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PSBIM > ONCO > Flashcards

ONCO Flashcards

1
Q

Hodgkin’s lymphoma is a malignancy of

A

mature B lymphocytes

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2
Q

Hodgkin’s lymphoma represents _____ of all lymphomas diagnosed each year

A

~10%

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3
Q

Majority of cases of Hodgkin’s lymphoma is

A

Classical HL (cHL)

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4
Q

One of the success stories of modern oncology is the success in the therapy of this disease

A

Classical HL (cHL)

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5
Q

A subtype of HL that is more related to the indolent B-cell NHLs biologically than it is to cHL

A

Nodular lymphocyte predominant HL (NLPHL)

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6
Q

New challenge in the treatment of Hodgkin’s lymphoma

A

late therapy-related toxicity

High rate of secondary malignancies and cardiovascular disease

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7
Q

Four distinct subtypes of classical Hodgkin’s lymphoma (cHL) that are differentiated based on their histopathologic features:

A
  1. Nodular sclerosis
  2. Mixed cellularity
  3. Lymphocyte-rich
  4. Lymphocyte-depleted
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8
Q

Classic HL that is more common in the younger age groups

A

Nodular sclerosis

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9
Q

Classic HL subtype that is more common in elderly patients, patients infected with HIV, and patients in Third World countries (2)

A

Mixed cellularity

Lymphocyte-depleted

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10
Q

Most common subtypes of classic HL (2)

A

nodular sclerosis and mixed cellularity types

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11
Q

Risk factors for classic HL (2)

A
  1. HIV

2. EBV

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12
Q

the malignant cells in HL

A

Reed-Sternberg (HRS) cells

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13
Q

Diagnostic of cHL

A

Reed-Sternberg (HRS) cells

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14
Q

Large cells with abundant cytoplasm with bilobed and/or multiple nuclei seen in cHL

A

Reed-Sternberg (HRS) cells

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15
Q

Reed-Sternberg cells express these 2 CD marker in 85 and 100% of cases, respectively

A

CD15 and CD30

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16
Q

97% of HRS cells in cHL harbor genetic aberrations in the ____ locus on chromosome ____

A

PD-L1

9p24.1

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17
Q

Most common finding in HL

A

Nontender palpable lymphadenopathy

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18
Q

Most common locations of palpabale lymph adenopathy in HL (3)

A

neck, supraclavicular area, and axilla

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19
Q

½ of patients of HL will have this adenopathy at diagnosis

A

Mediastinal adenopathy

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20
Q

Fever that persist for days to weeks, followed by afebrile intervals and then recurrence of the fever

A

Pel-Ebstein fever

In HL

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21
Q

Most common HL subtype that may present as FUO

A

mixed-cellularity HL in an abdominal site

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22
Q

More accurate than a bone marrow biopsy for evaluation of bone marrow involvement in cHL

A

PET/CT scan

as the bone marrow involvement in cHL tends to be patchy and therefore potentially missed on a unilateral bone marrow biopsy

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23
Q

Used for staging of HL

A

Ann Arbor staging system

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24
Q

Prognosis of advanced stage of cHL is bets predicted by the

A

International Prognostic Score (IPS)

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25
Q

International Prognostic Score (IPS) for cHL gives 1 point for each (7)

A
  1. Male sex
  2. Older age (>45 years)
  3. Stage IV disease
  4. Serum albumin <4 g/dL
  5. Hemoglobin <10.5 g/dL
  6. White blood cell count ≥15,000/μL
  7. Lymphocyte count <600/μL and/or <8% of WBC count
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26
Q

Five-year progression-free survival of cHL if with no risk factor or if with 4 and more risk factors:

A

88%

62%

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27
Q

Treatment recommendation for cHL

A

maximize treatment outcome without using radiotherapy

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28
Q

Most commonly used regimen in the early stage disease of cHL

A

ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine)

Given every other week
Each cycle including two treatments

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29
Q

Treatment recommendation for favorable early stage disease of cHL

A

4–6 cycles of ABVD alone

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30
Q

Treatment recommendations for unfavorable early stage disease of cHL

A
  1. ABVD x4 cycles followed by involved field radiation therapy
  2. ABVD alone for 6 cycles
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31
Q

