Exam 6 :(134) Skin, Eye, Pediatrics, Major Digestive Glands

T/F:UV radiation is not an etiologic factor for melanoma since they arise mostly from pre-existing nevi. (write all etiological factors for melanoma)

False: it still is

There are approximately how many skin cancers diagnosed each year in the U.S.:

1M

Which skin ca cell type is the most common?

Basal Cell Carcinoma

(Basal = Basic)

Which skin ca cell type is characterized by a raised, hard, red-gray, pearly lesion? (describe how both skin cancers look)

Basal

What type of skin cancer has the best prognosis?

Basal

(most common & best prognosis)

5 year survival for:

• BCC

• SCC

• Melanoma

• BCC: 95% (100% for small lesions)

• SCC: 85%

• Melanoma: 80-70%

Extra: 5 year survivals for all cancers

BS the RW MN, are ENG LiverPool Rascals

T/F: Skin ca's almost always spread via the para-aortic and inguinal nodes.

False, they spread via

1. Direct extension (BCC and SCC spread sideways)

2. Mets (Melanoma most often, SCC rare, BCC more rare)

T/F: RTT is just as effective at treating skin cancer as surgery.

True

But surgery is more common cuz RTT has side effects

A common dose for squamous cell skin ca is:

55-65cGy

Chemosurgery uses a specific technique developed by:

Mohs

____ (ratio/ most) of all pancreatic cancer is present in this region:

2/3; head

Pathologies (cell types) for pancreatic cancer

Infiltrating Ductal Adenocarcinoma

The most common symptom of pancreatic cancer:

Fast weight loss

Besides hepatitis B, which of the following viruses is associated with liver cancer etiology?

Hep C

Extra: Besides HBV/ HCV what can cause liver cancer?

1. Aflatoxin B

2. Cirrhosis - leading cause in USA

Five year survival for pancreatic and liver cancer is around:

~5%

From test: 2-5%

The surgical procedure described as a "partial pancreatectomy with en bloc excision of the distal stomach, common bile duct, and duodenum

Whipple Procedure

Cancer is the ____ leading cause of death in children

2nd

FYI: first is trauma

Wilms tumor is a cancer of the:

Kidney

Another name for Wilms tumor is:

1. nephroblastoma

2. embryonal kidney tumor

The average age of onset of Wilms tumor is

3

twenty 3 and kidney

Extra avg. age for all tumors

What is the combination chemo most commonly used for treating Wilms tumor?

VACA

FYI:

V: Vincristine

A: Adriamycin (doxorubicin)

C: Cytoxan (cyclophosphamide)

A: Actinomycin-D

Which of the following would be representative of a typical RTT dose (in cGy) for treating Wilm’s Tumor?

1080-2000cGy

Starting on day 9

Day 0 = Surgery

The most common soft-tissue sarcoma seen in pediatric cases is:

Rhabdomyosarcoma (this is soft tissue- ollie)

most common in children & worst prognosis

Extra: Most common body site for osteosarcoma

Bones around knee

Which of the following is best representative of a site for osteosarcoma incidence?

A Proximal humerus

B Lumbar vertebrae

C Distal femur

D Proximal tibia

E Distal femur and Proximal tibia about equally

E

A tumor comprised of epithelial tissues might be termed a:

Teratoma

How do you treat Wilms Tumor for stages

I

II

III

IV

I. Nephrectomy

II. Nephrectomy + VACA

III Nephrectomy + VACA

IV Nephrectomy + VACA +RTT

Skin cancer afflicts an estimated ____________ people every year in the U.S.

1M

Even though this is expected to change in the coming decades, right now skin cancer is more prevalent among:

1. Males

2. Females

3. Both equally

Males

FYI: cuz they have jobs out in the sun

Which of the following is not an etiologic factor for the common skin cancers as discussed in class:

• Just list them instead

1. UV radiation

2. Medical radiation- more likely in squamous cell

3. Some chemicals- specially arsenic

4. HPV virus- specially in squamous cells cancers

5. Scars or Chronic Inflammatory Conditions- in squamous cell cancers

6. Genetic disorders including albinism

What etiologic factor most commonly causes skin cancer?

UV radiation

Sporadic aniridia is a risk factor associated with what pediatric cancer?

Wilms Tumor

Which of the following areas is least susceptible to skin cancer?

• Write the ones that are instead

Sun exposed areas, specially in the H&N:

1. T-Zone

2. Cheeks

3. Back of ears

4. Shoulders

The term meaning “severe itching”:

pruritis

Most pancreatic ca's occur in the _________ segment.

head

Peak incidence for skin cancer occurs in what decade of life?

7th (60s)

Measuring the width of a skin cancer across the skin surface is an example of staging which of the following?

1. T

2. N

3. M

1. T

Which of the following treatment modalities is most commonly used for treating skin cancer?

Surgery

Which of the following treatment modalities is the most effective modality for treating skin cancer?

A. Surgery

B. RTT

C. Chemo

D. More than one of the above

D. Surgery and RTT

Which of the following doses (in Gy) would be most appropriate for treating squamous cell skin ca?

55-65 cGy

Which of the following doses (in Gy) would be most appropriate for treating basal cell skin ca?

45-55

A chemosurgery technique for skin cancer whereby the skin is shaved off a layer at a time with a topical chemotherapy agent being applied onto each layer is named after:

Mohs

At what spinal level is the pancreas locate?

