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OBGYN Oral Boards > ONC > Flashcards

ONC Flashcards

1
Q

when to stop mammograms?

A

Consider stopping at 75. If otherwise healthy, can continue

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2
Q

Breast screening for BRCA, PTEN and P53 mutations, lifetime risk of 20%

A

twice yearly clinical breast exam
annual mammo at 10 years before earliest dx, but not before 25
annual breast MRI

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3
Q

Breast screening for hx of thoracic rads

A

start at 25 years old
clinical breast exam q6-12 months
annual mammo
annual breast MRI

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4
Q

What percentage of mammo miss breast cancer?

A

20%

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5
Q

Concerning features on mammo

A

mass
calcfications- 5 or more clustered is concerning
architectural distortion-skin changes

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6
Q

Patient has a breast cyst and FNA is performed. What features would require further work via bx?

A

mass is solid and you get no fluid.
fluid is bloodly
mass is persistent after aspiration,

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7
Q

lifetime risk of breast cancer

A

1 in 8

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8
Q

most common breast cancer histology

second most common

most common location of breast cancer

A

ductal carcinoma

infiltrating lobular carcinoma

upper outer quadrant

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9
Q

Risk factors for breast cancer

A 
65+ yrs
BRCA, Li-fraumeni, Cowden
2 or more 1st degree relatives with breast cancer dx at an early age
biopsy confirmed atypical hyperplasia
nulliparity
menarhe <12, menopause >55
no breastfeeding
post-menopausal obesity
recent long term use of estrogen and progestin
EtOH
askenazi jewish heritage
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10
Q

inflammatory breast disease is what stage?

A

stage 3

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11
Q

Which patients are NOT candidates for breast conservation surgery

A 
stage 3 and 4 dz
his of rads
pregnancy
persistent  margins
family hx
tumor greater than 5cm
diffuse calcifications
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12
Q

Good prognostic factors for breast cancer

A

small tumor size, negative node, ER or PR positive

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13
Q

Breast CA adjuvant Therapy

  • positive lymph nodes?
  • Negative nodes, tumor <1cm?
  • negative nodes, tumor >1cm?
A
  • chemo, plus tamoxifen (if receptor positive), if post menopausal (tamoxifen plus aromatase inhibitor)
  • consider tamoxifen if receptor positive. or nothing further
  • tamoxifen if receptor positive with or without chemo, chemo is must if receptor negative.
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14
Q

What is DCIS?

treatment?

A

precursor to invasive breast cancer

mastectomy vs wide local excision with rads

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15
Q

How do you counsel patients on tamoxifen?

A

Risks: VTE, uterine cancer, fatty liver disease, vasomotor symptoms

Benefits: reduced risk of invasive breast cancer, but not in cancer deaths,
-reduced hip, radius, spine fractures

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16
Q

Can BRCA patients get HRT after having BSO?

A

yes! so long as they don’t have a history of breast cancer.

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17
Q

Letrozole inhibits the conversion of what to what?

workup before starting letrozole

A

androsteindione to estrone

BMD assessment with FRAX or DEXA and continue annual DEXA while on letrizole

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18
Q

Gest Troph Dz is comprised of GTN and benign molar pregnancy. What percentage is molar?

Of them, what percentage is partial vs complete?

Of GTN, name to metastatic types of disease?

A

80% benign mole

90% are complete mole, 10% partial

choriocarcinoma
placental site troph tumor
epitheliod troph tumor

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19
Q

Symptoms of a complete mole

A

hyperthyroidism, theca-lutein cyst

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20
Q

Preop molar pregnancy workup

A 
Hcg
TSH 
pelvic sono
CBC
PT/INR
Type and screen
CMP-renal and liver functions
CXR- to rule of GTN as lung is the most common site of mets
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21
Q

What are the differences between partial and complete mole?

