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Onco Flashcards

1
Q

pathologic description of Call–Exner bodies

A

Microfollicular pattern with numerous small cavities that may contain eosinophilic fluid

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2
Q

pathologic description of immature teratomas

A

Immature neural tissue with rosettes and tubules

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3
Q

pathologic description of dysgerminomas

A

Cytoplasmic glycogen demonstrated with periodic acid-Schiff stain

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4
Q

pathologic description of Schiller–Duval bodies

A

A central capillary surrounded by connective tissue and a peripheral layer of columnar cells

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5
Q

Schiller–Duval bodies are seen in

A

yolk sac tumors (germ cell variant)

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6
Q

“hobnail” cells on microscopy indicate

A

Clear cell carcinoma

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7
Q

Pelvic endometriosis linked to what cancer

A

clear cell carcinoma

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8
Q

Complete mole karyotype

A

46XX, 46XY
(All paternal)

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9
Q

Partial mole karyotype

A

69xxx, 69xxy, 69xyy
(Extra set is paternal)

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10
Q

What size simple cyst needs f/up?

A
  • > 5 and <7 cm, almost certainly benign; yearly follow-up with ultrasound recommended
  • > 7 cm, consider MRI vs. surgical evaluation to further characterize the mass
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11
Q

What size simple cyst doesnt need f/up?

A
  • ≤3 cm, physiologic finding
  • > 3 and ≤5 cm, almost certainly benign; does not need follow-up
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12
Q

lifetime risk for development of ovarian cancer (no risk factors)

A

1 in 75

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13
Q

Carrier of BRCA1 risk of ovarian CA

A

39–46%

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14
Q

Carrier of BRCA1 risk of breast CA

A

57%

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15
Q

Carrier of BRCA2 risk of ovarian CA

A

10–27%

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16
Q

Carrier of BRCA2 risk of breast CA

A

49%

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17
Q

When to perform risk reducing BSO for BRCA1 carrier

A

age 35–40

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18
Q

When to perform risk reducing BSO for BRCA2 carrier

A

age 40–45

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19
Q

Histologic feature of Uterine papillary serous carcinomas

A

Psammoma body

is characterized microscopically by a round central area with surrounding collections of calcium

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20
Q

Histologic feature of Ovarian granulosa cell tumor

A

Call-Exner bodies

Tumor cells are arranged in sheets punctuated by small follicle-like structures and coffee-bean nuclei (Call-Exner bodies)

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21
Q

Histologic feature of Yolk sac, Endodermal sinus tumor

A

Schiller-Duval bodies

Invaginated papillary structures with a central vessel

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22
Q

Histologic feature of Clear cell carcinoma

A

Hobnail cells

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23
Q

Histologic feature of Dysgerminoma

A

Sheets of lymphocytes / germ cells

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24
Q

Histologic feature of Brenner tumor

A

Walthard nests

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25
Q

Histologic feature of Krukenberg tumor

A

Signet cells

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26
Q

Name for pathologic description:

Invaginated papillary structures with a central vessel

A

Schiller-Duvall bodies

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27
Q

Name for pathologic description:

small follicle-like structures and coffee-bean nuclei

A

Call-Exner bodies

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28
Q

Name for pathologic description:

round central area with surrounding collections of calcium

A

Psammoma body

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29
Q

Histologic feature of Immature teratoma

A

Immature neuroepithelium

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30
Q

Histologic feature of Choriocarcinoma, Embryonal carcinoma

A

Malignant cytotrophoblasts/syncytiotrophooblasts

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31
Q

GTN FIGO dx criteria

A

one of:
- 4 or more B-hCG plateau over at least 3k
- increase in B-hCG of 10% or more for 3 or more values over at least 3wks
- histologic choriocarcinoma
- persistence of beta-hcg 6mo after molar evacuation

