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BCOP- Joey > Diagnostics > Flashcards

Diagnostics Flashcards

1
Q

Deletion or mutation of INI—1 (SMARCB1)

A

Epitheloid sarcoma

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2
Q

High risk gist

A

-Gastric gist >5 cm and >5 mitosis per 50 HPFs
-Intestinal gist independent of size with >5 mitosis per 50 HPFs, or >10 cm
-Or tumor rupture

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3
Q

Renal cell carcinoma mskcc and IMRD scoring

A

Mskcc:
-low KPS (<80%)
-low hgb
-high corrected ca
-<1yrfrom initial diagnosis to systemic therapy
-high LDH (>1.5 ULN)

IMRD:
-Low KPS (<80%)
-low Hgb
-high corrected calcium
-<1 yr from diagnosis to systemic therapy
-ANC high
-plt high

*if ANY of the above criteria is met, the patient is NOT favorable or good risk!

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4
Q

1p19q co-deletion vs 1p19q intact

A

-co-deletion = oligodendroglioma
-intact = astrocytoma

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5
Q

Asttocytoma IDH mutated vs wild type.
What is the grade?

A

Mutated= grade 2-3
Wild type= grade 4

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6
Q

At what stage is bladder cancer considered muscle invasive (MIBC)

A

T2

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7
Q

Bladder cancer staging

A

Stage 0: ta or tis- NMIBC
Stage 1: t1-NMIBC
Stage 2: t2- MIBC
Stage 3: t3-t4 or any N- MIBC
Stage 4: t4, metastatic

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8
Q

Non-seminoma good risk

A

-Testicular or retroperitoneal primary AND
-no non-pulmonary visceral Mets AND
-post- orchiectomy markers all:
-AFP<1000
-hcg<5000
-LDH<1.5 ULN

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9
Q

Non-seminoma intermediate risk

A

-Testicular or retroperitoneal primary AND
-no non-pulmonary visceral Mets AND
-post- orchiectomy markers ANY of:
-AFP<1000-10,000
-hcg<5000-50,000
-LDH<1.5-10x ULN

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10
Q

Non-seminoma poor risk

A

-mediastinal primary OR
-non-pulmonary visceral Mets OR
-post- orchiectomy markers ANY of:
-AFP >10,000
-hcg >50,000
-LDH >10x ULN

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11
Q

Seminoma good risk

A

-any primary site AND
-no non-pulmonary visceral Mets AND
-normal AFP (any hcg and LDH)

*difference is this one has no non-pulmonary visceral mets

Tumor markers don’t matter for seminoma aside from having normal AFP

Tumor site doesn’t matter for seminoma

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12
Q

Seminoma intermediate risk

A

-any primary site AND
-non-pulmonary visceral Mets AND
-normal AFP (any hcg and LDH)

*difference is this one has non-pulmonary Mets

Tumor markers don’t matter for seminoma aside from having normal AFP

Tumor site doesn’t matter for seminoma

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13
Q

Seminoma poor risk

A

No Seminomas are poor risk!

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14
Q

Non-seminoma risk factors for relapse

A

-lymphovascular invasion
-spermatic cord invasion
-scrotum invasion

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15
Q

Pediatric ALL standard vs high risk

A

Standard:
-age 1-9.99
-wbc < 50k
-must be B cell lineage

High:
-age <1 or 10+
-wbc > 50k
-presence of CNS 3 or testicular dx
-mrd > 0.01% on day 8 AND at end of induction (day 29) (B cell)
-mrd >0.1 end of consolidation (T cell)
-t-cell lineage
-steroid pre-treatment (makes WBC falsely low so can’t use WBC count to risk stratify)

*very high risk features: >13y, BCR-ABL, KMT2A, hypodiploidy (<44), induction failure (>5-25% blast at end of induction)

*good risk features: double trisomies 4 and 10, ETV-RUNX1

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16
Q

Pediatric medulloblastoma average vs high risk

A

Average:
-3+ y
-<1.5 cm residual tumor
-M0
-not anaplastic

High risk:
-<3 y
-1.5+ cm residual tumor
-Metastatic
-anaplastic

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17
Q

Neuroblastoma MS (aka 4S)

