onco - breast, nasopharynx, lung, neck, cervix Flashcards
(149 cards)
0
Q
Peak age of incidence in breast Ca
A
70 y/o
1
Q
Most common cause of morbidity in women
A
Breast Ca
2
Q
Risk factors in breast Ca
A
- Family history
- Age of menarche, 1st pregnancy, menopause
- Nulliparity
- Low socio-economic status
- Hormones (estrogen)
- Endometrial Ca
3
Q
Environmental toxins in breast Ca
A
Organochlorine
Pesticides
Smoking
4
Q
T/f: breast feeding decreases risk for breast Ca
A
True
5
Q
First step for management of a palpable mass
A
Ultrasound
6
Q
Movable, small (2mm nodule), hard and not painful mass in breast
Stimulated by pregnancy and regression occurs post menopause
A
Fibroadenoma
7
Q
Most common benign tumor of female breast
A
Fibroadenoma
8
Q
Small, scattered, cyclic painful mass in the breast
Multiple, irreg lumps common in premenopausal than postmeno.
A
Fibrocystic changes
9
Q
Management for fibrocystic change
A
Aspiration, if bloody then it is Ca
10
Q
Biopsy indication in breast Ca
A
Marked unilateral breast enlargement
Enlarged hard mass which can’t be aspirated
Nipple discharge
Skin dimpling and redness (peau de orange)
Breast pain
11
Q
Diagnostic procedures for breast Ca
A
Self examination Pe Mammography (low dose rad) - reveals breast architecture UTZ Needle aspiration Excisional biopsy
12
Q
Most ominous sign found in mammography
A
Clustered, irregular microcalcification
13
Q
Pre-op evaluation (indication for surgery)
A
- Extensive edema of the breast
- Signs of inflammation
- Satellite nodules of Ca
- Supraclavicular mets, and neighboring distal mets
- Spread to internal mammary ln
14
Q
T/f: pregnancy is a contraindications for surgery for breast Ca
A
False.
15
Q
Survival rate for non-met breast Ca
A
95%
16
Q
Survival rate for intraductal papillary Ca
A
50% 5 yr SR
17
Q
Breast mass with bloody discharge
A
Paget’s disease
18
Q
Biggest breast ca
A
Phyllodes tumor of breast
19
Q
Types of breast Ca that rarely mets
A
- Colloid Ca - mucin producing
- Medullary Ca - lymphocytic infiltration with sheath like pattern
- Well-diff adenoma
- Tubular Ca- good prognosis
- Comedo Ca - ducts and lobules dilated by sheets of pleomorphic cells with zones of central necrosis
20
Q
Mod/highly met Ca:
Highly invasive, spread early to regional lymph node
A
Mod met Ca
21
Q
SR of mod met Ca
A
50-65%
22
Q
SR of highly met Ca
A
15%
23
Q
Mod met Ca
A
Infiltrating adenocarcinoma of Ductal origin (most common)
Intraductal Ca with stromal invasion
24
Mod/highly met Ca:
Vascular invasion, signs of inflam
< 3% 5 yr SR
Poor prognosis
Highly mets Ca
25
Clinical charac that worsen prognosis in breast Ca
1. Edema
2. Tumor fixation to chest wall and overlying skin
3. Peau de orange
4. Skin retraction/dimpling (due to shortening of tumor cells involving cooper's ligament)
5. Involvement of medial portion of lower inner quadrant of breast
6. Evidence Distant mets
26
T/f: estrogen receptor positive tumor responds to hormonal therapy and has good prognosis
True
27
Treatment for breast Ca
Surgery
Radiation
Hormonal therapy
28
Surgical procedures of breast Ca:
| Axillary lymphadenectomy followed by post-op radiation
Lumpectomy/segmental mastectomy
29
Surgical procedures of breast Ca:
For small primary lesions
Long thoracic nerve should be preserved to prevent denervation of serratus anterior (winged scapula)
Lumpectomy/segmental mastectomy
30
Surgical procedures of breast Ca:
Removal of breast with nipple-areola complex, sometimes combined with level1 axillary lymph node
Pectoralis major is preserved
Simple mastectomy
31
Surgical procedures of breast Ca:
