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Onc Prolog Flashcards

1
Q

lynch, HNPCC syndrome

A
  • gene association MLH1, MSH2
  • AD
  • endometrium, ovary, gastric tract, small bowel
  • positive screening needs referal for genetic counseling
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2
Q

Li Fraumeni syndrome

A
  • associated with soft tiddue sarcoma
  • TP53 associated
  • almost 100% get cancer
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3
Q

Cowden Disease

A
  • PTEN association (genes)
  • AD
  • breast, thyroid, endometrial cancer
  • benign mucocutaneous lesions
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4
Q

capacity to make decisison (suggested guideliens)

A
  • communicate choice between treatment optoins
    0- undrestand treatment optoins
  • understand info leading to the decision
  • undersatnd consequences of treatment
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5
Q

women who have a 20-25%+ risk of breast and ovarian cancer due to familiar risk include;

A
  • personal hx of BOTH cancer
  • peronal hx breast or ovarian and close family member with it (especially males, young family, any family with ovarian, self Ashkenzi and dx 40 yo, or family BRCA+)
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6
Q

women who have 5-10% risk breast/ovarian cancer include those with:

A
  • personal hx breast 40 years or younger
  • personal hx ovarian cancer any age
  • presonal hx bilateral breast cancer
  • perosnal breast cancer 50yo and family breast 50 years old
  • personal breast 50 yo, ashkinasy,
  • breast cancer any age + two family members Br Cx any age
  • unaffected women with family member who meets any above criteria
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7
Q

paraneoplastic syndromes from ovarian disease

A
  • systemtic sx not due to direct efect on local cancer
  • cerebellar degeneration, motor/cognitive decline
  • anti-Yo preogressive cerebellar degeneration most commonly with ovarian and breast cancer
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8
Q

GTN WHO scoring

A

review the photo for a general idea

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9
Q

pharmacologic ppx anticoaguation preferneces in surgery

A
  • LMWH better than unfractionated heparin for surgery
  • LMWH better beacuse daily dosign (not BID), predictable pharmacodynamics, greaster anti-factor Xa activity, less thrombin activity, reduced risk of thrombocyotpenia
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10
Q

risk factors for PE well criteria and imaging to dx

A
  • clincal s/sx PE
  • PE more likely than alternative idea
  • HR > 100
  • immobilization greater than 3 days
  • surgery in last four weeks
  • previosuly had PE/DVT
  • hemoptysis
  • cancer

CT angio is how you diagnose for everyoene (not ddimer, VQ scan etc)

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11
Q

tamoxifen

A
  • used for anjunctive breast cancer treatment or ppx for women at high risk breast cacner
  • affects endometrium by increasing estrogen at that site
  • asymptmatic women on tamoxifen do not need uterine surveillance (not helpfuL)
  • symptomatic women REGARDLESS OF ENDO THICKENESS need yearly endometrial biopsies
  • increas your risk for endometrial cancer 2-3x
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12
Q

women >30yo with breast mass need what work up

A
  • diagnostic mammogrpahcy

- (MRI only helpful in women with breast implants, very dense breast tissue, lots of breast scaring from prior surgery)

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13
Q

gas embolism

A
  • risk of LSC surgery
  • sx include: dropped BP, end tidal carbon dioxide, SaO2
  • sx also include: tachycardia, cardiac arrthymias, hyptension, icnreased central venous pressures, cyanosis, right heart strain
  • Capnography is better than oximetry
  • caues decareased cardiac output due to righr heart issues and vena cava issues, can cause cardiac collpase
  • first you reduce all pneumo
  • place in steeper trendeleburg
  • turned to left side (all prevents gas embolis from getting into pulmonary system
  • hyperventillate them
  • mill wheel murmur classic for gas emolism
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14
Q

bowel obstruction with cancer

A
  • SBO needs NG tube (often has vomiting)
  • colonic obstruction look severely ill and needs treatment to avoid perforation (there forms a closed loop and gas cant’ go anywere)
  • if palliative care underway, don’t want to have recovery time wasted after surgery, therefore endoscopic stenting is preferred to shit bag.
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15
Q

necrotizing fasciitis symptmos

A
  • exquisitely tender (due to nerve death), erythematuous, edemtous (woody), watery dish water coming from incision after CS
  • also with systmeic fever, tachycardia, relatively low BP
  • risk factors include poor healing set up: diabetes
  • fascial necrosis is a hallmark of the dieases
  • dont need CT for this eval, take to OR for debridement (but CT findings would include gas). Large abdominal wound afterwards, can close by secondary intention wtih vaccum
  • fatal in 25% of cases, need to act fast. Go until get to bloody good tissue.
  • polymicrobial: clostridium, group A step, staph aureus,
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16
Q

