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Med Prep > onco - breast, nasopharynx, lung, neck, cervix > Flashcards

onco - breast, nasopharynx, lung, neck, cervix Flashcards

0
Q

Peak age of incidence in breast Ca

A

70 y/o

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1
Q

Most common cause of morbidity in women

A

Breast Ca

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2
Q

Risk factors in breast Ca

A
  1. Family history
  2. Age of menarche, 1st pregnancy, menopause
  3. Nulliparity
  4. Low socio-economic status
  5. Hormones (estrogen)
  6. Endometrial Ca
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3
Q

Environmental toxins in breast Ca

A

Organochlorine
Pesticides
Smoking

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4
Q

T/f: breast feeding decreases risk for breast Ca

A

True

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5
Q

First step for management of a palpable mass

A

Ultrasound

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6
Q

Movable, small (2mm nodule), hard and not painful mass in breast
Stimulated by pregnancy and regression occurs post menopause

A

Fibroadenoma

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7
Q

Most common benign tumor of female breast

A

Fibroadenoma

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8
Q

Small, scattered, cyclic painful mass in the breast

Multiple, irreg lumps common in premenopausal than postmeno.

A

Fibrocystic changes

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9
Q

Management for fibrocystic change

A

Aspiration, if bloody then it is Ca

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10
Q

Biopsy indication in breast Ca

A

Marked unilateral breast enlargement
Enlarged hard mass which can’t be aspirated
Nipple discharge
Skin dimpling and redness (peau de orange)
Breast pain

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11
Q

Diagnostic procedures for breast Ca

A 
Self examination 
Pe 
Mammography (low dose rad) - reveals breast architecture
UTZ
Needle aspiration 
Excisional biopsy
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12
Q

Most ominous sign found in mammography

A

Clustered, irregular microcalcification

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13
Q

Pre-op evaluation (indication for surgery)

A
  1. Extensive edema of the breast
  2. Signs of inflammation
  3. Satellite nodules of Ca
  4. Supraclavicular mets, and neighboring distal mets
  5. Spread to internal mammary ln
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14
Q

T/f: pregnancy is a contraindications for surgery for breast Ca

A

False.

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15
Q

Survival rate for non-met breast Ca

A

95%

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16
Q

Survival rate for intraductal papillary Ca

A

50% 5 yr SR

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17
Q

Breast mass with bloody discharge

A

Paget’s disease

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18
Q

Biggest breast ca

A

Phyllodes tumor of breast

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19
Q

Types of breast Ca that rarely mets

A
  1. Colloid Ca - mucin producing
  2. Medullary Ca - lymphocytic infiltration with sheath like pattern
  3. Well-diff adenoma
  4. Tubular Ca- good prognosis
  5. Comedo Ca - ducts and lobules dilated by sheets of pleomorphic cells with zones of central necrosis
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20
Q

Mod/highly met Ca:

Highly invasive, spread early to regional lymph node

A

Mod met Ca

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21
Q

SR of mod met Ca

A

50-65%

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22
Q

SR of highly met Ca

A

15%

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23
Q

Mod met Ca

A

Infiltrating adenocarcinoma of Ductal origin (most common)

Intraductal Ca with stromal invasion

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24
Q

Mod/highly met Ca:
Vascular invasion, signs of inflam
< 3% 5 yr SR
Poor prognosis

A

Highly mets Ca

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25
Q

Clinical charac that worsen prognosis in breast Ca

A
  1. Edema
  2. Tumor fixation to chest wall and overlying skin
  3. Peau de orange
  4. Skin retraction/dimpling (due to shortening of tumor cells involving cooper’s ligament)
  5. Involvement of medial portion of lower inner quadrant of breast
  6. Evidence Distant mets
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26
Q

T/f: estrogen receptor positive tumor responds to hormonal therapy and has good prognosis

A

True

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27
Q

Treatment for breast Ca

A

Surgery
Radiation
Hormonal therapy

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28
Q

Surgical procedures of breast Ca:

Axillary lymphadenectomy followed by post-op radiation

A

Lumpectomy/segmental mastectomy

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29
Q

Surgical procedures of breast Ca:
For small primary lesions
Long thoracic nerve should be preserved to prevent denervation of serratus anterior (winged scapula)

A

Lumpectomy/segmental mastectomy

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30
Q

Surgical procedures of breast Ca:
Removal of breast with nipple-areola complex, sometimes combined with level1 axillary lymph node
Pectoralis major is preserved

A

Simple mastectomy

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31
Q

Surgical procedures of breast Ca:
Removal of generous amt or entire breast, Pectoralis muscle and lymph node inferior to axillary vein
SM + axillary dissection

