Heme/Onc Flashcards by Jesse Schenendorf

CLL Staging

Stg I: Increased lymphocytes, possibly lymphadenopathy
Stg II: splenomegaly
Stg III: anemia
Stg IV: Thrombocytopenia

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Bad prognostic signs in CLL

Stg III or IV
B2 microglobulin >3.5
Unmutated heavy gene
ZAP 70 +
deletion of 17p

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CLL treatment

Start if poor prognostic features or symptomatic
Treatment focus on fludarabine chemo with rituximab
Definitive treatment would be HSCT

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Hormone therapy in breast cancer

For PRE-menopausal women need to use tamoxifen (blocks ER receptor)
For post-menopausal use aromatase inhibitors (peripheral conversion of androgen to estrogen)

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Management of anal cancer

If it is Stg I, II or III best managed with radiation and chemotherapy (mitomycin plus 5-FU) rather than surgery

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Management of rectal cancer

Surgery, if stg II or III treat with radiation and chemo before surgery. After surgery get FOLFOX.

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Management of Hodgkin Lymphoma

Curable at all stages. Treat with ABVD (Doxo, bleomycin, vinblastine, and dacarbazine) and radiation. Rituximab can be used in lymphocyte predominant CD20+ variants.

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Lung mets from CRC

If recurrent as a lung mass would resect it!

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Treatment of ovarian cancer

Stage IA is just surgery alone. IC or higher would get adjuvant chemo. II and III would get intraperitoneal chemo as well.

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Treatment of papillary thyroid cancer

If Stage III or IV needs treatment with radioactive iodine. Stg III tumors are >4 cm in size and and might have cervical lymph node involvement

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Surveillance after Stg III CRC

CEA monitoring every 3-6 months
Colonoscopy in 1 year and then every 3-5 years
CT chest/ab/pelvis annually for 3-5 years

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HIT management

Discontinue heparin

Anticoag with lepirudin, argatroban or danaparoid. Lepirudin is renally cleared. Argatroban is hepatically cleared

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Management of Stg IV NSCLC

No radiation unless to a targeted met, chemo only

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Diagnosis of Lynch syndrome (HNPCC)

3-2-1 rule for colon cancer and HNPCC:
3 affected family members
2 generations
1 under the age of 50

These patients should start screening by 20-25 years old or 10 years before first family member dx

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Testicular cancer dx tests

Obtain:
alpha-fetoprotein (if present it is a NON-seminoma)
B HCG (either)
LDH

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Management of gastric carcinoid tumors

Type I: Small

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Alpha thalassemia trait presents as

Mild anemia, microcytosis, hypochromia, target cells and in ADULTS normal hemoglobin electrophoresis. B thalasemia will NOT have a normal hemoglobin electrophoresis

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Danazol

can be used to treat primary myleofibrosis anemia

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Treat acquired factor VIII deficency

Can use activated factor VII. Do not need to use FFP or cryo

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Management of prostate Ca

If it has extended beyond the prostate, PSA >20 or Gleason 8 or 10 NOT a candidate for surgery. Use androgen deprivation and brachy therapy

Beta thalassemia trait

microcytic, hypochromasia and target cells. Will have normal or slightly increased erythrocyte count

Mentzer index

Ratio of MCV/erythrocyte count, 13 then iron def

Recurrent breast cancer

Want to biopsy it to see what the receptor status is to see if they are suitable for hormone therapy, etc

B12 v Folate deficency

with B12 both homocysteine and methylmalonic levels will be elevated

Atra side effect

Can have ATRA induced differentiation syndrome which manifests as dyspnea, peripheral edema, wt gain, fever, hypotension, AKI, effusions. Treat with dexamethasone

Hemophilia B

PT will be normal. aPTT will be prolonged and correct with a mixing study. Lack Factor IX

Hemophilia A

PT will be normal. aPTT will be prolonged and correct with a mixing study. Lack factor VIII.

Acquired factor VIII inhibitor

PT will be normal. aPTT will be prolonged and NOT fully correct with a mixing study,

Hereditary spherocytosis

Will see sphereocytes (red balls), splenomegaly, leg ulcers, gallstones and family history of anemia

Small cell lung cancer treatment

If patient responds to chemo and radiation would then give whole brain radiation

Treatment of MALT

If H pylori positive treat for this first. If not responsive than can consider rituximab or chemotherapy

Gastric carcinoid treatment

Type I and type II gastric carcinoids (associated with hypergastrinemia resulting from chronic atrophic gastritis or gastrinoma, respectively) account for approximately 70% to 80% of these tumors and have a relatively favorable prognosis. Endoscopic resection may be adequate for smaller lesions (≤2 cm)

Aplastic anemia treatment

- stem cell transplants for those

Iron deficiency versus anemia of chronic disease

- a serum ferritin of >100 rules out iron def - serum iron low in both - TIBC high in iron def, low in anemia of chronic disease

An increased PT with normal aPTT

Factor VII deficiency (warfarin)

Myelofibrosis and the spleen

DO NOT perform a splenectomy

Myelodysplastic syndrome

- clonal disorders of hematopoietic stem cells that can progress to leukemia - look for clones with chromosomal abnormalities - if 5q-deletion syndrome treat with lenalidomide

Treatment of CLL (detailed)

- Young patient stg III/IV: fludarabine, cyclophosphamide and rituximab - Old patient stg III/IV: chlorambucil

Treatment of hairy cell

cladribine

AML and lymphadenopathy?

NO lymphadenopathy with AM

Cytogenetics in AML

Good: t(8;21), t(15;17), inv(16), or t(16;16) Bad: loss or deletion of chromosome 7

APML

- see t(15;17) | - treat with ATRA

HER2 + breast cancer treatment

Avoid giving trastuzumab in combination with anthracylines (doxorubicin) d/t increased risk of cardiac toxicity

Hyperplastic polyp on colonoscopy?

Screen every 10 years as usual

Symptoms with endobronchial carcinoid?

NO carcinoid syndrome. Carcinoid syndrome can happen when mets are in the liver.

BRAF gene mutation

Specific for papillary thyroid cancer

RET gene mutation

Associated with medullary thyroid cancer

Radioactive iodine treatment in thyroid cancer?

Only works for papillary and follicular as medullary comes from C cells that do NOT take up iodine

Elevated calcitonin?

Think medullary thyroid cancer