A

Metastatic dx in children <18 months with Mets confined to skin, liver, and/or bone marrow

Observation. Most spontaneously regress with favorable genetics (below):
-<10% malignant cells in BM
-no MYCN or 11q aberration

Treat as high risk if unfavorable genetics

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18
Q

Define high volume prostate CA (when we add docetaxel)

A

Visceral Mets or 4+ bone Mets (at least 1 outside vertebral column/pelvis)

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19
Q

What grade is high grade serous ovarian cancer?

A

Grade 2-3

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20
Q

pediatric Burkitts risk groups

A

Group A (low): Completely resected stage I and abdominal stage II

Group B (Int):
-mx extra abdominal sites
-non-respected Stage I-IV
-marrow blasts <25%
-no CNS dx

Group C (high): ->25% marrow blasts and/or CNS dx

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21
Q

Khorana score

A

2+: DVT ppx x6 months
<2: no DVT ppx needed

xarelto 10 mg QD or eliquis 2.5 mcg BID x6 MONTHS or more

Or dalt 200 u/kg sq qd x1 mo—>150 u/kg qd x2 mo, or Lovenox 1 mg/kg sq qd x3 mo—>40 mg qd- THESE ARE FOR ADVANCED/MET PANCREATIC

2pts: stomach or pancreatic cancer
1pt: lung, gyn, testicular, bladder, lymphoma, plt >350 (pre chemo), Hgb <10 or ESA, leukocyte >11 (pre- chemo), BMI 35+

Note: not used for MM, acute leukemia, myeloproliferative neoplasms, primary/metastatic brain tumors.
Note: brain, myeloproliferative, and kidney also have high risk of VTE
Note: primary and metastatic brain tumor is a relative contraindication to anticoagulation-NOT ABSOLUTE (but don’t use thrombolytics)

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22
Q

Impede/saved scores

A

For AC in multiple myeloma pts
-saved is for pts on IMiDs and impede is for MM pts in general

-impede 1-3, saved 0-1: daily Asa
-impede 4+ or saved 2+: AC

Notice save score of 0 still gets aspirin

Lovenox 40 QD, dalt 5000 Iu QD? warfarin, Apix 2.5 BID, xarelto 10 QD, fondaparinux 2.5 qd

don’t need ppx in IMiD maintenance

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23
Q

HR positive vs negative

A

HR negative: Stain <1% HR receptors

HR positive: stain 1-100%

*1-10% still get endocrine therapy but likely less benefit

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24
Q

HER2 postive vs negative

A

Negative: IHC 0, IHC 1, IHC 2 and fish negative

Positive: IHC 3, IHC 2 and fish positive

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25
Q

Who qualifies for breast cancer gene expression assays?

A

Post-menopausal or >50y, HR+, HER-2-, LN negative or 1-3 LN +

-Can also use OncotypeDx in premenopausal if they meet above criteria and LN negative
-prosigna only for LN negative

T3 (>5 cm) will need chemo so don’t bother with assay

Note: oncotype is prognostics AND predicative (others are just prognostic)

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26
Q

How is HER-2 low defined

A

HER IHC 1+ or 2+ FISH negative

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27
Q

Breast cancer pN1

A

1-3 LN +

If n2 or more this means >4 LN

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28
Q

Definition of AML

A

> 20% blasts

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29
Q

Philadelphia chromosome

A

t(9;22)

Also seen as t(9;22)(q34;q11)

P210- most common form of activating kinase region

Other adverse cytogenetics:
-trisomy 8
-trisomy 21
-isochromosome 17q
-chromosome 3 abnormalities
-second ph+
-deletion 7

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30
Q

Hallmark of APL

A

Blasts with t(15;17)

PML::RARA fusion

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31
Q

Core binding fx (AML)

A

inv(16), t(16;16), t(8;21 I.e., RUNX1)

add Gemtuzumab ozagamicin (don’t need CD33+ listed)

