Adult Oncology Flashcards
1
Q
when you see male, smoker, painless red urine, think
A
bladder cancer
2
Q
what is the major risk factor for bladder ca
A
smoking
3
Q
what gold standard test can be used for dx and bx in bladder cancer
A
cystoscopy
4
Q
what 3 types of UA can be used for dx of bladder ca
A
dipstick
microscopic
gross analysis
5
Q
what are the two types of bladder cancer
A
- muscle invasive
- non-muscle invasive
6
Q
what is the tx of choice for non muscle invasive bladder ca
A
TURBT (trans urethral resection of bladder)
7
Q
what is the tx of choice for muscle invasive bladder ca
A
cystectomy
8
Q
what are some secondary tx for bladder ca
A
intravesical chemo, systemic chemo, XRT
9
Q
most bladder cancers are __ carcinomas
A
transitional cell
10
Q
what is the most common ca in men aged 15-35
A
testicular ca
11
Q
what is the most common symptom of testicular ca
A
painless mass or swelling in testis
(+/- heavy feeling in lower abd)
12
Q
when you see cryptochordism, think
A
testicular ca
13
Q
what is the diagnostic test of choice for testicular ca
A
scrotal US
14
Q
besides scrotal US, what is another helpful diagnostic tool for testicular ca
A
tumor markers (AFP, beta hCG, LDH)
15
Q
what is the tx for stage 1 testicular ca
A
inguinal orchiectomy + surveillance
16
Q
what is the tx for higher stages of testicular ca
A
RPLND (retroperitoneal lymph node dissection), XRT, +/- platinum based chemo
17
Q
when you see abdominal fullness, bloating, nausea, early satiety, and age 60’s, think
A
ovarian ca
18
Q
what are some initial evaluation tools for ovarian ca
A
- pelvic exam
- CA-125 (tumor marker), CXR, CT, +/- genetic counseling
19
Q
when you see BRCA, lynch II syndrome, infertility, PCOS, and endometriosis, think
A
ovarian ca
20
Q
what is the diagnostic test of choice for ovarian ca
A
unilateral salpingo-oophrectomy
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
22
Q
what are the 3 main symptoms of multiple myeloma
A
bone pain
anemia (Rouleaux)
hypercalcemia
23
Q
besides hypercalcemia, what other lab might be elevated in multiple myeloma
A
creatinine
24
Q
when you see, proliferation of plasma cells producing monoclonal abs that cause end organ damage, think
A
multiple myeloma
25
what does CRAB stand for
end organ damage sites of multiple myeloma
hyperCalcemia
renal dz
anemia
bone dz
26
what are the diagnostic tests of choice for multiple myeloma
monoclonal spike on SPEP
Bence Jones proteins on UPEP
27
you need both \_\_
and __ to diagnose multiple myeloma
SPEP (serum protein electrophoresis)
UPEP (urine protein electrophoresis)
28
how do you confirm dx of multiple myeloma
bx of plasmacytoma
29
when you see “punched out, lytic" lesions on Xray, think
multiple myeloma
30
\_\_ are more effective than
\_\_ in multiple myeloma
MRI, CT, PET
31
\_\_ are NOT helpful in the assessment of multiple myeloma
bone scans
32
what is the order of tx in multiple myeloma
1. induction therapy (lower dose chemo)
2. high dose chemo + stem cell transplant
3. +/- bisphosphanates to reduce fx
33
is prostate ca common
yes! → 2nd most common ca in men
34
when you see AA, high fat diet, and increased age, think
prostate ca
35
early prostate ca is
asymptomatic
36
what are some common symptoms of later stages of prostate ca
increased PSA, hematuria, hematospermia, obstructive urinary sx, bone pain
37
prostate cancer is usually what type of carcinoma
adenocarcinoma
38
what is the most common site of metastasis for prostate ca
bone
39
what is the diagnostic test of choice for prostate ca
prostate bx
40
what is used for grading of prostate ca
gleason score
41
what is the tx for low grade prostate ca
watchful waiting (esp if short life expectancy)
42
what is the tx for higher stages of prostate ca
radical prostatectomy, brachytherapy, XRT
43
what is the tx of choice for metastatic prostate ca
radical prostatectomy, brachytherapy, XRT
PLUS castration (physical and chemical)
PLUS bisphosphanates
44
when you see gnawing epigastric pain, nausea, wt loss, anorexia, and Courvoisier sign, think
pancreatic ca
45
what does Courvoisier sign make you think of
pancreatic ca
| (large, palpable gallbladder)
46
name 3 signs of mets in pancreatic ca