A
  • Partial mole has fetal parts (normal ovum, fertilized with two sperm or diploid sperm).
  • Complete mole-two sperm fertilize empty egg or one sperm fertilizes empty egg and duplicates it s DNA
  • partial mole has focal villous edema abd trophoblastic hyperplasia

Partial mole is triploid

Partial mole has lower risk of GTN. Complete mole has 19% chance of invasive mole (aka nonmetastatic GTN)

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22
Q

Post op Molar follow up

A

HCG 48hrs after evacuation
weekly while elevated then monthly for 6 months

contraception to reduce the risk of a normal pregnancy causing a rise in hcg vs GTN

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23
Q

You are following a molar pregnancy. What hcg findings would make you suspicious for GTN?

A
  • hcg plataeu over 4 values over 3 weeks (day 1, 7, 14, 21) +/- 10%
  • > 10% rise over 3 values (day 1, 7, 14).
  • Hcg +more than 6 months

rule out new pregnancy.

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24
Q

When to suspect phantom hcg?

A

low level plataeu hcg in blood

due to heterophilic antibody, check urine hcg to rule it out. antibody is not excreted in the urine

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25
Q

Which BRCA patients should get tamoxifen?

A

BRCA2 bc they are ore estrogen dependent

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26
Q

Risk of cancer with EIN?

A

40%

need ONC present for possible lymph node dissection

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27
Q

GTN workup

A 
HCG
CXR
CBC
CMP
CT Head chest abd pelvis
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28
Q

Type of trophoblasts for Placental site trophoblastic tumor?

What is the tumor marker?

A

intermediate trophoblasts

human placental lactogen

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29
Q

Good prognostic factors in GTN

A

last pregnancy <4 months
low HCG titer <40k
no brain or liver mets
no prior chemo

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30
Q

WHO Staging system

What constitutes low risk?

A

= 6 which means they can have single agent chemo

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31
Q

GTN

  • Patient has complete mole..You follow hcg but it plateaus over 4 values.
  • you dx GTN.
  • she gets CT H/A/P, CXR, CMP, CBC, Hcg.
  • WHO score is <6 so she startes single agent chemo.
  • HCG rises.
  • What is our next step?
A

-change to other chemo agent
-consider TAH
-switch to EMA-CO
etoposide, methotrexate, actinomycin D, cyclophosphomide, vincristine

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32
Q

When to stop paps?

A

age 65, 2 prior negative HPV tests, 2 negative cotests, 3 negative cytology with the past 10 years. most recent test must be within the last 3-5 yrs

after total hysterectomy with no history CIN 2 or worse in the past 25 years

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33
Q

How do you manage ASCUS?

A

get HPV
If positive–> colpo

if negative–> repeat cotesting in 3 years

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34
Q

What should you do with the following results?

  1. cytology neg, HPV neg
  2. cytology neg, HPV pos
A
  1. repeat in 5 year
  2. cotest in 1 year or reflex to 16/18 and if positive-do colpo,

if negative for 16/18, retest in 1 year

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35
Q

You test for HPV alone, like the new guidelines say and your patient is HPV positive.

Next step?

A

get cytology

or if HPV 16/18 positive then do a colpo

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36
Q

How long do you keep doing cervical cancer screening in patients with a history of HSIL?

A

HPV with or without cytology every 3 years for 25 years

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37
Q

How to manage HSIL?

A

LEEP for everyone except if pregnant or age 21-24, then do colpo

38
Q

ASCUS with +HPV and negative colpo.

next step?

A

repeat co test in 1 year.

if ASCUS with +HPV again, repeat in 1 year again.

if still ASCUS with +HPV for 2 years, then colpo again.

39
Q

How to manage LSIL?

A

colpo, expect 21-24 then repeat cytology in 1 year

40
Q

postmenopausal endometrial cells on pap?

Next step?

premenopausal endometrial cells on pap?

A

post-menopausal - EMB

pre-menopausal - do nothing

41
Q

Atypical glandular cells
next step

<35
>35

A

Colpo/ECC for everyone
<35–>EMB if risk factors for endometrial cancer
>35–> EMB

42
Q

Pap comes back with atypical endometrial cells.

next step?