Removal of generous amt or entire breast, Pectoralis muscle and lymph node inferior to axillary vein
SM + axillary dissection
Modified radical mastectomy
32
Surgical procedures of breast Ca:
Removes Pectoralis major in addition to tissue in modified radical mastectomy
En bloc removal of breast, Pectoralis major and minor and axillary contents
Halsted radical mastectomy
33
Country where nasopharyngeal Ca is most commonly seen
China
34
Virus asso with NPC
EBV
35
NPC is common in what population
Young population
36
Most common symptom in NPC in young population
Epistaxis
| Otitis media
37
Most common symptom of NPC in Middle Ages
Basal obstruction
38
Other symptoms of NPC
Ptosis, Diplopia, hoarseness (late sign)
39
Diagnostic procedure for NPC
Bronchoscopy
CT scan - cn, bone,lymph node involvement, compliments MRI
MRI - soft tissue
40
Most common types in NPC
Epithelioma (85%)
| Lymphoma (75%) - malignant
41
Treatment for NPC
1. Initial treatment for all forms - radiation
2. Chemotherapy and radiation - for distant mets
3. Neck dissection
42
Prognosis for NPC
Poor prognosis with <20% 5 yr SR
43
Most common etiologic factor for Bronchogenic Ca
Smoking
44
Other etiologic factors for lung Ca
Asbestos, chromates, nickel, arsenic, uranium, flower sprays
45
Peak age incidence of lung Ca
40 years old
46
Lung Ca is most common in what sex
Male
47
Most common Bronchogenic Ca
Adenocarcinoma
48
Most common in women, non smokers and smokers who quit
Adenocarcinoma
49
Site of adenocarcinoma
Periphery
50
Variant of adenocarcinoma with tall columnar cells lining the bronchioles (should be cuboidal)
Bronchioalveolar Ca
51
Has butterfly wings or lepidic appearance
Bronchioalveolar Ca
52
Types of Bronchioalveolar Ca
Solitary and multinodular
53
Lung Ca that looks like pneumonia
Bronchioalveolar Ca
54
Ling Ca that produces obstruction and can undergo central necrosis which may lead to calcification. Slow growing.
SCC
55
Asso to PTH excessive secretion
SCC
56
Site of SCC
Centrally
57
Site of SCLC
Centrally
58
Histologically, with keratin pearls and intercellular bridges (desmosomes)
SCC
59
Lung Ca that is anaplastic, fast metastatic spread
SCLC
60
Lung Ca that arises form kulchintsky cells of basal layer of bronchial epith. Stains for neuron-specific enolase (NSE) which reflects that the cells are derived from neural crest
SCLC
61
Associated with ACTH excessive secretion
SCLC
62
Oat cell CA
SCLC
63
Lung Ca found centrally of peripherally, which is highly malignant and has worst prognosis
Undiff large cell Ca
64
Clinical presentation of lung Ca
Cough - chronic, unproductive (due to bronchial irritation)
Dyspnea - deficiency of pulmonary ventilation
Fever
Wheezing sound
65
If pt is asymptomatic, what is the clinical finding that would most likely indicate lung Ca
Abnormal chest X-ray
66
Diagnostic procedures for lung Ca
```
Bronchoscopy
1. Assess bronchial involvement
2. Resected or not Resected
3. Sampling of tissue for biopsy
Mediastinoscopy - staging of lymph node
Per cutaneous needle biopsy - cytologic examination
```
67
In pancoast tumor of lung Ca, what is affected
Brachial plexus. Which manifests as pain radiation to ipsi arm of medial forearm. This develops to Horner's syndrome
68
Horner's syndrome
Ptosis
Enophthalmos
Anhydrosis
69
Management for lung Ca
Lobectomy followed by oral chemotherapy (vincristine, adriamycin, cisplatin)
70
Involvement of mediastinum
Trachea, sub carina
Recurrent laryngeal nerve (hoarseness)
Phrenic nerve (paralysis of diaphragm, causes dyspnea and later with pain
71
Prognosis of 5 yr SR in lung Ca
Bronchoalveolar:
SCC:
Adenocarcinoma:
Bronchoalveolar: 30-35%
SCC: 8-6%?
