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Emma Heme/Onc > Lab Dx of Cancer, Intro to Hematologic Malignancies, Acute Leukemias > Flashcards

Lab Dx of Cancer, Intro to Hematologic Malignancies, Acute Leukemias Flashcards

1
Q

PSA

A

early detection/screening

men over 50, poor specificity for cancer

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2
Q

alpha-fetoprotein

A

diagnostic, assess for presence of testicular cancer

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3
Q

ER
HER2
KRAS

A

Predictive: Effective drug therapy

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4
Q

CEA

carcinoembryonic antigen

A

Post-Therapeutic Monitor: Detect tumor recurrence

colorectal cancer

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5
Q

BRAC1

A

Risk Stratification: Chance of getting cancer

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6
Q

k-ras mutation

A

Predicts lack of therapeutic response to a specifc drug

Testing should be done in all pts w/ metastatic colorectal cancer

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7
Q

Absence of MLH-1

A

raises possibility of inherited tumor susceptibility in the family

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8
Q

CA-125

A

ovarian cancer screening

can also be elevated in normal post-menopausal women

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9
Q

genetic diseases inc risk of hematologic malignancy

A

Down syndrome Klinefelter syndrome
Wiskott-Aldrich syndrome
Bloom syndrome Fanconi anemia neuroqbromatosis ataxia telangiectasia

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10
Q

viral infections inc risk of hematologic malignancy

A

EBV
HTLV
HHV-8
HIV

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11
Q

bacterial infections inc risk of hematologic malignancy

A

H. pylori

–> gastric MALT lymphoma

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12
Q

most significant tumor suppressor gene

A

p53

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13
Q

fluorescence in situ hybridization

A

each normal chromosome produces 2 dots

monosomy –> 1dot

trisomy –> 2dots

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14
Q

flow cytometry

A

uses Abs labeled to recognize cell surface antigens

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15
Q

most common childhood cancer

A

ALL

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16
Q

genetic disorders that are risk fx for acute leukemia

A 
Down
Klinefelter
Turner
Neurofibromatosis
Fanconi anemia
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17
Q

leukostasis

A

stasis of blood in cerebral/pulm circulation

blast >50,000

HA, visual change, confusion, stroke, coma (cerebral)

dyspnea, tachypnea, hypoxia

AML>ALL

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18
Q

ALL extra-medullary manifestations

A

lymphadenopathy
splenomegaly
mediastinal mass

leukemic meningitis rare at dx, CNS = common site of relapse

testes

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19
Q

AML extra-medullary manifestations

A

leukemic cutis
gingival hypertrophy
chloromas (green tumor of blasts)

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20
Q

ALL metabolic abnormalities

A

tumor lysis syndrome

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21
Q

AML metabolic abnormalities

A

hypOkalemia (via renal tubular damage by enzyme released from myeloblasts)

hypOglycemia (artificial finding due to metabolic activity of blasts in blood tube after draw)

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22
Q

WHO dx of AML

A

> 20% blasts in bone marrow

+ cytogenetic findings

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23
Q

Auer rods

A

linear aggregates of primary granules seen only in myeloblasts

24
Q

myeloblast nucleoli

A

single-multiple

25
Q

lymphoblast nuclei

A

less conspicuous nucleoli

26
Q

AML stains

A

lysozyme
myeloperoxidase
non-specific esterase

27
Q

ALL stains

A

terminal deoxynucleotidyl transferase (TdT)

28
Q

AML cell surface antigens

A

CD13
CD33
CD117

29
Q

ALL cell surface antigens

precursor B cell

A

CD10
CD19
CD20

30
Q

ALL cell surface antigens

precursor T cell

A 
CD2
CD3
CD4
CD5
CD7
CD8
31
Q

acute leukemia transfusion support

A

required for effective support

platelets (count of 10,000 is threshold)

leukocyte depleted

irradiated

32
Q

leukostasis

A

IV fluids
leukapheresis
hydroxyurea to reduce leukemic burden
steroids helpful if ALL

avoid rbc transfusion (inc viscosity)

33
Q

DIC tx during acute leukemia

A

replace clotting fx w/ FFP

replace fibrinogen w/ cyroprecipitate

platelet transfusion

34
Q

tumor lysis syndrome tx during acute leukemia

A

IV hydration for rapid saline diuresis

allopurinol to prevent accumulation of uric acid

RASBURICASE

hemodialysis if renal failure

35
Q

rasburicase

A

catalyzes oxidation of uric acid to soluble allantoin

36
Q

AML poor prognosis factors

A

older age

11q23 (MLL)

deletions of 5/7 (alkylating agents)

multiple cryogenic abnormalities

hx of BM disorder

37
Q

AML favorable risk cytogenetics

A

t(15;17)

core binding factors

38
Q

AML intermediate risk cytogenetics

A

normal karyotype

39
Q

AML therapy-related AML from chemo

A

alkylating agents (4-6 yr post exposure)

topoisomerase II inhibitors (1-3 yr post exposure)

poor prognosis, unfavorable risk

40
Q

AML curative therapy

A

induction (quickly restore normal hematopoiesis)

post-remission (consolidation, eradicate residual leukemia cells)

41
Q

most common AML induction regimen

A

cytarabine + anthracyline

daunorubicin, idarubicin

42
Q

AML complete remission

A

<5% blasts in BM w/ recovery of normal hematopoiesis and resolution of all extra medullary infiltrates

43
Q

acute promyelocytic leukemia

A

t(15;17)
or detection of PML/RAR

younger pts
leukopenia
often DIC at dx

44
Q

APL tx

A

ATRA (all trans-retinoid acid), vitamin A analogue

ligand for RAR receptor, binds PML-RAR fusion protein

restores transcription of genes allowing differentiation

NO lysis of blasts/marrow aplasia

45
Q

APL differentiation syndrome

A

leukocytosis
fever
pulm infiltrates

fatal if not recognized and tx w. steroids

46
Q

arsenic trioxide (ATO)

A

induces apoptosis in APL cells and targets PML/RAR fusion protein –> differentiation

47
Q

standard tx for APL

A

ATRA

anthracycline for induction

48
Q

maintenance tx for ATRA and oral anti-metabolite

A

long-term remission in 70%

49
Q

ATO w/ ARTA

tx for what?

A

acute promyelocytic leukemia

50
Q

ALL poor prognosis

A

infants/adults

t(9;22) Philadelphia

translocations (MLL, on 11)

hypOploidy

T cell

boys

51
Q

ALL good prognosis

A

1-9 y/o

t(12;21)

hypERploidy

normal cytogenetics

B cell immunophenotype

girls

minimal residual disease at end of induction tx

52
Q

ALL induction therapy

A

multi-agent chemo

anthracycline vincristine glucocorticoid
L-asparaginase
cytarabine
cyclophosphamide
methotrexate

tyrosine kinase inhibitors in Ph+

53
Q

_____ is a sanctuary site for leukemic blasts

A

CSF

54
Q

to prevent relapse, CNS prophylaxis in ALL includes

A

intrathecal chemo with or without craniospiral irradiation

55
Q

ALL maintenance therapy

A

prolonged chemo (shown to extend survival/improve cure rates)

Emma Heme/Onc (16 decks)

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