This is actually favorable risk (as is t(15;17)- so would NOT consolidate with HCT

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32
Q

APL risk stratification

A

Low/intermediate: wbc<10k
High: wbc>10k

Note: APL is M3 subtype of AML

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33
Q

NMIBC risk stratification

A

Low risk:
-Ta (low grade), solitary, <3cm

Intermittent risk:
-Ta (low grade): recurrence in <1y, >3cm, or multifocal
-Ta (high grade) <3 cm
-T1 (low grade)

High risk:
-Ta (high grade) recurrent, >3cm, multifocal
-T1: high grade
-Tis

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34
Q

Laboratory TLS criteria

A

2 or more of the following:
-UA>8
-phos >4.5 (6.5 for kids)
-k >6
-corrected ca <7 (or ionized<1.12)
-scr >1.5 ULN

Note: typically happens 12-72 hours after starting chemo (up to 7 days)

Note: increased risk with high LDH >2xULN or WBC>25k, BL renal impairment, BL elevated UA

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35
Q

In which diseases do patients have the Philadelphia chromosome ?

A

CML and ALL

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36
Q

Richters transformation

A

When CLL becomes an aggressive lymphoma:
-B symptoms
-lymphadenopathy
-highly symptomatic

-This usually occurred earlier (1-2yrs) than progressive CLL
-poor outcomes
-90% become DLBCL
-10% become HL

Get them to allo HCT (interesting bc this is DLBCL (90%) of HL (10%) which usually gets ASCT)

NOTCH1 mutation associated with this and shorter PFS

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37
Q

Which chronic leukemia is divided into 3 phases

A

CML

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38
Q

Gold standard definition of complete response in CML

A

0% Ph+ metaphases at 12 months (this is cytogenetic response)

Other types of response:
-hematologic (CHR)- measure blood counts
-molecular (EMR, MMR, DMR)-measures BCR::ABL

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39
Q

T315I mutation

A

CML resistance to imatinib, dasatinib, nilotinib, bosutinib

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40
Q

Follicular lymphoma cytogenetics

A

t(14;18)—>BCL-2

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41
Q

Mantle cell lymphoma cytogenetics

A

t(11;14)(q13;q32)—>BCL-1

CD5+, CD23-

Aggressive disease
-blastoid and pleomorphic subtypes
-TP53 mutatio
-high ki67 >20-40%
-high Sox-11
-complex karyotype
-high b2-microtubulin
-CNS involvement

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42
Q

Non-advance prostate risk groups

A

very low
-cT1c, grade 1 (Gleason 6), PSA<10, <3 bx cores + and <50% CA in each core, PSA density <0.15

low
-cT1-2a, grade 1, PSA<10

intermediate
-cT2b-cT2c, grade 2-3, PSA 10-20
-Favorable: 1 IRF, grade 1-2, <50% bx cores +
-unfavorable: 2-3 IRF, grade 3, >50% bc cores +

High risk
-T3a or grade 4-5 (grade 4 is Gleason 8), or PSA >20

very high risk
One or more of:
-T3b-T4, Gleason 5, >4 cores with grade 4-5, or 2-3 HRF

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43
Q

Multiple myeloma high risk and high risk cytogenetics

A

high risk dx
1. High risk cytogenetics
-del (17p)
-t(4;14)
-t(14;16)
-amplification 1q (>3 copies)
2. Circulating plasma cells in blood
3. extra-medullary plasmacytoma

gravitate towards KRD (carfilzomib)

MAY WANT DUAL MAINTENANCE (velcade + revlimid)
________________________________________

Others:
-t(14;20)
-gain 1q
-del 1p
-del 13q
-very high LDH (>2x ULN)

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44
Q

Clinical risk in BC

A

Remember 4 to determine high risk:

-grade 1, > 3cm
- grade 2 , >2 cm
-grade 3, >1 cm

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45
Q

Multiple myeloma diagnosis

A

BMPC >/=10% OR bx proven plasmacytoma/bone lesion

AND
Any of the CRAN criteria
Ca: >11 or >1 above ULN
Renal: scr >2, crcl<40
Anemia: <10 or >2 below ULN
Bone: 1+ bony lesion on imaging