Treatment recommendations for bulky disease of cHL

A

Combined modality therapy

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32
Q

Treatment recommendations advanced stage disease of cHL

A

chemotherapy alone
ABVD x 6 cycles

Do not benefit from the addition of radiation therapy after a complete response to chemotherapy alone

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33
Q

Newer drugs for the treatment of relapsed HL (3)

A

Brentuximab
Pembrolizumab
Nivolumab

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34
Q

Antibody against CD30 conjugated to the microtubule inhibitor MMAE that is used for treatment of relapsed HL

A

Brentuximab

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35
Q

Drugs that target the PD-1/PD-L1 axis that used in the treatment of relapsed HL (2)

A

Pembrolizumab and nivolumab

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36
Q

T or F. Relapsed disease of HL can frequently still be cured

A

True

Usually not curable with subsequent chemotherapy administered at standard doses

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37
Q

Standard salvage chemotherapy regimens for relapsed HL (2)

A
  • ICE (ifosfamide, carboplatin, etoposide)

* GND (gemcitabine, navelbine, doxil)

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38
Q

Most serious late side effects of HL chemotherapy (2)

A
  • Second malignancy

* Cardiac injury

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39
Q

Most common second malignancies post HL chemotherapy in the first 10 years in regimens that contain alkylating agents plus radiation therapy

A

Acute leukemia

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40
Q

Most common second malignancies post HL chemotherapy that occur ≥ 10 years after treatment and are associated with use of radiotherapy

A

Carcinomas

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41
Q

Manifested by an “electric shock” sensation into the lower extremities on flexion of the neck that occurs in ~15% of patients who receive thoracic radiotherapy for HL

A

Lhermitte’s syndrome

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42
Q

HL subtype that sometimes transforms to diffuse large B-cell lymphoma

A

Nodular lymphocyte-predominant HL

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43
Q

Ann Arbor stage with Involvement of a single lymph node region or lymphoid structure (e.g., spleen, thymus, Waldeyer’s ring)

A

Ann Arbor Stage I

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44
Q

Ann Arbor stage with Involvement of two or more lymph node regions on the same side of the diaphragm

A

Ann Arbor Stage II

The mediastinum is a single site; hilar lymph nodes should be considered “lateralized” and, when involved on both sides, constitute stage II disease

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45
Q

Ann Arbor stage with involvement of lymph node regions or lymphoid structures on both sides of the diaphragm

A

Stage III

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46
Q

Ann Arbor stage with involvement of lymph node regions or lymphoid structures on both sides of the diaphragm, and with subdiaphragmatic involvement limited to spleen, splenic hilar nodes, celiac nodes, or portal nodes

A

Stage III-1

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47
Q

Ann Arbor stage with involvement of lymph node regions or lymphoid structures on both sides of the diaphragm, and with subdiaphragmatic involvement limited to spleen, splenic hilar nodes, celiac nodes, portal nodes, paraaortic, iliac, or mesenteric nodes

A

Stage III-2

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48
Q

Ann Arbor stage with Involvement of extranodal site(s) beyond that designated as “E”

A

IV

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49
Q

Ann Arbor stage with no symptoms

50
Q

Ann Arbor stage with unexplained weight loss of >10% of the body weight during the 6 months before staging investigation, unexplained, persistent, or recurrent fever with temperatures >38°C during the previous month, and recurrent drenching night sweats during the previous month

51
Q

Ann Arbor stage with localized, solitary involvement of extralymphatic tissue, excluding liver and bone marrow

52
Q

A continuum of discrete tissue and cellular changes over time resulting in aberrant physiologic processes

A

Carcinogenesis

53
Q

Cancers associated with tobacco:

A

Aerodigestive cancers, and kidney and bladder

54
Q

Save more lives than any other public health activity

A

Smoking cessation

55
Q

Smoking cessation results to _____ lower 10-year lung cancer mortality

56
Q

Cigars causes what cancers

A

Oral and esophageal cancer

  • 1-2 cigars daily – doubles the risk for oral and esophageal cancer
  • 3-4 cigars daily – 8-fold increase in oral cancer, 4-fold increase in esophageal cancer
57
Q

This cancer is linked to carcinogen in smokeless tobacco dissolved in saliva and swallowed

A

Esophageal cancer

58
Q

Physical activity decrease risk of what 2 cancers

A

Colon

Breast

59
Q

High BMI has inverse association with cancers of (2)

A

Prostate

Breast (premenopausal)

60
Q

Precursor of squamous cell cancer of the skin

A

actinic keratoses

61
Q

T or F. Sunscreens reduce risk of melanoma

A

False. They may prevent burning but may encourage more prolonged exposure to the sun and may not filter out wavelengths of energy that cause melanoma.