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32
Q

GTN Staging

A
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33
Q

GTN Risk Scoring

A
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34
Q

BRCA2 higher risk for which CA

A

breast

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35
Q

BRCA1 higher risk for which CA

A

ovarian

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36
Q

Lynch genes

A

MLH1, MSH2, MSH6, PMS2

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37
Q

Cowden

A

breast and thyroid cancer
PTEN mutation

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38
Q

Li Fraumeni

A

soft tissue sarcomas and breast cancer
p53 mutation

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39
Q

Tumor marker: inhibin

A

granulosa-cell tumor

inhibiting calls from your grandma

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40
Q

Tumor marker: CA 125

A

epithelial ovarian CA

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41
Q

Tumor marker: CEA

A

pancreatic and colon cancers

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42
Q

Tumor marker: AFP

A

germ cell tumors

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43
Q

Tumor marker: CA 19-9

A

pancreatric

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44
Q

Tumor marker: B-hCG

A

germ cell tumors

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45
Q

mural nodularity indicates which CA

A

Ovarian CA

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46
Q

Tumor marker: LDH

A

germ cell tumors

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47
Q

CA 125 level requiring onco referral

A

> 200 PREMENO
35 POSTMENO

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48
Q

risk of progression of endometrial hyperplasia to cancer

A

1% simple without atypia
3% complex without atypia
8% simple with atypia
29% complex with atypia

  • penny, nickle, dime, quarter
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49
Q

CA associated with DES exposure

A

vaginal clear cell
(can be ovarian)

also have T shaped uterus

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50
Q

highest risk factor for breast CA

A

age

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51
Q

most deadly GYN malignancy

A

ovarian CA

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52
Q

ovarian CA most common stage at dx

A

Stage III, IV

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53
Q

most common ovarian CA

A

epithelial type:

High grade serous
Endometrioid
Clear cell
Mucinous
Low grade serous

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54
Q

Most common sex-cord stromal tumor

A

granulosa cell tumor

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55
Q

types of germ cell tumors

A

DEEP CT

Dysgerminoma (most common)
Endodermal sinus (yolk sac)
Embryonal
Polyembryonal
Choriocarcinoma
Immature teratoma

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56
Q

endometriosis associated with which CA

A

clear cell

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57
Q

ovarian CA risk reduction from tubal ligation

A

24-28%

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58
Q

ovarian CA risk reduction from salpingectomy

A

65%

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59
Q

ovarian CA risk reduction from oophorectomy

A

97% (still have risk of primary peritoneal carcinoma)

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60
Q

type 1 epithelial ovarian CA

A

Papillary serous histology
High grade
P53 mutations in >95%
BRCA abnormalities

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61
Q

type 2 epithelial ovarian CA

A

Endometrioid, clear cell
May originate from endometriosis
PTEN, KRAS/BRAF, MMR mutations
LMP and low grade serous

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62
Q

BRCA1 chromosome

A

17q
- tumor suppressor gene

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63
Q

BRCA1 inheritance

A

autosomal dominant

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64
Q

when do to risk reducing BSO (+/- hyst) for BRCA1

A

age 35-40

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65
Q

BRCA2 chromosome

A

13q

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66
Q

BRCA2 inheritance

A

autosomal dominant

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67
Q

when to do risk reducing BSO (+/- hyst) for BRCA2

A

age 40-45

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68
Q

non-gyn associated malignancies with BRCA mutations

A

pancreatic cancer and prostate cancer

also melanoma for BRCA2

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69
Q

when to start breast CA screening in BRCA+

A

annual MRIs & clinical exams age 25-29

annual mmg and breast mri age 30-75

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70
Q

Lynch syndrome (HNPCC) inheritance

A

autosomal dominant

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71
Q

Lynch syndrome (HNPCC) gene defects

A
  • mismatch repair genes

MSH2, MSH6, PMS2, and MLH1

72
Q

Lynch syndrome (HNPCC) when to do hyst/BSO

A

when completed child bearing / early mid 40s

73
Q

screening/surveillance for Lynch syndrome pts

A
  • colonoscopy q1-2y starting at 20-25yo or 2-5y prior to earliest CA dx in family
  • EMB q1-2y starting at 30-35yo
  • monitor VB
74
Q

when to refer to gyn onc for elevated CA-125: postmenopausal

75
Q

when to refer to gyn onc for elevated CA-125: premenopausal

A

> 200 u/mL

76
Q

Most common chemo regimen for GYN CA

A

Carbo / Taxol

77
Q

borderline tumors precursor to

A

low-grade epithelial ovarian CA

78
Q

most common germ cell tumor

A

dysgerminoma

79
Q

dysgerminoma markers

A

LDH & low BHCG

80
Q

immature teratoma markers

A

AFP, CA125

81
Q

endodermal sinus tumor marker

82
Q

Schiller-duval bodies characteristic for

A

endodermal sinus tumor (aka yolk sac)

