Step 2 Cancers

Front 1

What kind of lesion happens in chornically wounded/scarred skin:

Back 1

Squamous Cell Cancer
aggresssive

Front 2

Marjolin ulcer

Back 2

Squamous Cell Carcinoma arising in burn wounds
also over osteomyelitis, radiotherapy skars, and venous ulcers

Front 3

[PSA] in prostate cancer

Back 3

>4

Front 4

Bowen's dz

Back 4

sqamous cell Carcinoma in situ of skin; thin erthematous plaque with well defined irrgular borders, overlyign scale/crust

Front 5

Reed Sturnburg

Back 5

Owls Eyes = Hodgkins

Front 6

Owls Eyes

Back 6

Reed Sturnburg = Owls Eyes = Hodgkins

Front 7

Pt has pernicious anemia
FU?

Back 7

3x increased risk of intestinal type gastric cancer & carcinoid
--> routine testing for FOBT

Front 8

Esogphageal Cancer:
Tx

Back 8

Surgery is Tx of Choice
Chem/Rad may be added to make easier to perform or be palliative if has extended, but will not sucre

Front 9

COPD with finger clubbing

Back 9

finger clubbing is not a normal part of COPD and suggests lung malignancy
[clubbing can be normal with hypoxia and hypertension of other causes but not COPD)

Front 10

Turcot's Sro, Cowden Sro, PJ Sro, Gardners Sro, Lynch Syndrome

Back 10

Turcot's sro: Beain tumors + FAP or HNPCC
Cowden Sro: GI tract Hamartomas + Breast Ca, Thyroid Ca & Nodular gingival hyperplasia
PJ: intestinal hamartomatous polyps + mucocutaneous malanocytic macules
Gardners: colonic polyps + extraintestinal teratomas & lesions
HNPCC (Lynch): colon + extracolonic
most common extracolonic: endometrial (40% of females)

[these each have their own cards as well]

Front 11

Brain tumors + FAP or HNPCC

Back 11

Turcot's sro

Front 12

GI tract Hamartomas + Breast Ca, Thyroid Ca & Nodular gingival hyperplasia

Back 12

Cowden Sro

Front 13

intestinal hamartomatous polyps + mucocutaneous malanocytic macules

Back 13

PJ

Front 14

colonic polyps + extraintestinal teratomas & lesions

Back 14

Gardners

Front 15

colon + endometrial tumors

Back 15

HNPCC (Lynch): colon + extracolonic
most common extracolonic: endometrial (40% of females)

Front 16

Squamous Cell Carcinoma in Neck LN
Course of Action

Back 16

--> Panendoscopy to look for 1* to determine course
(Esophagus, Bronchi)

Front 17

Gall bladder carcinoma:
Risk Factors, Tx

Back 17

Risk Factors: gallstones, proceain GB, salmonella carrage, anatomic variation,s carcinogen expsorue
cholecystectomy is sufficient if confined to mucosa

Front 18

Tx: solitary brain mass

Back 18

= surgical resexn followed by rad = treatment for ANY SOLITARY BRAIN METS ONCE 1* DZ is STABALIZED

Front 19

CLL staging/Px

Back 19

0: Lymphocytosis only: good
1: + Adenopathy/Fair
2: Splenomegaly: Fair
3: anemia: intermediate
4: Thrombocytopenia: Poor

Front 20

asbestos expose more likely to produce

Back 20

broncogenic carinoma than mesothelioma

Front 21

smudge cells

Back 21

think CLL, analyze with flow cytometry
smudge cells are "leukocytes which ave undergone partial breakdown during preparation because of greater fragility"

Front 22

myasthenic crises:

Back 22

life trheatening weakness of respiratory/laryngeal muscles likely caused by acute infection
all mysathenic crises pts need ET intubation

Front 23

alfa feto protein =

Back 23

LIVER HEPATOCELLULAR CA, not mets

Front 24

Hypercalcemia of Tumors

Back 24

Cytokines & local osteolysis: Breast & Lung
PTHrP: nonmetastatic solid stumors
Ectopic PTH: ovarian, lung & neuroendocrine
Calcitriol: Hodgkins

Front 25

MGUS vs MM

Back 25

MGUS: no anemia, normocalcemia, no lytic lesions or renal insufficiency; <3g/dL monoclonal protein <10% plasma cells in marrow
MM: all the opposite + elevated beta2 microglobulin

MGUS is relatively common
if <3g/dL, normocalcemia, no renal insufficiency then suspect MGUS
if MGUS suspected: skeletal bone survay of long bones & skull to exclude lytic lesions

Front 26

LN size:

Back 26

<1cm almost always benign, >2cm suggests malignant
Bx if greater than 2 cm

Front 27

nontender lymphadenopathy, peripheral smear is normal

Back 27

Suspected Hodgkins must Bx LN's, peripehral smear is normal.

