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ABSITE Flash Cards > Oncology > Flashcards

Oncology Flashcards

1
Q

most common source of metastatic parotid mass?

A

head and neck cutaneous squamous carcinoma

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2
Q

what kind of cells do carcinoid carcinoma arise from

A

enterochromaffin cells

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3
Q

what specifics of GIST tumors equate to highest risk of malignancy and mortality

A

size: > 5cm
mitoses: > 5 mitoses/hpf

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4
Q

best method to obtain tissue diagnosis for a pancreatic head mass

A

endoscopic ultrasound biopsy with needle stick

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5
Q

most common cause of parotid malignancy

A

metastatic disease

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6
Q

where are the deep inguinal lymph nodes located?

A

medial to femoral vein

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7
Q

what should you do if you see atypical ductal hyperplasia on a breast biopsy

A

excision biopsy

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8
Q

most common form of skin cancer?

A

basal cell carcinoma (80% of cases)

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9
Q

female patient with ER/PR + HER2 - breast cancer and high oncotype score. s/p resection with negative LNs…next step

A

chemotherapy given high oncotype AND hormone receptor positive

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10
Q

most common marker used to track epithelial ovarian cancer

A

CA-125 (Cancer Antigen 125)

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11
Q

role of CA-15-3

A

used in breast cancer surveillance after treatment

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12
Q

what constitutes locally advanced breast cancer

A
  • large tumor > 5 cm
  • involves chest wall/skin
  • ulceration/satellite skin nodules
  • inflammatory carcinoma
  • lymph node involvement
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13
Q

what should all locally advanced breast cancer get

A

neoadjuvant chemotherapy
Adjuvant radiation

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14
Q

risk of ovarian cancer in BRCA 1

A

40-60%

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15
Q

risk of ovarian cancer in BRCA2

A

15-30%

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16
Q

What should you get on patient prior to starting Trastuzumab

A

echocardiogram

  • most serious SE if cardiomyopathy
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17
Q

Nivolumab

A

mab to programmed death-1 and its ligand

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18
Q

Ipilimumab

A

mab to CTLA-4

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19
Q

Rituximab

A

mab to CD20

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20
Q

most common chemotherapeutic agents for pseudomyoxoma peritonei

A
  • cisplatin
  • doxorubicin
  • mitomycin-c
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21
Q

leading cause of superior vena cava syndrome

A

lung carcinoma (Pancoast tumor)

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22
Q

patient had abdominal radiation and two years later has refractory diarrhea, biopsy from colonoscopy shows patchy thickening of the basement membrane with lymphocytic infiltration of the lamina propria

A

microscopic colitis

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23
Q

treatment for microscopic colitis

A

steroids (budesonide)

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24
Q

surgery recommended to patient with inflammatory breast cancer who responded to neoadjuvant therapy

A

mastectomy with axillary lymph node dissection (modified radical mastectomy)

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25
Q

Patient with planned post-mastectomy radiation would like immediate reconstruction, what is her best option

A

tissue expander

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26
Q

which gene mutation is associated with male breast cancer, prostate cancer and pancreatic cancer?

A

BRCA2

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27
Q

most common primary malignant peritoneal neoplasm

A

Mesothelioma

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28
Q

what should women found to have LCIS or ADH be started on and why

A

Tamoxifen for risk reduction of invasive breast cancer

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29
Q

what does the HER2 gene encode for?

A
  • transmembrane glycoprotein with tyrosine kinase activity
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30
Q

is being HER2 + a good or bad prognostic sign in the setting of breast cancer?

A

negative prognostic sign

  • shorter disease free and overall survival
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31
Q

Operative approach for a presumed adrenal carcinoma

A

open adrenalectomy

  • risk of tumor seeding is 2-3 times higher with laparoscopic approach
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32
Q

Median survival for metastatic gastric adenoma

A

3-6 months

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33
Q

rate of synchronous cancer in breast with confirmed radial scar on biopsy

A

0-25%

  • most studies quote around 10%
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34
Q

What adjuvant therapy would you administer in the setting of adrenal carcinoma with high risk of recurrence

A
  • Mitotane
  • Radiation
  • +/- chemotherapy
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35
Q

typical age cut off for diagnostic mammography as imaging of choice

A

40 years of age or older

  • younger women should likely get an US first
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36
Q

patient with low grade malignant salivary gland in the deep parotid lobe, what is correct management?

A
  • total parotidectomy
  • +/- adjuvant radiation
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37
Q

Oncotype DX uses what kind of technology

A
  • Quatitative reverse transcriptase-PCR to detect RNA levels
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38
Q

Management of Merkel Cell Carcinoma

A
  • staging PTE/CT or MRI scan for possible metastatic disease
  • resection with 1-2 cm margins
  • Sentinel lymph node biopsy vs. Lymph node dissection
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39
Q

which hypertension medication has been shown to protect against small bowel enteritis from radiation therapy

A

angiotensin converting enzyme (ACE) inhibitors

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40
Q

key feature of lobular carcinoma that differentiates it from ductal carcinoma

A

lack of epithelial cadherin expression

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41
Q

Neoplasm arising from Eccrine sweat glands, are most often found where

A

palms of hands or soles of feet

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42
Q

neoplasm arising from an apocrine sweat gland, most often occur where?