A

Modified radical mastectomy

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32
Q

Surgical procedures of breast Ca:
Removes Pectoralis major in addition to tissue in modified radical mastectomy
En bloc removal of breast, Pectoralis major and minor and axillary contents

A

Halsted radical mastectomy

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33
Q

Country where nasopharyngeal Ca is most commonly seen

A

China

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34
Q

Virus asso with NPC

A

EBV

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35
Q

NPC is common in what population

A

Young population

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36
Q

Most common symptom in NPC in young population

A

Epistaxis

Otitis media

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37
Q

Most common symptom of NPC in Middle Ages

A

Basal obstruction

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38
Q

Other symptoms of NPC

A

Ptosis, Diplopia, hoarseness (late sign)

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39
Q

Diagnostic procedure for NPC

A

Bronchoscopy
CT scan - cn, bone,lymph node involvement, compliments MRI
MRI - soft tissue

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40
Q

Most common types in NPC

A

Epithelioma (85%)

Lymphoma (75%) - malignant

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41
Q

Treatment for NPC

A
  1. Initial treatment for all forms - radiation
  2. Chemotherapy and radiation - for distant mets
  3. Neck dissection
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42
Q

Prognosis for NPC

A

Poor prognosis with <20% 5 yr SR

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43
Q

Most common etiologic factor for Bronchogenic Ca

A

Smoking

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44
Q

Other etiologic factors for lung Ca

A

Asbestos, chromates, nickel, arsenic, uranium, flower sprays

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45
Q

Peak age incidence of lung Ca

A

40 years old

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46
Q

Lung Ca is most common in what sex

A

Male

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47
Q

Most common Bronchogenic Ca

A

Adenocarcinoma

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48
Q

Most common in women, non smokers and smokers who quit

A

Adenocarcinoma

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49
Q

Site of adenocarcinoma

A

Periphery

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50
Q

Variant of adenocarcinoma with tall columnar cells lining the bronchioles (should be cuboidal)

A

Bronchioalveolar Ca

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51
Q

Has butterfly wings or lepidic appearance

A

Bronchioalveolar Ca

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52
Q

Types of Bronchioalveolar Ca

A

Solitary and multinodular

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53
Q

Lung Ca that looks like pneumonia

A

Bronchioalveolar Ca

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54
Q

Ling Ca that produces obstruction and can undergo central necrosis which may lead to calcification. Slow growing.

A

SCC

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55
Q

Asso to PTH excessive secretion

A

SCC

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56
Q

Site of SCC

A

Centrally

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57
Q

Site of SCLC

A

Centrally

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58
Q

Histologically, with keratin pearls and intercellular bridges (desmosomes)

A

SCC

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59
Q

Lung Ca that is anaplastic, fast metastatic spread

60
Q

Lung Ca that arises form kulchintsky cells of basal layer of bronchial epith. Stains for neuron-specific enolase (NSE) which reflects that the cells are derived from neural crest

61
Q

Associated with ACTH excessive secretion

62
Q

Oat cell CA

63
Q

Lung Ca found centrally of peripherally, which is highly malignant and has worst prognosis

A

Undiff large cell Ca

64
Q

Clinical presentation of lung Ca

A

Cough - chronic, unproductive (due to bronchial irritation)
Dyspnea - deficiency of pulmonary ventilation
Fever
Wheezing sound

65
Q

If pt is asymptomatic, what is the clinical finding that would most likely indicate lung Ca

A

Abnormal chest X-ray

66
Q

Diagnostic procedures for lung Ca

A 
Bronchoscopy
1. Assess bronchial involvement
2. Resected or not Resected
3. Sampling of tissue for biopsy 
Mediastinoscopy - staging of lymph node 
Per cutaneous needle biopsy - cytologic examination
67
Q

In pancoast tumor of lung Ca, what is affected

A

Brachial plexus. Which manifests as pain radiation to ipsi arm of medial forearm. This develops to Horner’s syndrome

68
Q

Horner’s syndrome

A

Ptosis
Enophthalmos
Anhydrosis

69
Q

Management for lung Ca

A

Lobectomy followed by oral chemotherapy (vincristine, adriamycin, cisplatin)

70
Q

Involvement of mediastinum

A

Trachea, sub carina
Recurrent laryngeal nerve (hoarseness)
Phrenic nerve (paralysis of diaphragm, causes dyspnea and later with pain

71
Q

Prognosis of 5 yr SR in lung Ca
Bronchoalveolar:
SCC:
Adenocarcinoma:

A

Bronchoalveolar: 30-35%
SCC: 8-6%?
Adenocarcinoma: 5-10%

72
Q

Post op SR
Stage I:
Stage II:
Stage III:

A

Stage I: 60-80%
Stage II: 40-55%
Stage III: 10-25%

73
Q

Bronchial tree tumors

A

Bronchial adenoma

Carcinoid tumor

74
Q

Bronchial tree tumor which affects the ducts and glands, occurs at 5th decade of life and has evidence of atelectasis in CXR