Front 28

CLL vs Lymphoblastic Leukemia

Back 28

LL has a number of blast cells in blood

Front 29

signs of basal cell carcinoma:

Back 29

1. open sore that bleeds oozes or crusts >3weeks
2. reddish patch or irritated area
3. shiny bump, pearly
4. pink growth elevated rolled border, and crusted indentation in center
5. scar like area which is white, yellow or waxy with poorly defined borders

Front 30

most common location of basal cell carcinona

Back 30

: lower eyelid margin

tx: "Mohs technique" of surgical excision with microsopically controlled margins.
locally invasive to orbit --> enucleation

basal cell carcinoma only needs 1-2mm margins so in cricital face areas use technique = Mohs surgery, microscopically controlled shaving

Front 31

most common malignant tumor of eyelid:

Back 31

basalcell carcinoma

tx: "Mohs technique" of surgical excision with microsopically controlled margins.
locally invasive to orbit --> enucleation

basal cell carcinoma only needs 1-2mm margins so in cricital face areas use technique = Mohs surgery, microscopically controlled shaving

Front 32

melanoma course of action, prognosis

Back 32

excisional biopsy with narrow margins:
logic is you want to remove it completely;
pigmented basal cell caricnomas and seborrheic keratoses and atypical nevi look like melanoma
so excision allows you to determine depth
wider margins not recommended because you don't want to take huge margins around potentially benign lesions and any interruption in cutaneous blood flow will mess with your ability to ID sentinel LN's.
Removing any less than all the lesion may miss the malignant focus.

If lesion is melanoma with a depth of <1mm, then lesion can be excised with 1cm margin --> 99% 5 year survival.
>1mm depth requires sentinel LN study.

Front 33

back pain, anemia, renal dysfunction + elevated ESR

Back 33

= MM
MM causes constipation via hypercalcemia from bone breakdown

Front 34

sunscreen spf vs melanoma

Back 34

SPF 15-30 has NO PROTECTION AGAINST MALIGNANT MELANOMA
best protection clothing
(yes protection against squamous cell carcinoma)

Front 35

Wilms Tumor

Back 35

10% bilateral
few have lung mets
Tx: nephrectomy Px: good if early
Assoc> Denys-Drash & Beckwith-Wiedemann sros

Front 36

CML c Blast Crisis vs Leukemoid (Inflammatory) Reaction:

Back 36

indistinguihsable on perhiperahl film
Leukocypte Alk Phos is high in Leukemoid Rxns

Front 37

hypercalcemia in Lung cancer:

Back 37

most likely squamous cell cancer PTHrP
"SCa++mous Cell Cancer"

Front 38

Middle Aged pt treated as young adult for Hodgkins now has mass in lung

Back 38

Treatment of Hodgkins is Curative, but may induce other CA's, esp lung CA 20 years later

Front 39

Prognosis for breast cancer

Back 39

most importantly determined after staging

Her2 neu by FISH or ImmunoHistoChemistry: changes chemotherapy

Front 40

chronic recurrent stye

Back 40

requires histopathological examination (Not D&C)
could be sebaceous carcinoma, or basal cell carcinoma

Front 41

philadelphia

Back 41

CML

Front 42

decreased leukocyte alkaline phosphatease

Back 42

CML: excpet .
--the only other diseases with this is paroxysmal nocturnal hemoglobinuria and ypophosphatemia
elevated LAP is characteristic of leukemoid reaction;

Front 43

solid testicular cancer

Back 43

Any solid testicular cancer --> radical orchiectomy; do not sample, do not FNA, do not biopsy --> high risk of spillage; remove the testis;

Front 44

PTHrP is assocaited with

Back 44

Squamous Cell Lung Cancers

Front 45

Metabolic abnormalities of Tumor Lysis Syndrome

Back 45

Hypocalcemia, Hyperphosphatemia, Hyperkalemia, Hyperuricemia
The phosphate was intracellular but then binds the calcium