A

Axilla

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43
Q

why do you always image soft-tissue masses prior to biopsy

A

soft-tissue sarcomas are heterogenous, biopsy should be tailored to area most concerning for malignancy

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44
Q

Core needle biopsy of a skin lesion shows blue tumor with neuroendocrine differentiation, what is it?

A

Merkel cell carcinoma

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45
Q

Supplement used shown to reduce intestinal radiation injury during radiotherapy

A

Amifostine

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46
Q

Thyroid mass with associated hypothyroidism, biopsy shows highly cellular tissue with intermediate-sized lymphoid cells

A

Thyroid lymphoma

47
Q

Treatment for thyroid lymphoma

A

chemotherapy alone, if no compressive symptoms

48
Q

what is the main difference between hodgkin and non-hodgkin lymphoma

A

in Hodgkin Lymphoma there are Reed-Sternberg lymphocytes

49
Q

Treatment for diffuse large B-cell lymphoma

A

Chemotherapy and radiation

50
Q

what drug would you use for metastatic melanoma

A

Ipilimumab

  • T-cell checkpoint inhibitor, via CTLA-4 blocking
51
Q

what do > 90% of GIST tumors stain for

A

CD-117

  • c-kit proto-oncogene
52
Q

in whom is DX oncotyping recommended

A

ER/PR positive HER2 negative, node negative patients

53
Q

how many lymph nodes do you need to harvest in gastric adenocarcinoma

A

at least 16

54
Q

Chronic wound with rolled edges and overgrown granulation tissue. You also note some nodularity. What should you do?

A

Biopsy, might be cancer

55
Q

Marjolin’s Ulcer

A

Cutaneous Squamous cell carcinoma that arises from chronic wounds/scar

Typically burns

56
Q

why does finding atypical ductal hyperplasia on breast biopsy necessitate excision biopsy

A

chance of upstaging to DCIS or IDC is 20%

57
Q

aggressive tumor with calcifications surrounding a central vessel in the retroperitoneum, what is it most likely?

A

neuroblastoma

58
Q

when would you recommend neo-adjuvant therapy for gastric adenocarcinoma

A
  • T2 or above
  • any N stage
59
Q

when would you offer post-mastectomy radiation in breast cancer

A
  • tumor size > 5 cm
  • more than 4 positive lymph nodes
  • locally advanced cancer (chest wall involvement)
60
Q

when would you give imatinib as adjuvant therapy for a GIST

A
  • greater than 5 cm
  • more than 5 mitosis per high power field
61
Q

Bevacizumab

A

monoclonal antibody against vascular endothelial growth factor (VEGF)

62
Q

Cetuximab

A

monoclonal antibody against epidermal growth factor receptors

63
Q

Pembrolizumab

A

monoclonal antibody against PD-1 receptors on T-cells

64
Q

during a staging laparoscopy for gastric adenoma, how would you asses the celiac lymph nodes with ultrasound

A

place US probe on left lobe of liver or directly over hepatoduodenal ligament

65
Q

most common side effect of oxiplatin

A

peripheral neuropathy

66
Q

least aggressive form of melanoma

A

lentigno maligna

67
Q

Most common form of melanoma

A

Superficial spreading

68
Q

risk of cancer when breast biopsy shows LCIS, long term

A

Risk of developing invasive cancer is 20%

69
Q

how do melanomas evade detection by the immune system

A

decreased major histocompatibility complex on the surface of the cells

70
Q

when is adjuvant chemotherapy indicated for triple negative breast cancer

A

size > 0.5 cm

71
Q

what is LCIS found in a breast lump associated with

A

20% increased risk of breast cancer

72
Q

type of chemotherapy used in triple negative breast cancer

A

ddAC-T

73
Q

in who can you possibly omit radiation therapy for breast cancer

A
  • age > 70
  • stage I disease with ER/PR positivity
  • willing to take hormone therapy
74
Q

Female with breast mass, biopsy shows granulomatous lesion around a breast lobule. What should be your next step for diagnosis

A
  • Stain for Acid fast bacilli, and fungi
  • thinking is that you want to rule out tuberculosis and fungal infections that may be causing the issue
75
Q

what are the two main causes of granulomatous mastitis

A
  • tuberculosis
  • sarcoidosis
76
Q

how do you treat granulomatous mastitis

A
  • supportive care, typically resolves in 6-12 months
77
Q

abdominal mass from soft tissue with bundle of spindle cells on biopsy

A

Desmoid tumor

78
Q

What hormonal therapy do you use for hormone receptor positive breast cancer in post-menopausal women

A

Aromatase inhibitor

79
Q

Patient goes to urologist for a presumed hydrocele. At procedure urologist notes a large lipoma instead of a hydrocele originating from the inguinal canal. Pt is referred to you for inguinal hernia repair, what should you do before anything else

A

CT with IV contrast, this may be a retroperitoneal liposacrcoma

80
Q

Woman is found to have atypical lobar hyperplasia, what should she be counseled on

A
  • chemoprevention (Tamxoifen vs Anastrozole)
  • enhanced screening with addition of MRI
81
Q

can you repeat sentinel lymph node biopsy if the patient has had one in the past for breast cancer?

