Eugene Oncology Flashcards
(265 cards)
1
Q
increased lifetime estrogen exposure, BRCA, 1st degree relative, increased density, obesity, alcohol
A
Breast Cancer : Epi/Risk Factors
2
Q
Most common cancer in women in US (rising), 2nd leading cause of death (falling), 1 in 8
A
Breast Cancer : Signs/Symptoms/Findings
3
Q
sporadic>familial>hereditary(BRCA1)>BRCA2
A
Breast Cancer Etiology
4
Q
chro 17q OR 13q mutation of dsDNA repair
A
BRCA 1 and 2
5
Q
1:400 (1:40 Ash. Jews), 40%-60% breast, 20-40%ovarian, earlier onset, male risk of breast, prostate and pancreative cancer
A
BRCA cancer prevalence
6
Q
> 1% of cells are ER+ or PR+ (treat with tamoxifen)
A
Breast Cancer : Good Prognosis (most have 85-100% 5 year survival
7
Q
LN mets, more aggressive/less differentiated, HER2 gene
A
Breast Cancer, poor prognosis
8
Q
EGFR, chro 17, amplification of cell proliferation and resistance to apoptosis, tx: trastuzumab + chemo
A
HER2 mutations
9
Q
don’t treat with doxy. Increased risk of cardiotoxicity
A
HER2 mutation Breast Cancer (Trastuzumab)
10
Q
lumpectomy & radiation or total mastectomy
A
Local therapy for Breast Cancer
11
Q
antiestrogen therapy: oophorectomy, leuprolide (blocks hypo-pit axis), tamoxiphen. Post-menopuase: anastrole, letrozole, tamoxifen
A
Er+ breast tumors
12
Q
cyclophosphamide/cytotoxan, doxorubicin/adriamycin, paclitaxel/taxol
A
general chemo for breast cancer
13
Q
paclitaxel/taxol
A
indicated for breast cancer in young women with poorly differentiated triple negative tumors (ER-,PR-,HER-)
14
Q
cancerous cells but no invasion
A
stage 0 breast cancer
15
Q
tumor <2cm, no LN
A
stage 1 breast cancer
16
Q
tumor 2-5 cm or <4 LN
A
stage 2 breast cancer
17
Q
tumor >5 cm or >4 LN
A
stage 3 breast cancer
18
Q
metastatic
A
stage 4 breast cancer
19
Q
25% of breast Ca
A
Ductal Carcinoma In Situ (DCIS): Epi/Risk Factors
20
Q
microcalcification on mamm, fills ductal lumen, nuclear atypia, stage 0
A
Ductal Carcinoma In Situ (DCIS): Signs/Symptoms/Findings
21
Q
stage 0 neoplastic transformation of E-cadherin+ large ductal epithelial cells (noninvasive)
A
Ductal Carcinoma In Situ (DCIS): Pathophysiology/Diagnosis
22
Q
8-10x risk of invasive carcinoma, most don’t progress, worse if younger onset, larger size, high histo grade, small margin width
A
Ductal Carcinoma In Situ (DCIS): Prognosis
23
Q
Ipsilateral risk of invasive cancer
A
Ductal Carcinoma In Situ (DCIS): Treatment/Notes
24
Q
Often misdiagnosed as inflammatory (e.g. eczema)
A
Paget’s Disease: Epi/Risk Factors AND Signs/Symptoms/Findings AND Picture
25
Carcinoma of ducts, nipple
Paget's Disease: Pathophysiology/Diagnosis
26
High risk
Paget's Disease: Prognosis
27
Ulcerated, scaling nipple lesions
Paget's Disease: Treatment/Notes
28
Most common breast Ca
Invasive Ductal Carcinoma: Epi/Risk Factors
29
Grossly irregular; better prognosis if one of the better differentiated types
Invasive Ductal Carcinoma: Signs/Symptoms/Findings
30
infiltrative epithelial neoplasm resembing cells lining the ducts/lobules (E-cadherin +)
Invasive Ductal Carcinoma: Pathophysiology/Diagnosis
31
Prognosis: Medullary, colloid, tubular, mucinous good; inflammatory (erythematous, dermal lymphatics involved) bad
Invasive Ductal Carcinoma: Prognosis AND Treatment/Notes
32
invasive ductal carcinoma with abundant lyphocytes, mucin, or dilated tubules
medullary, colloid mucinous, or tubular carcinoma; good prognosis
