Onc - Lymphomas

Question 0

Non-Hodgkin Lymphoma staging? And treatment?

Answer 0

Stage:
1 - lymph node group (chemoradiation)
2 - 2 or more lymph node groups on same side of the diaphragm (chemoradiation)
3 - both sides of diaphragm (CHOP and rituximab)
4 - widespread disease (CHOP and rituximab)

Question 1

Patient with suspected non-Hodgkin’s lymphoma – best initial test? CBC finding? Lab that correlates with worse severity? Staging procedures?

Answer 1

Excisional biopsy (not needle aspiration)

Normal CBC

High LDH

CT of chest-abdomen-pelvis and bone marrow biopsy

Question 2

CHOP?

Answer 2

C – cyclophosphamide
H - Adriamycin (hydroxydaunorubicin)
O – vincristine (Oncovin)
P – prednisone

Question 3

Hodgkin lymphoma – smear will show? Prognosis based on?

Answer 3

Read-Sternberg cells

Lymphocyte predominant – best prognosis
Lymphocyte Depleted – worst prognosis

Question 4

Treatment for Hodgkin lymphoma?

Answer 4

Stage 1 and 2 – chemoradiation

Stage 3, 4, or anyone with constitutional symptoms: ABVD
Adriamycin
Bleomycin
Vinblastine
Dacarbazine

Question 5

Risks of radiation?

Answer 5

#Solid tumors (breast, thyroid, long)
#Premature coronary artery disease

Question 6

Female Patient undergoes chemoradiation for Hodgkin’s lymphoma – future cancer screening?

Answer 6

Breast cancer screening eight years after treatment

Question 7

Adverse affects of:

1. Doxorubicin
2. Vincristine
3. Bleomycin
4. Cyclophosphamide
5. Cisplatin

Answer 7

1. Cardiomyopathy
2. Neuropathy
3. Lung fibrosis
4. Hemorrhagic cystitis
5. Renal and ototoxicity

Question 8

Immunoglobulins in multiple myeloma versus Waldenström macroglobulinemia?

Answer 8

IgG/IgA versus IgM

Question 9

Patient with suspected multiple myeloma – initial test?

Answer 9

X-ray for lytic bone lesions

Question 10

Marker that corresponds with the severity of multiple myeloma?

Peripheral blood smear finding?

Definition of myeloma?

Answer 10

Beta-2 microglobulin

Rouleaux

Greater than 10% plasma cells in bone marrow

Question 11

Anion gap in myeloma?

Answer 11

Decreased (IgG is catatonic, increasing Cl and bicarb levels)

Question 12

Finding of technetium bone scan in multiple myeloma?

Nuclear bone scan?

Answer 12

Normal – lytic lesions do not pick up nuclear isotope

Increased uptake

Question 13

Medical Treatment for multiple myeloma? Best therapy?

Answer 13

Combination dexamethasone with Lenalidomide

Bone marrow transplant

Question 14

Patient with monoclonal gammopathy without other findings of multiple myeloma – likely diagnosis? next step?

Answer 14

MGUS

Biopsy to look for myeloma

Question 15

Waldenström Macroglobulinemia – Pathogenesis? Clinical features?

Answer 15

Overproduction of IgM leading to hyperviscosity

#Blurry vision/vertigo
#Engorged blood vessels
#Mucosal bleeding
#Raynaud phenomenon

Question 16

Waldenström Macroglobulinemia – Best initial therapy? Long-term treatment?

Answer 16

Plasmapheresis;

rituximab, prednisones, cyclophosphamide