Surgical Oncology Review

Question 1

What is thought to mediate cancer cachexia

Answer 1

Tumor Necrosis Factor alpha

Question 2

Treatment of choice for undifferentiated spindle cell tumor of the bone

Answer 2

neoadjuvant therapy then wide local excision

amputation as last resort

Question 3

Extremity soft tissue mass suspicious for malignancy should be biopsied how?

Answer 3

Core needle biopsy whenever possible

Question 4

definitive treatment for rhabdomyosarcoma

Answer 4

primary excision with sentinel lymph node biopsy if clinically node negative

can offer neoadjuvant or adjuvant chemo if positive

Question 5

How do taxanes work?

Give example of a taxane

Answer 5

• impair cellular division by inhibiting microtubule disassembly during mitosis
• Paclitaxel

Question 6

How does cyclophosphamide work?

Answer 6

• alkylating agent that inhibits DNA synthesis by preventing DNA transcription

Question 7

What is tumor lysis syndrome?

Answer 7

massive death of cells leads to intracellular ions and cellular byproducts to go into systemic circulation

Question 8

how does tumor lysis syndrome present clinically

Answer 8

Acute renal failure
hyperuricemia 
hyperkalemia
hyperphosphatemia 
hypocalcemia

Question 9

Pathophysiology of Tumor lysis syndrome

Answer 9

• cells die -> potassium, phosphate, nucleic acids into circulation -> hyperphosphatemia crystalizes calcium (develop hypocalcemia) -> calcium deposits into kidneys -> acute renal failure

Question 10

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

Answer 10

test 5-hydroxyindoleacetic acid (5-HIAA)

Carcinoid syndrome from a carcinoid tumor

Question 11

Medications for symptom control in carcinoid syndrome?

Answer 11

octeotride or lanreotide (somatostatin analog)

Question 12

how do you treat anal squamous cell carcinoma?

Answer 12

Nigro protocol: 5-fluorouracil (5-Fu) with mitomycin C and external beam radiation

APR for salvage

Question 13

What is the rate of local recurrence/tumor persistence for anal SCC after combined chemoradiation?

Answer 13

around 10-30%

those patients will need to have an APR for salvage therapy

Question 14

imaging characteristics for adrenal carcinoma that would warrant excision

Answer 14

• > 4cm mass above the kidneys
• central necrosis
• delayed imaging shows contrast washout

Question 15

Strongest predictor for prognosis in sarcomas?

Answer 15

Histologic grade

Question 16

what cancers have elevated AFP serum markers

Answer 16

germ cell tumors

HCC

Question 17

margin for melanoma with 1 mm depth

Answer 17

1 cm margin

Question 18

margin for melanoma with 2 mm depth

Answer 18

2 cm margin with SLNB

Question 19

What are Reed-Sternberg Cells

Answer 19

• giant multinucleated cells

- classic cells seen in Hodgkin’s Lymphhoma

Question 20

Stage I Hodgkin Lymphoma

Answer 20

• lymphoma is only seen in one lymphoid organ

Question 21

Stage 2 Hodgkin Lymphoma

Answer 21

Lymphoma is seen in 2 lymphoid tissues either above or below the diaphragm

Question 22

Stage 3 Hodgkin Lymphoma

Answer 22

Lymphoma seen in two or more lymphoid tissue above AND below diaphragm (Spleen counts)

Question 23

Stage 4 Hodgkin Lymphoma

Answer 23

lymphoma has spread to non lymphoid tissue

Question 24

Ipiliumab

Answer 24

• CTLA-4 inhibitor used in metastatic melanoma

Question 25

Nivolumab

Answer 25

PD-1 inhibitor used in metastatic melanoma

Question 26

Interllukin-2

Answer 26

- cytokine that causes increase in immune response by T-cells

Question 27

Vemurafenib

Answer 27

used in metastatic melanoma with V600E mutation at BRAF

Question 28

Contraindication for resection in non-small cell lung cancer?

Answer 28

Disseminated disease | contralateral lymph node involvement

Question 29

initial surgical treatment for melanoma with inguinal lymphadenopathy?

Answer 29

- resection of melanoma | - superficial inguinal lympahdenopathy

Question 30

high yield anatomy of a superficial inguinal lymphadenectomy

Answer 30

- 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

Question 31

Cloquet's node

Answer 31

first deep inguinal lymph node located within the femoral canal if taken should close residual defect with mesh or sartorius flap

Question 32

when do you perform a deep inguinal lymph node resection?

Answer 32

if Cloquet's node is positive

Question 33

patient with endometriosis s/p medical therapy and laparoscopic ablation with persistent symptoms, what can you offer

Answer 33

hysterectomy if they are done with child bearing

Question 34

Cells with a fried egg appearance is most likely what entity?

Answer 34

Paget's disease

Question 35

growing abdominal mass with biopsy showing cytologically bland fibrous neoplasm with local infiltration, what is this?

Answer 35

Desmoid tumor

Question 36

What are Desmond tumors associated with?

Answer 36

inherited disorders, most notably FAP

Question 37

Primary cancer most likely to metastasize to the adrenal glands?

Answer 37

Lung cancer

Question 38

precursor lesion to squamous cell carcinoma of the skin?

Answer 38

Actinic Keratosis

Question 39

biopsy of a skin lesion shows atypical keratinocytes that do not invade the dermis, what is this?

Answer 39

Actinic Keratosis

Question 40

exposure to aromatic amines increases risk for?

Answer 40

transitional cell bladder cancer

Question 41

nitrite consumption increases risk for?

Answer 41

gastric cancer

Question 42

most common malignancy of the tongue

Answer 42

squamous cell carcinoma

Question 43

most common genetic mutation in anaplastic thyroid cancer?

Answer 43

BRAF 600E mutation

Question 44

common SE of doxorubicin

Answer 44

cardiomyopathy

Question 45

common SE of cisplatin therapy

Answer 45

ototoxicity

Question 46

common SE of Vincristine

Answer 46

peripheral neuropathy

Question 47

common SE of bleomycin

Answer 47

pulmonary fibrosis

Question 48

tumor marker for yolk sac tumor

Answer 48

AFP