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Oncology/Skin Flashcards

1
Q

What else can trastuzamab be used to treat besides breast?

A

Her-2 overexpressing stomach or esophagogastric adenocarcinoma

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2
Q

Dabrafenib can be used for what cancer?

A

Melanoma. Unresectable or metastatic melanoma BRAF V600

daBRAFenib

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3
Q

Cetuximab can be used for what cancer?

mechanism?

A

EGFR expressing metastatic colon cancer

If the tumor is KRAS (+) then no benefit for cetuximab

Also for squamous cell head and neck cancer

Erlotinib also EGFR. Used for non small cell lung CA, pancreatic

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4
Q

Erlotinib is used for what cancer?

A

tarceva

Metastatic non-small cell lung cancer with EGFR mutations

locally advanced or unresectable pancreatic cancer

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5
Q

What is the “halo” sign?

A

US Finding for papillary thyroid CA

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6
Q

What is the accordion sign?

A

Pseudomembranous colitis

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7
Q

Radiation. When giving 5000 cGy, which one is more potent? 500 for 10 days or 250 for 20 days?

A

Higher dose, shorter time is more potent

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8
Q

Median survival when peritoneal carcinomatosis is left untreated?

With chemo?

A

~7mo.

~12mo. With chemo

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9
Q

Describe the steps for HIPEC. what temperature? For how long? What agent?

A

Laparotomy
Debulk all tumors to < 2mm, strip the diaphragm
Mitomycin C heated to 42C, 90 minutes
Make anastomosis if needed then closeq

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10
Q

Usual chemo regimen for breast CA?

A

Adriamycin, cytoxan +/- taxotere

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11
Q

What is merkel cell tumor?

What is the treatment? Do you have to do sentinel node?

A

Neuroendocrine tumor of the skin

Wide excision with 1-2cm margin + sentinel node biopsy + adj RADIATION to the tumor bed (esp for tumor size > 10mm)

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12
Q

Sarcomas spread hematomgeously. Which types are exceptions to this and spread via nodes?

A

Synovial sarcoma
Epithelioid sarcoma
Angiosarcoma

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13
Q

For sarcomas when do you do incisional vs excisional biopsy?

A

<3cm: excisional bx

>3cm: core needle biopsy first then incisional bx if inconclusive

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14
Q

What is the most important prognostic factor for sarcoma?

A

Grade, even moreso than size

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15
Q

What’s the T staging for sarcoma?

A

There’s only 2 T staging for sarcomas.

T1: <5cm
T2: >5cm

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16
Q

Preferrable margin for sarcoma WLE

A

2cm

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17
Q

After resection of GIST, how long does the gleevec therapy last?

A

Prolonged 3yr therapy increases 5yr survival by ~10%, reduced recurrence by ~20%

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18
Q

Von hippel lindau

A

VHL gene

Renal cell
Hemangioblastomas
Retina
Pheo
CNS tumor
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19
Q

Li fraumeni

A

P53

Breast
Sarcoma
Brain
Leukemia
Pancreatic
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20
Q

CDH1

A

Diffuse gastric cancer

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21
Q

Which cell cycle phase is most susceptible to radiation?

A

M phase and G2

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22
Q

Cetuximab targets what? What kinds of cancer is it used for?

A

EGFR

colon, head & neck

Also EGFR expressing metastatic colon cancer

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23
Q

Other than PTLD, what other cancer does EBV cause?

What is kaposi sarcoma caused by?

A

A subset of gastric cancer is caused by EBV

kaposi is caused by human herpes virus 8 HHV8

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24
Q

Merkel cell tumor. Immunohistochemistry stain for CK20 is positive or negative?

What about TFF-1?

How is this different from small cell lung cancer?

