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COACH / CAM REVIEW > TUMOR REVIEW 2013 > Flashcards

TUMOR REVIEW 2013 Flashcards

1
Q

Early stage esophageal cancer treatment

A

surgery alone
stage I and II
T1-2; N0-1
Up to T3 N0

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2
Q

workup for esophageal cancer

A

EUS - best

PET for distal mets

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3
Q

workup for gastric cancer

A

EGD
EUS
PET

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4
Q

treatment of T1 gastric cancer

A

surgery alone

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5
Q

treatment of T2 and greater gastric cancer

A

neoadjuvant chemotherapy:

plantar laparoscopy

implants are positive cells on washing abort

4-5 cm margin

D1 (slight benefit of D2 for long term survival) - increased morbidity

need 15 lymph nodes
careful, Colon and rectum 12

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6
Q

treatment of lymphoma of the stomach (not MALT)

A

chemotherapy:
CHOP
With or without Rituxan

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7
Q

functional reserve needed for hepatocellular carcinoma resection

A

20% functional if normal

40% functional child A./B.

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8
Q

best treatment for hepatocellular carcinoma and cirrhotic

A

transplant

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9
Q

Milan Criteria for transplant

A

no mass greater than 5 cm

if more than one lesion not greater than 3 cm and not more than 3 lesions total

no vascular invasion

no metastases

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10
Q

stage I gallbladder cancer

A

T1

Confined the mucosa

cholecystectomy alone

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11
Q

stage II gallbladder cancer

A

T2

Extent into muscularis propria

segment IVb and 5 resection

Node dissection

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12
Q

cholangiocarcinoma

A

intrahepatic:
Resection of possible
Transplant poor results

Extrahepatic:
 proximal third:
 hilar resection
Lymph nodes
In block liver resection
 include caudate

middle third:
Bile duct excision
Nodes
Frozen section of common bile duct margin

distal third
Whipple!

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13
Q

Best imaging to workup pancreatic cancer

A

triple phase CT scan

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14
Q

defined unresectable pancreatic cancer

A

SMA-did not have impingement
( SMA left and posterior to SMV)

SMV U./portal vein- CAN have abutment or encasement but they must be patent

borderline:
Abutment of the mass to SMA
short segment SMV occlusion

UNRESECTABLE:
Encasement of SMA
occlusion the portal vein

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15
Q

treatment unresectable pancreatic cancer

A

biliary drainage:
Gastro J
vs
stents if obstruction

Celiac ganglion block with alcohol
can’t be percutaneous or endoscopic
( for failed narcotics)

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16
Q

best overall test for neuroendocrine tumor of the pancreas and algorithm

A

chromogranin A

Neg:
he did not have in her endocrine tumor your done

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17
Q

order presentation of MEN 1 tumors

A 
parathyroid hyperplasia 90%
 pituitary adenoma 66%
( angiofibroma 64%)
 pancreatic:
Gastrinoma 50% ( more likely benign then when sporadic)
 insulinoma 20%
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18
Q

order presentation of MEN 2a

A

medullary thyroid cancer 100%
parathyroid hyperplasia and 50%
pheochromocytoma >33% ( possibly up to 50%)

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19
Q

order presentation of MEN 2b

A

medullary thyroid cancer 85-100%
mucosal neuroma 100%
pheochromocytoma 50%

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20
Q

best localization test for gastrinoma

A

octreotide scan
endoscopic ultrasound for pancreatic
endoluminal inspection and palpation for duodenal

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21
Q

can’t find insulinoma intraoperatively

A

venous sampling

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22
Q

surgical treatment for neuroendocrine tumors

A

less than 2 cm:
enucleate

greater than 2 cm:
resect- Whipple

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23
Q

medication to stabilize the patient with insulinoma

A

diazoxide

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24
Q

by screening test for carcinoid and subsequent algorithm

A 
chromogranin A
(same as screening test as  pancreatic neuroendocrine tumor)