33
invasive ductal carcinoma with dermal lymphocytic invasion, peau d'orange skin
inflammatory carcinoma; bad prognosis
34
E-cadherin(-) epithelial cells lining acini and terminal ducts
Lobular Carcinoma In Situ (LCIS): Signs/Symptoms/Findings
35
bilateral, multifocal small cells in lobules or ducts. Defined by cell type, not location
Lobular Carcinoma In Situ (LCIS): Pathophysiology/Diagnosis
36
6-9x risk of invasive cancer bilaterally, regardless of original side
Lobular Carcinoma In Situ (LCIS): Prognosis
37
general risk factor for cancer, but not a precursor, not treated surgically
Lobular Carcinoma In Situ (LCIS): Treatment/Notes
38
Bulls eye v. Indian file pattern of small cells with scant cytoplasm, decreased E-cadherin expression
Invasive Lobular Carcinoma: Signs/Symptoms/Findings
39
5-10% of breast cancers, 20% bilateral
Invasive Lobular Carcinoma: Epi
40
rare, advanced age, BRCA2
male breast cancer
41
Infiltrating carcinoma resembling cells lining lobules
Invasive Lobular Carcinoma: Pathophysiology/Diagnosis
42
Tends to be bilateral
Invasive Lobular Carcinoma: Treatment/Notes
43
40-50% of lumps
Fibrocystic Changes: Epi/Risk Factors
44
Fibrosis, cysts, apocrine metaplasia, expansion of periductal stroma
Fibrocystic Changes: Signs/Symptoms/Findings AND Picture
45
Normal part of aging process; increased risk for invasive breast cancer with atypical ductal/lobular hyperplasia, papilloma, adenosis
Fibrocystic Changes: Pathophysiology/Diagnosis AND Prognosis AND Treatment/Notes
46
Cookie-cutter, spherical appearance of ducts; some but not all features of in situ carcinoma
Atypical Ductal Hyperplasia: Signs/Symptoms/Findings
47
8-10% risk of progressing t ocarcinoma (ALH>ADH)
Atypical Ductal Hyperplasia: Prognosis
48
Bimodal: 20s, 40s
Fibroadenoma: Epi/Risk Factors
49
Lots of stroma, small mobile firm ball-like mass w/sharp edges, increased breast size and tenderness, esp. menses, pregnancy
Fibroadenoma: Signs/Symptoms/Findings
50
Benign fibroepithelial tumor, most common benign tumor, rarely leads to cancer
Fibroadenoma
51
Benign papillary neoplasm within duct, bloody discharge
Intraductal Papilloma: Signs/Symptoms/Findings
52
Can be peripheral or central (nipple), up to 2x risk if peripheral
Intraductal Papilloma: Pathophysiology/Diagnosis
53
50 yo, cured via excision
Cystosarcoma Phyllodes: Epi/Risk Factors
54
fibroepithelial neoplasm, Lots of stroma, invaginates into ducts
Cystosarcoma Phyllodes: Signs/Symptoms/Findings AND Picture
55
p53 inactivating, k-ras activating, EGFR mutation (activates k-ras), chimeric gene of EML4 & ALK
genetic abnormalities in lung cancer
56
chimeric gene of EML4 and ALK
genetic abnormality in nonsmoking lung cancer
57
k-ras activating mutation, constituitive activation of a GTPase and all downstream enzymes
genetic abnormality in 25% of adenocarcinoma, often in smokers
58
asbestos, ionizing radiation, benzypyrene (steel smelting), chloro-methyl ether
lung cancer carcinogens
59
percent of heavy smokers who get lung cancer
10-20%
60
risk increases greatly with exposure to multiple carcinogens (synergy)
lung cancer
61
highest cancer mortality, 2nd highest incidence (decreasing)
lunger cancer
62
Smoking causes 80-90%
Lung Cancer: Epi/Risk Factors
63
Cough, dyspnea, SVC syndrome, hoarseness (bad prognosis), clubbing, infxn/pneumonia, etc.
