Clinical questions - Oncology

Question 1

Most appropriate management for iron deficiency anemia

Answer 1

Iron supplementation

Endoscopy to r/o cancer

Question 2

Work up of pancreatic mass

Answer 2

Fine needle biopsy - either EUS or percutaneous with CT or US if it is a larger mass

Question 3

Criteria for surgical resection of pancreatic adenocarcinoma, and what procedure used

Answer 3

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

Question 4

What is the USPSTF recommendations for prostate cancer screening

Answer 4

No screening PSA
+/- DRE

American cancer society recs PSA if patient agrees after discussion of pros/cons

Question 5

Malignancy most closely associated with the following tumor marker: AFP

Answer 5

hepatocellular carcinoma, testicular, gastric

Question 6

Malignancy most closely associated with the following tumor marker: ALP

Answer 6

bone mets

Question 7

Malignancy most closely associated with the following tumor marker: CA125

Answer 7

ovarian

Question 8

Malignancy most closely associated with the following tumor marker: CA 19-9

Answer 8

pancreatic

Question 9

Malignancy most closely associated with the following tumor marker: CEA

Answer 9

colon, pancreatic

Question 10

Malignancy most closely associated with the following tumor marker: PSA

Answer 10

prostate

Question 11

Malignancy most closely associated with the following tumor marker: S100

Answer 11

melanoma, schwannoma (neurocrest origin)

Question 12

Hepatocellular carcinoma

Answer 12

Associated with Hep B/C infection, alcohol abuse, hemochromatosis
Think about HCC if cirrhotic acutely decompensates
Can secrete erythropoietin -> erythrocytosis
Follow AFP

Question 13

Carcinoid syndrome - presentation, common sites, lab findings, tx

Answer 13

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

Question 14

Zollinger-Ellison Sn - presentation, associated diseases, dx, tx

Answer 14

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

Question 15

MEN1

Answer 15

Hyperparathyroidism -> elevated Ca
Pituitary adenoma
Pancreatic islet cell tumors - insulinoma, glucagonoma

Question 16

Squamous cell lung cancer paraneoplastic syndromes

Answer 16

typically located close to bronchus - ssscentral

elevated PTHrP causing hypercalcemia

• increased bone turnover
• increased Ca reabsorption at the kidney

Question 17

Small cell lung cancer paraneoplastic syndromes

Answer 17

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

Question 18

Pancoast tumor associated symptoms

Answer 18

Superior sulcus of the lung tumor, invades sympathetic nervous system

Horner syndrome: ptosis, mitosis, anhydrosis

Question 19

Diagnosis and management of testicular mass

Answer 19

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

Question 20

Evaluation for painless hematuria

Answer 20

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