A

CK20(+) cytokeratin
TFF-1(-) thyroid transcription factor

Small cell lung cancer: both positive

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25
They give you a melanoma and asks how to biopsy but doesn't give you punch as an option. What to do? Does it depend on the size?
Excisional biopsy with 1-2 mm margin For lesions > 2cm may do partial incisional biopsy
26
Nec fasc. What is the most common organism? Overall? What is the most common monomicrobial nec fasc?
Overall: polymicrobial Most common monomicrobial: strep A
27
How do you classify nec fasc
First: clostridium vs non-clistridium nec fasc Then non-clistridium nec fasc has 4 types I: polymicrobial (mixed anaerobes and aerobes) II: group A strep III: vibrio (marine bacteria) IV: fungal
28
Skin lesion pathology: "microscopic tentacles that extend laterally from the lesion " or "spindle cells" What is it? Treatment?
Dematofibrosarcoma En Bloc excision with a wide 2cm margin
29
During a deep inguinal node dissection, where do you divide the inguinal ligament? Where does the dissection start? How do you close?
Over the femoral canal. Place the finger in the femoral canal to protect the femoral vessels Starts at the common iliac vessels and extend caudally Femoral canal is closed by suturing the inguinal ligament to the lacunar ligament. Then you can use a mesh or a sartorius flap to cover the defect to prevent hernias
30
Ehler danlos. Which type collagen defect? 18yo comes into your office with this. What screening do you recommend?
Type III CT angio for aortic root aneurysm
31
Flesh colored nodule on the back/arm. First step in diagnosis? Excisional biopsy?
Core needle first. If inconclusive then excisional bx
32
What is a natal cleft? How is the disease here classified? What's a navicular area?
Buttcrack ``` Type I: asymptomatic Type II: acute disease Type III: limited to navicular area Type IV: extend beyond navicular area Type V: recurrent disease ``` Navicular area: areas you can't see you when you push the buttcheeks together
33
What's stage V pressure ulcer?
There is no stage V. Stage IV: you see bone and muscle Stage III: subQ fat Stage II: partial skin breakdown Stage I: erythema
34
Actinic keratosis is a risk factor for developing what kind of cancer?
Squamous cell
35
Lentigo maligna predominantly affects what area?
Head & neck
36
What is the most important reason for meshing up the skin graft? Does it impact imbibition?
Surface area. Decreases the amt needed for harvest Doesn't really affect imbibition
37
CK20(+) TTF-1(-) treatment? It's 15mm
It's merkel cell carcinoma. Basically neuroendocrine tumor of the skin CT neck, CAP WLE with 2cm margin Sentinel node Adjuvant radiation (can be skipped if size < 10mm)
38
Why is sebaceous cyst a misnomer? What is the pathogenesis of this? What gets blocked and what gets trapped in the cyst? What is the most common location?
It's epidermal cyst. It doesn't contain sebum. It contains keratin Hair follicle gets blocked. Epidermal cells gets implanted into the dermis. Keratin gets trapped, not sebum Face, neck, scalp, back
39
Is Moh's surgery okay for melanoma?
Yes but only for in situ disease. Start with 5mm margin
40
Full thickness skin graft. Keep the fat or get rid of it? What is a usual donor site Designed into what shape? Rectangular? How to close donor site?
Make sure to remove fat to prevent fat necrosis Retroauricular or superior eyebrow region Other: subclailvicular, infraabdominal fold Elliptical shape Close donor site primarily. If unable split thickness skin graft can be used
41
Most common short term complication of inguinal node dissection?
Infection. 1-2%
42
Follow-up after melanoma Stage IA Everything else When do you do CBC/LFT/LDH/PET?
Stage IA: history and physical every 3-12 months Everything else: history and physical every 3-6 months for 3 years, then every 4-12 months for 2 years Labs and imaging only if suspicion based on hnp
43
4 tumors that you can resect the liver met and can get a cure
Colon Melanoma (primary from the eye. Typically only goes to liver) Carcinoid/neuroendocrine Ovarian
44
Which tumor metastasizes to the pancreas?
Renal cell
45
What genes are associated with lynch syndrome?
MLH1, MSH2, MSH6, PMS2 Microsatellite instability
46
What is the most common malignancy encountered during pregnancy? Does pregnancy affect survival of this disease?
Melanoma Pregnancy does not affect melanoma survival
47
Mechanism of action of ipilimumab?
anti-CTLA4
48
What drug can be used for BRAF(+) melanoma? What % of melanoma are BRAF(+)?
Dabrafenib About half
49
Treatment for subungal/digit melanoma?
Used to be amputation of the proximal joint but now digit sparing WLE. No survival benefit Only if margin (+) amputate the joint
50
Dematofibrosarcoma protuberans - cells stain for what antibody? - treatment? - sensitive to radiation ? - what medical therapy?
- spindle cells stain for CD34 - WLE with 2cm margin. Sentinel node not needed because they don't usually go through the nodes. Go to the lungs - yes, sensitive to radiation - imatinib (Gleevec bcr-abl tyrosine kinase inhibitor)