A

Carcinoid tumor

75
Q

Surgical procedure for bronchial tree Ca

A

Lobectomy
Segmentectomy
Pneumonectomy

76
Q

A mediastinal tumor seen thru CXR and CT scan treated by surgical excision and radiation

A

PHEOCHROMOCYTOMA

77
Q

Pathognomonic sign of Hodgkin disease

A

Binucleate cells called Reed-Sternberg cells

78
Q

Peak age incidence of Hodgkins disease

79
Q

Most common site of Hodgkin disease

A

Lower cervical lymph node

80
Q

Most common site of nonHodgkin lymphoma

A

Upper cervical lymph node

81
Q

Most common extra nodal site of Hodgkins disease

82
Q

Characteristic of the mass in Hodgkin and nonhodgkins lymphoma

A

Firm,fixed,rubbery, hard cervical mass

83
Q

Where does systemic manifestation commonly seen? Hodgkin/nonhodgkins?

A

Hodgkins disease

84
Q

Systemic manifestations or “B” symptoms

A

Fever, weight loss, night sweats

85
Q

Surgical procedures in nonhodgkins lymphoma

A

Excisional biopsy - if detected early

Endoscopy - assess metastasis and for staging

86
Q

Treatment for NHL
Stage I and II:
Stage III and IV:
Advanced stage:

A

Stage I and II: radiation therapy (50-70%)
Stage III and IV: chemotherapy
Advanced stage: combi (20-45% 5 yr SR)

87
Q

Diagnostic procedure for cervical Ca

A

Pap smear
Random biopsy of Vulva, vagina and cervix (if Pap smear shows abn result)
Colposcopic examination with biopsy

88
Q

Components of cervical examination

A
  1. Transformation zone must be visualized
  2. Endometrial curettage must be performed and should be free from neoplastic cells
  3. Biopsy should correspond to Pap smear result

(If above 3 criteria are not met and pt does not have invasive lesion, proceed to treatment)

89
Q

Techniques to eliminate transformation zone

A

Electro cautery
Cryocautery
Laser ablation

90
Q

Assist clearing of cervix
Better than Pap smear
Shows areas with increase N:C ratio

A

Acetic acid test

91
Q

Indications of biopsy after colposcopy

A

If pre-invasive lesion is extensive

When there is widespread glandular involvement (treatment is laser/cold knife conization)

92
Q

If invasive Ca is >3mm, what procedure will you do?

A

Radical hysterectomy

93
Q

T/f: micro invasive Ca of the cervix is not a pre-invasive disease

94
Q

Etiologic factors of pre-invasive lesions of cervix

A
  1. Early age of first coitus
  2. Multiple sexual partners
  3. Freq coitus with multiple partners
  4. Smoking
  5. Low socioeconomic status
  6. Herpes simplex
  7. HPV
95
Q

How many years will CIN take to become neoplastic?

96
Q

HPV type of condyloma (venereal warts), charac with itchiness, benign, elevated papule

97
Q

HPV type asso with invasive cervical lesion. Charac with flat warts and rapidly progressive

A

HPV 16, 18

98
Q

VIN characteristics

A

Itchy, red or pigmented, sharply demarcated, raised surface

99
Q

Vaginal Ca management

A

Vulvectomy

100
Q

VIN management

A

Wide local excision with skin block

101
Q

Signs and symptoms of cervical Ca

A 
Post coital bleeding
Menorrhagia 
Back ache
Leg pain
Leg edema 
Bloody urine
102
Q

Removal of cervix, uterus, ovaries and Fallopian tube. Invasion of =< 3mm , lymphatic and vascular involvement not demonstrated

A

Simple hysterectomy

103
Q

SH + uterine artery lighted at its origin from the internal iliac artery

A

Radical hysterectomy

104
Q

Other option if patient doesn’t want to do radical hysterectomy

A

Primary radiation therapy (for earlier stage )

105
Q

Complication of radical hysterectomy

A

Bladder dysfunction
Lymphocytic formation
Risk of pulmonary embolus and hemorrhage
Urethral fistula

106
Q 
SR rate of Cervical Ca
Stage I: 
Stage II: 
Stage III: 
Stage IV:
A

Stage I: 80-85%
Stage II: 60-65%
Stage III: 25-35%
Stage IV: 8-14%

107
Q

What will you do for cervical Ca recurrence

A

Pelvic exenteration

108
Q

Chemo therapeutic agent

109
Q

Rare catechu laminar producing neoplasm of chromatin cells in adrenal medulla

A

Pheochromocytomr

110
Q

S&s of pheochromocytoma

A 
Rapid elevated bp 
Palpitations 
Sweating
Anxiety 
Tremor 
Headache 
Nausea and vomiting
111
Q

Pheochromocytoma is asso with what intoxication

112
Q

Complication of excessive catecholamine

A

Cardiomyopathy

Mi

113
Q

Diagnosis of pheochromocytoma

A

Increased urinary catecholamine (vanillylmandelic acid and metanephrine)
Elev.24hr urinary excretion of free catecholamine (epi and norepi)
CT scan or MRI of abdomen to detect extra adrenal tumors

114
Q

Pheochromocytoma is a post/para/preganglioma?

