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ABOG Written Exam > ONC > Flashcards

ONC Flashcards

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1
Q

cervical cancer- what number most common for USA, worldwide

A

third most common gyn cancer US, third most common gyn cancer death US, 2nd most common cancer worldwide

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2
Q

natural h/o hpv infection- natural clearance

A

70% resolve by 12 mo, 90% by 24 mo

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3
Q

advantages/disadvantages of HPV only screening

A

+: sens and NPV 99-100% when combined

-: increased colpos, lowever PPV

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4
Q

ASCUS 21-65 yo, what next?

A

reflex cotest: if + colpo, if - routine screen

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5
Q

negative HPV, ASCUS 30-65 yo

A

rpt screen 3-5 yr

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6
Q

negative HPV, LSIL pap 30-65

A

pap/cotest one year, colpo also ok

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7
Q

negative HPV, HSIL pap 30-65

A

colpo

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8
Q

any abnormal pap, pos HPV 30-65

A

colpo

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9
Q

When is ECC indicated during colpo?

A
  1. inadequate colpo 2. concern for endocervical extension
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10
Q

what percentage of excisional procedures are curative? what if there are pos margins?

A

95% cure rate

of those w/ pos margins, 67% resolve spontaneously; rpt pap/ECC in 6 mos would be next step

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11
Q

endometrial cells on pap- pre vs post menop

A

pre-men: if asx, routine, if pos sx (AUB) then EMB TVUS

post-men: EMB TVUS

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12
Q

AGC (AGUS) on pap

A

HPV, ECC, colpo + EMB if greater than 35 and/or endometrial cells

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13
Q

AIS on excisional procedure?

A

hyst preferred, reexcise is pos and desire fertility

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14
Q

pap screening in HIV pt, when start how often?

A

w/in one year sexual activity no later than 21, pap q 60 then q year if first two are normal; if three consecutive normal can do q3yr

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15
Q

cervical ca stage 1- define and tx?

A

IA1: <3mm deep and nor visible: hyst
1A2: <5mm deep and not visible: mod rad hyst
IB1: >5 mm and <2 cm wide: rad hyst + PLND
IB2: >5 mm and 2-4 cm wide: rad hyst + PLND
IB3: >5 mm and >4 cm wide chemo-RT + brady

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16
Q

cervical ca stage 2- define and tx?

A

IIA1: upper 2/3 vagina- chemo RT + brachy
IIA2: upper 2/3 vagina- “
IIA3: parametrial involvement- “

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17
Q

cervical ca stage 3- define and tx?

A

IIIA: lower 1/3 vagina- chemo/RT
IIIB: pelvic sidewall or kidney- “
IIIC1: pelvic nodes- “
IIIC2: paraortic nodes- “

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18
Q

cervical ca stage 4- define and tx?

A

IVA: adjacent pelvic structures, bladder, rectum
IVB: distant mets

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19
Q

most common early, late complications of radical hyst?

A

early- UTI, late- bladder atony

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20
Q

when is radiation indicated for ca cancer?

A

primary tx for anything and/or those not surg candidates, adjuvant tx for nodes (after surgery), palliative tx

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21
Q

cervical ca recurrence tx?

A

if central recurrence, do whatever you didn’t do the first time (surgery, chemo/RT)
if lateral recurrence, do chemo/RT for ppl who had a hyst, for those who had chemo/RT, do another dose of chemo (can’t do another dose of rad)
do a pap at each f/up visit, the majority of recurrences are asymptomatic

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22
Q

ACOG breast ca guidelines

A

q1-2 y 40-50, then qy after 50

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23
Q

most common mammo sign of malignancy

A

clusters of calcifications (fat necrosis- benign- can mimic)

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24
Q

what stage (and more severe) would be worrisome w/ the BI-RADSs score? who needs change in mgmt, who needs bx?

A

BI-RADS 3 and above is abnormal. 3 needs ipsilateral mammo q6 mo. 4 and 5 need bx. 6 is known ca.