Pos:
5HIAA

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25
Q

preop medical management of carcinoid

A

octreotide-avoid serotonin syndrome

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26
Q

treatment of rectal carcinoid

A

just to enucleate

do not cause carcinoid syndrome

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27
Q

bronchopulmonary carcinoids

A

can get carcinoid syndrome-bypass liver

effects mitral valve
careful, abdominal carcinoma his affect tricuspid via drainage

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28
Q

algorithm for working up pheochromocytoma

A

chromogranin A positive

plasma free metanephrine x2

24-hour urine metanephrine

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29
Q

substances producing pheochromocytoma when adrenal medulla versus sympathetic chain

A

adrenal medulla:
Norepinephrine and epinephrine

sympathetic chain/extra-adrenal:
epinephrine only

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30
Q

localization test for pheochromocytoma

A

MIBG scan - analog norepinephrine

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31
Q

alpha blockers

A

phenoxybenzamine

prazosin

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32
Q

treatment of intraoperative hypertension during pheochromocytoma resection

A

nicardipine

short-acting beta blocker ( labetalol)

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33
Q

extrapancreatic manifestation of glucagonoma

A

migratory necrolytic erythema

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34
Q

where our glucagonomas found

A

body and tail

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35
Q

treatment of glucagonoma

A

if body or tail can excise it

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36
Q

colon Surveillance if polyp is excised

A

colonoscopy 3-5 years

if negative:
q 10 years

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37
Q

stage I colon cancer

A

T1

T2

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38
Q

stage II colon cancer

A

T3

T4

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39
Q

right colon cancers get chemotherapy

A

all stage III

high risk
includes stage IIB:
T4 lesion with invasion of extracolonic viscera

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40
Q

HNPCC

A

Lynch syndrome

Lynch 2:
uterus
Brain
Not breast?

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41
Q

FAP

A

APC

flex sig or colonoscope yearly
starting age 10-15 yo!

Desmoid tumors ( also seen in Gardner syndrome)

Duodenal cancer more likely after ileorectal anastomosis IJAA

because resorbed bile and ileal rectal anastomosis carcinogenic to the duodenum

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42
Q

medical treatment of FAP

A

nonsteroidal anti-inflammatories and a decrease polyp formation

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43
Q

Peutz-Jeghers syndrome

A

STK11 weird name weird gene tumor suppressor

early colectomy

mucosal pigmented

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44
Q

juvenile polyposis syndrome

A

BMPRIA and SMAD
dominant
only cancer of 10%

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45
Q

Cowden syndrome

A

PTEN mutation tumors or pressor gene
dominant

 extracolonic:
Breast
Endometrial
Thyroid
Kidney
Skin papillomas
Neurologic -  nonmalignant  brain tumors

colorectal cancer

hematomas:
Mucous membranes mouth and nose and skin

benign breast disease

non-medullary thyroid cancer
multinodular goiters

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46
Q

serrated polyp syndrome

A

also called a sessile ulcerated polyp syndrome

premalignant

Path:
Edges serrated
Non-hyperchromic nuclei

most common sites:
CECUM
ASCENDING colon

inactivated APC gene

treatment:
Endoscopic excision

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47
Q

treatment of rectal cancer

A

formal resection

T1 and T2 node neg:
done

All others (T3 or any nodes):
NEOadjuvant chemo and XRT
Adjuvant chemo and XRT:
Capecitabine
or
5FU  /  leucovorin
 4500-5000 Gy
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48
Q

