Onco Flashcards
1
Q
pathologic description of Call–Exner bodies
A
Microfollicular pattern with numerous small cavities that may contain eosinophilic fluid
2
Q
pathologic description of immature teratomas
A
Immature neural tissue with rosettes and tubules
3
Q
pathologic description of dysgerminomas
A
Cytoplasmic glycogen demonstrated with periodic acid-Schiff stain
4
Q
pathologic description of Schiller–Duval bodies
A
A central capillary surrounded by connective tissue and a peripheral layer of columnar cells
5
Q
Schiller–Duval bodies are seen in
A
yolk sac tumors (germ cell variant)
6
Q
“hobnail” cells on microscopy indicate
A
Clear cell carcinoma
7
Q
Pelvic endometriosis linked to what cancer
A
clear cell carcinoma
8
Q
Complete mole karyotype
A
46XX, 46XY
(All paternal)
9
Q
Partial mole karyotype
A
69xxx, 69xxy, 69xyy
(Extra set is paternal)
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
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
12
Q
lifetime risk for development of ovarian cancer (no risk factors)
A
1 in 75
13
Q
Carrier of BRCA1 risk of ovarian CA
A
39–46%
14
Q
Carrier of BRCA1 risk of breast CA
A
57%
15
Q
Carrier of BRCA2 risk of ovarian CA
A
10–27%
16
Q
Carrier of BRCA2 risk of breast CA
A
49%
17
Q
When to perform risk reducing BSO for BRCA1 carrier
A
age 35–40
18
Q
When to perform risk reducing BSO for BRCA2 carrier
A
age 40–45
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
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)
21
Q
Histologic feature of Yolk sac, Endodermal sinus tumor
A
Schiller-Duval bodies
Invaginated papillary structures with a central vessel
22
Q
Histologic feature of Clear cell carcinoma
A
Hobnail cells
23
Q
Histologic feature of Dysgerminoma
A
Sheets of lymphocytes / germ cells
24
Q
Histologic feature of Brenner tumor
A
Walthard nests
25
Histologic feature of Krukenberg tumor
Signet cells
26
Name for pathologic description:
Invaginated papillary structures with a central vessel
Schiller-Duvall bodies
27
Name for pathologic description:
small follicle-like structures and coffee-bean nuclei
Call-Exner bodies
28
Name for pathologic description:
round central area with surrounding collections of calcium
Psammoma body
29
Histologic feature of Immature teratoma
Immature neuroepithelium
30
Histologic feature of Choriocarcinoma, Embryonal carcinoma
Malignant cytotrophoblasts/syncytiotrophooblasts
31
GTN FIGO dx criteria
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
32
GTN Staging
33
GTN Risk Scoring
34
BRCA2 higher risk for which CA
breast
35
BRCA1 higher risk for which CA
ovarian
36
Lynch genes
MLH1, MSH2, MSH6, PMS2
37
Cowden
breast and thyroid cancer
PTEN mutation
38
Li Fraumeni
soft tissue sarcomas and breast cancer
p53 mutation
39
Tumor marker: inhibin
granulosa-cell tumor
inhibiting calls from your grandma
40
Tumor marker: CA 125
epithelial ovarian CA
41
Tumor marker: CEA
pancreatic and colon cancers
42
Tumor marker: AFP
germ cell tumors
43
Tumor marker: CA 19-9
pancreatric
44
Tumor marker: B-hCG
germ cell tumors
45
mural nodularity indicates which CA
Ovarian CA
46
Tumor marker: LDH
germ cell tumors
47
CA 125 level requiring onco referral
>200 PREMENO
>35 POSTMENO
48
risk of progression of endometrial hyperplasia to cancer
1% simple without atypia
3% complex without atypia
8% simple with atypia
29% complex with atypia
- penny, nickle, dime, quarter
49
CA associated with DES exposure
vaginal clear cell
(can be ovarian)
also have T shaped uterus
50
highest risk factor for breast CA
age
51
most deadly GYN malignancy
ovarian CA
52
ovarian CA most common stage at dx
