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Clin Med II - Exam 1 > Adult Oncology > Flashcards

Adult Oncology Flashcards

1
Q

when you see male, smoker, painless red urine, think

A

bladder cancer

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2
Q

what is the major risk factor for bladder ca

A

smoking

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3
Q

what gold standard test can be used for dx and bx in bladder cancer

A

cystoscopy

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4
Q

what 3 types of UA can be used for dx of bladder ca

A

dipstick

microscopic

gross analysis

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5
Q

what are the two types of bladder cancer

A
  1. muscle invasive
  2. non-muscle invasive
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6
Q

what is the tx of choice for non muscle invasive bladder ca

A

TURBT (trans urethral resection of bladder)

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7
Q

what is the tx of choice for muscle invasive bladder ca

A

cystectomy

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8
Q

what are some secondary tx for bladder ca

A

intravesical chemo, systemic chemo, XRT

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9
Q

most bladder cancers are __ carcinomas

A

transitional cell

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10
Q

what is the most common ca in men aged 15-35

A

testicular ca

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11
Q

what is the most common symptom of testicular ca

A

painless mass or swelling in testis

(+/- heavy feeling in lower abd)

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12
Q

when you see cryptochordism, think

A

testicular ca

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13
Q

what is the diagnostic test of choice for testicular ca

A

scrotal US

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14
Q

besides scrotal US, what is another helpful diagnostic tool for testicular ca

A

tumor markers (AFP, beta hCG, LDH)

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15
Q

what is the tx for stage 1 testicular ca

A

inguinal orchiectomy + surveillance

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16
Q

what is the tx for higher stages of testicular ca

A

RPLND (retroperitoneal lymph node dissection), XRT, +/- platinum based chemo

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17
Q

when you see abdominal fullness, bloating, nausea, early satiety, and age 60’s, think

A

ovarian ca

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18
Q

what are some initial evaluation tools for ovarian ca

A
  1. pelvic exam
  2. CA-125 (tumor marker), CXR, CT, +/- genetic counseling
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19
Q

when you see BRCA, lynch II syndrome, infertility, PCOS, and endometriosis, think

A

ovarian ca

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20
Q

what is the diagnostic test of choice for ovarian ca

A

unilateral salpingo-oophrectomy

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21
Q

if ovarian ca is determined to the primary cancer, what are the next steps in tx

A

hysterectomy, contralateral salpingo-oophrectomy, omentectomy, pelvic node sampling + platinum based chemo

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22
Q

what are the 3 main symptoms of multiple myeloma

A

bone pain

anemia (Rouleaux)

hypercalcemia

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23
Q

besides hypercalcemia, what other lab might be elevated in multiple myeloma

A

creatinine

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24
Q

when you see, proliferation of plasma cells producing monoclonal abs that cause end organ damage, think

A

multiple myeloma

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25
Q

what does CRAB stand for

A

end organ damage sites of multiple myeloma

hyperCalcemia

renal dz

anemia

bone dz

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26
Q

what are the diagnostic tests of choice for multiple myeloma

A

monoclonal spike on SPEP

Bence Jones proteins on UPEP

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27
Q

you need both __

and __ to diagnose multiple myeloma

A

SPEP (serum protein electrophoresis)

UPEP (urine protein electrophoresis)

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28
Q

how do you confirm dx of multiple myeloma

A

bx of plasmacytoma

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29
Q

when you see “punched out, lytic” lesions on Xray, think

A

multiple myeloma

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30
Q

__ are more effective than

__ in multiple myeloma

A

MRI, CT, PET

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31
Q

__ are NOT helpful in the assessment of multiple myeloma

A

bone scans

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32
Q

what is the order of tx in multiple myeloma

A
  1. induction therapy (lower dose chemo)
  2. high dose chemo + stem cell transplant
  3. +/- bisphosphanates to reduce fx
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33
Q

is prostate ca common

A

yes! → 2nd most common ca in men

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34
Q

when you see AA, high fat diet, and increased age, think

A

prostate ca

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35
Q

early prostate ca is

A

asymptomatic

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36
Q

what are some common symptoms of later stages of prostate ca

A

increased PSA, hematuria, hematospermia, obstructive urinary sx, bone pain

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37
Q

prostate cancer is usually what type of carcinoma

A

adenocarcinoma

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38
Q

what is the most common site of metastasis for prostate ca

A

bone

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39
Q

what is the diagnostic test of choice for prostate ca

A

prostate bx

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40
Q

what is used for grading of prostate ca

A

gleason score

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41
Q

what is the tx for low grade prostate ca

A

watchful waiting (esp if short life expectancy)

