Oncology

Question 1

What is carcinoma in situ?

Answer 1

Stage 0 cancer; not moving anywhere yet

Question 2

What are some characteristics of malignant lesions?

Answer 2

• Change in color
• Lymphadenopathy
• Raised borders
• Painful, firm nodules
• Bleeding and crusting

Question 3

What are adnexal tumors?

Answer 3

• Arise from cells of appendages, like hair follicles and sweat glands;
• Also from fibrous or neural tissue

Question 4

Most skin cancers are caused by what?

Answer 4

• Ionizing radiation

- UVB rays

Question 5

Besides UVB rays, what other carcinogens contribute to skin cancer?

Answer 5

• Paraffin oil UVA chemotherapy
• Creosote Fuel oil
• Coal Pitch
• Psoralens

Question 6

Under what conditions can SCCs metastasize?

Answer 6

• Large lesions
• Lesions on transplant patients
• Lesions associated with burn scars (Marjolin’s ulcers)

Question 7

What are Marjolin’s ulcers?

Answer 7

Progressively growing, aggressive SSC lesions appearing on previously traumatized skin or scars.

Question 8

What is nevoid BCC syndrome?

Answer 8

• BCC in childhood
• May not be in sun-exposed areas
• Associated with medulloblastomas and reproductive tumors.

Question 9

Cell of origin for BCC?

Answer 9

Pluripotential cell from pylosebaceous tissue

Question 10

What do BCCs look like?

Answer 10

• Waxy, translucent nodules
• Telangiectasias
• Umbilicated centers

Question 11

Treatment of BCSS?

Answer 11

• Less than 1 cm: may be removed by curettage, electro-dessication, cryotherapy, or excision
• More than 1 cm: excision with minimum of 1 mm margins laterally and deep

Question 12

What causes SCCs?

Answer 12

• Sun exposure
• Exposure to environmental carcinogens
• Malignancy of untreated wounds

Question 13

What are actinic keratosis?

Answer 13

• Turn into Squamous cell carcinoma

- Involve epidermis and dermis

Question 14

How do SCCs metastasize?

Answer 14

Regionally and systemically

Question 15

What do SCCs look like?

Answer 15

• Irregularly-shaped plaque or nodule

- Pink rolled edge with or without central ulceration

Question 16

Treatment of SCCs?

Answer 16

Excision: 5mm margins laterally and deep

-Can use Moh’s procedure on face

Question 17

Treatment of actinic keratoses?

Answer 17

• Topical cytotoxic cream
• Cryosurgery
• Electrodessication

Question 18

Treatment for adnexal tumors?

Answer 18

• Excision
• Possibly sentinel node sampling
• Sebaceous carcinomas, cylindromas, and Merkel cell carcinoma
• Prognosis varies with cell type

Question 19

What do melanomas arise from?

Answer 19

Benign nevi usually

Question 20

At what stage does melanoma become regional?

Answer 20

III

Question 21

At what stage is melanoma localized?

Answer 21

I-II

Question 22

At what stage is melanoma metastasis advanced and distant?

Answer 22

IV

Question 23

What are the four types of melanomas?

Answer 23

1. Lentigo maligna
2. Superficial spreading
3. Nodular
4. Acral lentiginous

Question 24

At what size do nevi become suspicious?

Answer 24

6 mm

Question 25

What should we do with atypical nevi?

Answer 25

Excise to clear margins

Question 26

What should we do if we suspect a lesion is a melanoma?

Answer 26

Full-thickness punch biopsy or excision: | -Wide margins

Question 27

How should we treat melanomas?

Answer 27

- Stage I, II, III: surgery | - Stage IV: systemic therapy

Question 28

How is cancer staged?

Answer 28

- Tumor: depth, regression, ulceration - Node status - Metastasis

Question 29

What size margins should we excise for melanoma lesions that are less than 1 mm thick?

Answer 29

1 cm

Question 30

What size margins should we excise for melanoma lesions that are 1-4 mm thick?

Answer 30

2 cm

Question 31

What size margins should we use for melanoma lesions that are more than 4 mm thick?

Answer 31

>2 cm

Question 32

When should we take sentinel lymph node biopsies?

Answer 32

- Tumors .76-1 thick or - with ulceration or - with positive deep margins or - with mitoses or with Clark's IV

Question 33

From what sites do we biopsy lymph nodes?

Answer 33

- Axillary: levels 1, 2, and 3 - Inguinal - Iliac - Cervical

Question 34

From what tissues do soft tissue sarcomas develop?

Answer 34

Mesenchymal tissue

Question 35

Where are malignant soft tissue sarcomas found?

Answer 35

-Anywhere: bone, cartilage, connective tissue -Usually extremities -

Question 36

Who usually gets rhabdomyosarcomas?

Answer 36

Children

Question 37

Who usually gets histiocytomas?

Answer 37

Elderly

Question 38

Where does the underlying fundamental defect lie in soft tissue sarcomas?

Answer 38

Genetic origin

Question 39

Most common site of metastasis for sarcomas of the extremities?

Answer 39

Lungs

Question 40

Most common site of metastasis for sarcomas of the abdomen?

Answer 40

Liver

Question 41

What size sarcomas have a good prognosis?

Answer 41

Less then 5 cm | -Over 5 cm worse prognosis

Question 42

What imaging is most useful in diagnosing a sarcoma?

Answer 42

MRI | -CT and X-ray to assess chest and lungs

Question 43

Treatment of sarcomas?

Answer 43

Surgery: 1-2 cm margins - Limbs: surgery plus radiation - Chemotherapy - Radiation