Stage III, IV
53
most common ovarian CA
epithelial type:
High grade serous
Endometrioid
Clear cell
Mucinous
Low grade serous
54
Most common sex-cord stromal tumor
granulosa cell tumor
55
types of germ cell tumors
DEEP CT
Dysgerminoma (most common)
Endodermal sinus (yolk sac)
Embryonal
Polyembryonal
Choriocarcinoma
Immature teratoma
56
endometriosis associated with which CA
clear cell
57
ovarian CA risk reduction from tubal ligation
24-28%
58
ovarian CA risk reduction from salpingectomy
65%
59
ovarian CA risk reduction from oophorectomy
97% (still have risk of primary peritoneal carcinoma)
60
type 1 epithelial ovarian CA
Papillary serous histology
High grade
P53 mutations in >95%
BRCA abnormalities
61
type 2 epithelial ovarian CA
Endometrioid, clear cell
May originate from endometriosis
PTEN, KRAS/BRAF, MMR mutations
LMP and low grade serous
62
BRCA1 chromosome
17q
- tumor suppressor gene
63
BRCA1 inheritance
autosomal dominant
64
when do to risk reducing BSO (+/- hyst) for BRCA1
age 35-40
65
BRCA2 chromosome
13q
66
BRCA2 inheritance
autosomal dominant
67
when to do risk reducing BSO (+/- hyst) for BRCA2
age 40-45
68
non-gyn associated malignancies with BRCA mutations
pancreatic cancer and prostate cancer
also melanoma for BRCA2
69
when to start breast CA screening in BRCA+
annual MRIs & clinical exams age 25-29
annual mmg and breast mri age 30-75
70
Lynch syndrome (HNPCC) inheritance
autosomal dominant
71
Lynch syndrome (HNPCC) gene defects
- mismatch repair genes
MSH2, MSH6, PMS2, and MLH1
72
Lynch syndrome (HNPCC) when to do hyst/BSO
when completed child bearing / early mid 40s
73
screening/surveillance for Lynch syndrome pts
- 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
when to refer to gyn onc for elevated CA-125: postmenopausal
>35 u/mL
75
when to refer to gyn onc for elevated CA-125: premenopausal
>200 u/mL
76
Most common chemo regimen for GYN CA
Carbo / Taxol
77
borderline tumors precursor to
low-grade epithelial ovarian CA
78
most common germ cell tumor
dysgerminoma
79
dysgerminoma markers
LDH & low BHCG
80
immature teratoma markers
AFP, CA125
81
endodermal sinus tumor marker
AFP
82
Schiller-duval bodies characteristic for
endodermal sinus tumor (aka yolk sac)
83
bleomycin toxicity
pulmonary fibrosis
84
granulosa cell tumor markers
Inhibin A/B, AMH
85
granulosa cell tumors can produce
estrogen - can see endometrial path
86
sertoli-leydig tumors can produce
testosterone
87
most common GYN malignancy in US
endometrial CA
88
endometrial cancer type associated with estrogen excess
Type 1
89
characteristics of Type 1 endometrial CA
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
characteristics of type 2 endometrial CA
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
p53 associated with what type of cancer
serous (ovarian or endometrial)
92
Risks of Tamoxifen use
endometrial proliferation, hyperplasia, cancer, polyps
93
Endometrial intraepithelial neoplasia (EIN) categories
Benign (benign endometrial hyperplasia)
Premalignant (EIN - have nuclear atypia)
Malignant (endometrial adenocarcinoma, endometrioid type, well differentiated)
94
management endometrial hyperplasia without atypia
progesterone
- repeat sampling in 3mo
95
management endometrial hyperplasia with atypia (EIN)
surgery (have to be prepared to perform pelvic LN sampling)
- only progesterone for fertility sparing purposes
Lifestyle modifications
96
when to do EMB based on US
PMB + endometrial thickness >4mm
or persistent PMB
no sampling for PMB and endometrial thickness 4mm or less (NPV >99%)
97
CA stage with omental mets
