ONC Flashcards
cervical cancer- what number most common for USA, worldwide
third most common gyn cancer US, third most common gyn cancer death US, 2nd most common cancer worldwide
natural h/o hpv infection- natural clearance
70% resolve by 12 mo, 90% by 24 mo
advantages/disadvantages of HPV only screening
+: sens and NPV 99-100% when combined
-: increased colpos, lowever PPV
ASCUS 21-65 yo, what next?
reflex cotest: if + colpo, if - routine screen
negative HPV, ASCUS 30-65 yo
rpt screen 3-5 yr
negative HPV, LSIL pap 30-65
pap/cotest one year, colpo also ok
negative HPV, HSIL pap 30-65
colpo
any abnormal pap, pos HPV 30-65
colpo
When is ECC indicated during colpo?
- inadequate colpo 2. concern for endocervical extension
what percentage of excisional procedures are curative? what if there are pos margins?
95% cure rate
of those w/ pos margins, 67% resolve spontaneously; rpt pap/ECC in 6 mos would be next step
endometrial cells on pap- pre vs post menop
pre-men: if asx, routine, if pos sx (AUB) then EMB TVUS
post-men: EMB TVUS
AGC (AGUS) on pap
HPV, ECC, colpo + EMB if greater than 35 and/or endometrial cells
AIS on excisional procedure?
hyst preferred, reexcise is pos and desire fertility
pap screening in HIV pt, when start how often?
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
cervical ca stage 1- define and tx?
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
cervical ca stage 2- define and tx?
IIA1: upper 2/3 vagina- chemo RT + brachy
IIA2: upper 2/3 vagina- “
IIA3: parametrial involvement- “
cervical ca stage 3- define and tx?
IIIA: lower 1/3 vagina- chemo/RT
IIIB: pelvic sidewall or kidney- “
IIIC1: pelvic nodes- “
IIIC2: paraortic nodes- “
cervical ca stage 4- define and tx?
IVA: adjacent pelvic structures, bladder, rectum
IVB: distant mets
most common early, late complications of radical hyst?
early- UTI, late- bladder atony
when is radiation indicated for ca cancer?
primary tx for anything and/or those not surg candidates, adjuvant tx for nodes (after surgery), palliative tx
cervical ca recurrence tx?
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
ACOG breast ca guidelines
q1-2 y 40-50, then qy after 50
most common mammo sign of malignancy
clusters of calcifications (fat necrosis- benign- can mimic)
what stage (and more severe) would be worrisome w/ the BI-RADSs score? who needs change in mgmt, who needs bx?
BI-RADS 3 and above is abnormal. 3 needs ipsilateral mammo q6 mo. 4 and 5 need bx. 6 is known ca.
what chromosome is BRCA1 on? what are the odds of breast and ov ca for those pts?
chromosome 17. Breast ca 50-85%. Ovarian ca 50%
what chromosome is BRCA2 on? what are the odds of breast and ov ca for those pts?
chromosome 13. Breast ca 50-85%. 25 % risk ov ca.
describe risk reducing mgmt for BRCA
at age 25, begin intensive breast screen (alt mammo/MRI q 6 mo). At age 35 (?or when done w/ childbearing) berform BSO
what is the most common breast condition? describe its tx
fibrocystic change. tx = reassurance, support
most common breast tumor women age 20-35?
fibroadenoma- benign. may bx to perform, then can obsere or if pt prefers excise
DCIS: describe clinical consequences, presentation, age of dx, tx
a cancer precursor, age= postmenopausal, MC arises after mammo, tx= mastectomy +/- reconstruction
LCIS: describe clinical consequences, presentation, age of dx, tx
a risk factor for either breast, age=40-50 yo, tx= cautious observation,
what is the most common histological type of breast ca? at what anatomical location?
invasive ductal ca (70%), “indian filing” be invasice lobular (30%), arise in the terminal duct lobular unit in upper/outer quadrant
what is the role of tamoxifen vs raloxifene?
tamoxifien- pre-menopausal women w/ ER pos breast ca and ?high risk for dz
raloxifene- post-menopausal women w/ ER pos breast ca
what is the role of aromatase inhibitors in breast ca? how long can they be used?
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
what is the most important prognostic factor for breast ca?
axillary node status (stage)
what is the most common gyn ca?
endometrial
what is the most common histological type of endo ca?
endometrioid
at what stage do most endo ca pts present?
stage 1 (75%)
endo ca staging + tx
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= "
describe relationship of pos nodes and survivorship in endo ca
No LN- 5 yr survival 85% Pelvic Nodes (IIIC1): 65% Paraaortic Nodes (IIIC2): 45%
when do most endo ca recurrences occur? where do they occur? what is the tx?
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.
leiomyosarcoma location , median age, dx modality, mitotic definition
myometrium, 52-54 age, can’t be sampled w/ EMB/D&C, >10in 10 HPF,
endometrial stromal sarcoma
endometrium smooth muscle cell, can be dx’d w/ EMB/D&C, better px than other sarcomas those high grade still bad
carcinosarcoma (MMMT)
the most common sarcoma of the uterus, somewhat older (65+), can be dx w/ EMB/D&C,
cowden syndrome: mechanism, inheritance, findings
autosomal dominant, PTEN mut, hamartomas, breast, thyroid, then colon/uterus
when do pre-menop women see onc for ov ca concern? post-men?
Pre-menopausal: CA125 >200, ascites, fam hx, evidence of mets
Post-menopausal: CA125>35, ascites, evidence of mets
stage 1 ovarian ca definition and tx
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
when do you re-operate vs do chemotx for ovarian ca pts?
> 6 mo and potentially amenable dz- operate
<6 mo or unresectable- don’t operate
dysgerminoma marker, pearls
LDH. most common GCCT, B/L 20%, contralateral should be removed if XY mosaic
yolk sac tumor marker, histo finding and its description
AFP, schiller-duvall (central vessel w/ tumor cells)
GCCT and SCST tx?
resection and BEP
how do granulosa cell tx present? what is the pathomneumonic histo finding? what is the tumor markers?
abnormal bleeding (get an EMB), large mass, call-exner bodies, inhibin
most common skin cancer dx overall? most common and 2nd most common vulvar ca
basal cell ca = mc overall
most common vulvar ca is SCC, 2nd most common melanoma
most common early and late complications of vulvar ca
early- wound separation, late- lymphedema
most common vulvar survival consideration
nodes
vulva, vaginal ca tx?
vulvar is individualized but often WLE + SNL +/- RT
vaginal ca mainstay is RT
most common complete mole karyotype, incomplete karyotype
complete= dipolid- 46XX, incomplete = triploidy- XXY is MC
what percentage of complete moles result in persistent GTD? Incomplete moles?
30% complete moles result in GTD, 3% of incomplete
hydatidiform mole bHCG frequency
weekly for 3 consecutive “normals”, then monthly for 6 mo
what are the histo findings of choriocarcinoma? Placental site trophoblastic tumor?
cyto and syncytiotrophoblast
intermediate trophboblastic cells
describe high risk GTD findings, what tx do these require?
brain/liver mets, super high hcg (>100,000), long interval since pregnancy, term gestation; these pts need emaco tx
most radiosensitive tissue?
ovaries, kidney (20 Gy), small bowel (30)