L1-L2

pancreast in shape of an L-1

RTT treatments for Wilms tumor should start on day:

9

The 5-year survival rate for basal cell skin cancer is about:

95%

A procedure in which the whole lesion is removed during biopsy is called:

excisional biopsy

The membranous coat lining the abdominal cavity is called:

peritoneum

A dose range that best represents the dose range for RTT for Wilms tumor patients:

1080-2000cGy

The technique using those various angles for treating the entire skin surface was developed at what university?

Stanford

FYI: TX mycosis fungoides w/ TSI using Stanford Technique- 6 angles

This is a rare neoplastic disease that is associated with Those of Mediterranean or North African descent and a type of this disease is also associated with AIDS patients:

Kaposi’s Sarcoma

RTT for Wilm’s tumors is currently indicated for what stage?

IV

Psychiatric disturbances are occasionally observed in patients with what type of ca?

Pancreas

(cuz it messes with your hormones)

The first part of the small intestine connected to the pylorus of the stomach is called:

duodenum

T / F UV radiation is an etiologic factor for melanoma.

True

Where is the island of Langerhans located?

Pancreas

Up to ____% of the liver can be removed and yet it will still function normally

90

T / F Melanomas are generally considered radioresistant.

True

FYI: That is why we dont really cure

The overall survival for malignant melanoma is about:

70-80

What is the name of the chemotherapy agent most often used for ca of the pancreas?

5-FU

HINT: cuz its in the abdomen

The pancreas is not included in which of the following abdominal regions:

• just list the ones that it is in instead

1. Left hypochondriac region

2. Epigastric region

T / F Most liver tumors are benign

True

EXTRA: liver tumor pathologies

Ca of the major digestive glands tends to be a disease of the (infants /young/ elderly)

elderly

Age is the MOST important factor in the prognosis of this childhood disease:

Neuroblastoma

FYI: the adrenal glands one, it is the one that has 2 survival %

This is the most radiosensitive bone/soft tissue tumor:

Ewings Sarcoma

(that is why we can treat with RTT)

This cancer is often associated with fetal alcohol syndrome and most commonly presents in the head and neck region:

Rhabdomyosarcoma

This cancers symptomology often includes the "cats eye reflex":

Retinoblastoma

This cancer has the highest rate of spontaneous regression (about 1%) of any true malignancy:

Retinoblastoma

This cancer is also known as nephroblastoma:

Wilm's tumor

This cancer originates from neural crest cells that normally develop into the adrenal medulla:

neuroblastoma

Wilms tumors most commonly mets to what organ?

Lung

FYI: That is why we take a chest x—ray when diagnosing Wilms

When caring for preschool aged children, it is important to:

A Keep communications simple and honest

B Make sure that they do not cry

C Be authoritative and firm

D Acknowledge that modesty and privacy are important

A Keep communications simple and honest

When caring for adolescent, it is important to:

A Acknowledge that modesty and privacy are important

B Make sure that they do not cry

C Speak to them in simple 2 or 3 word sentences

D Be authoritative and firm

A Acknowledge that modesty and privacy are important

What is the main concern (side effect) when irradiating around the eye?

cataracts

(lens)

What is the most common site for neuroblastomas?

adrenal glands

FYI: anywhere along the sympathetic nerve chain, but usually on the adrenal glands

This tumor of the eye has the highest rate (about 90%) of spontaneous regression:

Hemangioma

FYI: It’s benign

This is the most common intraocular malignancy:

Melanoma

This term means the surgical removal of the eye:

enucleation

What is the most common symptom for a Wilms Tumor?

A palpable, sometimes painful abdominal mass

What is the most common endocrine tumor (cell type) of the pancreas?

Insulinoma

This tumor of the eye commonly spreads along the optic nerve making RTT a possible treatment choice after the eye has been removed and their is tumor present along the cut end of the optic nerve:

Retinoblastoma

This is the most common orbital tumor :

Hemangioma

FYI: its benign

A non-osseous tumor that usually arises from soft tissue (periosteum) near the bone is called:

Ewings sarcoma

This is the most common primary tumor of the bone:

osteosarcoma

This disease is sometimes not even classified as a true malignancy since 30-40% of all patients survive with no treatment at all:

Histiocytosis X

(aka Langerhans Cell Histiocytosis)

What is the most common benign tumor of the liver?

Hemangioma

Cancer is the number ____ cause of death in children.

2

first is trauma

The most common of all pediatric cancers is:

Leukemia

FYI: second most common is brain

Most pediatric tumors have some sort of hereditary etiology and originate in(___1) tissue vs. (___2) tissue, as is the case for adults.

1. Nerve/Connective

2. Epithelial

A "success story" for the multi-modal treatment approach is:

Wilms Tumor

What is the most common presenting symptom for pancreatic ca?

fast weight loss

What is the name of the artery or vein that transports blood from the intestines to the liver?

Portal vein

What is the name of the artery or vein that transports blood from the heart directly to the liver?

Hepatic Artery

An abdominal mass with associated hypertension would be most indicative of this cancer:

Neuroblastoma

FYI: Neuroblastoma

• Diagnosis for Neuroblastoma includes

  • Urinalysis from diapers

  • hypotension

The gallbladder is normally found by its attachment to the ventral surface of the:

Right Lobe of Liver

The head of the pancreas will normally be located within the:

Sweep of the duodenum

Chemoembolization is:

A Systemic administration of chemotherapy with one bolus injection

B Systemic administration of chemotherapy using the enteral route

C Local administration of chemotherapy using proximal venous access

D Local administration of chemotherapy using the transdermal route

C