51
Does groin dissection for melanoma improve survival? What is the rate of post-inguinal dissection lymphedema?
It improves disease free survival But it does not improve melanoma specific survival. Aka it decreases nodal relapse but overall survival is the same MSLT-II. 24% lymphedema rate
52
Keloids and hypertrophic scars have excess type I or type III collagen?
Excess type I
53
What are the medical treatment options for hidradenitis suppurativa?
Zinc gluconate Steroids Crftriaxone, rifampin, moxifloxacin for weeks If they fail, dapsone and or cyclosporine Then adalinumab (humira. binds to TNF-a)
54
Diagnosis and treatment for: Fluctuance under the nail bed Erythema, pain, and edema of the fingertip pulo
Fluctuance under the nail bed: Paronychia. Rx: remove the nail plate Erythema, pain, and edema of the fingertip pulp: Felon. Rx: incision and drainage
55
What is an early sign of nec fasc of LE?
Severe pain on passive motion
56
Think of the cancer for: - BCR/abl - erb-B2 - c-Kit - K-ras - B-raf
- BCR/abl: proto oncogene for CML - erb-B2: breast proto onco. This is HER2 - c-Kit: proto onco for GIST - K-ras: proto onco for CRS/pancreas - B-raf: melanoma
57
For gastric cancer which pts get neoadj?
MAGIC trial: resectable T2 or greater lesions T1: mucosa, submucosa T2: muscularis propria T3: serosa T4: adjacent structures actually the same as the esophagus. for esophagus, T4a: attaches to resectable things like pericardium, pleura, diaphragm, T4b: attaches to unresectable things like the vertebrae, aorta, trachea
58
Annular pancreas: Duodenoduodenostomy vs DJ vs GJ. When to use what?
In neonates DD Adults: DJ/GJ
59
Melanoma metastasis to where have better prognosis?
Skin and lung
60
What tumor is CK-20(+) TFF-1 (+)?
Small cell carcinoma of the lung
61
For cytoreductive debulking for ovarian cancer, residual tumor diameter of what size is considered "optimal debulking"?
<1cm
62
what drug is Anti CD-20 ? Used to treat what?
Rituximab. CML, rheumatoid, MS PTLD in txp
63
Hereditary diffuse gastric cancer (DGC) inheritance pattern? Mutation in what gene? What prophylactic surgery should be done at what age? Anything else to do for women?
Autosomal dominant CDH1 gene: codes for E-cadherin (found 30-50% of the time) E-cadherin in breast is ADH. ALH = (-) e-cadherin Prophylactic gastrectomy between 18-40 For women screen like BRCA1/2. Us and mri
64
What virus is related to kaposi sarcoma?
Human herpes virus 8. HHV-8
65
What cancer is EBV related to?
Burkitt, hodgkin, PTLD, gastric cancers, nasopharyngeal
66
Which cancer? Malignant degeneration if epithelial cells with differentiation toward keratin formation
SCC
67
Which cancer? Areas of tumor islands rising from the epidermis with peripheral palisading if nuclei and stromal retraction
Basal cell
68
What is the most common malignancy associated with DVT/PE?
lung cancer followed by pancreatic
69
Which poses a higher risk for DVT/PE? prolonged hospitalization and immobility vs cancer?
Prolong hospitalization and immobility higher risk for DVT than cancer
70
PRSS1 is related to what?
Hereditary pancreatitis. It's diagnostic for it
71
Renal cell carcinomas are associated with what paraneoplastic syndromes? Most common site of metastasis for RCC? Major risk factor?
PTH related protein ACTH renin Erythrocytosis most common met to lung Smoking is the major risk factor
72
What is doxorubicin's Moa?
Inhibition of DNA synthesis by inhibition if toooisomerase II Cardiotoxicity
73
What genetic alteration is associated with improved prognosis for pancreatic neuroendocrine tumor?
Hypermethylation of hMLH1 This leads to microsatellite instability and is associated with improved prognosis
74
Sarcoma abuts but does not invade the artery. What to do?
Excision with adjacent vascular adventitia
75
Margin for marjolin's ulcer?
5-20mm
76
Pembrolizumab Target? Therapy for what?
PD-1 melanoma
77
STK11?
Peutz Jeghers Autosomal dominant
78
What do the BRCA1 and BRCA2 proteins actually do?
BRCA1: complexes with RNA polymerase in the transcription process BRCA2: binds directly to DNA to repair damage
79
What are the two biggest risk factors for cholangiocarcinoma?
Primary sclerosing cholangitis Fibropolucystic liver disease
80
retroperitoneal liposarcoma: [T/F]: recurrence is most likely to be local [T/F]: debulking of recurrent or primary tumor improves survival
true. recurrence is most likely to be local false. debulking doesn't improve survival. even the primary tumor. thus, subtotal resection should be limited to relieving intestinal obstruction when deemed appropriate
81
dermatofibrosarcoma vs. merkel cell: - margin? - sentinel node? - radiation? - medical therapy?
dermatofibrosarcoma protuberans: - 2cm margin - NO SLN - YES RADIATE - Imatinib can be used for locally advanced and metastatic disease. Merkel cell: - 1-2cm margin - YES SLN - YES RADIATE (esp for tumor size > 10mm)
82
Adjuvant therapy for resectable cholangiocarcinoma?
Capecitabine > gemcita + cisplatin.

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