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42
Q

what is the tx for higher stages of prostate ca

A

radical prostatectomy, brachytherapy, XRT

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43
Q

what is the tx of choice for metastatic prostate ca

A

radical prostatectomy, brachytherapy, XRT

PLUS castration (physical and chemical)

PLUS bisphosphanates

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44
Q

when you see gnawing epigastric pain, nausea, wt loss, anorexia, and Courvoisier sign, think

A

pancreatic ca

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45
Q

what does Courvoisier sign make you think of

A

pancreatic ca

(large, palpable gallbladder)

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46
Q

name 3 signs of mets in pancreatic ca

A

abdominal mass

ascites

Virchow’s node

Sister Mary Joseph node

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47
Q

what are 2 diagnostic tests of choice for pancreatic ca

A

labs and imaging

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48
Q

what 2 labs are used in the diagnosis of pancreatic ca

A

LFTs

lipase

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49
Q

what are 2 types of imaging used in the dx of pancreatic ca

A

abd US

CT

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50
Q

what does the double duct sign make you think of

A

pancreatic ca

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51
Q

what is the double duct sign

A

dilated common bile duct and pancreatic duct

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52
Q

what is the only potential cure for pancreatic ca

A

Whipple procedure

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53
Q

what is the order of tx for pt’s w.o metastatic pancreatic ca

A
  1. whipple procedure
  2. chemo +/- XRT for pt w.o resectable tumor
  3. palliative care
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54
Q

colorectal ca can be __

or __

A

symptomatic

asymptomatic

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55
Q

what are 3 main symptoms of colorectal ca

A

blood in stool

change in bowel habits

unexplained IDA

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56
Q

when you see tenesmus, urgency, and recurrent hematochezia, think

A

rectal ca

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57
Q

when you see >50 yo, Lynch syndrome, high fat diet, and IBD, think

A

colorectal ca

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58
Q

what is the diagnostic test of choice for colorectal ca

A

colonoscopy

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59
Q

what test do you use for colorectal ca screening

A

FOBT (fecal occult blood test)

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60
Q

what is used to stage colorectal ca

A

C/A/P CT scan

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61
Q

what is the tx of choice for colorectal ca

A

surgical resection plus chemo

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62
Q

what is the treatment of choice for rectal tumors

A

surgical resection and chemo plus XRT

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63
Q

what should not be used for screening or diagnosis of colorectal cancer

A

CEA levels

can be used for monitoring

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64
Q

80% of pt’s w. hepatocellular carcinoma have

A

cirrhosis

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65
Q

hepatocellular cancer is usually __

except for symptoms of __

disease

A

asymptomatic

liver

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66
Q

symptoms of hepatocellular cancer may include (3)

A

abdominal pain

new decompensation of cirrhosis

paraneoplastic syndromes

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67
Q

what test is used for the dx and screening of hepatocellular ca

A

US

(followed by CT or MRI)

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68
Q

what other test besides US/CT/MRI is useful in evaluation of hepatocellular ca

A

AFP (alpha fetoprotein)

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69
Q

when used in hepatocellular ca, bx can increase risk for

A

tumor seeding

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70
Q

what is the tx of choice for hepatocellular ca if liver fxn is preserved

A

surgical resection

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71
Q

what is the tx of choice for hepatocellular ca with advanced cirrhosis

A

liver transplant

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72
Q

what is the tx of choice for hepatocellular ca in pt’s who are not surgical candidates

A

ablation, etoh injxn, cryotherapy, chemo, XRT

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73
Q

what is the most common type of melanoma

A

superficial spreading

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74
Q

what is the most common type of melanoma in darker skinned pt’s

A

acral lentiginous

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75
Q

what are the 4 types of melanoma

A
  1. superficial spreading
  2. nodular melanoma
  3. lentigo maligna
  4. acral lentiginous
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76
Q

what test is used to dx melanoma

A

bx

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77
Q

what is the most important prognostic factor for melanoma

A

Breslow depth (tumor thickness)