treatment of colorectal hepatic metastasis

A

treated simultaneously or stage

Neoadjuvant or adjuvant chemotherapy

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49
Q

Treatment of pulmonary colorectal metastases

A

more common with rectal

Consider resection

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50
Q

Ultrasound rectal findings

A

First black layer: Muscularis propria/lamina propria

this layer is penetrated to be T1

Second black layer:
T2

Past the second Black layer:
T3-4

51
Q

squamous cell carcinoma of the anus

A

Niagro protocol

mitomycin-C
5-FU
4500 gray

52
Q

persistent disease after nigra protocol with squamous cell carcinoma of the anus

A

Second line chemotherapy/XRT

Or

Excision

Failed second line:
APR with groin dissection if node positive

53
Q

Melanoma Of the anus

A

Local excision

Only APR sphincters involved

54
Q

adenocarcinoma the anus

A

treated with rectal adenocarcinoma protocol

Neoadjuvant chemoradiation

Excision APR

55
Q

Treatment of squamous and basal cell skin cancer

A

surgery radiation for either

56
Q

management of clinically enlarged nodes with squamous cell of the lip and

A

FNA

57
Q

drainage of skin cancer parietal region of the head

A

parotid gland

May need superficial parotidectomy for melanoma’s

58
Q

indications for sentinel node for melanoma

A

1 mm greater

possible no sentinel node F. greater than 4 mm-patient most likely has systemic disease

59
Q

melanoma management went groin node is positive

A

superficial node dissection
STOP at Cloquet’s node end do frozen section

the frozen section positive:
Proceed with deep femoral node dissection
includes region along femoral artery
NOT up to iliacs

60
Q

alternate treatment for squamous cell carcinoma in situ SCC Cis (and name for this)

A

Bowman’s disease

 consider topical:
 5-FU
imiquimod
Photodynamic
 cryotherapy
61
Q

management squamous cell carcinoma Considered more advanced: large tumor OR positive nodes

A

this is unusual

less than 3 cm positive node:
excision ipsilateral selective neck dissection

greater than 3 cm or multiple nodes:
excision and comprehensive neck dissection

62
Q

with postoperative radiation for squamous cell carcinoma

A

extracapsular invasion

Greater than 2 positive nodes

Lymph node greater than 3 cm in size

Positive margin

63
Q

staging for squamous cell carcinoma skin cancer

A

T1 up to 2 cm
T2 greater than 2 cm with high-risk features
T3 invasion maxilla mandible
T4 Skeletal invasion neuro invasion skull base

64
Q

adjuvant treatment for melanoma

A

interferon first

If fails:
Interloop and 2 by protocol

65
Q

new drug for melanoma

A

Ipilimumab
(Yervoy)

Used for metastatic disease

66
Q

most common type of melanoma

A

superficial spreading

67
Q

best prognosis type of melanoma

A

lentigo

68
Q

worsed prognosis melanoma

A

nodular

69
Q

Merkel cell

A

wide excision
Include node dissection
Postop chemotherapy and radiation

70
Q

low risk GIST criteria

A

less than 5 cm

less than 5 mitoses per high-power field

71
Q

intermediate GIST

A

5-10 cm

5-10 mitoses

72
Q

high risk GIST

A

greater than 10 cm

greater than 10 mitoses

73
Q

when is Gleevack given for GIST ( generic name for Gleevack)

A

Imatinib

high risk:
Greater than 10 cm
Greater than 10 mitoses

now treat for 5 years

74
Q

other medication for GIST

A

Sunitinib

75
Q

Adjuvant for soft tissue sarcoma

A

Greater than 5 cm

close margin or sparing major involved structure or close / pos margin

76
Q

workup and treatment for soft tissue sarcoma

A

less than 3 cm:
start with wide excisional biopsy

3 cm or greater:
core needle biopsy

if positive:
Wide excision 2 cm margin
en bloc vascular resection with reconstruction
spare muscle group and nerves

