Q

cervical ca stage 1- define and tx?

A

IA1: <3mm deep and nor visible: hyst
1A2: <5mm deep and not visible: mod rad hyst
IB1: >5 mm and <2 cm wide: rad hyst + PLND
IB2: >5 mm and 2-4 cm wide: rad hyst + PLND
IB3: >5 mm and >4 cm wide chemo-RT + brady

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16
Q

cervical ca stage 2- define and tx?

A

IIA1: upper 2/3 vagina- chemo RT + brachy
IIA2: upper 2/3 vagina- “
IIA3: parametrial involvement- “

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17
Q

cervical ca stage 3- define and tx?

A

IIIA: lower 1/3 vagina- chemo/RT
IIIB: pelvic sidewall or kidney- “
IIIC1: pelvic nodes- “
IIIC2: paraortic nodes- “

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18
Q

cervical ca stage 4- define and tx?

A

IVA: adjacent pelvic structures, bladder, rectum
IVB: distant mets

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19
Q

most common early, late complications of radical hyst?

A

early- UTI, late- bladder atony

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20
Q

when is radiation indicated for ca cancer?

A

primary tx for anything and/or those not surg candidates, adjuvant tx for nodes (after surgery), palliative tx

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21
Q

cervical ca recurrence tx?

A

if central recurrence, do whatever you didn’t do the first time (surgery, chemo/RT)
if lateral recurrence, do chemo/RT for ppl who had a hyst, for those who had chemo/RT, do another dose of chemo (can’t do another dose of rad)
do a pap at each f/up visit, the majority of recurrences are asymptomatic

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22
Q

ACOG breast ca guidelines

A

q1-2 y 40-50, then qy after 50

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23
Q

most common mammo sign of malignancy

A

clusters of calcifications (fat necrosis- benign- can mimic)

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24
Q

what stage (and more severe) would be worrisome w/ the BI-RADSs score? who needs change in mgmt, who needs bx?

A

BI-RADS 3 and above is abnormal. 3 needs ipsilateral mammo q6 mo. 4 and 5 need bx. 6 is known ca.

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25
Q

what chromosome is BRCA1 on? what are the odds of breast and ov ca for those pts?

A

chromosome 17. Breast ca 50-85%. Ovarian ca 50%

26
Q

what chromosome is BRCA2 on? what are the odds of breast and ov ca for those pts?

A

chromosome 13. Breast ca 50-85%. 25 % risk ov ca.

27
Q

describe risk reducing mgmt for BRCA

A

at age 25, begin intensive breast screen (alt mammo/MRI q 6 mo). At age 35 (?or when done w/ childbearing) berform BSO

28
Q

what is the most common breast condition? describe its tx

A

fibrocystic change. tx = reassurance, support

29
Q

most common breast tumor women age 20-35?

A

fibroadenoma- benign. may bx to perform, then can obsere or if pt prefers excise

30
Q

DCIS: describe clinical consequences, presentation, age of dx, tx

A

a cancer precursor, age= postmenopausal, MC arises after mammo, tx= mastectomy +/- reconstruction

31
Q

LCIS: describe clinical consequences, presentation, age of dx, tx

A

a risk factor for either breast, age=40-50 yo, tx= cautious observation,

32
Q

what is the most common histological type of breast ca? at what anatomical location?

A

invasive ductal ca (70%), “indian filing” be invasice lobular (30%), arise in the terminal duct lobular unit in upper/outer quadrant

33
Q

what is the role of tamoxifen vs raloxifene?

A

tamoxifien- pre-menopausal women w/ ER pos breast ca and ?high risk for dz
raloxifene- post-menopausal women w/ ER pos breast ca

34
Q

what is the role of aromatase inhibitors in breast ca? how long can they be used?

A

indicated only for postmenopausal women w/ ER pos breast ca. block estrogen synthesis= MOA, reduces estrogen by 95%
can be used max 5 yr- consider then tamoxifen after

35
Q

what is the most important prognostic factor for breast ca?

A

axillary node status (stage)

36
Q

what is the most common gyn ca?

A

endometrial

37
Q

what is the most common histological type of endo ca?