OR
Any of the SLiM criteria
-BCPC >60%
-involved:uninvolved FLCR >/=100 (or<0.1)
- > 1 focal marrow lesion 5mm+ on mri (not just 1)
(Sixty, Light chains, MRI)

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46
Q

Double/triple hit DLBCL

A

MYC rearrangement, in addition to BCL-2 and/or BCL-6 rearrangements

High grade

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47
Q

Reed stern berg cytogenetics

A

CD15 and CD30

Hodgkin’s

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48
Q

Bulky disease DLBCL

Hodgkin’s?

A

NCCN: 7.5cm

Hodgkin’s: 10 cm

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49
Q

Breast cancer staging

A

Early stage: IA-IIA

Locally advanced: stage IIB-III

Advanced: stage 4

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50
Q

Gleason score

A

Grade 1: 3+3
Grade 2: 3+4
Grade 3: 4+3
Grade 4: 4+4
Grade 5: 4+5, 5+4, 5+5

-the first number is the most common grade among the cores, second number is next most common

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51
Q

Free PSA

A

Free PSA is associated with benign condition- so if low (<10%) it’s more likely prostate cancer

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52
Q

Define menopause

A

-bilateral oopherectomy
-60+ y/o
-<60 w/ 12 months amenorrheic
-can’t assign menopause status to women on LHRN antagonist or on chemo

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53
Q

Higher risk MDS

A

-IPSS: intermediate-2 or high risk

-IPSS-R: intermediate (>3.5), high or very high

-WHO: high or very high

Note SFB1 mutation is good risk

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54
Q

Types of thyroid cancer

A
  1. Differentiated
    -papillary- 89%
    -follicular- 4%
    -Hurthle cell -2%
  2. Medullary thyroid carcinoma- 3%
    -hereditary (MEN2)
    -sporadic (RET, usually RET M918T (somatic)
  3. Anaplastic thyroid cancer- 1.5%
55
Q

4 types of ovarian cancer

A

Epithelial adenocarcinomas
1. Serous (70%) most common
2. Endometriod (10%)
3. Clear cell (10%)- poor prognosis
4. Mucinous (3%)

56
Q

subtypes of ALL

A

-precursor B-cell
-mature B-cell
-T-cell
-pro-b cell (poor risk)

57
Q

PSA relapse

A

After surgery: any PSA rise (usually proceed to salvage RT)

After RT: increase of 2 from PSA nadir (nadir is 3-6 mo after RT)- assess for CS vs CR and PSADT

58
Q

Types of T-cell lymphoma

A

Indolent
-mycosis fungoides
-Sezary syndrome

Aggressive
-peripheral T-cell lymphoma (PTCL)
-extranodal NK/T-cell lymphoma

59
Q

Cholangiocarcinoma

A

Cancer of gallbladder or bile duct

60
Q

Cholangiocarcinoma

A

Cancer of gallbladder or bile duct

61
Q

Types of testicular cancer

A

Seminoma
-classical
-anaplastic
-spermatocytic

Non-Seminoma
-embryonal
-yolk sac
-choriocarcinoma
-teratoma

Stromal (usually beningn but bad if they spread bc unresponsive to chemo)
-leydig
-seratoli

62
Q

What are the four mmr proteins

A

-MLH-1
-MSH-2
-MSH-6
-PMS-2

There are DNA repair genes

63
Q

MSS and pMMR

A

MSS: Micro satellite stable

pMMR: MMR proficient

64
Q

ABCDEs of melanoma

A

Asymmetry
Borders are irregular
Color
Diameter >6mm
Evolving characteristics

Others:
-bleeding or crusting
-sensory change
-inflammation

65
Q

Carcinoma vs sarcoma

A

Carcinoma: epithelial tissue

Sarcoma: connective tissue

66
Q

TMB

A

Tumor mutational burden- measurement somatic mutations per coding area of tumor genome

