Surgical Oncology Review Flashcards
What is thought to mediate cancer cachexia
Tumor Necrosis Factor alpha
Treatment of choice for undifferentiated spindle cell tumor of the bone
neoadjuvant therapy then wide local excision
amputation as last resort
Extremity soft tissue mass suspicious for malignancy should be biopsied how?
Core needle biopsy whenever possible
definitive treatment for rhabdomyosarcoma
primary excision with sentinel lymph node biopsy if clinically node negative
can offer neoadjuvant or adjuvant chemo if positive
How do taxanes work?
Give example of a taxane
- impair cellular division by inhibiting microtubule disassembly during mitosis
- Paclitaxel
How does cyclophosphamide work?
- alkylating agent that inhibits DNA synthesis by preventing DNA transcription
What is tumor lysis syndrome?
massive death of cells leads to intracellular ions and cellular byproducts to go into systemic circulation
how does tumor lysis syndrome present clinically
Acute renal failure hyperuricemia hyperkalemia hyperphosphatemia hypocalcemia
Pathophysiology of Tumor lysis syndrome
- cells die -> potassium, phosphate, nucleic acids into circulation -> hyperphosphatemia crystalizes calcium (develop hypocalcemia) -> calcium deposits into kidneys -> acute renal failure
Patient presents with 3 months of diarrhea and facial flushing, noted to have 2 cm small bowel mass…what test should you perform to confirm diagnosis?
What is the diagnosis
test 5-hydroxyindoleacetic acid (5-HIAA)
Carcinoid syndrome from a carcinoid tumor
Medications for symptom control in carcinoid syndrome?
octeotride or lanreotide (somatostatin analog)
how do you treat anal squamous cell carcinoma?
Nigro protocol: 5-fluorouracil (5-Fu) with mitomycin C and external beam radiation
APR for salvage
What is the rate of local recurrence/tumor persistence for anal SCC after combined chemoradiation?
around 10-30%
those patients will need to have an APR for salvage therapy
imaging characteristics for adrenal carcinoma that would warrant excision
- > 4cm mass above the kidneys
- central necrosis
- delayed imaging shows contrast washout
Strongest predictor for prognosis in sarcomas?
Histologic grade
what cancers have elevated AFP serum markers
germ cell tumors
HCC
margin for melanoma with 1 mm depth
1 cm margin
margin for melanoma with 2 mm depth
2 cm margin with SLNB
What are Reed-Sternberg Cells
- giant multinucleated cells
- classic cells seen in Hodgkin’s Lymphhoma
Stage I Hodgkin Lymphoma
- lymphoma is only seen in one lymphoid organ
Stage 2 Hodgkin Lymphoma
Lymphoma is seen in 2 lymphoid tissues either above or below the diaphragm
Stage 3 Hodgkin Lymphoma
Lymphoma seen in two or more lymphoid tissue above AND below diaphragm (Spleen counts)
Stage 4 Hodgkin Lymphoma
lymphoma has spread to non lymphoid tissue
Ipiliumab
- CTLA-4 inhibitor used in metastatic melanoma
Nivolumab
PD-1 inhibitor used in metastatic melanoma
Interllukin-2
- cytokine that causes increase in immune response by T-cells
Vemurafenib
used in metastatic melanoma with V600E mutation at BRAF
Contraindication for resection in non-small cell lung cancer?
Disseminated disease
contralateral lymph node involvement
initial surgical treatment for melanoma with inguinal lymphadenopathy?
- resection of melanoma
- superficial inguinal lympahdenopathy
high yield anatomy of a superficial inguinal lymphadenectomy
- Saphenous vein at junction of Sartorius and adductor muscles
- lateral cutaneous femoral nerve under sartorius
- femoral nerve, vein, and artery in femoral triangle
- Cloquet’s node in femoral canal
Cloquet’s node
first deep inguinal lymph node located within the femoral canal
if taken should close residual defect with mesh or sartorius flap
when do you perform a deep inguinal lymph node resection?
if Cloquet’s node is positive
patient with endometriosis s/p medical therapy and laparoscopic ablation with persistent symptoms, what can you offer
hysterectomy if they are done with child bearing
Cells with a fried egg appearance is most likely what entity?
Paget’s disease
growing abdominal mass with biopsy showing cytologically bland fibrous neoplasm with local infiltration, what is this?
Desmoid tumor
What are Desmond tumors associated with?
inherited disorders, most notably FAP
Primary cancer most likely to metastasize to the adrenal glands?
Lung cancer
precursor lesion to squamous cell carcinoma of the skin?
Actinic Keratosis
biopsy of a skin lesion shows atypical keratinocytes that do not invade the dermis, what is this?
Actinic Keratosis
exposure to aromatic amines increases risk for?
transitional cell bladder cancer
nitrite consumption increases risk for?
gastric cancer
most common malignancy of the tongue
squamous cell carcinoma
most common genetic mutation in anaplastic thyroid cancer?
BRAF 600E mutation
common SE of doxorubicin
cardiomyopathy
common SE of cisplatin therapy
ototoxicity
common SE of Vincristine
peripheral neuropathy
common SE of bleomycin
pulmonary fibrosis
tumor marker for yolk sac tumor
AFP
