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OITE > Oncology > Flashcards

Oncology Flashcards

1
Q

Location of primary tumors that metastasize to bone

A 
Breast
Lung
Renal
Thryoid 
Prostate

***spine is most common area of metastasis

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2
Q

Osteolytic bone lesions occur via activation of ______ by ______

A

osteoclasts; RANK-L

***Denosumab inhibits RANK-L and is especially effective in giant cell tumors as they secrete RANK-L

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3
Q

Osteoblastic bone metastases secrete ______

A

endothelin-1

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4
Q

Almost always biopsy prior to surgery, and if you are not planning the tumor surgery then don’t do the biopsy.

A

Do not assume bony lesions are metastases from a known cancer, always do a biopsy.

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5
Q

Key points to remember when doing a biopsy?

A
  • You must go THROUGH a compartment, not between
  • Biopsy through the compartment you will be doing definitive surgery, this should be an extensile approach
  • Do not go through a joint
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6
Q

Mirel criteria for prophylactic fixation

A

Consider fixation for score >7

Generally this is in patients with LE/pertrochanteric, lytic lesions, >2/3 width of bone and moderate or functional pain

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7
Q

Ewing Sarcoma tumor marker

A

t(11:22)

Gene: Fusion protein (EWS-FLi1)

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8
Q

Rhabdomyosarcoma tumor marker

A

t(2;13)

Gene: Pax3-FKHR

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9
Q

Myxoid Liposarcoma tumor marker

A

t(12:16)

Gene: TLS-CHOP

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10
Q

Synovial Sarcoma tumor marker

A

t(X:18)

Gene: SYT-SSX1, 2, or 4 fusion protein

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11
Q

Chondromsarcoma tumor marker

A

t(9:22)

Fusion protein EWS-CHN

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12
Q

Osteosarcoma tumor genes

A

mutations in p53 and Rb tumor suppressor genes

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13
Q

Giant cell tumor mutation?

A

Telomere translocation

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14
Q

How would you manage a metastatic renal cell carcinoma to the intertroch region?

A
  • Preoperative embolization (very vascular tumors with high risk of significant blood loss)
  • Wide resection and arthroplasty
  • **Prophylactic fixation is no longer enough as patients are living longer on chemo agents and resection needs to be done to prevent recurrence and further mets
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15
Q

Synovial sarcoma

A
  • Is NOT located in the synovium. Commonly located in the lower extremity (plantar aspect of foot)
  • Image lungs and local regiona lymph nodes to r/o metastasis
  • Size correlates with 10-year survival, <5cm 88% survival
  • t(X;18), SYT-SSX fusion protein
  • Stains positive for Vimentin, epithelial membrane antigen, S-100
  • Histology: sheets of spindle cells and epithelial “gland-like” formations
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16
Q

Types of soft tissue sarcomas and general treatment

A
  1. Synovial sarcoma (plantar aspect of foot)
  2. Liposarcoma (intermuscular)
  3. Rhabdomyosarcoma
  4. Fibrosarcoma

Radiation therapy and wide surgical resection

17
Q

Liposarcoma

A
  • Between muscles (intermuscular)
  • MRI: heterogeneous soft tissue mass
  • Histology: lipoblast (signet ring cell)
  • Translocation: 12;16
  • Metastasize to lung and retroperitoneum
18
Q

Myxoma

A

Intramuscular.
Easily confused with lipoma or soft tissue sarcoma, so must know histology.
-Histology: BLAND, hypocellular myxoid stroma, NO signet ring cells to suggest lipoblasts.

19
Q

What are the 3 small round blue cell tumors?

How can these be differentiated?