Sunscreens – decrease risk of actinic keratoses (precursor of squamous cell cancer)

62
Q

Risk factors for melanoma (3)

A
  1. Propensity to sunburn
  2. Large number of benign melanocytic nevi
  3. Atypical nevi
63
Q

T or F. Patients cured of squamous cell cancers of the lung, esophagus, oral cavity, and neck are at risk of developing second cancers of the upper aerodigestive tract

64
Q

T or F. Smoking cessation decrease the cured cancer patients’ risk of second malignancy

A

False.

Lowers the cancer risk in those who have never developed a malignancy

65
Q

This virus increases risk for cancers of the oropharynx

66
Q

Oral premalignant lesion commonly found in smokers

A

Oral leukoplakia

67
Q

Drugs that may cause regression of oral leukoplakia

A

High, relatively toxic doses of isotretinoin

68
Q

In the ATBC Lung Cancer Prevention Trial and CARET trial, this substance was found to have caused harm

A

β-carotene

α-tocopherol/β-carotene (ATBC) Lung Cancer Prevention Trial

β-Carotene and Retinol Efficacy Trial (CARET)

69
Q

These group of drugs may prevent adenoma formation or cause regression of adenomatous polyps

A

NSAIDs

Other chemoprevention:
Diets high in calcium
Estrogen plus progestin

70
Q

An antiestrogen with partial estrogen agonistic activity in some tissues, such as endometrium and bone that decreased the risk of developing breast cancer by 49%

A

Tamoxifen

Small increase in risk of endometrial cancer, stroke, pulmonary emboli, and DVT

71
Q

Selective estrogen receptor modulator used in chemoprevention of breast CA and with no risk of endometrial CA and with only fewer thromboembolic events

A

Raloxifene

Both tamoxifen and raloxifene have been approved by US FDA for reduction of breast cancer in women at high risk for the disease

72
Q

More effective than tamoxifen in adjuvant breast cancer therapy

A

Aromatase inhibitors

It has been hypothesized that they would be more effective in breast cancer prevention

73
Q

Inhibit conversion of testosterone to dihydrotestosterone (DHT) – a potent stimulator of prostate cell proliferation

A

5-α-reductase inhibitors (Finasteride and dutasteride)

74
Q

T or F. Finasteride and dutasteride are approved as chemoprevention of prostate cancer.

A

False. Based on trials, use of 5-α-reductase inhibitor for prostate cancer chemoprevention would result in one additional high-grade (Gleason score 8-10) prostate cancer for every 3-4 lower-grade (Gleason score <6) tumors averted.

75
Q

T or F. A trend toward a decreased risk of developing prostate cancer was observed for those men taking Vitamin E alone as compared to the placebo arm

A

False. Increased risk.

Selenium and Vitamin E Cancer Prevention Trial (SELECT)

76
Q

Prophylactic bilateral mastectomy has _______reduction in breast CA risk

77
Q

Proportion of persons with the disease who test positive in the screen

A

Sensitivity

True-positive rate

78
Q

Ability of the test to detect disease when it is present

A

Specificity

1 minus the false-positive rate

79
Q

Ability of a test to correctly indicate that the disease is not present

A

Specificity

80
Q

Proportion of persons who test positive that actually have the disease

A

Positive predictive value

Depend strongly on the prevalence of the disease

81
Q

Proportion testing negative that does not have the disease

A

Negative predictive value

Depend strongly on the prevalence of the disease

82
Q

Bias of screening tests that occurs whether or not a test influences the natural history of the disease and patient is merely diagnosed at an earlier date

A

Lead time bias

Screening test only prolongs the time the subject is aware of the disease and spends as a patient

83
Q

Bias that occurs because screening tests generally can more easily detect slow-growing, less aggressive cancers than fast-growing cancers

A

Length-biased sampling

84
Q

Extreme form of length bias sampling

A

Overdiagnosis

85
Q

Bias that occurs because the population most likely to seek screening often differs from the general population to which the screening test might be applied

A

Selection bias

86
Q

Screening test that is known to decrease the mortality rate of the cervical cancer