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78
Q

what are the 2 steps of melanoma tx

A
  1. excision w. margins
  2. sentinel lymph node excision (SLNE) for staging
79
Q

what third step do you add for tx of metastatic melanoma

A

inferferon alpha, immune therapy, chemo

80
Q

what are the most common sites of squamous cell carcinoma (SCC)

A

head and neck

also top of pinna, dorsum of hands, lip

81
Q

what is a common precursor of SCC

A

actinic keratosis

82
Q

what are 3 characteristics of SCC

A
  1. scaly patch, plaque, or nodule. or ulceration
  2. irregular borders
  3. can bleed or crust
83
Q

what is the diagnostic test of choice for SCC

A

bx

shave, punch, or excisional

84
Q

what are 4 tx options for SCC

A
  1. Mohs micrographic surgery
  2. 5-FU
  3. imiquimod
  4. electrodessication
85
Q

what is the most common site of basal cell carcinoma (BCC)

A

nose

also head and neck

86
Q

what is the most common form of BCC

A

nodular

87
Q

name 3 characteristics of BCC

A
  1. pearly
  2. papule
  3. telangiectasia
88
Q

what is a rodent ulcer

A

BCC w. central ulceration

89
Q

what do you call a circumscribed, scaling lesion with raised pearly-white border

A

superficial BCC

90
Q

what is a flat or slightly raised yellowish/white lesion that scar like w. a waxy surface

A

morpheaform BCC

91
Q

what is the dx test for BCC

A

bx

shave or punch

92
Q

what tx has the highest cure rates for BCC

A

Mohs micrographic surgery

93
Q

what do you think of when you see, abnormal uterine bleeding, postmenopausal women, and abnormal vaginal d.c

A

endometrial carcinoma

94
Q

what cancer is caused by unopposed estrogen therapy

A

endometrial ca

95
Q

smoking and OCP decreases risk for

A

endometrial ca

96
Q

what are 2 dx tests for endometrial ca

A

bx

endometrial D&C (dilation and cutterage)

97
Q

in post menopausal women __ can be used first to assess endometrial thickness

A

transvaginal US

98
Q

what is the tx of choice for endometrial ca

A

hysterectomy w. bilateral salpingo-oophrectomy

+/- postop chemo and XRT

99
Q

what tx preserves fertility in endometrial ca

A

progestin therapy

100
Q

cervical ca is mostly __ and

found on __

A

asymptomatic

screening

101
Q

what are symptoms of advanced cervical ca

A

abnormal vaginal d.c or bleeding

102
Q

what is a major risk factor for cervical ca

A

HPV 16 and 18

103
Q

what are the diagnostic steps for cervical ca

A
  1. pap smear
  2. if abnormal → repeat or colonoscopy + bx
104
Q

name 3 possible tx options for cervical ca

A

LEEP (loop electrosurgical excision procedure)

ablation

hysterectomy

105
Q

what is the main characteristic of vulvar ca

A

pruritis

106
Q

what is the dx test of choice for vulvar ca

A

vulvar bx

107
Q

what are 3 tx options for vulvar ca

A
  1. wide local excision
  2. topical 5-FU
  3. laser therapy (early lesions)
108
Q

what is the leading cause of cancer deaths

A

lung ca

109
Q

what are the 2 cardinal symptoms of lung ca

A

new cough

hemoptysis

110
Q

what are the 2 types of lung ca

A
  1. SCLC (small cell lung carcinoma)
  2. NSCLC (non small cell lung carcinoma)
111
Q

SCLC is also called __ carcinoma

A

oat cell

112
Q

what is the more aggressive type of lung ca

A

SCLC (oat)

113
Q

NSCLC is what type of carcinoma

A

adenocarcinoma

114
Q

lung ca may be found incidentally on __

or __

A

CT or CXR

115
Q

lung ca needs __ confirmation for dx

A

histologic

116
Q

histologic confirmation of lung ca may include (5)