Lung Cancer: Signs/Symptoms/Findings
64
Dx: transbronchial biopsy, bronchoscopy, CT screening (decreases mortality 20%)
Lung Cancer: Picture
65
mets to brain, bones, liver, ADRENALS
lung cancer
66
Precursor lesions: atypical adenomatous hyperplasia, squamous, DIPNECH
Lung Cancer: Pathophysiology/Diagnosis
67
Screening by low-dose helical CT = 20% mortality reduction; EGFR TKIs helpful (see drug chart)
Lung Cancer: Treatment/Notes
68
Central, hilar, high grade poorly differentiated tumor
Small Cell Lung Carcinoma (aka Oat Cell): Signs/Symptoms/Findings
69
Older Age, smoking related
Small Cell Lung Carcinoma Epi
70
large central tumor w/necrosis, extrapulmonary disease, high N:C, nuclear molding, salt and pepper chromatin, high grade (mitoses and apoptosis), poorly differentiated (few granules)
Small Cell Lung Carcinoma (aka Oat Cell): Pathophysiology/Diagnosis
71
Only 5% found early
Small Cell Lung Carcinoma (aka Oat Cell): Prognosis
72
Poor prognosis, associated with SIADH, Cushing's
Small Cell Lung Carcinoma (aka Oat Cell): Treatment/Notes
73
cell type: neuroendocrine: neurosecretory cells in airway epithelium which control smooth muscle tone
Carcinoid, Small Cell Lung Carcinoma
74
central, low grade, salt & pepper chromatin, nests and chords, well-differentiated w/neurosecretory granules
Carcinoid Lung Cancer: Signs/Symptoms/Findings
75
NE cell hyperplasia, tumorlet invades through airway wall, formation of microscopic nodule
Carcinoid Lung Cancer
76
Younger, nonsmoker
Carcinoid Lung Cancer Epi
77
Invasive, peripheral tumor can produce umbilicated lesion, may form glands (goblet cells, clara cells, type 2 pneumocytes)
Adenocarcinoma: Signs/Symptoms/Findings
78
most common cancer of nonsmokers
Adenocarcinoma: Epi
79
atypical adenomatous hyperplasia, in situ: ground glass histo, still has some functional alveoli, then forms invasive adenocarcinoma
Adenocarinoma
80
Disorganized, nested keratinization (pearls), central tumor with squamous differentiation, adhesions and bridges
Squamous Cell Carcinoma: Signs/Symptoms/Findings
81
squamous dysplasia in metaplastic bronchial cells, nuclear stratification and atypia
Squamous Cell Carcinoma: Signs/Symptoms/Findings
82
Early stage NSCLC: Surgery (lobectomy vs. wedge), XRT/RF ablation if nonsurgical, adjuvants: Cisplatin + Vinorelbine, Gemcitabine or Pemetrexed
treatment for all non-small cell carcinomas: adeno, squamous, large and giant cell
83
radiotherapy at site, LN, and brain prophylactic Etoposide and Cisplatin
treatment for all small-cell
84
Cisplatin and second agent, plus Erlotinib (TK inhibitor, for EGFR mutation) or Crizotinib (TKi for ALK)
treatment for metastatic lung cancer (e.g. of skeleton/brain)
85
High grade, non-differentiated tumor, poor prognosis, giant cell variant
Large Cell Carcinoma: Signs/Symptoms/Findings
86
3rd most common cancer, 10% of cancer deaths
Colorectal Cancer: Epi/Risk Factors
87
over 50, first degree relative, polyps(15-20%), IBD (15-40%), western diet
Colorectal Cancer: Epi/Risk Factors
88
AK53 leads to loss of APC/beta-catenin leads to k-ras mutation leads to p53 mutation
Colorectal Cancer
89
Tends to metastasize to lymphatics, liver via portal circulation
Colorectal Cancer: Signs/Symptoms/Findings
90
65-85% sporadic, 10-25% familial, 6% hereditary syndromes; stage I even if invades muscularis
Colorectal Cancer: Pathophysiology/Diagnosis
91
#1 Cause of Ca death in non-smokers
Colorectal Cancer: Prognosis
92
Risk factors: developed nations , age, smoking, meat, decreased fiber and exercise, family history, polyps, IBD < HNPCC (~80%) < FAP (~95%)
Colorectal Cancer: Treatment/Notes
93
AD APC loss, 30% de novo. 1% of CRCs, 100% lifetime risk of CRC
