Oncology Flashcards
Histopath findings: Reed Sternberg Cells
Hodgkin Lymphoma
Philadelphia Chromosome- BCR-ABL fusion (9:22)
B-Cell ALL- POOR prognostic sign
- Poor response to chemo is the worst prognostic sign
Mutation- PTPN11 (associated with Noonan’s)- can be somatic or germline
JMML
GATA1 mutations/ ALL or AML
Down’s Syndrome/T21
Histopath findings: Starry sky appearance on film
Burkitt Lymphoma
Histopath findings: Auer rod
AML
Signs of VOD?
Jaundice and hyperbilirubinaemia
Right upper quadrant pain, generally with tender hepatomegaly.- raised transaminases
Weight gain and ascites
DDx: portal obstruction- expect splenomegaly
DDx anterior, posterior, superior & middle mediastinal masses
Posterior: Neuroblastoma (adjacent to paraspinal ganglion), thoracic meningiocele, aortic aneurysm
Superior: cystic hygroma, thymic mass, teratoma, ectopic thyroid, oesophageal lesions, AVM
Anterior: epithelial tumor, lymphoma, thymoma
Middle: lymphoma, lymphadenopathy, bronchogenic/pericardial cysts
Blood findings in TLS & management
High K
High Phos
High uric acid
Low calcium
- Hyperhydration/HCO3
- Rasburicase= promotes the conversion of uric acid to allantoin, which is less harmful and easily excreted
- Allopurinol = xanthine oxidase inhibitor, TLS prophylaxis
What patients need irradiated blood cells?
Patients at risk of GVHD:
* Transplant.
* Hodgkin lymphoma, aplastic anaemia.
* Monoclonal antibodies or therapeutic antibodies.
* Granulocyte transfusions.
Denys-Drash & Frasier syndrome and tumor associated?
Wilms (WT1)
- Early-onset renal failure
- XY gonadal dysgenesis
Frasier
M phase chemo drugs?
Vincristine/blastine
Docetaxel/paclitaxel
S phase chemo drugs?
Antimetabolites:
- Folate analoges: methotrexate
- Purine analogues: fludarabine, mercaptopurine, thioguanine
- Pyrimidine analogues: cytarabine, 5-FU
Misc: hydroxyurea
G2 phase chemo drugs?
Topoisomerase 1 inhibitors: etopaside
Bleomycin
G1 phase chemo drugs?
Asparaginase/PEG
Common pathogens in febrile neutropenia
(patients with Rx AML, cytarabine, awaiting transplant)
Strep mitis (CONS- occupies port/line)
Chemotherapies at risk of 2nd malignancy
TAAAT
Topoisomerase inhibitors
Alkylating agents (cyclophosphamide)- biggest risk
Anthracyclines (doxorubicin)
Antimetabolites (MTx, thiopurine, mycophenylate)
(anti)Tubulin (vincristine)
Cancer with highest likelihood of secondary malignancy
Hodgkin lymphoma- 18.5x increase
- AML (3yrs)
- Breast
- Thyroid
- Soft tissue
(14yrs solid)
Mutation and Ca predisposition in T21?
AML in Trisomy 21
* Secondary to GATA1 mutation
* 150x increased risk of AML
* Increased sensitivity to chemotherapy, survival >90% age <4years
Favourable prognosis genes in AML
RUNX
CBFb-MYH
NPM
CEBPA
Poor prognosis gene mutations in AML
Monosomy 5,7
FLT/ITD
KMT2A
NUP
DEK
Dx on this Xray?
Ewings sarcoma
Dx on this XR?
Osteosarcoma
5-25yrs, M>F
- Most common bone tumor
- Most commonly long bone metaphyses (distal femur/prox humerus, tibia, pelvis and skull)
- Formed by osteoblasts/mesenchymal cells
XR: dense sclerosis at metaphysis with soft tissue expansion- ‘sunburst appearence’
Explain 2 hit hypothesis with retinoblastoma
- Germline mutation of one of the RB1 tumour suppressor gene
- Second mutation in the remaining RB1 allele of retinal cells.
Most important factors impacting survival for donor cell transplant in 8/8 HLA matched unrelated donor?
- full HLA match of the donor at HLA-A, HLA-B, HLA-C and HLA-DR loci- overall survival drops 10% with each mismatch
- Age 5.5% increase in risk for each 10yr increment
- CMV- seronegative = better survival
- ABO compatability not required however can lead to complications if incompatible
Which is more common AML/ALL? Features to suggest
ALL 75%
AML 20%
- Gum hypertrophy
- Syndromic association
Both have HSM, pancytopenia with blasts
Cell markers AML vs ALL
AML
- CD7, 3
- MPO
ALL
- CD34, CD 19, CD10, CD 79a, CD33