Adenocarcinoma: 5-10%
72
Post op SR
Stage I:
Stage II:
Stage III:
Stage I: 60-80%
Stage II: 40-55%
Stage III: 10-25%
73
Bronchial tree tumors
Bronchial adenoma
| Carcinoid tumor
74
Bronchial tree tumor which affects the ducts and glands, occurs at 5th decade of life and has evidence of atelectasis in CXR
Carcinoid tumor
75
Surgical procedure for bronchial tree Ca
Lobectomy
Segmentectomy
Pneumonectomy
76
A mediastinal tumor seen thru CXR and CT scan treated by surgical excision and radiation
PHEOCHROMOCYTOMA
77
Pathognomonic sign of Hodgkin disease
Binucleate cells called Reed-Sternberg cells
78
Peak age incidence of Hodgkins disease
60 y/o
79
Most common site of Hodgkin disease
Lower cervical lymph node
80
Most common site of nonHodgkin lymphoma
Upper cervical lymph node
81
Most common extra nodal site of Hodgkins disease
Spleen
82
Characteristic of the mass in Hodgkin and nonhodgkins lymphoma
Firm,fixed,rubbery, hard cervical mass
83
Where does systemic manifestation commonly seen? Hodgkin/nonhodgkins?
Hodgkins disease
84
Systemic manifestations or "B" symptoms
Fever, weight loss, night sweats
85
Surgical procedures in nonhodgkins lymphoma
Excisional biopsy - if detected early
| Endoscopy - assess metastasis and for staging
86
Treatment for NHL
Stage I and II:
Stage III and IV:
Advanced stage:
Stage I and II: radiation therapy (50-70%)
Stage III and IV: chemotherapy
Advanced stage: combi (20-45% 5 yr SR)
87
Diagnostic procedure for cervical Ca
Pap smear
Random biopsy of Vulva, vagina and cervix (if Pap smear shows abn result)
Colposcopic examination with biopsy
88
Components of cervical examination
1. Transformation zone must be visualized
2. Endometrial curettage must be performed and should be free from neoplastic cells
3. Biopsy should correspond to Pap smear result
(If above 3 criteria are not met and pt does not have invasive lesion, proceed to treatment)
89
Techniques to eliminate transformation zone
Electro cautery
Cryocautery
Laser ablation
90
Assist clearing of cervix
Better than Pap smear
Shows areas with increase N:C ratio
Acetic acid test
91
Indications of biopsy after colposcopy
If pre-invasive lesion is extensive
| When there is widespread glandular involvement (treatment is laser/cold knife conization)
92
If invasive Ca is >3mm, what procedure will you do?
Radical hysterectomy
93
T/f: micro invasive Ca of the cervix is not a pre-invasive disease
True
94
Etiologic factors of pre-invasive lesions of cervix
1. Early age of first coitus
2. Multiple sexual partners
3. Freq coitus with multiple partners
4. Smoking
5. Low socioeconomic status
6. Herpes simplex
7. HPV
95
How many years will CIN take to become neoplastic?
1-20years
96
HPV type of condyloma (venereal warts), charac with itchiness, benign, elevated papule
HPV 6, 11
97
HPV type asso with invasive cervical lesion. Charac with flat warts and rapidly progressive
HPV 16, 18
98
VIN characteristics
Itchy, red or pigmented, sharply demarcated, raised surface
99
Vaginal Ca management
Vulvectomy
100
VIN management
Wide local excision with skin block
101
Signs and symptoms of cervical Ca
```
Post coital bleeding
Menorrhagia
Back ache
Leg pain
Leg edema
Bloody urine
```
102
Removal of cervix, uterus, ovaries and Fallopian tube. Invasion of =< 3mm , lymphatic and vascular involvement not demonstrated
Simple hysterectomy
103
SH + uterine artery lighted at its origin from the internal iliac artery
Radical hysterectomy
104
Other option if patient doesn't want to do radical hysterectomy
Primary radiation therapy (for earlier stage )
105
Complication of radical hysterectomy
Bladder dysfunction
Lymphocytic formation
Risk of pulmonary embolus and hemorrhage
Urethral fistula
106
```
SR rate of Cervical Ca
Stage I:
Stage II:
Stage III:
Stage IV:
```
Stage I: 80-85%
Stage II: 60-65%
Stage III: 25-35%
Stage IV: 8-14%
107
What will you do for cervical Ca recurrence
Pelvic exenteration
108
Chemo therapeutic agent
Cisplatin
109
Rare catechu laminar producing neoplasm of chromatin cells in adrenal medulla
Pheochromocytomr
110
S&s of pheochromocytoma
```
Rapid elevated bp
Palpitations
Sweating
Anxiety
Tremor
Headache
Nausea and vomiting
```
111
Pheochromocytoma is asso with what intoxication
Cocaine
112
Complication of excessive catecholamine
Cardiomyopathy
| Mi
113
Diagnosis of pheochromocytoma
Increased urinary catecholamine (vanillylmandelic acid and metanephrine)
Elev.24hr urinary excretion of free catecholamine (epi and norepi)
CT scan or MRI of abdomen to detect extra adrenal tumors
114
Pheochromocytoma is a post/para/preganglioma?
