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Oncology > IPAP Senior Onc > Flashcards

IPAP Senior Onc Flashcards

1
Q

What are examples of cancers that are hematologically spread

A

Sarcomas of the Liver and Lungs

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2
Q

Define a benign tumor

A

Remains in the pr ray location; well defined; well differentiated; abnormal growth without Mets.

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3
Q

What are the two reasons for cancer

A

Sporadic and hereditary

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4
Q

What is a proto onco gene

A

Gene proliferation growth factor

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5
Q

What is the #1 modifiable risk factor that predisposes someone to cancer

A

Cigarette smoke

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6
Q

Where do cancers often manifest in alcoholics

A

Liver
Head
Neck
Esophagus

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7
Q

What is screening grade levels ABCDI

A

A;B = recommend
C= clinical judgement
D = not recommended
I = No evidence

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8
Q

What are the 5 common cancers

A

Breast
Colon
Cervical
Lung
Prostate

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9
Q

What is the best primary prevention for cancer

A

Screening!

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10
Q

What kind of cancers are associated with EBV

A

Nasopharyngeal

B-cell

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11
Q

What is the recommendation for breast cancer screening

A

Mammography ever 2 years b/w the age of 50-74

WITHOUT CBE / SBE

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12
Q

What is the recommendation for colorectal screen

A

Colonoscopy Screen @
A) 50 yrs
B) 45 yrs

OR

High Risk at 40 years or 10 years before family member with a 5 year repeat

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13
Q

What is the cervical cancer screen criteria

A

21-29 yrs every 5 years w/ HPV test combo STOP: @ 65 yrs or hysterectomy

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14
Q

Prostate screen recommendation

A

DRE + PSA = best test
C- recommendation between age of 55-69 years old

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15
Q

Lung cancer screen recommendation

A

50-80 yrs
CT w/ 20 pack yr Hx or if they stopped smoking within the last 15 yrs

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16
Q

Tumor markers :

AFP
CA125
CA19-9
CEA

A

Liver
Ovarian
Pancreatic
Colon pancreatic breast

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17
Q

What is the best staging system

A

TNM

T= size and extension

N= absent or present NODES

M= absent or present METS

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18
Q

Define polycythemia

A

Increase in all blood cells (RBC’s most)
60 yrs old common
+/- plethora / PUD
Splenomegaly

“Aquagenic Pruritis”

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19
Q

Labs for polycythemia (4)

A

Increased Hct / WBC increased
Peripheral = NML Smear
EPO = LOW
Serum Irone Low

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20
Q

What is the confirmatory test for polycythemia

A

JAK2 mutation

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21
Q

What painful dz process is also associated with polycythemia

A

Gout ;
From : increased Uric acid and B12

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22
Q

What is good txm for polycythemia

A

Phlebotomy
+/- low dose ASA
Allopurinol for GOUT
Antihistamines for PRURITIS

Hydroxyurea : refractory txm

Roxolitinib : JAK2 Inhibitor

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23
Q

What progression of polycythemia is lethal

A

AML

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24
Q

What is the goal platelet and neutro’s for polycythemia

A

Platelets below 500 K
Neutro’s above 2 K

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25
Q

Essential thrombocytopenia dz characteristics

A

NML life expectancy
50 -60 yrs BM = megakarocytes
Erythromyalgia (Burning Hands)
Levied o Reticularis
Mucosal Bleeding
Splenomegaly
+/- HA/ Vision changes

Increase in PLATELETS on CBC (over 2mil)

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26
Q

When should you suspect essential thrombocytopenia

A

Thrombos:

Mesenteric
Hepatic
Portal vein

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27
Q

What are labs for essential thrombocytopenia

A

CBC = Hct NML
Platelets over 2 mil

BM= megakarocytes

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28
Q

What is good txm for Essential thrombocytopenia

A

Hydroxyurea (Cytotoxic to platelets)

ASA(dec thrombi events)

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29
Q

CML dz process

A

Multipluripotent stem cell dz w/ BCR/ABL gene
Oncogenes with increased leukocytosis
+Philly chromosome

TRIPHASIC = Chronic/Accelerated/Blast

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30
Q

Define the triphasic process of CML

A

Chronic = Anemic WBC avg 150K peripheral smear = NML RBC Morphology Blasts = less than 10% avg = 5% Fever Chills Bone Pain.