A

Paraganglioma

115
Q

Derived from neural crest which synthesizes catecholamine secretion stimulated by SNS

A

Chromaffin cells

116
Q

Autosomal dominant familial syndrome with medullary thyroid Ca, parathyroid hyperplasia and pheochromocytoma

117
Q

Autosomal dominant familial syndrome with medullary thyroid Ca, neuromas, marfanoid features and pheochromocytoma

118
Q

Catecholamine acts at a- and b-adrenergic receptors. What are the signs caused by a-adrenergic receptors?

A 
Elev bp
Increased cardiac contractility 
Glycogenolysis
Gluconeogenesis
Intestinal relaxation
119
Q

Catecholamine acts at a- and b-adrenergic receptors. What are the signs caused by b-adrenergic receptors?

A

Increased heart rate and contractility

120
Q

Primary treatment for pheochromocytoma

A

Surgical resection

Preop High salt diet and a- and b-adrenergic blockade (alpha first)

121
Q

Cervical cancer is asso w/ what virus

122
Q

Where does cervical Ca arises?

A

Transformation zone

123
Q

What is the best diagnostic test to evaluate cervical mass?

A

Cervical biopsy, not Pap smear. Pap smear is a screening test and appropriate for women with a normal appearing cervix

124
Q

Cervical cytology begins at what age

A

Begins 3 yrs after onset of sexual activity or by age 21 up to 30

125
Q

Cervical cytology is contraindicated to

A

To women who had hysterectomy (but if done because of CIN III, then it is still needed)

126
Q

Treatment for advanced stages of cervical ca

127
Q

Treatment for early stage of cervical Ca

A

Surgery + RT

128
Q

Most common ovarian neoplasm in <35 and pregnant

A

Benign cystic teratoma /dermoid cyst

129
Q

Benign teratoma of ovary in which functional thyroid tissue is predominant histologic finding

A

Struma ovarii

130
Q

Most common ovarian neoplasm in >35 y/o and postmeno

Asso with ascites

A

Epithelial tumors / serous cystadenoma

131
Q

Complication of ovarian Ca which is commonly assoc with mucinous tumor

A

Pseudomyxoma peritonei

132
Q

Most common vulvar Ca

133
Q

2nd most common vulvar Ca

134
Q

Vulvar Ca that is not asso to HPV

A

Basaloid SCC and verrucous Ca

135
Q

Adenocarcinoma of vulva charac by crust, pruritic scaling lesions usually in labia majors

A

Paget’s disease

136
Q

Most common vaginal Ca

137
Q

Most common site of vaginal Ca

A

Upper 3rd, anterior/lateral wall

138
Q

Vaginal Ca which occurs in hound women whose mothers has been treated with diethylstilbestrol (DES) during their pregnancy for threatened abortion

A

Clear cell adenocarcinoma (mesonephroid)

139
Q

Most common cervical Ca

140
Q

Signet ring appearance

A

Krukenberg tumor

141
Q

Schiller-duval bodies

A

Yolk-sac tumor

142
Q

Breast Ca staging

A

0 - DCIS or LCIS
1 - invasive Ca <=2cm without node involvement
2 - <=5cm with up to 3 nodes or
>5cm without lymph node
3 - <=5cm with 4 axillary lymph nodes or
>5cm with >=10 lymph node / skin involvement / inflammatory Ca
4 - distant metastasis

143
Q

Cervical Ca staging

A 
0 - CIS or CIN III 
1 - confined to cervix
2 - beyond cervix 
3 - includes pelvic sidewall and lower third of vagina 
4 - beyond true pelvis
144
Q

Most common extra mammary paget’s disease

145
Q

A biopsy that reveals PAS-positive cells with pale cytoplasm and prominent nucleoli

A

Paget’s disease of breast

146
Q

Erythema, eczematous changes of nipple of the skin with scaling and flaking which may advance to crusting, skin erosion and ulceration with exudation or frank discharge

A

Paget’s disease of breast

147
Q

Most common breast disorder
Blue dome cyst
Don’t have increased risk of breast Ca

148
Q

T/F: radiation has no increased risk for breast Ca

Med Prep (52 decks)

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