Front 46

Solitary Pulmonary Nodule

Back 46

Rule out Malignancy by comparing to previous imgaging
Cannot rule out:
Low probabiliyt: serial CT fu's
high prob: PET scan &/ bx --> surgical removal
high prob: >50yo, smoker, weight loss, previous malignancy, large, low desnity, spiculated borders, absence of Ca2+

Front 47

unique features of waldenstroms:

Back 47

Hyperviscosity, IgM spike, visual problems, demyelinating neuroapthy

Front 48

Pt with Brain mass shows on CT: butterfly mass with central necrosis & serpiginous contrast enhancement

Back 48

Classic for glioblastoma multiforme
NB: brain mets show acute changes, are spherical in shape & multiple

Front 49

Tx: Gastric MALTOMA

Back 49

Step 1: Omeprazole, Clarith, Amox --> Eliminate H pylori
Step 2: Still a problem: CHOP (Cyclophosphamide, adriamycin, vinchristine & predinisone) +- Bleomycin

Front 50

hormones of germ cell tumors

Back 50

Dysgerminomas don't secrete hormones
Granulosa cell tumors secrete estrogn

Front 51

MCC: mass in liver

Back 51

mets are 25x more common than hepatocellular CA

Front 52

enlarged non-tender GB

Back 52

pancreatic CA

Front 53

Solitary non-tender node in head/neck

Back 53

--> think squamous cell CA

Front 54

breast skin bx: large cells surrounded by halo-like areas invading epidermis

Back 54

: cancer cells beome retracted from adjacent cells;
most pts with paget's dz have undelrying adenocarcinoma
changes of paget's dz thought to be from migration of enoplastic celsl migrating through ducts to nipple surface

Front 55

paraproteinemia

Back 55

: excessive production of immunoglobulin ie multiple myeloma
Bence Jones --> renal damage
Also: Hypercalcemia, hyperuricemia, amyloid depoisition, pyelonephritis --> renal damage

Front 56

Relative importance of factors in the prognosis of breast CA:

Back 56

1. TMN staging << most important factor
2. ER+, PR+ are good
3. Her2/neu overexpression is bad
4. Histologic Grade

Front 57

Polycythemia vera:

Back 57

JAK2 mutation >95%
low EPO
Heat (Shower) Pruritis is both from Mast cells & RBC prostaglandins
Hypertension, plethoric face, spelnomegaly
Complications: Thromboses (too many platelets), Hemorrhage (Dysfunctional Platelets)
Tx: phlebotomy to keep HCT <45%

Front 58

Seminoma vs Non-seminomatos Germ cell tumors

Back 58

Seminoma: high bHCG, normal AFP
Non-seminomatous germ cell tumor: yolk sac, choriocarcinoma, embryonal carcinoma
mixture: elevated AFP & elevated bHCG

Front 59

scar develops into non-healing painless ulcers

Back 59

--> Squamous Cell Carcinoma
dx: punch bx.

Front 60

Managing bone pain in prostate CA pts:

Back 60

1. orchiectomy to remove androgens
2. radiation
Flutamide is DHT antagonist, when combined with LHRH agonist prolongs survival (but no longer provides benefits once androgens are removed)
Estramustine = estrogen + nitrogen mustard = 40% response rate in castrated men, not well tolerated if hematopoietic or cardiovascular comorbidities.

Front 61

Risk factors for Pancreatic CA:

Back 61

FHx, Chronic Pancreatitis, smoking, DM, obesity, high fat diet.

Front 62

first test in a pt with suspected lung ca

Back 62

cxr

Front 63

Suspected drop mets --> cauda equina
course of action

Back 63

immediate dexamethasone & MRI
dexamethasone prevents the swelling & damage to neurons

Front 64

Four tumors which NEVER met to the brain

Back 64

1. Non-melanomatous skin cancer
2. Orophyrngeal CA
3. Esophageal
4. Prostate

Front 65

Metastatic mass inside brain is bleeding

Back 65

--> think malignant melanoma.

Front 66

celiac dz at risk for cancer

Back 66

GI lymphomas reduce risk by gluten free diet

Front 67

Acute monocytic leukemia (M5)

Back 67

alpha napthyl esterase positive
(mostly "Blast forms" but then many promonocytes & monocytes)

Front 68

Acute promyeocytic leukemia:

Back 68

many hyperganular promyelocytes with many auer rods/cell
-->DIC

Front 69

m6 Acute erythroleukemai:

Back 69

erythroblasts c irregualr outline & high nuclear cytoplasmic ratio