abdominal mass
ascites
Virchow's node
Sister Mary Joseph node
47
what are 2 diagnostic tests of choice for pancreatic ca
labs and imaging
48
what 2 labs are used in the diagnosis of pancreatic ca
LFTs
lipase
49
what are 2 types of imaging used in the dx of pancreatic ca
abd US
CT
50
what does the double duct sign make you think of
pancreatic ca
51
what is the double duct sign
dilated common bile duct and pancreatic duct
52
what is the only potential cure for pancreatic ca
Whipple procedure
53
what is the order of tx for pt's w.o metastatic pancreatic ca
1. whipple procedure
2. chemo +/- XRT for pt w.o resectable tumor
3. palliative care
54
colorectal ca can be \_\_
or \_\_
symptomatic
asymptomatic
55
what are 3 main symptoms of colorectal ca
blood in stool
change in bowel habits
unexplained IDA
56
when you see tenesmus, urgency, and recurrent hematochezia, think
rectal ca
57
when you see \>50 yo, Lynch syndrome, high fat diet, and IBD, think
colorectal ca
58
what is the diagnostic test of choice for colorectal ca
colonoscopy
59
what test do you use for colorectal ca screening
FOBT (fecal occult blood test)
60
what is used to stage colorectal ca
C/A/P CT scan
61
what is the tx of choice for colorectal ca
surgical resection plus chemo
62
what is the treatment of choice for rectal tumors
surgical resection and chemo plus XRT
63
what should not be used for screening or diagnosis of colorectal cancer
CEA levels
*can be used for monitoring*
64
80% of pt's w. hepatocellular carcinoma have
cirrhosis
65
hepatocellular cancer is usually \_\_
except for symptoms of \_\_
disease
asymptomatic
liver
66
symptoms of hepatocellular cancer may include (3)
abdominal pain
new decompensation of cirrhosis
paraneoplastic syndromes
67
what test is used for the dx and screening of hepatocellular ca
US
| (followed by CT or MRI)
68
what other test besides US/CT/MRI is useful in evaluation of hepatocellular ca
AFP (alpha fetoprotein)
69
when used in hepatocellular ca, bx can increase risk for
tumor seeding
70
what is the tx of choice for hepatocellular ca if liver fxn is preserved
surgical resection
71
what is the tx of choice for hepatocellular ca with advanced cirrhosis
liver transplant
72
what is the tx of choice for hepatocellular ca in pt's who are not surgical candidates
ablation, etoh injxn, cryotherapy, chemo, XRT
73
what is the most common type of melanoma
superficial spreading
74
what is the most common type of melanoma in darker skinned pt's
acral lentiginous
75
what are the 4 types of melanoma
1. superficial spreading
2. nodular melanoma
3. lentigo maligna
4. acral lentiginous
76
what test is used to dx melanoma
bx
77
what is the most important prognostic factor for melanoma
Breslow depth (tumor thickness)
78
what are the 2 steps of melanoma tx
1. excision w. margins
2. sentinel lymph node excision (SLNE) for staging
79
what third step do you add for tx of metastatic melanoma
inferferon alpha, immune therapy, chemo
80
what are the most common sites of squamous cell carcinoma (SCC)
head and neck
also top of pinna, dorsum of hands, lip
81
what is a common precursor of SCC
actinic keratosis
82
what are 3 characteristics of SCC
1. scaly patch, plaque, or nodule. or ulceration
2. irregular borders
3. can bleed or crust
83
what is the diagnostic test of choice for SCC
bx
shave, punch, or excisional
84
what are 4 tx options for SCC
1. Mohs micrographic surgery
2. 5-FU
3. imiquimod
4. electrodessication
85
what is the most common site of basal cell carcinoma (BCC)
nose
also head and neck
86
what is the most common form of BCC
nodular
87
name 3 characteristics of BCC
1. pearly
2. papule
3. telangiectasia
88
what is a rodent ulcer
BCC w. central ulceration
89
what do you call a circumscribed, scaling lesion with raised pearly-white border
superficial BCC
90
what is a flat or slightly raised yellowish/white lesion that scar like w. a waxy surface
morpheaform BCC
91
what is the dx test for BCC
bx
shave or punch
92
what tx has the highest cure rates for BCC
Mohs micrographic surgery
93
what do you think of when you see, abnormal uterine bleeding, postmenopausal women, and abnormal vaginal d.c