NEOadjuvant CHEMO:
Ewings
Rhabdo
Osteosarcoma
synovial sarcoma
Round cell liposarcoma
LARGE pleomorphic liposarcoma
77
Q

management of positive margin soft tissue sarcoma

A

brachy therapy

NOT reexcision

78
Q

staging a soft tissue sarcoma

A

less than 5 cm
5-10 cm
Greater than 10 cm

nuclear grade

79
Q

soft tissue sarcoma that go to lymph nodes

A

synovial - lots of drainage here

Clear cell - cell is clear like lymph

Epitheloid

Rhabdomyosarcoma

80
Q

common soft tissue sarcoma

A

Most common:
Epithelioid malignant histiocytoma

Second:
Liposarcoma

Third:
Leiomyosarcoma

81
Q

treatment of retroperitoneal sarcoma

A

complete resection

en bloc adjacent organs

82
Q

treatment of papillary thyroid cancer

A

less than 1 cm:
Total thyroidectomy and done
postoperative levothyroxine

greater than 1 cm:
Total thyroidectomy
Central node dissection (VI)

Palpable nodes:
Modified radical neck dissection
or 
 central neck level VI
Lateral levels 2 through 5b
Ablation

postop thyroglobulin elevated:
metastatic workup

iodine-131

83
Q

treatment of thyroid Hurthle cell

A

positive tissue diagnosis

Thyroidectomy and central node dissection

84
Q

how is a follicular or Hürthle cell carcinoma diagnosed by pathology

A

vascular or capsular invasion-cannot be determined on FNA

85
Q

prognosticators for papillary carcinoma

A 
AMES
 age  45
Mets
Extension
Size > 4 cm

Aggressive: tall cell, columnar cell, poorly differentiated

86
Q

treatment of residual positive margin papillary thyroid

A

re resect if possible

87
Q

indications for iodine-131

A

greater than 1 cm papillary
Greater than 2 cm follicular/ Hurthle cell
cervical nodes

88
Q

treatment of follicular thyroid cancer

A

thyroidectomy

NO central node dissection

iodine-131

follow thyroglobulin

89
Q

treatment of medullary thyroid cancer

A

Get chromogranin a - negative no pheo

total thyroidectomy
4 gland parathyroidectomy with reimplantation

Central node dissection

NO iodine-131 ablation - will not work on medullary tissue

follow with calcitonin

90
Q

age for recommended thyroidectomy in MEN 2a vs MEN 2b

A

MEN 2b WORSE :
total thyroidectomy before one year of age!

MEN 2a:
Total thyroidectomy before the age of 5

91
Q

most common location for medullary cancer in the thyroid gland

A

UPPER lobes

because the fourth pouch settles and upper

92
Q

for head and neck cancer adjuvant therapy recommended if node dissection done

A

radiation therapy

93
Q

lip, oral cavity, salivary gland T. stage

A

TI - less than 2 cm
T2 2-4 cm
T3 greater than 4 cm
( and or extraparenchymal extension)
T4a invaded skin and bone, other adjacent structures, ear canal, facial nerve
T4b invades skull base, masticator space, pterygoid plates, encases internal carotid

94
Q

lip, oral cavity, salivary gland N stage

A

N1 single ipsilateral less than 3 cm
N2 single ipsilateral 3-6 cm
(or multiple ipsilateral, bilateral, contralateral less than 6 cm)
N3 greater than 6 cm

95
Q

lip oral cavity salivary gland stage

A

I TI less than 2 cm
II T2 2-4 cm
III T3 ( greater than 4 cm / extension)
or
N1 ( single ipsilateral node less than 3 cm)
IV T4 invades skin bone and nerve
or
N2 single node 3-6 cm; bilateral nodes less than 6 cm
or
N3 greater than 6 cm

96
Q

mucosal melanoma adjuvant treatment

A

stage III-4
wide local excision
neck dissection
postoperative radiation therapy

stage IV:
chemotherapy or radiation therapy

97
Q

occult primary head and neck cancer

A 
FNA node
 workup likely source:
 adenocarcinoma 
female breast
 male prostate
98
Q

defined high-risk breast cancer

A

1.66% in 5 years

20% lifetime

99
Q

management of nipple discharge from isolated duct

A

one duct

excised duct

diagnosis intraductal papilloma

100
Q

management of nipple discharge from multiple ducts

A

mammography

101
Q

breast cancer stage

A

TI less than 2 cm
T2 2- 5 cm
T3 greater than 5 cm
T4 extra lesional extension chest wall skin