non-cancer breast diagnosis

A
  • non-profilferative: fibrocystic changes, fibrocystic disease, chronic cystic mastitis, mammary dysplasia and breast cysts. NTD
  • proliferative breast lesions WITHOUT atypia: ductal hyperplasia w/o atypia, intraductal papillomas, sclerosing adenosis, radial scars, fibroadenomas. Slighty 1x risk icnrease in breast cancer. NTD.
  • proliferative lesions: atypical ductal hyperplasia, atypical lobular hyperplasia. Can increase surveillence, but otherwise nothing to do.
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17
Q

gynecological hemorrhage

A

1000mL QBL or any QBL that requires transfusion

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18
Q

hcg levels in peri/postmenopausal women elevated <14

A
  • can just be a weird thing that happens

- suppress with OCPs, shoudl go down, and then recheck hcg levels

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19
Q

ovarian cacner with bowel involvement: surgical extent

A
  • go for complete resection with bowel resection. increases survival significantly and risk of mortailyt from surgery is acceptably low (5%)
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20
Q

AGC finding on pap requires what additional testing

A
  • ECC, colpo if <35

- if >35 then ECC and Embx and colpo

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21
Q

when to pause chemo treatments based on lab values

A

Granulocysts

    • day of therapy <1500
    • cycle nadir <1000

Platelets

    • day of therapy <7500
    • cycle nadir <50,000
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22
Q

psuedomyxoma peritonei

A
  • jelly belly
  • associated with appendix tumor (not ovarian)
  • occur because shit in the appendix accumulates and then bursts adn goes all over the bdomen
  • these are mucous producing cells that repliate
  • they spread to the ovary for some reason
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23
Q

anemia panel findings and meaning

A
  • normal MCV: normal B12 and folate
  • ferritin stores: iron related

*note that EPO and associated meds (darbopoein) are contraindicated beause of an association of cancer progressoin

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24
Q 
some immunostaining markers to help tell cancers apart: 
CK7
KRT7
CA 125
PAX8
WT1
KRT 20
CK20
CEA
CDX2
Vementin
A 
SErous ovarian tumors
CK7
KRT7
CA 125
PAX8
WT1
Gatsrointestintal tumors
KRT 20
CK20
CEA
CDX2

negative vinmentin: no endometiral or ovarian

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25
Q

palliative care and has bowel obstruction, what do you do?

A
  • percutaneous endoscopic gastrotomy tube placement. This is done with minimal sedation and fixes n/v
  • doesn’t need surgery too invasive
  • TPN doens’t make a person not feel hungry and doesn’t stop the nausea from a blockage.
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26
Q

germ cell tumors

including immature teratomas

A
  • germ cell respond very well with chemo (bleo,etopo, ciplatin)
  • grade 1 immature teratomas only need removal though, and only need chemo if they are Stage 1A grade 2 or 3
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27
Q

SE of

  • bleo
  • etoposide
  • cisplatin
A
  • bleo: pulmonary
  • etoposide: hemtoogic malignicnacies
  • cisplatin: neuropathy and nephropathy
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28
Q

hyperkalemia

A
  • risk with ACE - I increase
  • risk with kidney issues
  • EKG shows QT shortening
  • treat with calcium to stabilize cardiac activity
  • shoudl be hsopitalized, this needs to be managed aggressively
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29
Q

fibroids wtih undetermined malignant potential needs waht fu

A
  • surveillance if had myomectomy. unliekly to actually be cacncerous
  • no fu if had h ysterectomy
  • cancerous fibroids have usually coagulative necrosis, 10+ mitoses per 10 high power fields, significant nuclear atypia
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30
Q

cisplatin antiemetic best

A
  • zofran (5-HT3 antagonist) + dexa
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31
Q

sruveilleance after hyst for endo cancer

A
  • PE, assessment of symptoms
32
Q

prediction models for breast cancer include what

A
  1. age by a long shot is the most critical
  2. size of lesion

– note lymphaticvascular isn’t included. This is somehow different than nodes.

33
Q

anal pap for women with what commorbidity

A

HIV (anal sex practices dont maek the cut)

34
Q

types of endometrial cacner

A

Type 1: adeno

  • younger
  • estrongen related
  • PTEN, DNA mismatch repair, B-caton, KRAS associatied
  • lower stage at presentation, better prog

Type 2

  • serous, poorly differentiated adeno, clear cell
  • older
  • unrelated to estrogen
  • TP53 related
  • later stage on presentatin, worse prognosis
35
Q

tamoxifen vs aromaste inhibitors

A

TAMOXIFEN

  • used for estrogen + breast cancer up to 10 years
  • antiestrogen at breast, pro estrogen at bones and endometrium, also overall increase in estrogen therefore risk for VTE
  • used wth PRE and POST meno pausal women with estrogen + breast cancer AND with women at high risk for breast cancer for prevention
  • symptoms: POSTMENOPAUSAL SYMTPOMTS somehow…hot flushes,vaginal dryness, decreased libido, thin vaginal discharge
  • going to be osteopenia protective