A

endometrioid

38
Q

at what stage do most endo ca pts present?

A

stage 1 (75%)

39
Q

endo ca staging + tx

A 
1A: <50% myometrium- surgery alone
1B: >50% myometrium- surgery + RT
II: cervix- surgery + RT
III: pelvic anatomy and/or nodes- likely surgery, RT/chemo
IV: bladder, bowel, distant dz= "
40
Q

describe relationship of pos nodes and survivorship in endo ca

A 
No LN- 5 yr survival 85%
Pelvic Nodes (IIIC1): 65%
Paraaortic Nodes (IIIC2): 45%
41
Q

when do most endo ca recurrences occur? where do they occur? what is the tx?

A

w/in two years, MC location = vaginal cuff, tx= if surgery previously, then do RT; if h/o RT, then do chemotx. metastatic recurrence = chemotx.

42
Q

leiomyosarcoma location , median age, dx modality, mitotic definition

A

myometrium, 52-54 age, can’t be sampled w/ EMB/D&C, >10in 10 HPF,

43
Q

endometrial stromal sarcoma

A

endometrium smooth muscle cell, can be dx’d w/ EMB/D&C, better px than other sarcomas those high grade still bad

44
Q

carcinosarcoma (MMMT)

A

the most common sarcoma of the uterus, somewhat older (65+), can be dx w/ EMB/D&C,

45
Q

cowden syndrome: mechanism, inheritance, findings

A

autosomal dominant, PTEN mut, hamartomas, breast, thyroid, then colon/uterus

46
Q

when do pre-menop women see onc for ov ca concern? post-men?

A

Pre-menopausal: CA125 >200, ascites, fam hx, evidence of mets
Post-menopausal: CA125>35, ascites, evidence of mets

47
Q

stage 1 ovarian ca definition and tx

A 
1A1: unilateral- no further tx required
1B: bilateral- no further tx required
1c1: surgical spillage- chemotx
1c2: capsule rupture prior to surgery- chemotx
1c3: pos washings or ascites- chemotx
48
Q

when do you re-operate vs do chemotx for ovarian ca pts?

A

> 6 mo and potentially amenable dz- operate

<6 mo or unresectable- don’t operate

49
Q

dysgerminoma marker, pearls

A

LDH. most common GCCT, B/L 20%, contralateral should be removed if XY mosaic

50
Q

yolk sac tumor marker, histo finding and its description

A

AFP, schiller-duvall (central vessel w/ tumor cells)

51
Q

GCCT and SCST tx?

A

resection and BEP

52
Q

how do granulosa cell tx present? what is the pathomneumonic histo finding? what is the tumor markers?

A

abnormal bleeding (get an EMB), large mass, call-exner bodies, inhibin

53
Q

most common skin cancer dx overall? most common and 2nd most common vulvar ca

A

basal cell ca = mc overall

most common vulvar ca is SCC, 2nd most common melanoma

54
Q

most common early and late complications of vulvar ca

A

early- wound separation, late- lymphedema

55
Q

most common vulvar survival consideration

A

nodes

56
Q

vulva, vaginal ca tx?

A

vulvar is individualized but often WLE + SNL +/- RT

vaginal ca mainstay is RT

57
Q

most common complete mole karyotype, incomplete karyotype

A

complete= dipolid- 46XX, incomplete = triploidy- XXY is MC

58
Q

what percentage of complete moles result in persistent GTD? Incomplete moles?

A

30% complete moles result in GTD, 3% of incomplete

59
Q

hydatidiform mole bHCG frequency

A

weekly for 3 consecutive “normals”, then monthly for 6 mo

60
Q

what are the histo findings of choriocarcinoma? Placental site trophoblastic tumor?

A

cyto and syncytiotrophoblast

intermediate trophboblastic cells

61
Q

describe high risk GTD findings, what tx do these require?

A

brain/liver mets, super high hcg (>100,000), long interval since pregnancy, term gestation; these pts need emaco tx

62
Q

most radiosensitive tissue?

A

ovaries, kidney (20 Gy), small bowel (30)

ABOG Written Exam (5 decks)

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