Familial Adenomatous Polyposis (FAP): Epi/Risk Factors
94
100s-1000s of polyps
Familial Adenomatous Polyposis (FAP): Signs/Symptoms/Findings
95
blocks beta-catenin, stopping growth and proliferation via Wnt pathway
normal APC gene
96
APC gene sequencing, k-ras, congential hypertrophy of retinal pigment epithelium
Familial Adenomatous Polyposis (FAP): Pathophysiology/Diagnosis
97
desmoid tumors (benign), brain, thyroid and duodenal cancers
Familial Adenomatous Polyposis (FAP): Prognosis
98
Screening: Sigmoidoscopy at 10-12 yo, q2yr after for FAP (start yearly colonoscopy in 20s for Lynch) Tx: Surgery for localized, XRT for rectal; Stg. III/IV: 5-FU, Irinotecan, Oxaliplatin, Bevacizumab, Cetuximab/Panitumumab
Familial Adenomatous Polyposis & Lynch Syndrome
99
AD, early age (40s)
Lynch Syndrome (HNPCC): Epi/Risk Factors
100
Multiple primary cancers (endometrium, ovary, GU tract, etc.); more likely to be right-sided, MSIs
Lynch Syndrome (HNPCC): Signs/Symptoms/Findings
101
lifetime risk of CRC 70%, accelerated polyp to tumor timeline
Lynch Syndrome
102
Right v. left in CCR
Right bleeds, left obstructs (look for anemia, not blood)
103
IHC staining for MLH1 and 2 shows decrease, BRAF mutation
Lynch Syndrome (HNPCC): Diagnosis
104
DNA mismatch repair defects leads to MSIs leads to normal tumor initiation, increased progression
Lynch Syndrome (HNPCC): Pathophysiology
105
Bethesda guidelines for risk
Lynch Syndrome (HNPCC): Prognosis
106
precancerous, low surface maturation, enlarged nuclei, low mucin, purple/ble, MIB-1/Ki67 positive (proliferation)
Adenomatous Polyp: Signs/Symptoms/Findings
107
Malignancy risk, endoscopic resection if pedunculated, sessile if small
Adenomatous Polyp: Prognosis
108
no risk, grossly flatter, sawtooth appearance of surface epithelium due to increased epithelium
Hyperplastic Polyp
109
Benign except for sessile serrated adenomas (SSAs)
Hyperplastic Polyp
110
Most lethal US cancer, average prognosis 1 y
Pancreatic Cancer
111
M>F, >50 yo, mean age 72, smoking, DM, family history
Pancreatic Ductal Adenocarcinoma (90% of Pancreatic Cancers): Epi/Risk Factors
112
k-ras mutation leads to p16/CDKN2a, leads to TP53 and SMAD4
pancreatic ductal adenocarcinoma: sporadic over time
113
BRCA2 and the pancreas
pancreatic ductal adenocarcinoma: familial mutation
114
hMLH1 and hMSH2
pancreatic ductal adenocarcinoma: sporadic or familial (5% of cancers)
115
most arise from exocrine cells, surrounded by dense stroma/fibrosis
pancreatic ductal adenocarcinoma
116
Sx: Painless jaundice, weight loss, linear lower back pain relieved in fetal position, malabsorption, depression. Histo: Loss of polarity and lobular architecture, atypia, neural invasion
Pancreatic Ductal Adenocarcinoma (90% of Pancreatic Cancers): Signs/Symptoms/Findings
117
diffuse upper abdominal pain
tail/body pancreatic cancer
118
obstructive jaundice (rare)
head pancreatic cancer, obstructs common bile duct
119
new onset diabetes (rare)
pancreatic cancer, secondary to destruction of pancrease
120
gastric outlet obstruction, gastric bleeding, pain and impaired motility, liver, bone, lung, CNS
pancreatic cancer metastasis
121
Poor (most present late stage), <4% 5-yr OS; biliary obstruction = better (since in head)
Pancreatic Ductal Adenocarcinoma (90% of Pancreatic Cancers): Prognosis
122
Tx: Whipple pancreatoduodenectomy if resectable (<20%); adjuvant chemo or radiation always, gemcitabine for palliative chemo
Pancreatic Ductal Adenocarcinoma (90% of Pancreatic Cancers): Treatment/Notes
123
Trousseau's syndrome (hypercoagulability) if Lewis blood group antigens are >1000; redness and tenderness on palpation of hands and feet
