Cancers

Question 1

5 most common CAs

Answer 1

1. leukemia
2. CNS tumor
3. lymphoma
4. neuroblastoma
5. soft tissue sarcoma

Question 2

main types of leukemia

Answer 2

1. acute (95%)
   - ALL 80
   - AML - 15
2. chronic

Question 3

risk factors for ALL

Answer 3

1. genetic
   - male
   - white
   - DS
2. env.
   - rads
3. infection

Question 4

presentation of ALL

Answer 4

non-specific and mimic a viral infection

1. expansion within the bone marrow
   - Sx of the cells lines that are down
   - bone pain
2. extramedullary
   - infiltration of spleen, liver, nodes
   - CNS - commonly asymptoms
   - testes - painless enlargement

Question 5

invest. for ALL

Answer 5

1. CBC and diff
   - WBC can be high, low, or normal
   - RBC and plat can be low or normal
2. Smear - blasts
3. chemisrty for tumor lysis syndrome
4. viral titres
5. blood cultures
6. marrow aspirate
7. LP - for CNS

Question 6

features of high and low risk ALL

Answer 6

low - 85% survive

• Bcell
• 1-9yo
• WBC

Question 7

features of high and low risk AML

Answer 7

low - 70% live

• 1-10yo
• de novo
• 100
• secondary AML

Question 8

best prog. factor

Answer 8

response to initial therapy
meaured by
1. marrow morphlogy - blast

Question 9

mgmt of ALL

Answer 9

chemo

- induction, consolidation, re-intensifiaction, maintenance

Question 10

presentation and chars. of hodgkins lymphoma

Answer 10

present - single node with contiguous spread
char.
- reed-sternberg cells
- progressive enlargment of nodes
- painless
- itch
- pain with alc.
anorexia

Question 11

presentation and chars. of non-hodgkins lymphoma

Answer 11

present - multiple sites and peripheral nodes
chars:
- lymphoblastic - solid tumor, T cell, adolescent
- burkitts - peripheral Bcell, diffuse, high grade
- large cell - B or T cell

Question 12

when to be concerned about nodes

Answer 12

over 10mm
- epitroclear - 5
- inguinal - 15
cervical vs. other
systemic components

Question 13

DDx for nodes

Answer 13

1. infection
2. malig.
   - lymphoma
   - solid tumors that have mets
3. auto immune
   - Rheum, SLE
4. storage disease
5. Misc
   - kawasaki, serum sickness, sarcoidosis

Question 14

workup for lymphadenopathy

Answer 14

1. CBC
2. LFTs, renal
3. cultures
4. immune profile - B and T cell count, Igs
5. inflamm. CRP, ESR, ANA, RF
6. PPD for TB
7. imaging

Question 15

when to Bx a node

Answer 15

1. > 2 cm
2. supraclavicular
3. hard, matted, rubery
4. B Sx

Question 16

what is important about mediastinal mass

Answer 16

EMERGENCY!

Question 17

most common causes of mediastinal mass based on location

Answer 17

anterior
- lymphoma
- thymoma
- ectopic thyroids
middle
- lymphoma
posterior
- neuroblastoma
- ganglioneuromas

Question 18

Sx of mediastinal mass

Answer 18

- cough, cehst pain, constitutional Sx
others possible
- horners
- SVC syndrome - echo
- airway compromise - DO NOT LIE flat
- tamponade - pulsus para, echo, EKG

Question 19

workup of med. mass

Answer 19

• anastesia and onc
• tissue Bx
• bone marrow aspirate