Clinical questions - Oncology Flashcards
Most appropriate management for iron deficiency anemia
Iron supplementation
Endoscopy to r/o cancer
Work up of pancreatic mass
Fine needle biopsy - either EUS or percutaneous with CT or US if it is a larger mass
Criteria for surgical resection of pancreatic adenocarcinoma, and what procedure used
Whipple: resection distal stomach, CBD, duodenum, head of pancreas, and proximal jejunum
Resectable if:
- no mets to LN beyond peripancreatic region
- No mets to liver, peritoneum, or extra abdominal site
- no encasement of vasculature
What is the USPSTF recommendations for prostate cancer screening
No screening PSA
+/- DRE
American cancer society recs PSA if patient agrees after discussion of pros/cons
Malignancy most closely associated with the following tumor marker: AFP
hepatocellular carcinoma, testicular, gastric
Malignancy most closely associated with the following tumor marker: ALP
bone mets
Malignancy most closely associated with the following tumor marker: CA125
ovarian
Malignancy most closely associated with the following tumor marker: CA 19-9
pancreatic
Malignancy most closely associated with the following tumor marker: CEA
colon, pancreatic
Malignancy most closely associated with the following tumor marker: PSA
prostate
Malignancy most closely associated with the following tumor marker: S100
melanoma, schwannoma (neurocrest origin)
Hepatocellular carcinoma
Associated with Hep B/C infection, alcohol abuse, hemochromatosis
Think about HCC if cirrhotic acutely decompensates
Can secrete erythropoietin -> erythrocytosis
Follow AFP
Carcinoid syndrome - presentation, common sites, lab findings, tx
serotonin and vasoactive substance secreting tumor
Presents with bronchospasm, flushing, diarrhea, right sided heart murmur (fibrous deposits on leaflets)
Most common site: small intestine and appendix, but can arise in bronchopulmonary tree or gut
Labs: elevated 5-hydroxyindoleacetic acid (HIAA) levels
Sxs tx:
Somatostatin analog: Octreotide or lanreotide to suppress secretion of hormones
Zollinger-Ellison Sn - presentation, associated diseases, dx, tx
gastrinoma, typically in the distal duodenum or pancreatic islet cells that secretes gastrin leading to PUD and diarrhea
Can be associated with MEN1
Dx:
- elevated serum gastrin level
- CT/MRI of and to ID location of tumor
Tx:
PPI
Octreotide - shuts down GI hormone secretion, use if fail PPI
Surgical resection
MEN1
Hyperparathyroidism -> elevated Ca
Pituitary adenoma
Pancreatic islet cell tumors - insulinoma, glucagonoma
Squamous cell lung cancer paraneoplastic syndromes
typically located close to bronchus - ssscentral
elevated PTHrP causing hypercalcemia
- increased bone turnover
- increased Ca reabsorption at the kidney
Small cell lung cancer paraneoplastic syndromes
not typically a surgical candidate, just chemo and radiation
ADH -> SIADH, hyponatremia
ACTH -> cushing syndrome, elevated cortisol
Lambert-Eaton myasthenia Sn - Ab against presynaptic Ca channel at the NMJ -> weakness that improves with use
Pancoast tumor associated symptoms
Superior sulcus of the lung tumor, invades sympathetic nervous system
Horner syndrome: ptosis, mitosis, anhydrosis
Diagnosis and management of testicular mass
1st scrotal ultrasound
Further testing:
Serum tumor markers- beta hCG, AFP, LDH
Imaging - CXR to r/o lung mets, CT A/P r/o LN mets
Offer sperm banking
Tx: Orchiectomy Chemotherapy "Eradicate Ball Cancer" -Etopisode -Bleomycin -Cisplatin
Evaluation for painless hematuria
Cystoscopy - concern for transitional cell carcinoma
CT A/P
Urine cytology
If they also have flank pain, concern for renal cell carcinoma
Urine cytology
CT A/P
