Oncology Flashcards
most common source of metastatic parotid mass?
head and neck cutaneous squamous carcinoma
what kind of cells do carcinoid carcinoma arise from
enterochromaffin cells
what specifics of GIST tumors equate to highest risk of malignancy and mortality
size: > 5cm
mitoses: > 5 mitoses/hpf
best method to obtain tissue diagnosis for a pancreatic head mass
endoscopic ultrasound biopsy with needle stick
most common cause of parotid malignancy
metastatic disease
where are the deep inguinal lymph nodes located?
medial to femoral vein
what should you do if you see atypical ductal hyperplasia on a breast biopsy
excision biopsy
most common form of skin cancer?
basal cell carcinoma (80% of cases)
female patient with ER/PR + HER2 - breast cancer and high oncotype score. s/p resection with negative LNs…next step
chemotherapy given high oncotype AND hormone receptor positive
most common marker used to track epithelial ovarian cancer
CA-125 (Cancer Antigen 125)
role of CA-15-3
used in breast cancer surveillance after treatment
what constitutes locally advanced breast cancer
- large tumor > 5 cm
- involves chest wall/skin
- ulceration/satellite skin nodules
- inflammatory carcinoma
- lymph node involvement
what should all locally advanced breast cancer get
neoadjuvant chemotherapy
Adjuvant radiation
risk of ovarian cancer in BRCA 1
40-60%
risk of ovarian cancer in BRCA2
15-30%
What should you get on patient prior to starting Trastuzumab
echocardiogram
- most serious SE if cardiomyopathy
Nivolumab
mab to programmed death-1 and its ligand
Ipilimumab
mab to CTLA-4
Rituximab
mab to CD20
most common chemotherapeutic agents for pseudomyoxoma peritonei
- cisplatin
- doxorubicin
- mitomycin-c
leading cause of superior vena cava syndrome
lung carcinoma (Pancoast tumor)
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
microscopic colitis
treatment for microscopic colitis
steroids (budesonide)
surgery recommended to patient with inflammatory breast cancer who responded to neoadjuvant therapy
mastectomy with axillary lymph node dissection (modified radical mastectomy)
Patient with planned post-mastectomy radiation would like immediate reconstruction, what is her best option
tissue expander
which gene mutation is associated with male breast cancer, prostate cancer and pancreatic cancer?
BRCA2
most common primary malignant peritoneal neoplasm
Mesothelioma
what should women found to have LCIS or ADH be started on and why
Tamoxifen for risk reduction of invasive breast cancer
what does the HER2 gene encode for?
- transmembrane glycoprotein with tyrosine kinase activity
is being HER2 + a good or bad prognostic sign in the setting of breast cancer?
negative prognostic sign
- shorter disease free and overall survival
Operative approach for a presumed adrenal carcinoma
open adrenalectomy
- risk of tumor seeding is 2-3 times higher with laparoscopic approach
Median survival for metastatic gastric adenoma
3-6 months
rate of synchronous cancer in breast with confirmed radial scar on biopsy
0-25%
- most studies quote around 10%
What adjuvant therapy would you administer in the setting of adrenal carcinoma with high risk of recurrence
- Mitotane
- Radiation
- +/- chemotherapy
typical age cut off for diagnostic mammography as imaging of choice
40 years of age or older
- younger women should likely get an US first
patient with low grade malignant salivary gland in the deep parotid lobe, what is correct management?
- total parotidectomy
- +/- adjuvant radiation
Oncotype DX uses what kind of technology
- Quatitative reverse transcriptase-PCR to detect RNA levels
Management of Merkel Cell Carcinoma
- staging PTE/CT or MRI scan for possible metastatic disease
- resection with 1-2 cm margins
- Sentinel lymph node biopsy vs. Lymph node dissection
which hypertension medication has been shown to protect against small bowel enteritis from radiation therapy
angiotensin converting enzyme (ACE) inhibitors
key feature of lobular carcinoma that differentiates it from ductal carcinoma
lack of epithelial cadherin expression
Neoplasm arising from Eccrine sweat glands, are most often found where
palms of hands or soles of feet
neoplasm arising from an apocrine sweat gland, most often occur where?
Axilla
why do you always image soft-tissue masses prior to biopsy
soft-tissue sarcomas are heterogenous, biopsy should be tailored to area most concerning for malignancy
Core needle biopsy of a skin lesion shows blue tumor with neuroendocrine differentiation, what is it?
Merkel cell carcinoma
Supplement used shown to reduce intestinal radiation injury during radiotherapy
Amifostine
Thyroid mass with associated hypothyroidism, biopsy shows highly cellular tissue with intermediate-sized lymphoid cells
Thyroid lymphoma
Treatment for thyroid lymphoma
chemotherapy alone, if no compressive symptoms
what is the main difference between hodgkin and non-hodgkin lymphoma
in Hodgkin Lymphoma there are Reed-Sternberg lymphocytes
Treatment for diffuse large B-cell lymphoma
Chemotherapy and radiation
what drug would you use for metastatic melanoma
Ipilimumab
- T-cell checkpoint inhibitor, via CTLA-4 blocking
what do > 90% of GIST tumors stain for
CD-117
- c-kit proto-oncogene
in whom is DX oncotyping recommended
ER/PR positive HER2 negative, node negative patients
how many lymph nodes do you need to harvest in gastric adenocarcinoma
at least 16
Chronic wound with rolled edges and overgrown granulation tissue. You also note some nodularity. What should you do?