complications of pancreatic ductal adenocarcinoma
124
Parenchymal necrosis, PMN infiltrate, bacterial or parasitic (amebiasis) if abscess, echinococcus if cyst
Liver Abscess or Cyst
125
Young women's Livers
Hemangioma, Liver Cell adenoma, focal nodular hyperplasia
126
Large, painful, rarely rupture, veins > arteries, most common benign liver tumor
Hemangioma
127
No bile ducts, benign hepatocyte tumor, central scarring, arterial malformations
Liver Cell Adenoma
128
Too much perfusion, results in nodules resembling cirrhosis
Focal Nodular Hyperplasia
129
Most common tumor in liver
Metastatic Liver Cancer: Epi/Risk Factors
130
Desmoplasia, hemorrhage, central necrosis
Metastatic Liver Cancer: Signs/Symptoms/Findings
131
Commonly from colorectal, pancreas, lung breast
Metastatic Liver Cancer: Pathophysiology/Diagnosis
132
Elderly, M>F, cirrhosis; most common primary tumor
Hepatocellular Carcinoma (HCC): Epi/Risk Factors
133
Microtrabecular pattern, look normal but falling apart because of decreased adhesion molecules
Hepatocellular Carcinoma (HCC): Signs/Symptoms/Findings
134
75% have cirrhosis + serum AFP(+), HBV biggest cause worldwide, steatohepatitis is another common cause
Hepatocellular Carcinoma (HCC): Pathophysiology/Diagnosis
135
Invades veins (portal, hepatic, IVC to lungs)
Hepatocellular Carcinoma (HCC): Prognosis
136
Screen cirrhosis pts; Tx: transplant based on Milan criteria, resect if liver fxn good, RF ablation / chemoembolization, Sorafenib
Hepatocellular Carcinoma (HCC): Treatment/Notes
137
Young, 20s, no risk factors
Fibrolamellar Carcinoma of Liver: Epi/Risk Factors
138
Parallel lamellae of fibrosis + big hepatocytes
Fibrolamellar Carcinoma of Liver: Signs/Symptoms/Findings
139
Better prognosis than HCC
Fibrolamellar Carcinoma of Liver: Prognosis
140
Liver: Local resection
Fibrolamellar Carcinoma of Liver: Treatment/Notes
141
Malignant glands + desmoplasia
Cholangiocarcinoma: Signs/Symptoms/Findings AND Picture
142
Bile duct carcinoma; caused by liver flukes from fish, PSC, gallstone disease
Cholangiocarcinoma: Pathophysiology/Diagnosis AND Prognosis AND Treatment/Notes
143
Men in 40s
Biliary Cancers: Epi/Risk Factors
144
Caused by PSC, gallbladder dz, parasites, genetic; resect ± liver transplant
Biliary Cancers: Pathophysiology/Diagnosis AND Prognosis AND Treatment/Notes
145
M>F, smoking, achalasia, black
Squamous Cell Carcinoma (SCC): Epi/Risk Factors
146
Dysphagia, wt loss, dysplastic epithelium (GI/esophageal)
Squamous Cell Carcinoma (SCC): Signs/Symptoms/Findings
147
Dx: Upper endoscopy + biopsy
Squamous Cell Carcinoma (SCC): Pathophysiology/Diagnosis
148
Poor (37% localized, 3% met)
Squamous Cell Carcinoma (SCC): Prognosis
149
Early: EMR; Advanced: chemoradiation ± esophagectomy; Mets: palliative
Squamous Cell Carcinoma (SCC): Treatment/Notes
150
M>F, smoking, white, GERD
Esophageal Adenocarcinoma (EAC): Epi/Risk Factors
151
Dysphagia, wt loss, tends to be lower 1/3
Esophageal Adenocarcinoma (EAC): Signs/Symptoms/Findings
152
Dx: Upper endoscopy + biopsy
Esophageal Adenocarcinoma (EAC): Pathophysiology/Diagnosis
153
Poor (37% localized, 3% met)
Esophageal Adenocarcinoma (EAC): Prognosis
154
Early: EMR; Advanced: chemoradiation ± esophagectomy; Mets: palliative
Esophageal Adenocarcinoma (EAC): Treatment/Notes
155
Intestinal metaplasia 2/2 GERD can lead to EAC, EMR indicated in high grade dysplasia
Barrett's Esophagus
156
M=F, Wt loss, Virchow's node, Sis. Mary Joseph's nodule, Krukenberg's tumor, acanthosis nigricans
Diffuse Gastric Cancer: Signs/Symptoms/Findings
157
Signet ring cells, linitis plastica
Diffuse Gastric Cancer: Picture
158
AD inherited CDH1/E-cadherin mutations
