Oncology Flashcards
Melanoma in situ margins
5 mm
Melanoma depth of invasion < 1mm margins
1 cm
Melanoma depth of invasion 1-2 mm margins
1-2 cm
Melanoma depth of invasion > 2mm margins
2cm
When do you need sentinel lymph node for melanoma?
Depth of invasion >0.8 mm
What malignant colon polyps need oncologist resection?
< 2mm margins
Histologic features: + LVI, poor differentiation, tumor budding
Incomplete or piecemeal resection, or inability to assess margins
Sessile polyps with SM3 invasion or > 1 mm submucosal invasion
Haggit 4 lesions
Components of the Nigra protocol
5-FU and mitomycin
30 Gy radiation over 3 weeks
RET proto-oncogene
MEN2
Familial medullary thyroid cancer
PPAR gamma/ PAX 8
Follicular thyroid cancer
BRAF
Papillary thyroid cancer
P53 tumor suppressor gene
Anaplastic thyroid cancer
Small cell lung cancer
Li-Fraumeni syndrome
Li-Fraumeni syndrome
Childhood sarcomas Breast cancer Leukemia Brain tumors Adrenal tumors
C-myc
Burkitt lymphoma
N-myc
Neuroblastoma
CDK/MC1R
Melanoma
APC gene
FAP
KRAS
Adenocarcinomas (lung, colon, pancreas)
MSH1/MSH2
Lynch syndrome/HNPCC
CDH1-cadherin 1
Hereditary gastric cancer
Invasive lobular breast cancer
EML4-ALK tyrosine kinase
Non-small cell lung cancer
BCR/ABL
CML
Loss of WT1/WT2
Wilms tumor
What chromosome is WT1/WT2 on?
Chromosome 11
BRCA1
ovarian cancer, triple negative breast cancers
What chromosome is BRCA1 on?
Chromosome 17
BRCA2
Breast, ovarian, pancreas, prostate, melanoma, male breast cancer
What chromosome is BRCA2 on?
Chromosome 13
PTEN
Cowden syndrome
Cowden syndrome
GI hamartomas, endothelial cancer, breast cancer, oral papillomas
SMAD4, BMPR1A
Juvenile polyposis syndrome
STK11
Peutz-Jeghers syndrome
Treatment for stage I and II NSCLC
Lobectomy, mediastinal node dissection
What NSCLC gets neoadjuvant chemotherapy?
Stage IIIa disease (any T4 tumor, T3 tumors with N1 nodes, any N2 tumor
Stage IIIb usually does not undergo surgery
Stage III NSCLC
Nodes in single digit stations
Superior mediastinal nodes
1: highest mediastinal
2: upper paratracheal
3: pre-vascular and retrotracheal
4: lower paratracheal (including Azygos nodes)
Aortic nodes
5: subaortic (A-P window
6: para-aortic (ascending aorta or phrenic)
Inferior mediastinal nodes
7: subcarinal
8: paraesophageal (below carina)
9: pulmonary ligament
N1 nodes
10: hilar
11: interlobar
12: lobar
13: segmental
14: subsegmental
Stage I NSCLC treatment
Surgery
Stage II NSCLC treatment
Surgery
Stage IIIa NSCLC treatment
Chemotherapy followed by radiation or surgery
Stage IIIb NSCLC treatment
Combination chemo and radiation
Stage IV NSCLC treatment
Chemotherapy and/or palliative care
Who gets surgery for small cell lung cancer?
Tumor <5cm
No nodal metastasis
No metastatic disease
(Only T1-2N0M0)
Ovarian type stoma indicates what type of pancreatic lesion?
Mucinous cystic neoplasm
Fish mouth or patulous papilla?
Main duct IPMN
T1a gastric cancer
Invades lamina propecia, muscularis mucosa
T1b gastric cancer
Invades submucosa but not muscularis propria
T2 gastric cancer
Invades muscularis propria
T3 gastric cancer
Penetrates subserosal connective tissue without invasion of visceral peritoneum
T4 gastric cancer
Invades visceral peritoneum (T4a)
Invades adjacent organ structures (T4b)
N1 gastric cancer
1-2 nodes
N2 gastric cancer
3-6 nodes
N3 gastric cancer
7+ nodes
Which patients with gastric cancer should undergo laparoscopy peritoneal washings, and cytology?
Clinical T3 or clinical N+
Which patients with gastric cancer should undergo endoscopic resection?
Tis or T1a
Procedure for a T1b-T3 adenocarcinoma of the body of the stomach?
Total gastrectomy and D2 lymphadenectomy (15 nodes)
RNY esophagojejunostomy
Procedure for a T1b-T3 adenocarcinoma of the antrum of the stomach?
Subtotal gastrectomy and D2 lymphadenectomy (15 nodes)
Bilroth I or II reconstruction
Procedure for a T1b-T3 adenocarcinoma of the cardia of the stomach
Depends of Siewart classification
Siewart I
Tumor center located between 5 and 1 cm proximal to the anatomic cardia
Approached as esophageal or EGJ cancer
Siewart II
Tumor center located between 1cm proximal and 2cm distal to the anatomic cardia
Approached as esophageal or EGJ cancer
Siewart III
Tumor center located between 2 and 5 cm distal to the anatomic cardia
Approached as gastric cancer
cT4bN1M0 gastric cancer invading the spleen and diaphragm. What treatment should be offered?
Total gastrectomy, en bloc splenectomy and diaphragm resection, D2 lymphadenectomy (15 nodes)
Who gets neoadjuvant ch6in gastric cancer?
Everyone
Can consider surgery first in cT2N0 tumors
Neoadjuvant radiation for gastric cancer?
No, unless it is gastric cardia and being treated as esophageal
Adjuvant radiation for gastric cancer?
For R1 resection
Who gets adjuvant chemotherapy after R0 resection for gastric cancer?
T3 tumors
N+ disease
Most common subtype of malignant melanoma
Superficial spreading