83
Q

bleomycin toxicity

A

pulmonary fibrosis

84
Q

granulosa cell tumor markers

A

Inhibin A/B, AMH

85
Q

granulosa cell tumors can produce

A

estrogen - can see endometrial path

86
Q

sertoli-leydig tumors can produce

A

testosterone

87
Q

most common GYN malignancy in US

A

endometrial CA

88
Q

endometrial cancer type associated with estrogen excess

89
Q

characteristics of Type 1 endometrial CA

A

Obesity, estrogen excess
Loss of PTEN function, MSI (microsatelite instability), and K-ras alterations
Arises from endometrial hyperplasia
Androstenedione converted to estrone by aromatase in adipose tissue
85% 5 year survival rate
Histology- grade 1-2, endometrioid

90
Q

characteristics of type 2 endometrial CA

A

Estrogen independent
Background of atrophy, may see polyp
High grade, advanced stage, aggressive cell types
Overexpression of P53
Poor prognosis: 58% 5 year survival
Histology: serous, clear cell, mucinous, squamous, transitional cell, undifferentiated and carcinosarcoma

91
Q

p53 associated with what type of cancer

A

serous (ovarian or endometrial)

92
Q

Risks of Tamoxifen use

A

endometrial proliferation, hyperplasia, cancer, polyps

93
Q

Endometrial intraepithelial neoplasia (EIN) categories

A

Benign (benign endometrial hyperplasia)

Premalignant (EIN - have nuclear atypia)

Malignant (endometrial adenocarcinoma, endometrioid type, well differentiated)

94
Q

management endometrial hyperplasia without atypia

A

progesterone
- repeat sampling in 3mo

95
Q

management endometrial hyperplasia with atypia (EIN)

A

surgery (have to be prepared to perform pelvic LN sampling)

  • only progesterone for fertility sparing purposes

Lifestyle modifications

96
Q

when to do EMB based on US

A

PMB + endometrial thickness >4mm

or persistent PMB

no sampling for PMB and endometrial thickness 4mm or less (NPV >99%)

97
Q

CA stage with omental mets

A

ovarian CA - III
endometrial CA - IV

98
Q

when to include omentectomy and upper abdominal biopsies and washings in surgical staging

A

serous histology

99
Q

where does uterine sarcoma met to

A

lung & liver

100
Q

mole type where fetal tissue present

A

partial mole

101
Q

karyotype of partial mole

A

Triploidy
XXX, XXY, XYY

102
Q

karyotype of complete mole

A

46 XX (90%)
46 XY (10%)

103
Q

risk of progression to GTN higher for which type of mole

104
Q

theca-lutein cysts associated with which type of mole

105
Q

HCG f/up for molar pregnancy

A

HCG 48 hrs after evacuation,
every 1-2 weeks while elevated,
then monthly for 6 months

106
Q

GTN common met sites

A

Lung (80%), vagina (30%), liver (10%), and brain (10%)

107
Q

GTN prognostic score low vs high risk criteria

A

score
low risk <7
high risk >= 7

108
Q

highest risk criteria for WHO prognostic score GTN

A

4 points each for:
>12mo from preg
pre-tx HCG >= 10^5
mets to brain, liver
>8 mets
previously failed 2 or more chemo

109
Q

tx for nonmestastatic GTN

A

Single agent chemo: MTX or Actinomycin-D

110
Q

tx for low risk GTN

A

1st therapy single agent MTX or Acti-D.