Paraganglioma
115
Derived from neural crest which synthesizes catecholamine secretion stimulated by SNS
Chromaffin cells
116
Autosomal dominant familial syndrome with medullary thyroid Ca, parathyroid hyperplasia and pheochromocytoma
MEN2a
117
Autosomal dominant familial syndrome with medullary thyroid Ca, neuromas, marfanoid features and pheochromocytoma
MEN2b
118
Catecholamine acts at a- and b-adrenergic receptors. What are the signs caused by a-adrenergic receptors?
```
Elev bp
Increased cardiac contractility
Glycogenolysis
Gluconeogenesis
Intestinal relaxation
```
119
Catecholamine acts at a- and b-adrenergic receptors. What are the signs caused by b-adrenergic receptors?
Increased heart rate and contractility
120
Primary treatment for pheochromocytoma
Surgical resection
| Preop High salt diet and a- and b-adrenergic blockade (alpha first)
121
Cervical cancer is asso w/ what virus
HPV
122
Where does cervical Ca arises?
Transformation zone
123
What is the best diagnostic test to evaluate cervical mass?
Cervical biopsy, not Pap smear. Pap smear is a screening test and appropriate for women with a normal appearing cervix
124
Cervical cytology begins at what age
Begins 3 yrs after onset of sexual activity or by age 21 up to 30
125
Cervical cytology is contraindicated to
To women who had hysterectomy (but if done because of CIN III, then it is still needed)
126
Treatment for advanced stages of cervical ca
RT
127
Treatment for early stage of cervical Ca
Surgery + RT
128
Most common ovarian neoplasm in <35 and pregnant
Benign cystic teratoma /dermoid cyst
129
Benign teratoma of ovary in which functional thyroid tissue is predominant histologic finding
Struma ovarii
130
Most common ovarian neoplasm in >35 y/o and postmeno
| Asso with ascites
Epithelial tumors / serous cystadenoma
131
Complication of ovarian Ca which is commonly assoc with mucinous tumor
Pseudomyxoma peritonei
132
Most common vulvar Ca
SCC
133
2nd most common vulvar Ca
Melanoma
134
Vulvar Ca that is not asso to HPV
Basaloid SCC and verrucous Ca
135
Adenocarcinoma of vulva charac by crust, pruritic scaling lesions usually in labia majors
Paget's disease
136
Most common vaginal Ca
SCC
137
Most common site of vaginal Ca
Upper 3rd, anterior/lateral wall
138
Vaginal Ca which occurs in hound women whose mothers has been treated with diethylstilbestrol (DES) during their pregnancy for threatened abortion
Clear cell adenocarcinoma (mesonephroid)
139
Most common cervical Ca
SCC
140
Signet ring appearance
Krukenberg tumor
141
Schiller-duval bodies
Yolk-sac tumor
142
Breast Ca staging
0 - DCIS or LCIS
1 - invasive Ca <=2cm without node involvement
2 - <=5cm with up to 3 nodes or
>5cm without lymph node
3 - <=5cm with 4 axillary lymph nodes or
>5cm with >=10 lymph node / skin involvement / inflammatory Ca
4 - distant metastasis
143
Cervical Ca staging
```
0 - CIS or CIN III
1 - confined to cervix
2 - beyond cervix
3 - includes pelvic sidewall and lower third of vagina
4 - beyond true pelvis
```
144
Most common extra mammary paget's disease
Vulva
145
A biopsy that reveals PAS-positive cells with pale cytoplasm and prominent nucleoli
Paget's disease of breast
146
Erythema, eczematous changes of nipple of the skin with scaling and flaking which may advance to crusting, skin erosion and ulceration with exudation or frank discharge
Paget's disease of breast
147
Most common breast disorder
Blue dome cyst
Don't have increased risk of breast Ca
FCC
148
T/F: radiation has no increased risk for breast Ca
True