endometrial carcinoma
94
what cancer is caused by unopposed estrogen therapy
endometrial ca
95
smoking and OCP decreases risk for
endometrial ca
96
what are 2 dx tests for endometrial ca
bx
endometrial D&C (dilation and cutterage)
97
in post menopausal women __ can be used first to assess endometrial thickness
transvaginal US
98
what is the tx of choice for endometrial ca
hysterectomy w. bilateral salpingo-oophrectomy
+/- postop chemo and XRT
99
what tx preserves fertility in endometrial ca
progestin therapy
100
cervical ca is mostly __ and
found on \_\_
asymptomatic
screening
101
what are symptoms of advanced cervical ca
abnormal vaginal d.c or bleeding
102
what is a major risk factor for cervical ca
HPV 16 and 18
103
what are the diagnostic steps for cervical ca
1. pap smear
2. if abnormal → repeat or colonoscopy + bx
104
name 3 possible tx options for cervical ca
LEEP (loop electrosurgical excision procedure)
ablation
hysterectomy
105
what is the main characteristic of vulvar ca
pruritis
106
what is the dx test of choice for vulvar ca
vulvar bx
107
what are 3 tx options for vulvar ca
1. wide local excision
2. topical 5-FU
3. laser therapy (early lesions)
108
what is the leading cause of cancer deaths
lung ca
109
what are the 2 cardinal symptoms of lung ca
new cough
hemoptysis
110
what are the 2 types of lung ca
1. SCLC (small cell lung carcinoma)
2. NSCLC (non small cell lung carcinoma)
111
SCLC is also called __ carcinoma
oat cell
112
what is the more aggressive type of lung ca
SCLC (oat)
113
NSCLC is what type of carcinoma
adenocarcinoma
114
lung ca may be found incidentally on \_\_
or \_\_
CT or CXR
115
lung ca needs __ confirmation for dx
histologic
116
histologic confirmation of lung ca may include (5)
1. sputum
2. cytology
3. bronchoscopy
4. pleural fluid
5. bx
117
what is the tx for NSCLC
surgical resection
+/- chemo/XRT
118
what is the tx of choice for SCLC
chemo
usually XRT
119
if renal cell carcinoma is symptomatic, what is the triad
hematuria
flank pain
palpable mass
120
what is the dx test of choice for renal cell carcinoma
abdominal CT
+/- US
121
what is the main tx for renal cell carcinoma
partial or radical nephrectomy
122
what is the tx for advanced renal cell carcinoma
immunotherapy (not super effective)
123
what is the cardinal sign of breast ca
single, nontender, firm immobile mss in upper quadrant
124
rare symptoms of breast ca include
nipple d.c and new retraction
pain
axillary LAD
peau d'orange
Paget dz
125
what are the 2 most common types of breast ca
1. ductal
2. lobular
126
what is the dx test of choice for breast ca
mammography → stereotacic or excisional core needle bx
127
what is the next step in breast ca evaluation after bx
estrogen and progesterone receptor analysis + histology of specimen
128
what drugs are used for breast cancers that are positive for hormone receptors
Armidex
Tamoxifen
Raloxifene
129
what drug is used for breast ca that is HER-2 positive
Herceptin
130
name 4 treatments for breast ca
1. lumpectomy w. SLNB (sentinel lymph node bx)
2. mastectomy
3. XRT
4. adjuvant chemo
131
name the 4 types of thyroid cancer from least aggressive/fatal to most aggressive/fatal
papillary
follicular
medullary
anaplastic
132
most thyroid cancers are \_\_
asymptomatic
133
if thyroid ca is symptomatic, what are the 2 main symptoms
1. painless neck swelling
2. palpable, single, firm nodule
134
when you see US guided FNA (fine needle aspiration), think
diagnostic test for thyroid ca
135
what is the tx for thyroid ca
surgical resection
+/- radioactive iodine (RAI) for residual tumor
136
thyroid ca pt's need __ for life
thyroid hormone replacement
137
which type of thyroid ca has no effective cure
anaplastic
138
what are the 2 types of non-hodgkin lymphoma
1. indolent (lazy)
2. aggressive
139
when you see painless, persistent LAD, HSM, and cytopenia, think
indolent non-hodgkin lymphoma
140
what are 2 unique symptoms of aggressive non-hodgkin lymphoma
1. rapidly growing mass
2. increased LDH and uric acid
141
what tests are used for dx and staging of non-hodgkin lymphoma
1. dx: bx of involved nodes
2. staging: bone marrow bx (before tx)
142
what is the treatment for indolent non-hodgkin lymphoma