A
  1. Multiple myeloma
  2. Lymphoma
  3. Ewings
Can be differentiated by age:
<5 yo = Neuroblastoma or leukemia
5-10 yo = Eosinophilic granuloma
5-30 yo = Ewing sarcoma
>30 yo = Lymphoma
>50 yo = Myeloma
20
Q

Multiple myeloma

A
  • ADULT >40 yo
  • Twice as common in African Americans
  • Can present with end organ damage (hypercalcemia, renal failure, anemia)
  • Work-up CBC, SPEP (M spike), UPEP (Bence Jones proteins)
  • XR multiple punched out lytic lesions
  • Histology: small round blue cell tumor
  • Treatment: multi-agent chemo + radiation. Prophylactic fixation as indicated.
21
Q

Lymphoma

A
  • Adults
  • Usually non-Hodgkins B-cell Lymphoma
  • Found in pelvis, spine and ribs (bones with persistent red marrow)
  • B-cell symptoms: fever, night sweats, weight loss
  • Labs can show neutropenia and high lymphocyte count
  • Large, diaphyseal, moth-eaten, lytic lesions (very hot on bone scan)
  • Histology: small round blue cell tumor. CD 20+, CD 45+. Lymphocyte common antigen +
  • Treatment: multi-agent chemo. Radiation if refractory to chemo.
22
Q

Ewing’s Sarcoma

A
  • KIDS
  • Mimics infection with pain, fever, elevated ESR and WBC
  • Agressive, lytic lesion of diaphyseal long bone. The lytic area of bone can also have sclerosis or be reactive.
  • MRI often reveals large soft tissue component
  • Work-up should also include bone marrow biopsy to rule out metastasis to marrow
  • t(11;22)
  • p53 mutation and EWS-FLI1 fusion protein
  • Treatment: chemo + limb salvage resection + radiation (if poor response to chemo or positive margins)
23
Q

Osteosarcoma tends to metastasize to the

A

pulmonary system

24
Q

Osteosarcoma mutations

A

Rb and p53

25
Q

Osteosarcoma treatment

A

Neoadjuvant chemotherapy + wide resection + adjuvant chemotherapy

26
Q

Enchondroma XRay findings

A

popcorn calcification

27
Q

Talengiectatic osteosarcoma Xray findings

A

Destructive, expansile lytic lesion with loss of cortex and no ossification.
MRI shows fluid-fluid levels

28
Q

Aneurysmal bone cyst Xray findings

A

Expanding lytic lesions with a circumferential cortical rim, septated with bubbly appearance

29
Q

Chondrosarcoma

A
  • Adults
  • Cartilage tumor
  • Cartilage tumors are slow growing, thus DO NOT RESPOND TO CHEMO OR RADIATION
  • XR can have popcorn calcification like enchondroma
  • MRI can show soft tissue involvement
  • Treatment is wide resection with reconstruction/prosthesis
30
Q

Giant Cell Tumor

A
  • Benign aggressive tumor in the metaphysis of long bones (proximal tibia, distal radius, distal femur)
  • Despite being benign, it can rarely metastasize to the lungs so get CXR or CT chest
  • XR: lytic lesion extending into subchondral bone
  • Low risk of malignant transformation, but if it was to transform it would likely become fibrosarcoma
  • Treat with curettage and bone grafting
31
Q

PVNS MRI finding

A

Hypointense on both T1 and T2

32
Q

Aneurysmal bone cyst

A
  • Metaphyseal lesions
  • XR: lesion expands the cortex
  • MRI: fluid-fluid levels
  • Histology: “lakes of blood”
  • Treatment: curettage and bone grafting
  • Radiation increases risk of malignant transformation
33
Q

PVNS MRI finding

A

Hypointense on both T1 and T2

34
Q

Aneurysmal bone cyst

A
  • Metaphyseal lesions
  • XR: lesion expands the cortex
  • MRI: fluid-fluid levels
  • Histology: “lakes of blood”
  • Treatment: curettage and bone grafting
  • Radiation increases risk of malignant transformation
35
Q

This tumor’s pain is relieved by NSAIDs

A

Osteoid osteoma

*NSAIDs effective because tumor has high PGE2 and COX 1 and 2

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