If elevated HCGs continue, swith to other single agent, consider TAH for local disease, combo chemo therapy

111
Q

tx for high risk GTN

A

EMA-CO
Etoposide, Methotrexate, Actinomycin-D, Cyclophosphamide, Vincristine (Oncovorin)

or MAC
Methotrexate, Actinomycin-D, Cyclophosphamide

Brain or liver metastases require XRT

112
Q

most common vulvar CA

113
Q

tx for Bartholin’s cyst in woman >40

A

excision recommended to rule out adenocarcinoma

114
Q

surgical margin for excision of vulvar CA

A

2cm wide
depth down to level coplanar with fascia over the pubic symphysis

want >8mm for good local control

115
Q

how to age out of cervical CA screening for gen pop

A

65yo with 2 consecutive, negative primary HPV tests, or 2 negative contests, or 3 negative cytology tests within the past 10 years, with the most recent test occurring within the past 3-5 years, depending on the test used

116
Q

how to age out of cervical CA screening s/p hyst

A

if hyst for CIN 2-3:
3 consecutive annual HPV based tests before entering long term surveillance
Incidence of abnormal vaginal cytology is 14%
Incidence of vaginal dysplasia is 1.7%

If no prior then screening not recommended

117
Q

cervical CA surveillance after tx for CIN 2-3, AIS

A

HPV based testing at 3 year intervals for 25 years

Regardless of whether hysterectomy has been performed during hte surveillance period

118
Q

HPV+ test should always

A

reflex to cytology, regardless of age

119
Q

HR HPV strains

A

HPV 16 and 18 in >70% of cervical cancer

120
Q

HPV-associated cancers

A

oropharyngeal, anal, vaginal, vulvar, penile, non-melanoma skin cancers

121
Q

cervical CA tx: when to do surgery

A

Stage IB2-IIA1
- all depends on tumor size and extension

122
Q

cervical CA tx: when to do chemo/rad

A

Stage IB3, IIA2, IIB, III, IVA
- all depends on tumor size and extension

123
Q

characteristics of Phase specific chemo drugs

A

Work on a specified phase
Most effective in rapidly growing cells

124
Q

characteristics of phase nonspecific chemo drugs

A

Work on multiple phases
Most effective in rapidly growing cells

125
Q

chemotherapy induction

A

initial treatment of disease with chemotherapy

126
Q

chemotherapy Consolidation

A

drug therapy used as follow up after remission from induction

127
Q

Adjuvant chemotherapy

A

drug therapy after initial surgery or radiation therapy

128
Q

Neoadjuvant chemotherapy

A

drug therapy given prior to surgery or radiation that is itself insufficient for cure

129
Q

Salvage chemotherapy

A

drug therapy after failure of primary therapy

130
Q

palliative chemotherapy

A

treatment given to reduce symptoms of disease without curative intent

131
Q

chemo complete response

A

no clinical evidence of disease/complete resolution of signs and symptoms of disease for at least one month

132
Q

chemo partial response

A

greater than 50% reduction in tumor masses without evidence of new lesions/tumor

133
Q

definition of stable disease after chemo

A

no change in overall size, number of tumor masses, neither increasing nor decreasing by 25%

134
Q

definition of dz progression after chemo

A

enlargement of tumor masses by at lease 25%

135
Q

S-phase specific drugs

A

Antimetabolites

Folate antagonists (MTX)
Purine antagonists
Pyrimidine antagonists (fluorouracil)

136
Q

Mitosis specific drugs

A

Vinca alkaloids (vincristine, vinblastine)

137
Q

Types of Chemo Drugs

A

S-phase specific drugs

Mitosis specific drugs

Taxanes (paclitaxel, docetaxel)

G2 phase specific drugs

Cell cycle non specific

138
Q

G2 phase specific drugs

A

Topoisomerase I inhibitors (topotecan)
Topoisomerase II inhibitors (etoposide)

139
Q

Cell cycle non specific chemo drugs

A

Alkylating agents
- Cylcophosphamide
Anthracyclines
- Doxorubicin
Antibiotics
- Mitomycin
- Bleomycin
- Dactinomycin
Hormones
- Tamoxifen
- Megace
- Lupron
Biologic agents
- Immunomodulators
Monoclonal antibodies

