Oncology Flashcards
Breast cancer tx:
- lumpectomy with radiation
- adjuvant chemo
- trastuzumab or pertuzumab
- atezolizumab
- serm or aromatase inhibitor
- best initial
- if cancer in axilla and cancer >1cm
- if her2/neu positive
- if triple neg
- if est or progest rec positive
Colon cancer tx
Resection and chemo with 5fu
Colon cancer screening that most lowers mortality
Colonoscopy starting at 50 and every 10 yrs
Tx for metastatic prostate cancer
Hormonal: flutamide first to block T receptors, then leuprolide or goserelin (gnrh agonists)
Also abiraterone, 17 hydroxylase inhib blocks androgen production
How to diagnose testicular cancer?
Orchiectomy , not biopsy
Tx for:
AML
APML
ALL
Curable with chemo! Unlike chronic leukemias
AML - chemo with idarubicin and cytosine arabinoside
APML - add atra
ALL - add intrathecal MTX
MDS tx
Transfusions, lenalidomide (esp if 5q-)
Philadelphia chromosome
CML - bcr/abl, test via pcr or fish
CML tx
TK inhibitors (-tinibs)
Bmt is only curative but tki—> 90% hematologic remissions without AEs
Interferon if pregnant
CLL smear finding
Smudge cells - ruptured lymphocytes (which produce abnormal Ig which hemolyze rbcs—>anemia and permit infection)
CLL tx
- no tx if early
- more advanced: fludarabine and ritux, add cyclophosphamide if young/fxal
- if fails, alemtuzumab (anticd52) and ibrutinib
- venetoclax if fail initial tx and 17p deletion
Teardrop cells on smear, jak2 mut
Myelofibrosis
Also pancytopenia, splenomeg, fibrotic marrow
Jak2 mutation
Myelofibrosia, pvera, essential thrombocythemia
Ruxolitinib is jak2 inhib
Multiple myeloma workup
- punched out lesions on skel survey
- elevated ig on spep
- bence Jones proteins in upep
- rouleaux stacked blood cells on periph smear
- bun and cr often up bc of kidney injury - give bortezomib
- hyperca and Uric acid, anemia
CRAB
MM - hyperCa, renal failure, anemia, bone lesions
Waldenstrom macroglobulinemia
Hypervisc from igm overproduction —> blurry vision, ha etc
Spep will show igm, increased serum viscosity, no cbc findings
Tx with plasmapheresis if sx
Vwd
Vwf stabilizes factor 8 so may have normal level but abnml ristocetin assay tells you it’s not working —> bleeding
Tx desmopressin or ddavp
ITP
Large, dysfxal plts, normal spleen size
Tx mild with pred, severe acute with ivig or rhogam to raise plt ct
Tx chronic with ritux (stop B cells from making ig against plts), splenectomy, romiplostim or eltrombopag to directly stim megakaryocytes
Pt vs ptt
Pt extrinsic and common
Ptt intrinsic (12, 11, 9, 8)
Ddavp only works for
Vwd and factor 8 deficiency
Evaluation of breast masses
<30yo, us First, mammo and or bx if solid mass
Older, mammo first
Evaluate when hormone levels are low (ie after menses in early follicular)
MM imagine workup
Whole body CT, mri, or pet to look for bone lesions (prognostic)
Vs technetium 99 identifies areas of bone remodeling (blastic lesions)
Hypercalcemia causes and which cancers cause them
Pthrp- squamous cell, breast and ovarian, kidney and bladder
Bone Mets - breast and mm - give ivf, calcitonin and bisphos
Vit d release in lymphoma - give pred
Lung cancer common location of masses and paraneoplastic stuff
- small cell - hilar, siadh
- mesothelioma - pleural thickening
- large cell - peripheral mass, can be painful if infiltrated chest wall
- squamous - cavitation lesion in bronchus, pthrp—> hyperca