A

Papanicolaou (Pap) smears

87
Q

Regular Pap testing for all women who have reached the age of ___

A

21

before this age, even in individuals that have begun sexual activity, screening may cause more harm than benefit

88
Q

Pap smear + HPV testing is done beginning at age

89
Q

Screening for cervical cancer may be stopped if (2)

A
  1. Age 65 years with no abnormal results in the previous 10 years
  2. Hysterectomy with cervical excision for non-cancerous reasons
90
Q

Interval of screening with sigmoidoscopy

91
Q

Some observational studies suggest that the efficacy of colonoscopy to decrease colorectal mortality is primarily limited to the ____ side of the colon

92
Q

Test that has higher sensitivity for colorectal cancer than nonrehydrated FOBT tests

A

Fecal immunohistochemical tests

93
Q

Screening tests for ovarian CA (3)

A
  1. Adnexal palpation
  2. Transvaginal USD
  3. Serum CA-125 assay
94
Q

Most common prostate cancer screening modalities:

A
  1. DRE

2. Serum PSA assay

95
Q
  1. DRE

2. Serum PSA assay

A
  1. Acute myeloid leukemia

2. Bladder cancer

96
Q

Neoplasm associated with androgens

A

Prostate CA

97
Q

Neoplasm associated with aromatic amines (dyes)

A

Bladder CA

98
Q

Neoplasm associated with arsenic (2)

A
  1. Lung CA

2. Skin CA

99
Q

Neoplasm associated with asbestos (3)

A
  1. Lung
  2. Pleura
  3. Peritoneum
100
Q

Neoplasm associated with benzene

101
Q

Neoplasm associated with chromium

102
Q

Neoplasm associated with diethylstilbestrol

A

Clear cell vaginal cancer

103
Q

Neoplasm associated with EVB (2)

A
  1. Burkitt’s lymphoma

2. Nasal T cell lymphoma

104
Q

Neoplasm associated with estrogens (3)

A
  1. Endometrium
  2. Liver
  3. Breast
105
Q

Neoplasm associated with ethyl alcohol (4)

A
  1. Breast
  2. Liver
  3. Esophagus
  4. Head and neck
106
Q

Neoplasm associated with HIV (3)

A
  1. NHL
  2. Kaposi’s sarcoma
  3. Squamous cell CA (esp in urogenital tract)
107
Q

Neoplasm associated with HPV (3)

A
  1. Cervix
  2. Anus
  3. Oropharynx
108
Q

Neoplasm associated with immunosuppressive agents

109
Q

Neoplasm associated with nitrogen mustard gas (3)

A
  1. Lung
  2. Head and neck
  3. Nasal sinuses
110
Q

Neoplasm associated with nickel dust (2)

A
  1. Lung

2. Nasal sinuses

111
Q

Neoplasm associated with diesel exhaust

A

Lung (miners)

112
Q

Neoplasm associated with phenacetin (2)

A
  1. Renal pelvis

2. Bladder

113
Q

Neoplasm associated with polycyclic hydrocarbons (2)

A
  1. Lung

2. Skin (squamous cell carcinoma of scrotal skin)

114
Q

Neoplasm associated with radon gas

115
Q

Neoplasm associated with vinyl chloride

A

Liver cancer (angiosarcoma)

116
Q

Screening mammography should begin at what age and how often

A

May start at 40

40–44 years: Provide the opportunity to begin annual screening
45–54 years: Screen annually
≥55 years: Transition to biennial screening or have the opportunity to continue annual screening

117
Q

MRI screening plus mammography for breast CA is done when

A

Women with >20% lifetime risk of breast cancer: Screen with MRI plus mammography annually

Women with 15–20% lifetime risk of breast cancer: Discuss option of MRI plus mammography annually

Women with <15% lifetime risk of breast cancer: Do not screen annually with MRI

118
Q

Interval of pap smear as screening test

A

Every 3 years

119
Q

HPV testing as screening test for cervical CA is done every

120
Q

FOBT and FIT as screening test is started at what age and how often?

A

≥50 years old

Every year

121
Q

Sigmoidoscopy as screening test is started at what age and how often?

A

≥ 50 years old

Every 5 years

122
Q

Colonoscopy as screening test is started at what age and how often?

A

≥ 50 years old

Every 10 years

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