AROMATASE INHIBITORS

  • only POST menopausal women
  • block enzyme aromatase, so lowers overall levels of estrogen
  • SE: POSTMENOPAUSLA SX
  • also have joint and muscle pain (tamoxifen doesn’t)
  • going ot have bone loss
36
Q

colon cancer screening

A
  • best optoin is colonoscopy
  • ## can treat polyps and screen for malignancy at same time
37
Q

ovarian chemo for

  • all comers
  • suboptimally reduced
  • recurrent
  • optimatlly reduced
A
  • all comers: platinum based chemo
  • supoptimally reduced: carboplatin/paclitaxel
  • recurrent disease: caroplatin/doxyrubicin, carboplatin/gemcitabine
  • optimally reduced can consider: IP (intraparitoneal) paclitaxel/cisplatin

**IV cisplatin/paciltaxel is old school and will likely not be a correct answer choice ever

38
Q

risk factors for breast cancer

A
  1. AGE
  2. (genetic markers)
  3. then BMI later
39
Q

ovarian cancer risk factors

A 
Age
Endometriosis
family hx braest/ovarian cancer
BRCA mutations
early menarche
late menopause
mulligravidity
infertility (but not infertility treatment) `
40
Q

Bowel prep

A

not helpful

41
Q

other name for internal iliac

A

hypogastric artery (ligate this if bleeding is out of control)

42
Q

Cervical cancer staging and treatment

A
  • Stage 1: cervix onl
  • Stage 2: outside cervix but not extending to pelvic side walls or lower 1/3 of vagina

Treat Stage
1A1: Cone (microscopic)
1A2-1B: radical hyst vs rad trachylectomy vs radiation

43
Q

vulvar lesion: slwoly growing, brown, raised,
1cm size, 1.5 from urethra
punch biopsy: basal cell carcinoma

A
  • just basal cell carcinoma of skin, on vulva
  • treatmetn: wide local excision, need negative margins 4-5mm
  • no LN dissection
  • (don’t want laser beacuse you dont’ get a path speciemn, margins, etc)
44
Q

cergvical cancer screenign for LN invovlement

A
  • no requried for staging, but useful for treatment where abliable
  • cerfvical cnacer is clinical diagnosis including (history, PE, cystoscopy, proctoscopy, limited radioogy studies which could include IV urography, XCRAY lungs/bones)
  • ## PET CT scan best for LN assessment
45
Q

standard pap smear guide lines

A

<21: none
21-29: pap q3y with reflex HPV
30-65: cotesting q5y
65y: stop if no prior CIN 2/3

46
Q

ovarian cancer looks like

A
  • ascities
  • pelvic pain/presure
  • urinary frequency
47
Q

endometriosis is assocaited wtih hat types of gyn cancer

A
  • endometrioid ovarian cancer
  • clear cell ovarian carcinoma
  • overall increased for ovarian cancer as well (but survivial improved with hx endometriosis)
  • related to downregulation of TDGF1
48
Q

soemthing that reduces functional residual capacity

A
  • lung parameter
  • functional residual capaciy is what is left over after passive exhale (before froced exhal)
  • with reduced, causes hypoxia
  • plus trendelneburg does it
  • BMI

_ lung conditions dont all do this, example:
COPD: increased functiona residual capacity because lungs can’t get small again

49
Q

small cell tumor of the cervix

A
  • neuroendocrine tumor of the cervix
    (cervix MC cancer squamous, second is adenocarcinomas, then third is everything else)
  • TREAT with cisplatin-etoposide
  • early stage: surgical (rad hyst, PLN out) + ajuvant chemo
  • 1B tumors need systemic chemo
50
Q 
32 yo
bmi 51, trying to lose weight
grade 1 endometrial adenocarcinoma
no mets seen on scans
wants fertility
--- what do you do next?
A

hormonal suppression taht wont increase wieght gain: IUD mirena

note surgical resection isn’t studied for this use

51
Q

post exposure HIV treatment

A
  • emtricitabline, tneofovir, raltegravir
  • start now and continue for 28d
  • need to prevent stpread to yoru partner if you actually got it, 6-12w condomes
52
Q
  • GTN contraceptions afterward for 6m is best doen by __. Also - what labs are part of the work up
  • what is survillence pattern
A
  • OCPs (beacuse you want to interpret the hcg levels)/ This is used cause this was studied, other methods weren’t studied
  • CBC, T&S, Rh status, liver, renal, coagulation labs, CMPhcg, CXR, D&C wil likely be done to evacuate uterus
  • after DC, weekly hcg, 3 weeks of normal range > mothly for 6 months
53
Q
  • woman with IIB squamous cell cancer cervix
  • recurrent cancer, with symtpoms now again
  • on chemo currently
  • liver malfunctino assumed
  • what do you do next? ____
A