Biopsy, might be cancer
Marjolin’s Ulcer
Cutaneous Squamous cell carcinoma that arises from chronic wounds/scar
Typically burns
why does finding atypical ductal hyperplasia on breast biopsy necessitate excision biopsy
chance of upstaging to DCIS or IDC is 20%
aggressive tumor with calcifications surrounding a central vessel in the retroperitoneum, what is it most likely?
neuroblastoma
when would you recommend neo-adjuvant therapy for gastric adenocarcinoma
- T2 or above
- any N stage
when would you offer post-mastectomy radiation in breast cancer
- tumor size > 5 cm
- more than 4 positive lymph nodes
- locally advanced cancer (chest wall involvement)
when would you give imatinib as adjuvant therapy for a GIST
- greater than 5 cm
- more than 5 mitosis per high power field
Bevacizumab
monoclonal antibody against vascular endothelial growth factor (VEGF)
Cetuximab
monoclonal antibody against epidermal growth factor receptors
Pembrolizumab
monoclonal antibody against PD-1 receptors on T-cells
during a staging laparoscopy for gastric adenoma, how would you asses the celiac lymph nodes with ultrasound
place US probe on left lobe of liver or directly over hepatoduodenal ligament
most common side effect of oxiplatin
peripheral neuropathy
least aggressive form of melanoma
lentigno maligna
Most common form of melanoma
Superficial spreading
risk of cancer when breast biopsy shows LCIS, long term
Risk of developing invasive cancer is 20%
how do melanomas evade detection by the immune system
decreased major histocompatibility complex on the surface of the cells
when is adjuvant chemotherapy indicated for triple negative breast cancer
size > 0.5 cm
what is LCIS found in a breast lump associated with
20% increased risk of breast cancer
type of chemotherapy used in triple negative breast cancer
ddAC-T
in who can you possibly omit radiation therapy for breast cancer
- age > 70
- stage I disease with ER/PR positivity
- willing to take hormone therapy
Female with breast mass, biopsy shows granulomatous lesion around a breast lobule. What should be your next step for diagnosis
- 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
what are the two main causes of granulomatous mastitis
- tuberculosis
- sarcoidosis
how do you treat granulomatous mastitis
- supportive care, typically resolves in 6-12 months
abdominal mass from soft tissue with bundle of spindle cells on biopsy
Desmoid tumor
What hormonal therapy do you use for hormone receptor positive breast cancer in post-menopausal women
Aromatase inhibitor
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
CT with IV contrast, this may be a retroperitoneal liposacrcoma
Woman is found to have atypical lobar hyperplasia, what should she be counseled on
- chemoprevention (Tamxoifen vs Anastrozole)
- enhanced screening with addition of MRI
can you repeat sentinel lymph node biopsy if the patient has had one in the past for breast cancer?
yes
- but be prepared for axillary lymph node dissection if the sentinel LN cannot be mapped in the OR
two drugs that have been shown to reduce the risk of radiation enteritis
ACE inhibitors
statins
optimal management of incidentally found small Desmoid tumor of the abdominal wall?
serial imaging
- 50% do not progress on short term follow up
- 10% regress
woman with spontaneous bloody nipple discharge, mammogram and ultrasound are normal…what is your next step
MRI or ductogram
- if those are normal you can either follow up in 6 months or excise the duct
best treatment option for a unilocular simple cyst of the small bowel mesentery
enucleation
which genectic variant has increased ER/PR positivity BRCA 1 or 2
BRCA 2
which genectic variant has decreased ER/PR positivity BRCA 1 or 2
BRCA 1
which genectic variant has increased association with DCIS BRCA 1 or 2
BRCA 1
which genectic variant has propensity for increased tumor grade at diagnosis BRCA 1 or 2
BRCA 1
Indication for MRI in breast cancer screening
- life time risk > 20%
- screening to start at the age of 30
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
Acral lentiginous melanoma
how do you diagnose paget’s disease of the breast
full thickness skin biopsy
spontaneous bloody nipple discharge with normal US, mammogram, prolactin and TSH…what would you do next
resist the urge to do a terminal duct incision
MRI of the breast OR a ductogram first
How much of a breast cancer risk reduction do you get from bilateral salpingo-oopherectomy in BRCA2 patient’s
50% life time risk reduction
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?
endometrial hyperplasia vs cancer
- “menstrual” cycle 7 years after menopause is a result of the unopposed estrogen stimulation from her hormonal therapy
what do GISTs stain for
C-kit
how do GIST spread to other organs
hematogenously
goes to liver and pancreas
normal plamsa aldosterone level
less than 15 ng/dL
normal aldosterone to renin ratio
lower than 23.6 ng/dL
normal 24-hour urine cortisol level
10-100 mcg/24hr
What is the clinical use of Phenoxybenzamine
initial treatment of a pheochromocytoma
mechanism of phenoxybenzamine
it is an irreversible alpha-adrenergic antagonist
Main stay of therapy for angiosarcoma
Wide local excision
For soft tissue sarcomas, do you do radiation?
yes, either pre-op or post-op
Treatment for angiosarcoma after mastectomy and radiation for breast cancer
wide local excision and adjuvant radiation
life time risk of colon cancer in a patient with no identifiable risks factors and no family history of colon cancer
5-6% lifetime risk
What marker is useful in diagnosing Endometriosis
CD-10
how do you treat a Subungual melanoma?
typically with amputation of the digit to a 1-2cm margin depending on depth of the melanoma
patient with breast cancer, risk of developing contralateral cancer?
0.2-0.5% per year
Fine linear pleomorphic calcifications on Diagnostic Mammogram is usually associated with what breast dx
DCIS
Which patients are considered high risk to develop prostate cancer?
- African American race
- 1st degree relative with prostate cancer before age 65
- Known BRCA mutation
which sarcoma do you get a sentinel lymph node biopsy
rhabdomyosarcoma
in patients with MENI what are the two most common functional neuroendocrine tumors?
Gastrinoma (54%) Insulinoma (18%)