Accelerated = progresses to anemia 10-20% blasts; TTP increased myeloid blasts

Blast Crisis = marrow overdrive EOD more than 20% blasts

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31
Q

Clinical presentation of CML

A

Bravo + with ABD FULLNESS
Sternal tenderness due to marrow overload
LEUKOCYTOSIS over 100K

Later = blurred vision resp. Distress priapism

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32
Q

TXM for CML

A

Chronic = stay here!
TKI = Imatinib/Nilotinib
Splenomeg. = better @ 3 months

Hydroxyurea = for the leukocytosis
Stem cell transplant to suppress the cell division

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33
Q

What is the dz process of myelofibrosis

A

BM replaced with fibrotic tissue by : megakarocytes
+DACROCYTES

TOO MUCH COLLAGEN = NO NORMAL CELL TISSUE

First = Fatigued Spenomeg then Hepatomeg w/ mild wt loss

Late = cache is satiety portal HTN cirrhosis

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34
Q

Labs for myelofibrosis

A

CBC = anemia
POIKOLOCYTOSIS

+ Dacrocytes

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35
Q

What are four cardinal bravo sxs

A

Fever
Chills
Night sweats
Wt loss

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36
Q

TXM for myelofibrosis

A

+/- androgens
1st Line = Hydroxyurea for splenomeg.

2nd Line = Roxukitinib = high risk TXM JAK2 inhibitor

3rd Line= Allogenic stem cell

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37
Q

Acute leukemia dz process
AML vs ALL

A

AML = + Auer Rods ; Gingival Hypertrophy MYELOID cells DOE

ALL = Kids; LYMPHOID cells + CNS sxs

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38
Q

Labs for AML

A

CBC = anemia
Reticular count low
TTP Abnormal WBC’s
Neutropenia

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39
Q

Labs for ALL

A

TTP
Anemia
Abnormal high WBC release

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40
Q

CLL dz process

A

Uncontrolled prol of maturing lymphocytes
+/- immune hemolytic anemia w/ +COOMBS test

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41
Q

Labs for CLL

A

CBC = peripheral smear wiht increaed lymphocytes

BM Biopsy confirm

42
Q

What is the richter transformation

A

Increased LDH with worse prognosis
Rapid progressive lymphadenopathy with TTP and Anemia

ISO B-celll lymphadenopathy

43
Q

TXM for CLL

A

Observe 1st; no cure
Active Dz (BM dysfn/Splenomeg/Lymphocytosis)
= CHEMO

44
Q

What CLIN presentation best describes CLL

A

ASX + Lymphadenoapthy
Splendor/Hepatomeg
Bravo + = worse dz

45
Q

NON HODKINS dz process

A

Heterogenous enlarged lymph nodes with varied presentation

B cell d/o primarily

Low grade and High grade

46
Q

Describe indolent NON HODGKINS

A

Hepatosplenomeg. with slow lymphadenopathy w/ MALT From Acute(h.pylori) or Chronic(Sjorgens)

47
Q

Describe aggressive NONHODKINS

A

Fever chills
TUMOR LYSIS SYNDROME
Burkitts = quick high grade swelling EBV infection

48
Q

What is stage 3 non hodgkins

A

Bravo sxs with significant NHL
Nodes below diaphragm
Bulk over 10 cm

49
Q

What predisposes poor prognosis for Non-HODKINS (5)

A

Age over 60 years
LDH high
Stages 3-4
2+ Extranodal spread
Poor response to txm

50
Q

Dz process of Hodgkin’s lymphoma

A

PAINLESS neck mass with hilar lymphad. Central and supraclavicular nodal spread

BIMODAL age distro

Nodular Mixed Rich Depleted

51
Q

HODGKINS can be due to what kind of infection

A

EBV / HIV

52
Q

Presentation of hodgkins

A

Painless singularly node [cerv/Supra/axilla]
Pruritis and excoriations after ETOH

Asx cough retracted chest pain

53
Q

Labs for hodgkins

A

R/o infxn

Smear = +REED STERNBERG cells

54
Q

Stage differences for Lugano hodgkins

A

2a = absent
2b = bravo sxs

Stage 3 = below the diaphragm

55
Q

What 5 things are poor prognostics for hodgkins

A

Liver Mets
Severe anemia
HGB low w/ albuminemia
WBC greater than 15K
Stage 4

56
Q

TXM hodgkins

A

Stage based.
Chemo : ABVD full course = stage 3/4

Stage 1/2 = chemo + rads

57
Q

What is plasma cell dyscrasia

A

Clonal disorder of plasma cells with MM as the end result

58
Q

What does plasma cell crisis define

A

Stage of severity

59
Q

What are on the light chains and heavy chains

A

Light = kappa and lambda

Heavy = class determinate

60
Q

What is the def of monoclonal

A

Proliferation of single type of Ig

61
Q

What assay is abnormal and defines dz in plasma cell dyscrasia

A

FLC-Assay

62
Q

Dz process of MGUS

A

Monoclonal gammon. Of undefined sign. Less than 10% mc abs in the BM
NO EOD

Elderly with unexplained HyperCa+

Vague sxs

63
Q

What is positive in MGUS

A

Bence jones proteins on SPEP or UPEP

64
Q

6 red flags of progression in MGUS

A

General weakness
Bleeding
Neuro sxs
Lymph.
Bravo+
Lymphadenopathy

65
Q

MGUS mgmt :

A

@ 6 months post dx and then annually SPEP/UPEP Ca2+ Renal with imaging as needed

66
Q

Dx for MGUS

A

FLC-Assay
Skeletal survey
CBC/CMP
SPEP/UPEP

67
Q

Smoldering Myeloma dz process

A

Low level indolent
10-60% mc cells
NO EOD
M protein greater than 3g/dL or equal.