palliatve care

- dont want to biopsy etc

54
Q

mesh hernia repair

LSC vs LAP

A

LSC is fine if <10cm

55
Q

salvage threapy after ovarian cancer recurrence

A
  • is not curative

- regimen is carboplatin and doxorubicin

56
Q

radiation cystitis

A
  • raditation field includes bladder adn distal ureters
  • short term problems are inflammation and edema : increased urgency, frequency, dysuria and nocturia (self limited)
  • late radiation effects: 6 months afterwrads to years afterwards, extensive intersittial fibroisis, scloerosis of conenctive tissue, can lead to necrosis and fistual. visually will have vascular telangiectasia which can cuase hematuria
  • most common long term effect is hemorrhagic cystitis
  • can be so extensive that you can need transfusions
57
Q
  • intraperitoneal adjuvant chemo

- most sign risk factor for IP catheter is ___

A
  • left colo-sigmoid (rectosigmoid) resection (because it’s palced at the time the shit is rolling around the abdomen)
  • need interval placement if you want to avoid infection
  • resection of other things didn’t create infection risks the same
58
Q

surveilence of endometrial cancer

A
  • History and PE

- most recurrenct cancer will have bleeding symtoms

59
Q

when shoud you intube

A
  • when they are unstable, when they are on pressers
  • low spo2
  • increased RR
  • vomiting new onset
  • less than 90 despite supplemental oxygen
  • acute hypercarbia (pH is going to drop below 7.2
  • increased work of breathing
  • inspiratory msucle weakness
  • acute decompensated heart failure (jugular venous distention, pulmonary edema, decreaed EF)
  • inadequate lung expansion (RR 35 or more)
60
Q

vulvar cancer palpible node means what regarding LN dissection

A
  • i think it means you need all nodes removed beacuse sentinal node wont’ be hlpful cause the die can’t get passed that inflamed node
61
Q

DCIS

A
  • non-invasive cancer that doesn’t cross the basement membrane
  • treatment mastectomy vs lumpectomy&radiation
  • never do chemo because it’s local disease
  • some want to consider lumpectomy alone without radiation to follow. Okay to consider for pt’s with large margin (>3mm), small lesion 2.5cm.
62
Q

nerves damanged during surgery

A
  • pudendal (S2-4) (vagina surgery during sacrospinous ligament suspension)
  • femoral (L2-4) (compression from freestanding
  • genitofemoral (L1-2) LN discetion (numb or pain over labia and medial thigh)
  • linioinguilnal (L1-2) transverse incision, trochar insertion (will burn over suprapubic area)
  • obturator (L2-4), LN dissection, placement of transobturaor tape
63
Q

digital film mammography

A
  • digital for dense breast tissue, young women
  • mammo scrennign at 40yo
  • MRI for epopel with personal hx of breast cancer or really big list
64
Q

methadone

A

conitue pp or post surery and give them narcotics as well

65
Q

CAM is good for what?

A

emesis

66
Q

cervical cancer and pregnnacy

A
  • CIN1 coplo (look) and leave alone until pp
  • CIN2/3 colpo/pap, leave alone until pp (bring them back in 12w)
  • if looks invasive, then biopsy
  • diagnosiztic conizatino only for invasive cancer confirm, or you can postpone until pp
67
Q

port site mets possible when

A
  • when you do LSC, but it’s also associated jsut with advanced dieases, so go ahead and do the LSC
68
Q

LMWH cancer pt with a midline incision… how long

A

4w

69
Q

pelvic irradiation complications

A
  • radiation enteritis secondary to adhesions, inflamation around the terminal ileum and proximal colon
70
Q
  • BRCA and HT after removing BSO risk prevention

- women with hx Breast cancer

A
  • okay. 1st line. (need progestin if uterus in place)

- never give HT

71
Q

ppx ovarian cancer

A
  • BSO

- if this doesn’t want or needs fertility then do OCPs

72
Q

greatest risk for lymphadenctomy is ____

A
  • lymph node resection + radiation
73
Q

GTN treatment

A
  • low risk: signel agent chemo (no mets) – dactinomycin or methotrexate
  • high risk: dual agent chemo
74
Q

surgical prep better:

A
  • chlorhexidine- alchol (better than idodine)

- hair clipping doens’t matter for infection

75
Q

common nephrotoxins include

A

NSAIDS, ACE-I, ARBS, amnioglycosides, radioconstrast agents, diuretics

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