ovarian CA - III
endometrial CA - IV
98
when to include omentectomy and upper abdominal biopsies and washings in surgical staging
serous histology
99
where does uterine sarcoma met to
lung & liver
100
mole type where fetal tissue present
partial mole
101
karyotype of partial mole
Triploidy
XXX, XXY, XYY
102
karyotype of complete mole
46 XX (90%)
46 XY (10%)
103
risk of progression to GTN higher for which type of mole
complete
104
theca-lutein cysts associated with which type of mole
complete
105
HCG f/up for molar pregnancy
HCG 48 hrs after evacuation,
every 1-2 weeks while elevated,
then monthly for 6 months
106
GTN common met sites
Lung (80%), vagina (30%), liver (10%), and brain (10%)
107
GTN prognostic score low vs high risk criteria
score
low risk <7
high risk >= 7
108
highest risk criteria for WHO prognostic score GTN
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
tx for nonmestastatic GTN
Single agent chemo: MTX or Actinomycin-D
110
tx for low risk GTN
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
tx for high risk GTN
EMA-CO
Etoposide, Methotrexate, Actinomycin-D, Cyclophosphamide, Vincristine (Oncovorin)
or MAC
Methotrexate, Actinomycin-D, Cyclophosphamide
Brain or liver metastases require XRT
112
most common vulvar CA
SCC
113
tx for Bartholin’s cyst in woman >40
excision recommended to rule out adenocarcinoma
114
surgical margin for excision of vulvar CA
2cm wide
depth down to level coplanar with fascia over the pubic symphysis
want >8mm for good local control
115
how to age out of cervical CA screening for gen pop
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
how to age out of cervical CA screening s/p hyst
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
cervical CA surveillance after tx for CIN 2-3, AIS
HPV based testing at 3 year intervals for 25 years
Regardless of whether hysterectomy has been performed during hte surveillance period
118
HPV+ test should always
reflex to cytology, regardless of age
119
HR HPV strains
HPV 16 and 18 in >70% of cervical cancer
120
HPV-associated cancers
oropharyngeal, anal, vaginal, vulvar, penile, non-melanoma skin cancers
121
cervical CA tx: when to do surgery
Stage IB2-IIA1
- all depends on tumor size and extension
122
cervical CA tx: when to do chemo/rad
Stage IB3, IIA2, IIB, III, IVA
- all depends on tumor size and extension
123
characteristics of Phase specific chemo drugs
Work on a specified phase
Most effective in rapidly growing cells
124
characteristics of phase nonspecific chemo drugs
Work on multiple phases
Most effective in rapidly growing cells
125
chemotherapy induction
initial treatment of disease with chemotherapy
126
chemotherapy Consolidation
drug therapy used as follow up after remission from induction
127
Adjuvant chemotherapy
drug therapy after initial surgery or radiation therapy
128
Neoadjuvant chemotherapy
drug therapy given prior to surgery or radiation that is itself insufficient for cure
129
Salvage chemotherapy
drug therapy after failure of primary therapy
130
palliative chemotherapy
treatment given to reduce symptoms of disease without curative intent
131
chemo complete response
no clinical evidence of disease/complete resolution of signs and symptoms of disease for at least one month
132
chemo partial response
greater than 50% reduction in tumor masses without evidence of new lesions/tumor
133
definition of stable disease after chemo
no change in overall size, number of tumor masses, neither increasing nor decreasing by 25%
134
definition of dz progression after chemo
enlargement of tumor masses by at lease 25%