A

yes

  • but be prepared for axillary lymph node dissection if the sentinel LN cannot be mapped in the OR
82
Q

two drugs that have been shown to reduce the risk of radiation enteritis

A

ACE inhibitors
statins

83
Q

optimal management of incidentally found small Desmoid tumor of the abdominal wall?

A

serial imaging

  • 50% do not progress on short term follow up
  • 10% regress
84
Q

woman with spontaneous bloody nipple discharge, mammogram and ultrasound are normal…what is your next step

A

MRI or ductogram

  • if those are normal you can either follow up in 6 months or excise the duct
85
Q

best treatment option for a unilocular simple cyst of the small bowel mesentery

A

enucleation

86
Q

which genectic variant has increased ER/PR positivity BRCA 1 or 2

A

BRCA 2

87
Q

which genectic variant has decreased ER/PR positivity BRCA 1 or 2

A

BRCA 1

88
Q

which genectic variant has increased association with DCIS BRCA 1 or 2

A

BRCA 1

89
Q

which genectic variant has propensity for increased tumor grade at diagnosis BRCA 1 or 2

A

BRCA 1

90
Q

Indication for MRI in breast cancer screening

A
  • life time risk > 20%
  • screening to start at the age of 30
91
Q

man with 1.2 cm ulcerated mass extending from his first toe nail onto the distal aspect of his first digit, it has been growing in size. What is the most likely diagnosis

A

Acral lentiginous melanoma

92
Q

how do you diagnose paget’s disease of the breast

A

full thickness skin biopsy

93
Q

spontaneous bloody nipple discharge with normal US, mammogram, prolactin and TSH…what would you do next

A

resist the urge to do a terminal duct incision
MRI of the breast OR a ductogram first

94
Q

How much of a breast cancer risk reduction do you get from bilateral salpingo-oopherectomy in BRCA2 patient’s

A

50% life time risk reduction

95
Q

54F s/p lumpectomy and SLNB for ER+/PR+/Her2- IDC , started on selective estrogen modulator therapy. She has her first menstrual cycle in 7 years. What should you be concerned about?

A

endometrial hyperplasia vs cancer

  • “menstrual” cycle 7 years after menopause is a result of the unopposed estrogen stimulation from her hormonal therapy
96
Q

what do GISTs stain for

A

C-kit

97
Q

how do GIST spread to other organs

A

hematogenously

goes to liver and pancreas

98
Q

normal plamsa aldosterone level

A

less than 15 ng/dL

99
Q

normal aldosterone to renin ratio

A

lower than 23.6 ng/dL

100
Q

normal 24-hour urine cortisol level

A

10-100 mcg/24hr

101
Q

What is the clinical use of Phenoxybenzamine

A

initial treatment of a pheochromocytoma

102
Q

mechanism of phenoxybenzamine

A

it is an irreversible alpha-adrenergic antagonist

103
Q

Main stay of therapy for angiosarcoma

A

Wide local excision

104
Q

For soft tissue sarcomas, do you do radiation?

A

yes, either pre-op or post-op

105
Q

Treatment for angiosarcoma after mastectomy and radiation for breast cancer

A

wide local excision and adjuvant radiation

106
Q

life time risk of colon cancer in a patient with no identifiable risks factors and no family history of colon cancer

A

5-6% lifetime risk

107
Q

What marker is useful in diagnosing Endometriosis

A

CD-10

108
Q

how do you treat a Subungual melanoma?

A

typically with amputation of the digit to a 1-2cm margin depending on depth of the melanoma

109
Q

patient with breast cancer, risk of developing contralateral cancer?

A

0.2-0.5% per year

110
Q
A
111
Q

Fine linear pleomorphic calcifications on Diagnostic Mammogram is usually associated with what breast dx

A

DCIS

112
Q

Which patients are considered high risk to develop prostate cancer?

A
  • African American race
  • 1st degree relative with prostate cancer before age 65
  • Known BRCA mutation
113
Q

which sarcoma do you get a sentinel lymph node biopsy

A

rhabdomyosarcoma

114
Q

in patients with MENI what are the two most common functional neuroendocrine tumors?

A

Gastrinoma (54%) Insulinoma (18%)

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