A
  1. sputum
  2. cytology
  3. bronchoscopy
  4. pleural fluid
  5. bx
117
Q

what is the tx for NSCLC

A

surgical resection

+/- chemo/XRT

118
Q

what is the tx of choice for SCLC

A

chemo

usually XRT

119
Q

if renal cell carcinoma is symptomatic, what is the triad

A

hematuria

flank pain

palpable mass

120
Q

what is the dx test of choice for renal cell carcinoma

A

abdominal CT

+/- US

121
Q

what is the main tx for renal cell carcinoma

A

partial or radical nephrectomy

122
Q

what is the tx for advanced renal cell carcinoma

A

immunotherapy (not super effective)

123
Q

what is the cardinal sign of breast ca

A

single, nontender, firm immobile mss in upper quadrant

124
Q

rare symptoms of breast ca include

A

nipple d.c and new retraction

pain

axillary LAD

peau d’orange

Paget dz

125
Q

what are the 2 most common types of breast ca

A
  1. ductal
  2. lobular
126
Q

what is the dx test of choice for breast ca

A

mammography → stereotacic or excisional core needle bx

127
Q

what is the next step in breast ca evaluation after bx

A

estrogen and progesterone receptor analysis + histology of specimen

128
Q

what drugs are used for breast cancers that are positive for hormone receptors

A

Armidex

Tamoxifen

Raloxifene

129
Q

what drug is used for breast ca that is HER-2 positive

A

Herceptin

130
Q

name 4 treatments for breast ca

A
  1. lumpectomy w. SLNB (sentinel lymph node bx)
  2. mastectomy
  3. XRT
  4. adjuvant chemo
131
Q

name the 4 types of thyroid cancer from least aggressive/fatal to most aggressive/fatal

A

papillary

follicular

medullary

anaplastic

132
Q

most thyroid cancers are __

A

asymptomatic

133
Q

if thyroid ca is symptomatic, what are the 2 main symptoms

A
  1. painless neck swelling
  2. palpable, single, firm nodule
134
Q

when you see US guided FNA (fine needle aspiration), think

A

diagnostic test for thyroid ca

135
Q

what is the tx for thyroid ca

A

surgical resection

+/- radioactive iodine (RAI) for residual tumor

136
Q

thyroid ca pt’s need __ for life

A

thyroid hormone replacement

137
Q

which type of thyroid ca has no effective cure

A

anaplastic

138
Q

what are the 2 types of non-hodgkin lymphoma

A
  1. indolent (lazy)
  2. aggressive
139
Q

when you see painless, persistent LAD, HSM, and cytopenia, think

A

indolent non-hodgkin lymphoma

140
Q

what are 2 unique symptoms of aggressive non-hodgkin lymphoma

A
  1. rapidly growing mass
  2. increased LDH and uric acid
141
Q

what tests are used for dx and staging of non-hodgkin lymphoma

A
  1. dx: bx of involved nodes
  2. staging: bone marrow bx (before tx)
142
Q

what is the treatment for indolent non-hodgkin lymphoma

A

XRT alone

143
Q

what is the tx for intermediate to high grade lymphoma (3)

A
  1. chemo
  2. immunotherapy (Rituximab)
  3. stem cell transplant
144
Q

prognosis is worse for __ related NHL

A

HIV

145
Q

when you see, LAD after drinking etoh, think

A

Hodgkin Lymphoma

146
Q

how do you describe the LAD in hodgkin lymphoma

A

painless

localized

rubbery

peripheral

cervical

147
Q

what do you see on a CXR for hodgkin lymphoma

A

mediastinal mass

148
Q

when you see Reed Sternberg cells on bx, think

A

hodgkin lymphoma dx

149
Q

what tests are used for staging of hodgkin lymphoma

A

PET/CT

150
Q

what are the 2 tx for hodgkin lymphoma

A
  1. ABVD chemo (adriamycin, bleomycin, vinblastine, dcarbazine)
  2. XRT
151
Q

what is the tx for refractory hodgkin lymphoma

A

autologous stem cell transplant

152
Q

if symptomatic, name 3 symptoms of chronic myelogenous leukemia (CML)

A

fatigue

abdominal fullness (splenomegaly)

anorexia

153
Q

what do you think when you see “blast crisis”