67
Q

Main types of non-melanoma skin cancer

A

-Basal cell carcinoma
-squamous cell cancer
-Merkel cell carcinoma

68
Q

High risk colon cancer

A

T4 or N2

6 months of therapy better here

69
Q

MSI vs dMMR

A

dMMR (test w/ IHC) results in MSI (PCR)

Micro satellites are repeating deferments of DNA found throughout genome- can have lots of mutations bc lots of repeats. Leads to lots of diversity, but also mutations that can cause malignancy

MMR proteins repair mutations- if there is a loss of one of these (as in with hereditary syndromes) we can’t repair mutations and this can cause cancer

MMR deficient just means there’s and absence of these repair proteins. And this will result in MSI, which correlates with high mutational burden in the tumor

Note: it’s sometimes better to have high mutational burden bc it’s makes it easier for immune system to recognize- also note chemo may be bad is some cases bc it blunts the immune system and makes it harder for it to kill the cancer (think stage II colon cancer)

-MLH-1
-MSH-2
-MSH-6
-PMS-2

70
Q

Stage 2 colon cancer high risk factors

A

-poorly or undifferentiated
-lymphatic/vascular invasion
-bowel obstruction
-<12 LN surgically examined
-perineural invasion
-localized perforation
-close, intermediate, or positive margins
-tumor budding
-T4??

71
Q

Mycosis fungoides vs sezary syndrome

A

MF effects skin, SS effects skin but large amounts end up in blood- I think SS is basically more advanced- more systemic options upfront

72
Q

Hodgkin’s lymphoma: unfavorable factors for early stage

A

Any of these factors places pt in UNFAVORABLE category

-ESR 50+
-B symptoms
-mediastinal mass ratio (MMR) >0.33
->3 LN+
-bulky dx (any node >10 cm)

73
Q

CLL poor prognosis markers

A

-CD49d >30%
-CD38 >30%
-ZAP-70 >20%
-IGHV </=2% mutated (aka 98+% homologous with germline sequence)
-TP53 mutated (del17p)
-del(11q)

Note: del(13q) as sole abnormality is associated with good prognosis

74
Q

Carcinoma vs sarcoma

A

Carcinoma: Starts in epithelial tissue

Sarcoma: connective tisssue

75
Q

Hairy cell leukemia

A

-Indolent mature B cell leukemia
-Incurable
-nearly all pts have BRAFV600E mutation

76
Q

Oligometastatic

A

Limited metastatic disease (one or two sites)

77
Q

Extramedullary disease

A

Aggressive multiple myeloma that forms tumors outside bone marrow in soft tissue

78
Q

IDH wildtype astrocytoma

A

Considered grade 4

79
Q

Colorectal cancer screening

A

Starting at ages 45-75years:

-Colonoscopy every 10 years
-flexible sigmoidoscopy q5-10 years
-CT colography q5 years
-FIT-DNA test q1 or q3 years
-fecal occult blood or fecal immunohistochemisty (FIT) q1yr

80
Q

Lung cancer screening

A

(NCCN doesn’t include current smoker or quit in past 15 yrs)

50+ and 20 pack year hx

USPSTF includes quit it past 15 yrs

81
Q

CEA (notecard in progress)

A

-colorectal- monitoring response to tx

Greater than 5 is elevated

5FU can increase CEA

82
Q

Lung cancer screening

A

-50+ y/o and 20+ pack year hx

-low dose CT annually

(NCCN doesn’t include current smoker or quit in past 15 yrs)

USPSTF includes quit it past 15 yrs

83
Q

CML molecular response goals for

A

BCR::ABL1 as follows:

3 months: <10%
6 months: <1%
12 months: <0.1% (MMR-major molecular response)

84
Q

Who needs genetic testing

A

Pts with advanced or Metastatic cancer where there are mutations with approved drugs

So all advanced solid tumors- bc TMB, DMMR and NTRk

Testing includes direct tissue based (gold standard) as well as cfDNA (note that these aren’t great at detecting germline mutations)

