Cancer Flashcards
What is the most common type of thyroid cancer?
Papillary
CFP Feb 2018
What findings from clinical history increase the likelihood of malignancy of a thyroid nodule?
Rapid growth
Head and neck irradiation
Total body irradiation for bone marrow transplant
Familial thyroid carcinoma
Thyroid cancer syndromes (e.g multiple endocrine neoplasia type 2, familial adenomatous polyposis)
Dysphagia
Dyspnea
CFP Feb 2018
What exam findings are suggestive of malignancy in the setting of a thyroid nodule
Dysphonia
Regional lymphadenopathy
Fixation of nodule to surrounding tissue
CFP Feb 2018
At what size should FNA of thyroid nodules be done?
> = 1.0 cm if high or intermediate suspicion on u/s
= 1.5 cm if low suspicion on u/s
= 2.0 cm if very low suspicion on u/s
No biopsy required if purely cystic on u/s
CFP Feb 2018
Independent features of thyroid nodules on ultrasound that are highly suggestive of malignancy include:
Microcalcifications Hypoechogenicity Irregular margins Taller than wide shape Invasion of normal structures Lymphadenopathy
CFP Feb 2018
A 75-year-old man with a history of moderate anemia presents at your office. Recently he underwent investigations by a gastroenterologist, who found no gastrointestinal cause for his anemia. The gastroenterologist raised the possibility of multiple myeloma and sent him back to you for further assessment. Upon questioning the patient, you find that over the past six months he has had various nonspecific symptoms, such as nausea, vomiting, weakness, recurrent infections, and weight loss. Considering his new symptoms, you decide you must rule out multiple myeloma.
Symptoms of hyperviscosity can occur with multiple myeloma. What medical complications are related to hyperviscosity? List three.
Transient ischemic attack
Retinal hemorrhage
Deep vein thrombosis
Dyspnea
Ref: CFPC Self-Learning Module Vol 32.5 Oct 2017
A 75-year-old man with a history of moderate anemia presents at your office. Recently he underwent investigations by a gastroenterologist, who found no gastrointestinal cause for his anemia. The gastroenterologist raised the possibility of multiple myeloma and sent him back to you for further assessment. Upon questioning the patient, you find that over the past six months he has had various nonspecific symptoms, such as nausea, vomiting, weakness, recurrent infections, and weight loss. Considering his new symptoms, you decide you must rule out multiple myeloma.
Results of his physical examination are normal. What laboratory tests should you order to rule out multiple myeloma? List three.
Complete blood count with differential Serum albumin Calcium Creatinine Electrolytes Urea nitrogen SPEP
A 75-year-old man with a history of moderate anemia presents at your office. Recently he underwent investigations by a gastroenterologist, who found no gastrointestinal cause for his anemia. The gastroenterologist raised the possibility of multiple myeloma and sent him back to you for further assessment. Upon questioning the patient, you find that over the past six months he has had various nonspecific symptoms, such as nausea, vomiting, weakness, recurrent infections, and weight loss. Considering his new symptoms, you decide you must rule out multiple myeloma.
Results of his initial laboratory tests are compatible with multiple myeloma. After these initial findings, he is referred to a hematologist/oncologist, who performs bone marrow aspiration. Findings meet the two criteria for multiple myeloma. The first criterion is clonal bone marrow plasma cells at or above 10% or biopsy-proven bony or extramedullary plasmacytoma. What are the myeloma-defining events included in the second criterion? List three.
Evidence of end-organ damage that can be attributed to the underlying plasma cell proliferative disorder, specifically the following:
Hypercalcemia
Renal insufficiency
Anemia
Bone lesions.
Clonal bone marrow plasma cells at or above 60%. Involved-to-uninvolved serum free light-chain ratio at or above 100 (involved free light-chain level must be =100 mg per L). More than one focal lesion on magnetic resonance imaging studies (=5 mm size).
A 75-year-old man with a history of moderate anemia presents at your office. Recently he underwent investigations by a gastroenterologist, who found no gastrointestinal cause for his anemia. The gastroenterologist raised the possibility of multiple myeloma and sent him back to you for further assessment. Upon questioning the patient, you find that over the past six months he has had various nonspecific symptoms, such as nausea, vomiting, weakness, recurrent infections, and weight loss. Considering his new symptoms, you decide you must rule out multiple myeloma.
He starts chemotherapy to treat his multiple myeloma. His oncologist has asked him to discuss initiating bisphosphonate treatment with you. The patient is surprised at the oncologist’s recommendation, as all investigations confirmed that he has no bone lesions. Are bisphosphonates indicated in this setting? Explain why or why not.
Yes:
The 2013 International Myeloma Working Group consensus statement on the treatment of bone disease recommends intravenous zoledronic acid or pamidronate for all patients with multiple myeloma who are receiving treatment, regardless of whether bone lesions are present. Both of these bisphosphonates have been shown to decrease vertebral compression fractures and other bone complications; zoledronic acid was shown to improve survival in one randomized, controlled trial.