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25
what chromosome is BRCA1 on? what are the odds of breast and ov ca for those pts?
chromosome 17. Breast ca 50-85%. Ovarian ca 50%
26
what chromosome is BRCA2 on? what are the odds of breast and ov ca for those pts?
chromosome 13. Breast ca 50-85%. 25 % risk ov ca.
27
describe risk reducing mgmt for BRCA
at age 25, begin intensive breast screen (alt mammo/MRI q 6 mo). At age 35 (?or when done w/ childbearing) berform BSO
28
what is the most common breast condition? describe its tx
fibrocystic change. tx = reassurance, support
29
most common breast tumor women age 20-35?
fibroadenoma- benign. may bx to perform, then can obsere or if pt prefers excise
30
DCIS: describe clinical consequences, presentation, age of dx, tx
a cancer precursor, age= postmenopausal, MC arises after mammo, tx= mastectomy +/- reconstruction
31
LCIS: describe clinical consequences, presentation, age of dx, tx
a *risk factor* for either breast, age=40-50 yo, tx= cautious observation,
32
what is the most common histological type of breast ca? at what anatomical location?
invasive ductal ca (70%), "indian filing" be invasice lobular (30%), arise in the terminal duct lobular unit in upper/outer quadrant
33
what is the role of tamoxifen vs raloxifene?
tamoxifien- pre-menopausal women w/ ER pos breast ca and ?high risk for dz raloxifene- post-menopausal women w/ ER pos breast ca
34
what is the role of aromatase inhibitors in breast ca? how long can they be used?
indicated only for postmenopausal women w/ ER pos breast ca. block estrogen synthesis= MOA, reduces estrogen by 95% can be used max 5 yr- consider then tamoxifen after
35
what is the most important prognostic factor for breast ca?
axillary node status (stage)
36
what is the most common gyn ca?
endometrial
37
what is the most common histological type of endo ca?
endometrioid
38
at what stage do most endo ca pts present?
stage 1 (75%)
39
endo ca staging + tx
``` 1A: <50% myometrium- surgery alone 1B: >50% myometrium- surgery + RT II: cervix- surgery + RT III: pelvic anatomy and/or nodes- likely surgery, RT/chemo IV: bladder, bowel, distant dz= " ```
40
describe relationship of pos nodes and survivorship in endo ca
``` No LN- 5 yr survival 85% Pelvic Nodes (IIIC1): 65% Paraaortic Nodes (IIIC2): 45% ```
41
when do most endo ca recurrences occur? where do they occur? what is the tx?
w/in two years, MC location = vaginal cuff, tx= if surgery previously, then do RT; if h/o RT, then do chemotx. metastatic recurrence = chemotx.
42
leiomyosarcoma location , median age, dx modality, mitotic definition
myometrium, 52-54 age, can't be sampled w/ EMB/D&C, >10in 10 HPF,
43
endometrial stromal sarcoma
endometrium smooth muscle cell, can be dx'd w/ EMB/D&C, better px than other sarcomas those high grade still bad
44
carcinosarcoma (MMMT)
the most common sarcoma of the uterus, somewhat older (65+), can be dx w/ EMB/D&C,
45
cowden syndrome: mechanism, inheritance, findings
autosomal dominant, PTEN mut, hamartomas, breast, thyroid, then colon/uterus
46
when do pre-menop women see onc for ov ca concern? post-men?
Pre-menopausal: CA125 >200, ascites, fam hx, evidence of mets Post-menopausal: CA125>35, ascites, evidence of mets
47
stage 1 ovarian ca definition and tx
``` 1A1: unilateral- no further tx required 1B: bilateral- no further tx required 1c1: surgical spillage- chemotx 1c2: capsule rupture prior to surgery- chemotx 1c3: pos washings or ascites- chemotx ```
48
when do you re-operate vs do chemotx for ovarian ca pts?
>6 mo and potentially amenable dz- operate | <6 mo or unresectable- don't operate
49
dysgerminoma marker, pearls
LDH. most common GCCT, B/L 20%, contralateral should be removed if XY mosaic
50
yolk sac tumor marker, histo finding and its description
AFP, schiller-duvall (central vessel w/ tumor cells)
51
GCCT and SCST tx?
resection and BEP
52
how do granulosa cell tx present? what is the pathomneumonic histo finding? what is the tumor markers?
abnormal bleeding (get an EMB), large mass, call-exner bodies, inhibin
53
most common skin cancer dx overall? most common and 2nd most common vulvar ca
basal cell ca = mc overall | most common vulvar ca is SCC, 2nd most common melanoma
54
most common early and late complications of vulvar ca
early- wound separation, late- lymphedema
55
most common vulvar survival consideration
nodes
56
vulva, vaginal ca tx?
vulvar is individualized but often WLE + SNL +/- RT | vaginal ca mainstay is RT
57
most common complete mole karyotype, incomplete karyotype
complete= dipolid- 46XX, incomplete = triploidy- XXY is MC
58
what percentage of complete moles result in persistent GTD? Incomplete moles?
30% complete moles result in GTD, 3% of incomplete
59
hydatidiform mole bHCG frequency
weekly for 3 consecutive "normals", then monthly for 6 mo
60
what are the histo findings of choriocarcinoma? Placental site trophoblastic tumor?
cyto and syncytiotrophoblast | intermediate trophboblastic cells
61
describe high risk GTD findings, what tx do these require?
brain/liver mets, super high hcg (>100,000), long interval since pregnancy, term gestation; these pts need emaco tx
62
most radiosensitive tissue?
ovaries, kidney (20 Gy), small bowel (30)

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