Diffuse Gastric Cancer: Pathophysiology/Diagnosis
159
Poor, usually late stage
Diffuse Gastric Cancer: Prognosis
160
Prophylactic gastrectomy
Diffuse Gastric Cancer: Treatment/Notes
161
H. Pylori, M>F, developing
Intestinal Pattern Gastric Cancer: Epi/Risk Factors
162
Wt loss, Virchow's node, Sis. Mary Joseph's nodule, Krukenberg's tumor, acanthosis nigricans
Intestinal Pattern Gastric Cancer: Signs/Symptoms/Findings
163
Resembles adenocarcinoma, gland-forming
Intestinal Pattern Gastric Cancer: Picture
164
Most common histology for early gastric cancer
Intestinal Pattern Gastric Cancer: Pathophysiology/Diagnosis
165
More likely to be caught early
Intestinal Pattern Gastric Cancer: Prognosis
166
Surgery + adjuvant chemo, trastuzumab if Her2(+), palliative if unresectable
Intestinal Pattern Gastric Cancer: Treatment/Notes
167
Gyn Cancer Mortality
ovarian>uterine>cervial>vulvar>vaginal
168
Gyn Cancer Incidence
uterine/endo>ovarain>cervical>vulvar>vaginal
169
poor middle aged female, young first intercourse, multiple partners, smoking, immunosuppression
Cervical Cancer: Epi/Risk Factors
170
bleeding: intermenstrrual, postcoital, heavy. Cachexia, wt. loss, anemia of chronic inflammation
Cervical Cancer: Signs/Symptoms/Findings
171
HPV16, 19 persistent infxn (10%) leads to viral encoded E6 (degrades p53) and E7 (increase DNA synth enzymes) leads to dysplasia, leads to cancer. HPV is causative agent (99.9%) along with other cofactors (OCPs, STDs, etc.)
Cervical Cancer: Pathophysiology/Diagnosis
172
Good but very stage-dependent
Cervical Cancer: Prognosis
173
Early: Radical surgery w/ adjuvant chemoradiation (cisplantin); Advanced: RT + brachy, chemo; Recurrent: no cure
Cervical Cancer: Treatment/Notes
174
80% of cervical cancer, ectocervix, eosinophils cytoplasm w/multiple nucleoli, premaginancy can be IDed on Pap
squamous cell type cervical cancer
175
10-15% of cervical cancer, arises in cervical canal
adenocarninoma type cervical cancer
176
Gardasil (HPV 16, 18, 6, 11) for M/F 9-26. most efficacy pre-sexual activity onset
Cervical cancer prevention
177
60 yo, post-menopausal
uterine cancer epi
178
obesity, estrogen replacement, tamoxifen, late menopause
uterine cancer risks
179
use of OCPs is protective
uterine cancer, ovarian cancer
180
HNPCC/Lynch (MLH1, MSH2/6, PMS2); PTEN or p53 LOF
etiologies of uterine cancer
181
poor prognosis in uterine cancer
sarcomas, arise in muscular wall of uterus
182
endo cancer in uterus
stage 1
183
endo cancer in uterus and cervix
stage 2
184
endo cancer in local pelvis tissue
stage 3
185
endo cancer with mets
stage 4
186
90-95% adenocarcinomas, rest sarcomas (carcino-sarcoma, leiomyosarcoma)
Uterine Cancer: Pathophysiology/Diagnosis
187
F, 50-70 yo, W>B, industrialized nations
Ovarian Cancer Epi
188
Abd/pelvic mass, early satiety, pain , ascites, N/V, pleural effusion, distention
Ovarian Cancer: Signs/Symptoms/Findings
189
increased # menstrual cycles, no OCP use, BRCA, HNPCC
ovarian cancer risks
190
use of OPC cuts Ovarian cancer risk
by half
191
10% from Hereditary Cancer Syndrome or HNPCC, 90% sporadic
Ovarian Cancer: Pathophysiology/Diagnosis
192
Poor, 70% advanced
Ovarian Cancer: Prognosis
193
Early: Surgery (TAH/BSO, lymphadenectomy / omentectomy) ± adjuvant chemo (carboplatin/paclitaxel); Advanced: Surgical cytoreduction + adjuvant chemo (IV or intraperitoneal) ± neoadjuvant; High relapse rate (80% advanced)
Ovarian Cancer: Treatment/Notes
194
Serous (fronds of papillary tissue), mucinous (glandular, mucinous, colonic-like tissue)
Epithelial Ovarian Tumors: Pathophysiology/Diagnosis
195
F 16-20, acute abdominal pain, fertility-conserving surgery, good prognosis, unique markers
Germ Cell tumor epi