85
Q

Prostate cancer screening

A

Don’t screen if <55 or >69 or LE<10 y

55-69 yr: shared decision making

86
Q

Breast cancer screening

A

ACS
45-54: yearly mammograms
55+: every other year (until LE<10y)

NCCN
40+: annual mammogram

Add MRI if BRCA of 1st degree relative or BRCA of yourself, or lifetime risk >20-25% (BRCAPRO or tyer cuzick), prior RT

Women 25+: breast awareness NOT self exams

High risk:
-CBE q6-12mo when identified as high risk but not before 21, or 8 y after RT
-mammogram annually starting at age 30 or: 8y after RT but not before age 30, 10 y before youngest family member but not before age 30, at diagnosis of LCIS/AHA but not before age 30, when identified as high risk by Gail model
-MRI annual w/ mammogram for women 25+ or: same exceptions as above fir mammogram
-breast awareness: all ages

High risk= thoracic RT age 10-30, 35+ w/ Gail >1.7%, bannayan-Riley-Ruvalcaba, cowdens (PTEN), li-fraumeni, lifetime risk 20%+ (BRCAPRO, tyrer cuzick, BOADICEA/CanRisk, pedigree suggestive or risk, ADH, LCIS

Also peutz jeghar (STK11)

87
Q

Cervical cancer screening

A

<21: no screening
21-29: cytology (pap smear): q3 y
30-65: pap q3y + hpv q5y or both q5y
66+: no screening unless high risk

HPV 16 and 18 cause cancer

88
Q

Endometrial cancer subtypes

A

Epithelia adenocarcinomas:
-Endometriod: most common, well differentiated, low grade
-serous, clear cell: poorly differentiated, and high grade, don’t use HT for these

-Carcinosarcoma aka malignant mixed mullerian tumor (MMMT)

89
Q

Which cancers is lynch syndrome associated with?

What’s another name for this?

A

Colorectal,gastric, small intestine, ovarian, endometrial, pancreas, liver, urinary tract, biliary tract, brain, sebatious tumors of the skin

Hereditary non-polyposis colorectal cancer

90
Q

HCC screening

A

-screen patients with cirrhosis or hepatitis B
-ultrasound and AFP every 3-6 months

91
Q

Breast cancer luminal A vs luminal B

A

Luminal A
-responds better to HT
-late recurrence

Luminal B
-responds better to chemo
-early recurrence

92
Q

FL, DLBCB, MCL, HL treatment categories

A

FL
-stage I-II contiguous
-stage II non-contiguous
-stage III-IV
-anything grade 3

MCL
-stage I or contiguous stage II, non-bulky
-stage II non-contiguous, non-bulky
-stage II bulky, stage III-IV

DLBCL
-stage I-II non-bulky
-stage I-II bulky
-stage II extensive mesenteric dx, stage III-IV

HL
-Stage IA-IIA favorable (non-bulky)
-stage I-II unfavorable (bulky or B symptoms)
-stage III-IV

93
Q

thyroid cancer tumor markers

A

Differentiated: Thyroglobulin (only if thyroidectomy since normal thyroid cells can secrete it also) Should look at Tg antibodies too

Medullary: CEA and calcitonin, NOT thyroglobulin

Anaplastic: none

94
Q

When to do brain MRI in testicular cancer?

A

HCG>5000, extensive pulmonary Mets, non-pulmonary visceral Mets

95
Q

Risk factors for deciding on tx for low grade gliomas

A

-age >40
-tumors >6 cm
-tumors that cross midline
-incomplete resection
-neurological deficit at baseline

96
Q

BCR-ABL tki resistance patterns

A

A337VT: no recs (resistance to Asciminib)

E255K/V: use bosutinib/dasatinib

F317L: use nilotinib

F317V/I/C: use bosutinib/nilotinib

F359V/I/C: use bosutinib/dasatinib

G250E: use dasatinib

L238V: use bosutinib/ nilotinib

P465S: no rec (resistance to Asciminib)

