Oncology

Question 1

Management of positive STNB in cutaneous melanoma

Answer 1

Ultrasound surveillance every 3 months

Question 2

What margin is recommended for invasive melanoma 1-2 mm thick?

Answer 2

1-2 cm margin

Question 3

What margin is recommended for melanoma in situ?

Answer 3

WLE with 0.5 cm margins. Consider up to 1.0 cm margin if tumor has large diameter / poorly define borders.

Question 4

What margin is recommended for a melanoma > 2 mm thick?

Answer 4

2 cm margin

Question 5

When should a SLNB be considered in a patient with melanoma?

Answer 5

Depth of < 0.8mm with ulceration, > 0.8 mm +/- ulceration, <0.8 mm with high risk features (mitotic rate > 2, LVI).

Question 6

Postoperative surveillance for patients with CRC:

Answer 6

1. Clinical exam Q3-6 months for 2 years then Q6 months for total 5 years
2. CEA Q3-6 months for 2 years then Q6 months for 5 years.

Question 7

Advanced stage cervical cancers (IIB - IVA / nodal spread) should be treated aggressively with

Answer 7

Radiation therapy and cisplatin-based chemo

Question 8

Treatment for clinically node negative Merkel cell carcinoma

Answer 8

1. WLE with 2 cm margins
2. SLNB
3. adjuvant radiation

Question 9

Where do most salivary gland tumors arise?

Answer 9

Parotid gland (most common is pleiomorphic adenoma)
pathology: stromal tissues with groups of epithelial / myoepithelial cells.

Question 10

Management of borderline or malignant phyllodes tumors

Answer 10

WLE to achieve 1 cm margins and no axillary staging

Question 11

What scan is used to localize pheochromocytomas?

Answer 11

I-131 MIBG scan (iodine-131 methyl iodobenzylguanidine)
- adrenal medulla and chromograffin tissue

Question 12

Most important prognostic factor for retroperitoneal sarcoma

Answer 12

Resectability followed by histologic grade and tumor subtype.

Question 13

Low grade lymphomas (gastric) can be treated with

Answer 13

Antibiotics (clarithromycin and amoxicillin)
- precipitated by H. pylori.

Question 14

Cauliflower like anal mass with mild cellular atypia and pushing margins on histology in a pt with HIV

Answer 14

Verrucous carcinoma
- treatment is WLE which may include APR if lesion involves anal sphincters.

Question 15

Smooth contoured submucosal mass in stomach / small bowel (jejunum) is most likely a

Answer 15

GIST (gastrointestinal stromal tumor)
- interstitial cells of Cajal
- c-KIT defect
- complete resection

Question 16

Management if lumpectomy path comes back with DCIS with adequate margin and small foci of IDC

Answer 16

SLNB
- radiation and anti-estrogen therapy can be offered.

Question 17

Characteristics of comedo DCIS

Answer 17

• central necrosis
• numerous mitotic figures
• large pleomorphic nuclei

Question 18

Squamous cell carcinoma in situ can be described as

Answer 18

High grade intraepithelial squamous lesion

Question 19

Management of Bowen disease (SCC in situ) of the anus

Answer 19

1. Topical therapy (imiquimod, 5-fluorouracil, trichloroacetic acid)
2. Cryotherapy
3. Curettage with cautery
4. Excision (margins of 4-6 mm)

Question 20

Well-circumscribed hepatic mass with a central scar and elevated neurotensin levels with normal AFP levels?

Answer 20

Fibrolamellar HCC
- clusters of large polygonal cells interspersed with collagen sheets.

Question 21

Management of undifferentiated spindle cell tumors

Answer 21

• Neoadjuvant chemotherapy and surgical excision with wide margins.
• Urgent surgical resection only if high risk for pathologic fracture.

Question 22

30% of patients with rectal cancer and complete clinical response after neoadjuvant chemoradiation will have local recurrence of their tumor within 2 years. The tumor surveillance strategy includes:

Answer 22

Physical exam, endoscopy, and MRI every 3 months.