196
dysgerminoma, yolk sac tumor, im/mature teratomas, embryonal carcinoma, choriocarcinoma, gonadoblastoma
Germ cell tumors
197
unique marker: LDH
germ cell tumor: dysgerminoma
198
unique marker: AFP, Schiller-Duval bodies (cleared out spaces around vessels)
germ cell tumor: yolk sac tumor
199
unique marker: hCG
germ cell tumor: choriocarcinoma
200
Sex cord stromal tumors arise from ovarian mesenchyme, leads to early sexual development, secrete estrogen, inhibin
Granulosa Cell Ovarian Tumors, Sertoli-Leydig Tumors
201
Call-Exner bodies, coffee-bean nuclei, secrete estrogen, inhibin
Granulosa Cell Ovarian Tumors
202
95% adult type, Tx: Surg
Granulosa Cell Ovarian Tumors: Pathophysiology/Diagnosis
203
Good prognosis gyn cancers
Granulosa Cell Ovarian Tumors, Germ cell tumors
204
Secrete androgen, poorly differentiated
Sertoli-Leydig Cell Tumors: Signs/Symptoms/Findings
205
Dysgerminoma (50%), yolk-sac tumors (20%)
Germ Cell Tumors: Pathophysiology/Diagnosis
206
smokers, obese, HTN
Renal Cell Carcinoma: Epi/Risk Factors
207
Nearly 50% found incidentally on CT, 1/3 met@dx; paraneoplastic syndromes
Renal Cell Carcinoma: Signs/Symptoms/Findings
208
Triad of hematuria, flank pain, abdominal mass only seen in 10%
Renal Cell Carcinoma: Picture
209
fever w/o infxn, hypercalcemia (due to PTHrP or prostaglandins), Erythrocytosis (Epo), cachexia, weight loss, anemia
Renal Cell carcinoma: pareneoplastic syndrome
210
HIF almost always involved: 75% clear cell (VHL gene mut), papillary (HPRC (MET pathway) or HLRCC), chromophobe or oncocytoma (Birt-Hogg Dube)
Renal Cell Carcinoma: Pathophysiology/Diagnosis AND Prognosis
211
Tx: nephrectomy (even if mets), sorafenib and sunitinib only decent treatments, mTOR inhibitors also approved
Renal Cell Carcinoma: Treatment/Notes
212
Hemangioblastomas in CNS, retina; pheochromocytoma
extrarenal renal cell carinoma presentation
213
loss of chro 3p (VHL)' nests of clear cells, separated by delicate vascularture, most common
Clear Cell RCC, worst prognosis
214
chro 7 & 17 trisomy, cuboid to columnar epithelial cells lining fibrovascular cores, papillary architecture, 10-20%
Papillary RCC, more favorable prognosis than clear cell
215
loss of chro 1,6,10; sheets of eosinophils w/prominent PM and raisinoid nuclie, 5-10%
Chromophobe RCC, ver ygood prognosis
216
oncocytoma, collecting duct carcinoma, urothelial carcinoma
very rare RCC variants
217
limited to kidney, excellent 5y survival
stage 1 & 2 RCC
218
extrarenal invasion of veins, (renal vein to IVC), LN, or peri-renal tissue
stage 3 RCC
219
metastatic spread with relatively poor five year survival
stage 4 RCC
220
most common peds kidney cancer, 2-5 yo
Wilms Tumor (nephroblastoma)
221
LOF in Wt1 (11p13), from hereditary syndrome (denys-drash) or sporadic mutation
Wilms Tumor (nephroblastoma)
222
huge flank mass, grossly hemorrhagic with blastemal, stromal and epithelial (triphasic) elements
Wilms Tumor (nephroblastoma)
223
7-8% of renal cancers, arise from renal pelvis
epithelial carcinoma
224
Most common Ca and Ca death cause in 20-34yo
Testicular Cancer: Epi/Risk Factors
225
Most are germ cell tumors (95%)
testicular cancers (other: gonadal stromal and mesenchyme of supporting stroma)
226
15-35 y/o male, low mortality, white>black, asian
testicular cancer epi
227
most are malignant (95%)
Testicular tumors
228
cryptorchidism, HIV, estrogen/DES exposure in utero
Testicular Cancer: Risks
229
Choriocarcinoma - increased HCG; yolk sac + embryonal - increased AFP
Testicular Cancer: Picture
230
painless mass, dull ache or heavy sensation in lower abdomen, perianal area or scrotum, or acute pain
Testicular Cancer Presentation
231