135
S-phase specific drugs
Antimetabolites
Folate antagonists (MTX)
Purine antagonists
Pyrimidine antagonists (fluorouracil)
136
Mitosis specific drugs
Vinca alkaloids (vincristine, vinblastine)
137
Types of Chemo Drugs
S-phase specific drugs
Mitosis specific drugs
Taxanes (paclitaxel, docetaxel)
G2 phase specific drugs
Cell cycle non specific
138
G2 phase specific drugs
Topoisomerase I inhibitors (topotecan)
Topoisomerase II inhibitors (etoposide)
139
Cell cycle non specific chemo drugs
Alkylating agents
- Cylcophosphamide
Anthracyclines
- Doxorubicin
Antibiotics
- Mitomycin
- Bleomycin
- Dactinomycin
Hormones
- Tamoxifen
- Megace
- Lupron
Biologic agents
- Immunomodulators
Monoclonal antibodies
140
MOA of alkylating agents
Bind to DNA, cause breaks
141
Cyclophosphamide toxicities
hemorrhagic cystitis (MESNA antidotes), cardiac necrosis
142
Ifosfamide toxicity
hemorrhagic cystitis (MESNA), neurologic (confusion, coma)
143
Platinum Agents MOA
Crosslinks to DNA and RNA
144
cisplatin toxicity
renal, electrolyte wasting, neuropathy, ototoxicity, nausea, vomiting
145
carboplatin toxicity
bone marrow suppression, neuropathy (rare)
146
Anthracylcines MOA
Intercalate DNA pairs
147
Doxorubicin (adriamycin) toxicity
cardiomyopathy, mucositis, vesicant
148
Chemo Antibiotics MOA
DNA breaks
149
Bleomycin toxicities
pulmonary fibrosis, mucositis
150
Actinomycin-D toxicities
mucositis, alopecia, vesicant
151
Antimetabolites: Pyrimidine antagonists MOA
Blocks DNA synthesis
152
5-FU toxicities
cerebellar syndrome, cardiac ischemia, blurry vision (lacrimal duct stenosis)
153
Gemcitabine toxicities
flu-like symptoms
154
Antimetabolites: Folate antagonists MOA
Blocks tetrahydrofolic acid production
155
MTX toxicity
mucositis, elevated LFTs, renal
156
Vinca Alkaloids MOA
Inhibit spindle formation
157
Vinca Alkaloids Toxicities
Toxicities include vesicants, neuropathy, alopecia
158
Vinca Alkaloids meds
vinblastine, vincristine, vinorelbine
159
Topoisomerase inhibitors drugs
Topotecan - inhibit topo I
Etoposide - inhibit topo II
160
Topotecan toxicity
causes myelosuppression
161
Etoposide toxicity
causes myelodysplastic syndrome, mucositis
162
Taxanes MOA
Stabilize microtubules
163
Taxane examples
paclitaxel, docetaxel
164
Taxane Toxicities
neuropathy, myelosuppression, alopecia, allergic reaction
165
Bevacizumab (Avastin) used in
Ovarian- used in up front or recurrence
Endometrial- mostly in recurrence
Cervix- advanced disease or recurrence
166
Bevacizumab (Avastin) MOA
VEGF inhibitor (monoclonal antibody)
167
Bevacizumab (Avastin) side effects
HTN, proteinuria, renal compromise, PRES, bowel perforation
168
PARP Inhibitors MOA
Inhibit DNA repair
169
Interaction with PARP inhibitors and BRCA mutant tumors
“Synthetic lethality” in BRCA mutant tumors which are already DNA repair deficient
170
PARP inhibitors side effects
nausea, lethargy, bone marrow suppression
171
Pembrolizumab toxicity
related immune system over activation
- typically treated with steroids but can be life threatening
172
Direct radiation therapy MOA
Damage to DNA directly causes cellular death in ⅓ of reactions
173
Indirect radiation therapy MOA
- Formation of free radicals via interaction of radiation with water
- Majority of RT effects are via this mechanism
174
Acute Radiation Toxicities
Diarrhea
Urinary frequency
Abdominal cramps
Dysuria
Hematochezia
Hematuria
175
Chronic Radiation Toxicities
Proctosigmoiditis
SBO
Fistula- rectovaginal, vesicovaginal, ureterovaginal
Necrosis
Strictures
176
utility of cisplatin with radiation
Radiosensitizer