T315I: use Asciminib/omacetaxine/Ponatinib

T315A: use bosutinib/nilotinib

V299L: use nilotinib

Y253F/H: use bosutinib/dasatinib

Tricks:
-Fickle-little Vicky: you ain’t getting Nil
-Ayyyyyy: no recs!!!
-Fickle 317 VICky and TA loves a BoNe
-Fickle 359 Vicky eats yellow- BaD!
-Gee dassss
-

97
Q

Waldenstrom macroglobulinemia genetics with best response to BTK

A

MYD88 mutated (defining mutation of WM)

CXCR4 wildtype (mutated CXCR4 is associated with resistance)

98
Q

Saved score

A

Risks:
-age >80: +1
-surgery within 90d: +2
-VTE hx: +3
-dex 120-160 mg/cycle: +1
-dex >160 mg/cycle: +2

Protective:
-Asian: -3

2+: Lovenox 40 QD, Fonda 2.5 QD, Apix 2.5 bid, xarelto 10 qd, warfarin 2-3

<2: Asa 81-325 qd

—————-/////—————/////———
Impede risks:
-IMiD, bmi>25, pelvic/hip/femur fx, ESA, dex, dox or mx agent chemo, VTE hx, tunneled line or Cvc,

Protective; Asian, VTE ppx or Tx dosing

99
Q

Double expresser lymphoma

A

Co-expression (unlike double hit which is rearrangement if MYC and BCL2 proteins without underlying rearrangements

It’s and adverse prognostic indicator

100
Q

IPI variables for intermediate to high grade lymphoma

A

-age>60
-stage III-IV
-extranodal dx >1 site
-ECOG 2+
-serum LDH >1x ULN

101
Q

Burkitts low v high risk

A

Low:
-normal LDH
-stage I completely resected abdominal lesion
-single extra abdominal lesion <10 cm

High risk:
-stage I and an abdominal mass
-extra abdominal mass >10 cm
-stage II-IV

102
Q

Melanoma screening

A

Monthly self assessments

Survivors: skin exam at least once per year for rest of your life

103
Q

Lung cancer: who do we see EGFR mutations in?

A

Female, light or never smokers, asians

104
Q

Which malignancies have bi-modal age distribution?

A

-ALL
-Hodgkin’s lymphoma
-osteosarcoma
-germ cell tumors
-breast cancer

105
Q

Which malignancies have bimodal age distribution?

A

-ALL
-Hodgkin’s lymphoma
-osteosarcoma
-germ cell tumors
-breast cancer

106
Q

P16

A

-surrogate for HPV tumor in head and neck cancer
-results from RB1 degradation
-required at diagnosis of oropharyngeal cancers

107
Q

Cancers linked to EBV

A

-Hodgkin’s
-nasopharyngeal
-Burkitts
-gastric
-PCNSL
-DLBCL

think lymphomas

108
Q

Cisplatin eligibility in bladder cancer

A

-Crcl>60
-ECOG PS 0 or 1
-adequate hearing

109
Q

CA19-9

A

Monitoring (not screening) pancreatic cancer and other GI cancers

Elevated in biliary inflammation, obstruction, or infection so must wait til bili returns to normal to get accurate level

will be negative in Lewis negative blood group

110
Q

What does lynch syndrome tell you?

A

MSI-H!!!!

111
Q

Colon ascending/descending left v right sided

A

Ascending and transverse (hepatic flexure to splenic flexure- right

Descending (splenic flexure to rectum), sigmoid- left

112
Q

Ovarian cancer screening

A

-Don’t do in general population
-for women with BRCA mutation who won’t do risk reducing saplings oophorectomy at age 35-45
-do transvaginal ultrasound and CA-125 beginning age 30-35

Note: oral contraceptives decrease risk (but increases risk of breast cancer)

113
Q

Define metachronus

A

Had disease and was treated earlier, now pops up with metastatic disease

114
Q

Who gets screened for endometrial cancer

A

-Women with lynch syndrome
-endometrial biopsy every 1-2 years starting at age 30-35 years old