A

emb and ecc, if negative, then do a colpo

43
Q

Pap comes back with adenocarinoma in situ

next step?

A

colpo, ecc, emb

44
Q

colpo comes back with adenocarcinoma in situ

next step?

A

refer to onc for CKC vs hyst.

45
Q

colpo comes back with adenocarcinoma in situ.

CKC come back with positive margins.

next step?

A

simple hyst for those done with children

repeat cone with counseling for those who still want children, follow with Co-testing at 1 year

46
Q

What are you looking for on colpo?

A

acetowhite changes,
abnormal blood vessels,
mosaicism (network of fine-caliber blood vessels),
area of punctation

47
Q

How does lugols work?

A

stains glycogen so abnormal cells are pale

48
Q

adequate colpo requires two things

A

see the whole cervix/lesion

see the squamocolumnar junction

49
Q

What does LEEP stand for?

A

Loop electrosurgical procedure

50
Q

Risks of preterm delivery after LEEP and CKC

A

CKC are 2.5 more likely to have Preterm delivery, low birth weight, and/or c/s.

LEEP 1.5 times more likely to have PTD.

51
Q

LEEP path comes back with positive margins.

next step?

A

repeat pap and ecc in 4-6 months

52
Q

Treatment options for cervical dysplasia

A 
cryosurgery
LEEP
CKC
Laser ablation
Hysterectomy
53
Q

How does gardasil work?

age for giving it?
how many doses?
can you get it while pregnant?
can you get it while breastfeeding?

A

vaccinates against the L1 virus like particles

9-45
2 dose if under 15, 3 if over 15
not while pregnant
okay while breastfeeding

54
Q

Cervical Cancer staging

What stage can you do a cone?

A

1A1- nonvisible lesion with = 3 mm stromal invasion

simple hyst is okay as well.

55
Q

Cervical Cancer staging

If the lesion is visible, it is at least what stage?

A

1B1

1B1 <2cm
1B3 >4cm

56
Q

Cervical Cancer staging

If the patient has hydronephrosis, she is at least what stage?

A

3B

57
Q

Cervical Cancer staging

What stages get rad hyst?

What if she wants future fertility?

A

IA2 thru 2A
nonvisible lesion with 3-5mm of invasion up through visible lesion in upper 2/3 of the vagina

radical trachalectomy for 1b1 and 1a2

58
Q

Margins of a rad hyst

A

parametrial, pelvic lymph nodes, upper 2 cm of vagina

59
Q

Who gets chemo/rads?

A

Stage II-4B

60
Q

Consequences of DES exposure

A 
cervico-vaginal clear cell CA
congenital GU tract anomalies
infertility,  PTL, PTD
CIN 
Vaginal adenosis
HIgher risk of breast ca
61
Q

-mammo and pap recommendations for pts with DES exposure

A

annual mammo

annual pap and colpo of cervix and upper vagina

62
Q

Pt in her 40% with bartholins. next step?

A

must excise to rule out adenoma carcinoma

63
Q

Vulvar cancer

If pt has inguinal lymph node mets, what stage is that?

What is the stromal invasion cut off for performing a lymphadnectomy?

A

stage 3

1mm

64
Q

Vulvar skin cancer

counseling and treatment

basal cell

A

localized, rarely mets

treat with wide local excision of 1cm margin

65
Q

Vulvar skin cancer

malignant melanoma
ABCD

A

asymetry
irregular borders
color variation
diameter >5mm

66
Q

Vulvar skin cancer

malignant melanoma
treatment

A

Radical local excision
>1mm–> 1cm margin
1-4mm –> 2cm margin
> 4mm –> 3cm margin

excellent chance for cure

if pregnant, send placenta due to mets!

67
Q

Which class of vulvar dysplasia is associated with lichen sclerosis

A

VIN differentiated type (dVIN) —>treat like high grade

other types are low-grade, and high grade

68
Q

postmenopausal woman presents with genital warts.

next step?