N1 1-3
N2 4-9
N3 10 or greater

stage I
T1 less than 2 cm
micro-node met less than 2 mm

stage II
T1-3
N0-1

stage III
T3 N1-2
T4

102
Q

breast cancer that gets chemotherapy

A

greater than 1 cm

103
Q

who gets tamoxifen

A 
premenopausal
DCIS
LCIS
ER PR Positive
 ER/PR NEGATIVE -  reduces chance of second primary
104
Q

negative effect of aromatase inhibitor

A

decreased bone density

105
Q

who can avoid chemotherapy

A

elderly woman with ER/PR positive

tamoxifen instead

106
Q

breast cancer types associated with decreased survival

A

luminal type a
Luminal type B
Basal

107
Q

implication of triple negative

A 
ER/PRHer2neu negative
 bad prognosis ( even though HER-2/neu  is more aggressive-  being positive means there is Herceptin  available)
108
Q

breast cancer first trimester

A

modified radical mastectomy with node dissection

109
Q

breast cancer second trimester

A

lumpectomy
start chemotherapy second trimester
start radiation therapy post delivery

110
Q

breast cancer third trimester

A

lumpectomy start chemotherapy

Radiation therapy post delivery

111
Q

sentinel node for pregnancy

A

no

no data on isotope and dye safety and pregnancy

112
Q

management of inflammatory breast cancer not responding to neoadjuvant chemotherapy

A

continue chemotherapy

At radiation therapy

113
Q

management of patient not responding to neoadjuvant chemotherapy and tried adding radiation therapy with no response

A

no surgery

114
Q

when the sentinel node done for DCIS

A

high-grade

if mastectomy is being done

115
Q

recent study demonstrated what regarding completion lymphadenectomy with sentinel node positive

A

Z0011

it less than 2 sentinel nodes positive and there is no lymphovascular invasion or capsular extension:

no value in completion lymphadenectomy..

116
Q

treatment mesothelioma

A

localize:
Extrapulmonary pneumonectomy
chemotherapy
radiation therapy

unresectable or sarcomatoid:
( diffuse-entire pleural surface,contralateral pleura, extension chest wall etc.)

Just sclerose pleural cavity with talc

117
Q

lung cancer treated with resection

A

stage I and 2

possible stage IIIa ( with good response to neoadjuvant)

abdomen considered for all resected patient’s

118
Q

what stage is chest wall expansion

A

stage IIB ONLY - proceed

119
Q

what lung cancer nodal stage is not resectable in most cases

A

N2

120
Q

value of postoperative radiation

A

decreased local recurrence

NO survival bandage

121
Q

where metastatic exceptions where a surgery for lung cancer and metastatic excision was performed

A

solitary brain metastasis

excise symptomatic organ first - example, seizures mandate metastasis excision first

122
Q

lung cancer tumor stage

A

T1 less than 3 cm

T2 3-7 cm
or
involved: main bronchus, distal to the carina, visceral pleura, obstructive pneumonitis,

T3 greater than 7 cm
PARIETAL pleura, IN main bronchus, entire lung pneumonitis

T4  any size
 mediastinum, heart ( careful, not just pericardium), 
 great vessels
Trachea
Recurrent laryngeal nerve
Esophagus
Carina
 different ipsilateral lobe ( careful, contralaterals metastatic disease)
123
Q

lung cancer node stage

A

N1 ipsilateral
intrapulmonary node
peribronchial
hilar

N2 ipsilateral
mediastinum
subcarinal

N3  contralateral
 mediastinum
 hilar
 or any scalene
 any supraclavicular
124
Q

lung cancer stage

A

I
T1 less than 3 cm
T2 3-5 (notb 5-7)

II
T1-3
N1

III a
T1-3 and T4!
N 1-2 (NOT N3)

IIIb
T4 ALSO or N3

Supraclavicular node out for resection!

COACH / CAM REVIEW (6 decks)

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