XRT alone
143
what is the tx for intermediate to high grade lymphoma (3)
1. chemo
2. immunotherapy (Rituximab)
3. stem cell transplant
144
prognosis is worse for __ related NHL
HIV
145
when you see, LAD after drinking etoh, think
Hodgkin Lymphoma
146
how do you describe the LAD in hodgkin lymphoma
painless
localized
rubbery
peripheral
cervical
147
what do you see on a CXR for hodgkin lymphoma
mediastinal mass
148
when you see Reed Sternberg cells on bx, think
hodgkin lymphoma dx
149
what tests are used for staging of hodgkin lymphoma
PET/CT
150
what are the 2 tx for hodgkin lymphoma
1. ABVD chemo (adriamycin, bleomycin, vinblastine, dcarbazine)
2. XRT
151
what is the tx for refractory hodgkin lymphoma
autologous stem cell transplant
152
if symptomatic, name 3 symptoms of chronic myelogenous leukemia (CML)
fatigue
abdominal fullness (splenomegaly)
anorexia
153
what do you think when you see “blast crisis”
chronic myelogenous leukemia (CML)
154
what are the 3 phases of chronic myelogenous leukemia (CML)
1. chronic → months to years
2. accelerated
3. acute → blast crisis
155
the acute phase of CML is also called
blast crisis
156
blast crisis occurs w.in \_\_
to __ years of CML if untreated
3-5
157
what are the 2 diagnostic tests for CML
1. CBC → shows leukocytosis
2. bone marrow bx
158
CBC for CML shows
leukocytosis
159
what is the tx for the chronic stage of CML
Gleevec
160
what is the only curative tx for accelerated CML
bone marrow transplant
161
what are the 2 steps in the tx of acute CML (blast crisis)
1. chemo
2. stem cell transplant
162
when you see weakness, gingival bleeding, ecchymosis, epistaxis, and anemia, think
acute myelogenous leukemia (AML)
163
what are risk factors for AML
cheo
XRT
chemical exposure
164
presumptive dx of AML is done using
CBC w. diff/peripheral smear → shows 20% blasts
165
definitive dx of AML is done using
bone marrow bx
166
when you see, 20% blasts on bone marrow or peripheral smear, think
AML
ALL
167
what are the 2 tx steps for AML
1. 2 stages of induction (aggressive) chemo
2. followed by consolidation (further chemo or stem cell transplant)
168
remission of AML is related to
age
169
what is the most prevalent leukemia
chronic lymphocytic leukemia (CLL)
170
most CLL are __ and discovered via
\_\_ on labs
asymptomatic
lymphocytosis
171
if CLL is symptomatic, what are 3 symptoms
LAD
recurrent infxns
HSM
172
when you see, clonal malignancy of B lymphocytes, think
CLL (chronic lymphocytic leukemia)
173
what is the diagnostic test of choice for CLL
CBC w. diff/peripheral smear showing smudge cells
174
when you see “smudge cells,” think
CLL
175
what test is used to determine immunophenotype and to demonstrate clonality in CLL
flow cytometry
176
what is the tx for early stages of CLL
observe
+/- chemo/XRT
177
what is the tx for stage I-II (acute) CLL
XRT
178
what is the tx for CLL that is stage 2 or higher
chemo
179
is there a cure for CLL
no
180
what are 2 risk factors for acute lymphocytic leukemia (ALL)
radiation
chemo
181
what are 3 symptoms of adult ALL
bruising
bleeding
petechiae
leukemia cutis
182
what 4 tests are used to dx adult ALL
1. bone marrow aspiration
2. bx → blast cells \>20%
3. cytogenetics
4. immunophenotyping
183
tx for ALL is __ in
pt up to __ yo
combo chemo
60
184
when you see focal neuro deficits, HA, and sz, think
brain tumors
185
half of brain tumors are \_\_
gliomas
186
what is the diagnostic test of choice for brain tumors
MRI w. gadolinium
(CT is 2nd choice) → not as good
187
what is the main tx for brain tumors
surgical removal
188
what 2 drugs are commonly used w. brain tumors
corticosteroids
anticonvulsants
189
what do pt's w. esophageal ca often complain of
sticking of food
retrosternal discomfort
burning
regurgitation of saliva or food
190
what are the 2 main RF for esophageal ca
smoking
etoh
191
what is the diagnostic test for esophageal ca
endoscopic bx
192
what test is used to visualize esophageal ca
barium esophogram
193
what are 5 aspects of esophageal ca tx
1. surgery
2. chemo
3. XRT
4. nutritional support
5. airway management
194
what are smudge cells
ruptured lymphocytes -\> found on CLL smear