140
Q

MOA of alkylating agents

A

Bind to DNA, cause breaks

141
Q

Cyclophosphamide toxicities

A

hemorrhagic cystitis (MESNA antidotes), cardiac necrosis

142
Q

Ifosfamide toxicity

A

hemorrhagic cystitis (MESNA), neurologic (confusion, coma)

143
Q

Platinum Agents MOA

A

Crosslinks to DNA and RNA

144
Q

cisplatin toxicity

A

renal, electrolyte wasting, neuropathy, ototoxicity, nausea, vomiting

145
Q

carboplatin toxicity

A

bone marrow suppression, neuropathy (rare)

146
Q

Anthracylcines MOA

A

Intercalate DNA pairs

147
Q

Doxorubicin (adriamycin) toxicity

A

cardiomyopathy, mucositis, vesicant

148
Q

Chemo Antibiotics MOA

A

DNA breaks

149
Q

Bleomycin toxicities

A

pulmonary fibrosis, mucositis

150
Q

Actinomycin-D toxicities

A

mucositis, alopecia, vesicant

151
Q

Antimetabolites: Pyrimidine antagonists MOA

A

Blocks DNA synthesis

152
Q

5-FU toxicities

A

cerebellar syndrome, cardiac ischemia, blurry vision (lacrimal duct stenosis)

153
Q

Gemcitabine toxicities

A

flu-like symptoms

154
Q

Antimetabolites: Folate antagonists MOA

A

Blocks tetrahydrofolic acid production

155
Q

MTX toxicity

A

mucositis, elevated LFTs, renal

156
Q

Vinca Alkaloids MOA

A

Inhibit spindle formation

157
Q

Vinca Alkaloids Toxicities

A

Toxicities include vesicants, neuropathy, alopecia

158
Q

Vinca Alkaloids meds

A

vinblastine, vincristine, vinorelbine

159
Q

Topoisomerase inhibitors drugs

A

Topotecan - inhibit topo I
Etoposide - inhibit topo II

160
Q

Topotecan toxicity

A

causes myelosuppression

161
Q

Etoposide toxicity

A

causes myelodysplastic syndrome, mucositis

162
Q

Taxanes MOA

A

Stabilize microtubules

163
Q

Taxane examples

A

paclitaxel, docetaxel

164
Q

Taxane Toxicities

A

neuropathy, myelosuppression, alopecia, allergic reaction

165
Q

Bevacizumab (Avastin) used in

A

Ovarian- used in up front or recurrence
Endometrial- mostly in recurrence
Cervix- advanced disease or recurrence

166
Q

Bevacizumab (Avastin) MOA

A

VEGF inhibitor (monoclonal antibody)

167
Q

Bevacizumab (Avastin) side effects

A

HTN, proteinuria, renal compromise, PRES, bowel perforation

168
Q

PARP Inhibitors MOA

A

Inhibit DNA repair

169
Q

Interaction with PARP inhibitors and BRCA mutant tumors

A

“Synthetic lethality” in BRCA mutant tumors which are already DNA repair deficient

170
Q

PARP inhibitors side effects

A

nausea, lethargy, bone marrow suppression

171
Q

Pembrolizumab toxicity

A

related immune system over activation

  • typically treated with steroids but can be life threatening
172
Q

Direct radiation therapy MOA

A

Damage to DNA directly causes cellular death in ⅓ of reactions

173
Q

Indirect radiation therapy MOA

A
  • Formation of free radicals via interaction of radiation with water
  • Majority of RT effects are via this mechanism
174
Q

Acute Radiation Toxicities

A

Diarrhea
Urinary frequency
Abdominal cramps
Dysuria
Hematochezia
Hematuria

175
Q

Chronic Radiation Toxicities

A

Proctosigmoiditis
SBO
Fistula- rectovaginal, vesicovaginal, ureterovaginal
Necrosis
Strictures

176
Q

utility of cisplatin with radiation

A

Radiosensitizer

CREOGS (12 decks)

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