40% seminoma, 30% NSGCT (choriocarcinoma, yolk sac, teratoma, embryonal)
Testicular Cancer: Pathophysiology/Diagnosis
232
Cure rate 95% but risk of 2° malig w/ Tx
Testicular Cancer: Prognosis
233
Seminoma Tx: surg + prophylactic XRT, chemo if fail; NSGCT: cisplatin, etoposide, bleomycin
Testicular Cancer: Treatment/Notes
234
increased APF and/or betaHCG +/- LDH
non-seminomatous testicular cancer
235
increased betaHCG +/- LDH
seminomatous testicular cancer
236
stromal tumor, benign, excess androgen leads to precocious puberty, gynecomastia
leydig cell tumor
237
bright yellow lipidy tumor with pink granular cytoplasm, Reinke crystals
leydig cell tumor
238
benign tumor from tunica mesothelium
adenomatoid tumor
239
most common testicular tumor in males over 50
malignant lymphoma
240
M>F, smoking, urine cytology
Bladder Cancer: Epi/Risk Factors/Dx
241
90-95% Transitional cell; localized (80%) and invasive cancers very different
Bladder Cancer: Pathophysiology/Diagnosis
242
Low invasion risk but field effects
Bladder Cancer: Prognosis
243
Early Tx: intravesical BCG; Invasive: radical cystectomy ± neoadjuvant chemo Mets: cisplatin combos
Bladder Cancer: Treatment/Notes
244
increased Age biggest factor, family Hx, black>white
Prostate Cancer: Epi/Risk Factors
245
Prevention hasn't really panned out. PSA screening no longer recommended
Prostate Cancer: Signs/Symptoms/Findings
246
Loss of GSTP1 starts down road towards PTEN/p53/Rb/Myc loss
Prostate Cancer: Pathophysiology/Diagnosis
247
Localized Tx: brachytherapy, radical surg, fancy radiotherapy; Locally advanced: radiotherapy + neoadjuvant hormonal therapy; Mets: androgen ablation if high grade, hormonal tx if resistant
Prostate Cancer: Prognosis AND Treatment/Notes
248
M>F, 60-70yo, poor prognosis
Conventional Squamous Cell Carcinoma (SCC): Epi/Risk Factors
249
Histo: keratin pearls
Conventional Squamous Cell Carcinoma (SCC)
250
hoarseness: throat, nasal fullness and bleeding: nose; mass or ulcer: tongue
Conventional Squamous Cell Carcinoma (SCC)
251
Tobacco + EtOH are risk factors, loss of p16
Conventional Squamous Cell Carcinoma (SCC): Pathophysiology/Diagnosis
252
I&II: unimodal radiation. III (LN involvement): ? IV (mets or below clavicle): palliative
Conventional Squamous Cell Carcinoma (SCC): Treatment/Notes
253
M>F, oral sex, oropharynx, younger pt
HPV-Related SCC: Epi/Risk Factors
254
p16 overexpression, Generally non-keratinizing, better prognosis
HPV-Related SCC: Pathophysiology/Diagnosis
255
Geographic necrosis, perineural, bone, vascular invasion, infiltrative growth
Salivary Gland Cancer: Signs/Symptoms/Findings
256
Mucoepidermoid most common, adenoid cystic common in minor glands
Salivary Gland Cancer: Pathophysiology/Diagnosis
257
Peds, Embryonal good, alveolar (PAX-FKHR) bad
Rhabdomyosarcoma: Pathophysiology/Diagnosis AND Prognosis
258
Peds, Painless mass, sclerosis, Codman's triangle, lace-like osteoid deposition on histology
Osteosarcoma: Epi/Risk Factors AND Signs/Symptoms/Findings
259
Peds: Small, round blue cell tumor, with anemia, permeating appearance on XR, increased ESR
Ewing's Sarcoma
260
EWS-FLI1 gene product, responsive to chemo
Ewing's Sarcoma
261
Lipid vesicles, adults
Liposarcoma: Signs/Symptoms/Findings AND Pathophysiology/Diagnosis
262
adultss, fibrous tissue, Spindled cells, uniform features
Fibrosarcoma: Signs/Symptoms/Findings AND Picture
263
adults: Malaligned smooth muscle fibers
Leiomyosarcoma: Signs/Symptoms/Findings AND Picture
264
aka Malignant fibrous histiocytoma, Not good prognosis
High Grade Undifferentiated Pleomorphic Sarcoma: Pathophysiology/Diagnosis
265
c-KIT mutation leads to sarcoma, treat w/Imatinib
GI Stromal Tumor (GIST)