A

biopsy because it could be vulvar dysplasia

69
Q

Vulvar skin cancer

treatment

A

excision, can consider laser, or topical treatments if no concern for occult invasion

70
Q

Pagets dz of the vulva

appearance

A
  • red and velvety
  • white islands of hyperkeratosis, cupcake frosting appearance

pruritis, will always have postitive margins

71
Q

Pagets dz of the vulva

histologic findings after biopsy

A

large, round cells, pale cystoplasm, cells may be clustered giving an acinar appearance

stain for CEA and CK-7 to differentiate from melanoma

72
Q

Pagets dz of the vulva

what screening tests would you recommend to this patient?

A

I recommend mammogram, colonoscopy, CT looking for GU tumors

73
Q

Pagets dz of the vulva

treatment

A

wide local excision

74
Q

Pap comes back with VAIN I

next step?

A

slow progressing, retest in 1 year,

colpo after 2 years

if persistent, can extend to retest in 2-3 years or refer for treatment with laser

75
Q

Pap comes back with VAIN 2/3

next step?

A

refer for treatment

76
Q

Pagets dz of the vulva

Where else can it manifest?

A

perianal, axilla

77
Q

Ovarian Cancer

Types

A

Epithelial-clear cell, high grade serous, low grade serous, endometrioid, mucinous

Germ cell-dysgerminoma, endodermal sinus, embryonal, polyembryoma, choriocarcinoma, immature teratoma, (DEEP CT)

Sex cord stromal-sertoli-laydig, granulosa

metastic-GI

78
Q

Most common type of ovarian cancer

A

high grade serous

79
Q

Sex cord stromal
Granulosa cell tumor

age range
tumor markers

A

<30 and >60
inhibin (A and) B, AMH

secrete estrogen, but not monitored with estrogen, need EMB

call exner bodies-rosettes
coffee bean nuclei

80
Q

Sex cord stromal
Sertoli Leydig tumor

age
tumor markers
treatment

A

20s and 30s

testosterone
oophorectomy in reproductive age women
hyst BSO if postmenopausal
-high survival

81
Q

Germ Cell Cancer

dysgerminoma

tumor markers
treatment

A

LDH bhcg

leave other ovary and uterus in place if they look normal for all germ cell.

most common malignant germ cell tumor

82
Q

Which epithelial ovarian cancer patients should get referred for genetic testing?

A

ALL women with epithelial ovarian cancer except mucinous

83
Q

Germ Cell Cancer

immature teratoma

tumor markers
treatment

A

AFP
Ca 125

at least unilateral BSO.
if stage 1A grade 1 then no adjuvent therapy (BEP)

immature neural components determine the grade

84
Q

Lynch Syndrome patients

routine screening

A
  • colonoscopy q1-2 year starting at age 25
  • annual UA to screen for GU cancers
  • hyst BSO in early 40s after EMB
85
Q

Germ Cell Cancer

endodermal sinus (yolk sac)

histology
tumor markers
treatment

A

Schiller-duval bodies, aggressive, rupture in abdomen with hemorrhage

AFP

unilateral BSO, responds to chemo and every needs chemo

86
Q

Germ Cell Tumor

chemo regimen

A

BEP
bleomycin
etopiside
cisplatnin

87
Q

What is the OVA1 test?

A

screening tool as to whether or not GYN ONC referral is needed pre-operatively

combines CA 125, transferrin, prealbumin, apolipoprotein AI, and Beta2 microglobulin

pre-menopausal >5 and post >4.4 call ONC

88
Q

Epithelial ovarian cancer

chemo regimen

A

carboplatin and paclitaxal

89
Q

Borderline tumors are precursors to what type of ovarian cancer

A

low grade serous

90
Q

EIN = complex atypical hyperplasia

What about endometrial hyperplasia without atypia? Management

A

Weight loss
D+C
MRI

Progestin therapy for example
IUD
provera 30mg daily
EMB q 3 months

then surgical management

OBGYN Oral Boards (6 decks)

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