Recommend BSO and hysterectomy after child bearing

115
Q

Match syndrome to gene:
autosomal dominant
Hereditary diffuse gastric
Peutz Jeghers
Juvenile poly posits
Lynch (hereditary non-polyposis colon CA)
Familial adenomatous polyposis
Hereditary breast and ovarian CA synd
Li fraumeni
Cowden
Autosomal recessive
Bloom
Fanconi

A

Match syndrome to gene:
Hereditary diffuse gastric: CDH1
Peutz Jeghers: STK11
Juvenile polyposis: SMAD4 or BMPR1A
Lynch: you know
Familial adenomatous polyposis: APc
HBOCS: BRCA1 or BRCA2
Li fraumeni: TP53
Cowden: PTEN

Autosomal recessive
Bloom: BLM/RECQL3
Fanconi: FABCD1, BRCA2, FANCN (PALB2)

Other idk:
-werner: RECQL2
-gorlin: PTCH1
-Tuberous sclerosis: TSC1/2
Gardner: APC

116
Q

Gastric cancer risk fx

A

-CDH1 loss
-h. Pylori
-high salt

117
Q

Child Pugh A

A

Score of 5-6 or less

2 Points for:
-bili>2
-albumin <3.5
-INR>1.7
-ascites
-encephalopathy

Minimum score is 5 bc 1 point automatically- for each, so basically look for any 2 of the above or less if really severe

118
Q

Benign brain tumors

A

-Meningioma
-schwannoma
-pituitary adenoma

119
Q

Differentiating b/w chronic, accelerated and blast phase CML

A

Chronic: blasts<10%
Accelerated: blasts 15-30%, basophils >20%, plt<100
Blast: >30%

120
Q

Gelf criteria

A

When do treat follicular lymphoma:
-3 LN+ each 3+ cm
-any node or mass 7cm+
-splenomegaly
-organ compression
-B symptoms
-cytopenias (wbc<1, plt<100)
-leukemia (>5k malignant cells)
-pleural effusion or ascites

121
Q

Aggressive variant prostate cancer

A

AVPC-C: small cell, exclusively visceral Mets, predominantly lyric bone Mets, bulky lymphadenopathy or Gleason 8+, psa<10 + 20+ bone Mets, elevated ldh or CEA, <6 months response to ADT

AVPC-MS: defect in 2 of 3 tumor suppressor genes: TP53, RB1, PTEN

122
Q

Another name for Waldenstroms macroglobulinemia

A

Lymphoplasmacytic lymphoma

123
Q

What does CD34 mean?

A

Blast

124
Q

AML favorable risk

A

-core binding fx
-NPM1 (without FLT-3)
-t(15;17)
-in frame bZIP in CEBPA

125
Q

Tumor markers in non-seminoma subtypes

A

Embryonal- HCG and AFP
Yolk-sac- AFP
Choriocarcinoma- HCG
Teratoma- none

126
Q

How to assess for response to AML induction

A

Bone marrow at day 14 to see that blasts <5%, then upon recovery (ANC >1000, plt>100k) repeat marrow to confirm still at blast <5%, then you can do consolidation

127
Q

EGFR rash grading

A

Grade 1: <10% bsa

Grade 2: 10-30% bsa or >30% mild or no symptoms

Grade 3: >30% with symptoms limiting ADLs

Grade 4: life threatening or superinfection requiring iv abx- Any amount of bsa

128
Q

Auer rods

A

AML

129
Q

CD10

A

B-ALL

Also CD19 and CD20

130
Q

CML risk fx

A

Radiation

131
Q

CML risk fx

A

Radiation

132
Q

Cancer associated with HIV

A

-Kaposi sarcoma
-Hodgkin’s lymphoma
-NHL (Burkitts, PCNSL esp.)
-cervical

133
Q

Radioactive iodine scan

A

-I-131
-thyroid cells take up iodine to make thyroid hormone
-suspicious areas don’t take it up
-iodine free diet before to avoid messing with results
-stop levoxyl before bc works better with high TSH (give thyrotropon before)

134
Q

Cancers linked to hpv

A

Cervical, vaginal, vulvar, penile, anal

Oropharyngeal, esophageal

BCOP- Joey (11 decks)

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