A

chronic myelogenous leukemia (CML)

154
Q

what are the 3 phases of chronic myelogenous leukemia (CML)

A
  1. chronic → months to years
  2. accelerated
  3. acute → blast crisis
155
Q

the acute phase of CML is also called

A

blast crisis

156
Q

blast crisis occurs w.in __

to __ years of CML if untreated

A

3-5

157
Q

what are the 2 diagnostic tests for CML

A
  1. CBC → shows leukocytosis
  2. bone marrow bx
158
Q

CBC for CML shows

A

leukocytosis

159
Q

what is the tx for the chronic stage of CML

A

Gleevec

160
Q

what is the only curative tx for accelerated CML

A

bone marrow transplant

161
Q

what are the 2 steps in the tx of acute CML (blast crisis)

A
  1. chemo
  2. stem cell transplant
162
Q

when you see weakness, gingival bleeding, ecchymosis, epistaxis, and anemia, think

A

acute myelogenous leukemia (AML)

163
Q

what are risk factors for AML

A

cheo

XRT

chemical exposure

164
Q

presumptive dx of AML is done using

A

CBC w. diff/peripheral smear → shows 20% blasts

165
Q

definitive dx of AML is done using

A

bone marrow bx

166
Q

when you see, 20% blasts on bone marrow or peripheral smear, think

A

AML

ALL

167
Q

what are the 2 tx steps for AML

A
  1. 2 stages of induction (aggressive) chemo
  2. followed by consolidation (further chemo or stem cell transplant)
168
Q

remission of AML is related to

A

age

169
Q

what is the most prevalent leukemia

A

chronic lymphocytic leukemia (CLL)

170
Q

most CLL are __ and discovered via

__ on labs

A

asymptomatic

lymphocytosis

171
Q

if CLL is symptomatic, what are 3 symptoms

A

LAD

recurrent infxns

HSM

172
Q

when you see, clonal malignancy of B lymphocytes, think

A

CLL (chronic lymphocytic leukemia)

173
Q

what is the diagnostic test of choice for CLL

A

CBC w. diff/peripheral smear showing smudge cells

174
Q

when you see “smudge cells,” think

A

CLL

175
Q

what test is used to determine immunophenotype and to demonstrate clonality in CLL

A

flow cytometry

176
Q

what is the tx for early stages of CLL

A

observe

+/- chemo/XRT

177
Q

what is the tx for stage I-II (acute) CLL

A

XRT

178
Q

what is the tx for CLL that is stage 2 or higher

A

chemo

179
Q

is there a cure for CLL

A

no

180
Q

what are 2 risk factors for acute lymphocytic leukemia (ALL)

A

radiation

chemo

181
Q

what are 3 symptoms of adult ALL

A

bruising

bleeding

petechiae

leukemia cutis

182
Q

what 4 tests are used to dx adult ALL

A
  1. bone marrow aspiration
  2. bx → blast cells >20%
  3. cytogenetics
  4. immunophenotyping
183
Q

tx for ALL is __ in

pt up to __ yo

A

combo chemo

60

184
Q

when you see focal neuro deficits, HA, and sz, think

A

brain tumors

185
Q

half of brain tumors are __

A

gliomas

186
Q

what is the diagnostic test of choice for brain tumors

A

MRI w. gadolinium

(CT is 2nd choice) → not as good

187
Q

what is the main tx for brain tumors

A

surgical removal

188
Q

what 2 drugs are commonly used w. brain tumors

A

corticosteroids

anticonvulsants

189
Q

what do pt’s w. esophageal ca often complain of

A

sticking of food

retrosternal discomfort

burning

regurgitation of saliva or food

190
Q

what are the 2 main RF for esophageal ca

A

smoking

etoh

191
Q

what is the diagnostic test for esophageal ca

A

endoscopic bx

192
Q

what test is used to visualize esophageal ca

A

barium esophogram

193
Q

what are 5 aspects of esophageal ca tx

A
  1. surgery
  2. chemo
  3. XRT
  4. nutritional support
  5. airway management
194
Q

what are smudge cells

A

ruptured lymphocytes -> found on CLL smear

Clin Med II - Exam 1 (7 decks)

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