68
Q

How often do you monitor smoldering myeloma

A

3-4 months

69
Q

Plasma cell myeloma dz process

A

MM
Medullary bone cavity cancer
Bone Pain
Anemia
Renal Insuff.
Pelvis
Ribs
Spine (Cord compression)

70
Q

What mc cell quantity defines MM

A

Greater than 60% clonal plasma cells OR plasma cytoma

w/

CRAB SLiM

71
Q

What is CRAB SLiM

A

Ca2+ greater than 11
Renal insuff. (CrCl over 2; GFR under 40)
Anemia less than 10
Bone Lesions greater than 5

Sixty Clonal cells
Light chains
MRI shows more than 1 lesion

72
Q

Lytic lesion with EOD clonal exp of plasma cell

A

MM

73
Q

What toxin can predispose you to plasma cell myeloma

A

Agent Orange Vietnam

74
Q

What defines sup vena cava syndrome

A

Obstructed BF by Tumor invasion
venous blood to the rat atrium dilated over weeks =

Upper body edema
Plethora and facial swelling

75
Q

What is the MC syndrome assoc with lung cancer

A

Sup vena cava syndrome

76
Q

What are 3 outcomes from sup vena cava syndrome

A

Cerebral edema
Laryngeal involvement
Pain increases with bending over or laying down

77
Q

What is the def dx of sup vena cava syndrome

A

Contrast venography

78
Q

What is 1st and 2nd line txm for sup vena cava syndrome

A

Endogenous recontstruciton with a stent

Thrombolysis

79
Q

What is evaluated in the arm in sup vena cava syndrome

A

Venous pressure over 20cm in the arm

80
Q

What is seen on peripheral smear for MM

A

Rouleaux (stacking RBC’s)

81
Q

What is spinal cord compression

A

Neoplastic epidural cord compression
HIGH neuro complications
INSIDIOUS radicular back pain-Elderly
URGENT +/- damage to myelin sheath w/ neuro imp.
WORSE if you lay down
+/- bowel bladder sxs (later)

82
Q

What can spinal cord compression progress to

A

Cauda equina

83
Q

What type of reflexes happen in cauda equina

A

Hyporeflexia

84
Q

Where should you get the MRI for spinal cord compression

A

Lumbar Thoracic Cervical

85
Q

Txt for unknown cancer spinal cord compression

A

IV/PO Dexamethasone Taper
Def: surgery/rads/chemo

86
Q

TXT fro known cancer spinal cord compression

A

Surgery w Neuro consult ASAP

87
Q

Febrile neutropenia dz process

A

Iatrogenic from CHEMO

Fever over 100.4F or 38C for longer than 1 hour with cancer
+ decreased neutrophils

88
Q

Mild mod severe febrile neutro count

A

Mild =1500-1000
Mod = 500-1000
Severe= less than 500

89
Q

Txt for febrile neutropenia

A

Broad spectrum

Cefeoime
Carbamazepine
Pipercillin Tazo

90
Q

When does febrile neutro get anti fungals

A

Condition consists for longer than 4-7 days

91
Q

3 anti fungals for febrile neutro

A

AMPHOTERICIN B
Itraconazole
Capsfungin

92
Q

Sxs for hyperca+ are what?

A

BONES
MOANS
GROANS
OVERTONES

93
Q

What us high in hyperca2+ with low normal PTH

A

PTHrp and potentially Vit D

94
Q

TXM for hyperca2+ assoc. with cancer

A

IV Fluids
IV Furosemide
IV Bisphosphonates
Calcitonin

THEN -CANCER TXM

95
Q

2 types of hyper ca 2+

A

Cancer (PTHrP)

Local(osteopathic w/ clastic activity)

96
Q

Abundant electrolytes in blood stream with chemo therapy can lead to what

A

Tumor lysis syndrome

97
Q

What dz process can lead to tumor lysis syndrome

A

Non hodkins burkitts lymphoma (indolent)

98
Q

What is released in TLS

A

Nucleic acids
Proteins
Phosphate
Potassium

99
Q

What can result from TLS

A

HyperKa+
Hyperuricemia
Hyperphosph.

100
Q

TXM for TLS

A

Aggressive hydration
Allopurinol before chemo (for hyperuricemia)
Rasburicase (for Hugh grade lymphomas with increased WBCs and refractory to allopurinol

101
Q

What are contras to rasburicase

A

Pregnant
Lactating
G6PD

102
Q

When are opiods given for pain mgmt of cancer

A

Short acting fro 24-48 hours or break through sxs control to block transmission of pain

Oncology (1 decks)

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