Oncology 2- Paulson Flashcards
Common presenting S/Sx of cancer?
- Weight loss
- Failure to thrive
- Anorexia
- Malaise
- Fever
- Lymphadenopathy
- Pallor
WBC development: Original stem cell?
Hemocytoblast
WBC development: Hemocytoblasts develop into what cells?
- Myeloid stem cell
- Lymphoid stem cell
Compare and contrast Leukemias and Lymphomas
Leukemias and lymphomas both start in lymphocytes BUT leukemias are mainly affecting bone marrow and blood. Lymphomas mainly affect lymph nodes
What is the MC form of pediatric cancer?
Acute lymphocytic leukemia (ALL)
ALL: A characteristic description of ALL is a proliferation of what cell type?
lymphoblasts
ALL: What is the peak age of ALL?
2-5 YO
ALL: S/Sx?
S/S: Fatigue, pallor, bruising/bleeding, lymphadenopathy, bone pain/limp/tenderness, painless testicular enlargement, HSM, fever, malaise (KNOW: lymphadenopathy, HSM, and fever)
**they are fatigued because they’re anemic
ALL: Labs?
- CBC w/ diff peripheral smear
- Bone marrow aspiration
ALL: CBC results?
- Anemia
- Thrombocytopenia
- Blasts on peripheral smear
- (+/-) Elevated WBC
What confirms your Dx of ALL?
Bone marrow confirms
ALL: Tx?
- Chemo!!! is Tx of choice
- Specific Tx is determined by phenotyping
ALL: what % have a 5-year survival rate
> 85%
What is the 2nd MC childhood cancer?
CNS tumors
CNS Tumors: S/Sx?
- HA (MC)
- NV (especially upon wakening)
- Ataxia/impaired gait
- Impaired vision
- Seizures
- Papilledema
- Macrocephaly
- Developmental delay
(classic presentation is early morning HA relieved by nausea)
CNS Tumors: Dx?
- **MRI preferred
- Bx needed for histologic diagnosis
CNS Tumors: Tx?
- **Open surgical procedures: Obtain tissue for Dx & remove most of the tumor.
- Avoid XRT in those <3 YO if possible. May also give chemo. Anticonvulsants for seizures.
CNS Tumors: Prognosis?
- Depends on tumor type.
- 5-year: 74% long-term sequelae common. Late mortality in 15-25% who survive beyond 5 years.
Retinoblastoma: Demographic?
Peak: up to age 2
Retinoblastoma: Genetic component to demographic?
~1/2 have heritable retinolastoma gene: RB1 gene
Retinoblastoma: S/Sx?
- **Leukocoria
- Strabismus
- Red inflamed eye
- Nystagmus
(leukocoria= white pupillary reflex)
Retinoblastoma: Unilateral or bilateral?
- Can be unilateral (⅔) or bilateral (⅓)
- **Refer to optho!!
- Molecular genetic testing recommended for all
Retinoblastoma: Tx?
cryotherapy, local or systemic chemo, laser photocoagulation, enucleation, radiation
**>95% survival but if untreated–> deadly!!!
Osteosarcoma: Risk factors?
- In kids, most sporadic
- Prior irradiation or chemo
- Genetics
- Paget disease
- Male
- *this is the MC bone malignancy in kids
Osteosarcoma: S/Sx?
- **Localized pain typically lasting months
- Soft tissue mass on exam
- Often large & TTP
Osteosarcoma: Common sites?
Distal femur, proximal tibia, proximal humerus, middle/proximal femur
Osteosarcoma: Dx? (key words)
- X-ray shows…
- – Destructive lesion
- – ** spiculated “sunburst” appearance
- – **Codman triangle
- –>Biopsy!!!
Osteosarcoma: Describe “Codman triangle”
Codman triangle is the triangular area of new subperiosteal bone that is created when a lesion, often a tumour, raises the periosteum away from the bone
Osterosarcoma: Tx
Almost all get chemo. Preop chemo–> surgery –> postop chemo. Radioresistant.
Osteosarcoma: Prognosis?
Depends on tumor response (necrosis) to chemo.
Ewing Sarcoma is described as what kind of cell tumor?
Small round blue cell tumor
Ewing sarcoma: Demographics?
Male>female. Peak: ages 10-20.
Ewing Sarcoma: S/Sx?
- **Localized bony pain or swelling for a few weeks or months
- Limp
- Fracture
- **MOST common in long bones and pelvis
Ewing sarcoma: Dx?
- Start with **plain radiograph
- **Onion peel periosteal reaction is classic
- Often a destructive lesion
- “moth-eaten” or “permeative” with poor margins, often with a soft tissue mass
- Confirm dx with biopsy
Ewing sarcoma: Tx?
- Almost all need **chemo
- **Local control with surgical resection + XRT
Ewing sarcoma: Prognosis?
- 5-yr survival: 55% non-metastatic; 21% metastatic
Nephroblastoma: Also known as?
Wilms tumor
What is the MC renal malignancy in kids?
Wilms Tumor
Nephroblastoma: Peak age? and Risk factors
- 2-5 YO
- Risk ↑ in African, WAGR syndrome, Denys-Drash syndrome, Beckwith-Wiedemann syndrome .
-dont memorize syndromes
Nephroblastoma: S/Sx?
- **Abdominal mass or swelling
- Firm, smooth, nontender unilateral mass.
- (+/-) ABD pain, hematuria, fever, HTN
Nephroblastoma: Imaging?
- **Abdominal U/S (1st imaging study). Also used for screening in high-risk PTs
Nephroblastoma: Dx
- Abdominal U/S (1st imaging study)
- Confirm w/ biopsy
Nephroblastoma Tx:
**surgical resection for all, **chemo for almost all, XRT based on stage/histology
-Prognosis: 90% 5 year survival
Bladder Cancer- demographics
- *Men > female. **Smoking ↑↑↑ risk. Animal fat-rich diets also ↑ risk.
- Most are transitional cell carcinomas
Bladder cancer: S/Sx?
- **Painless hematuria (gross or microscopic)
- May initially have frequency/urgency/dysuria.
- Pain usually from spread (local or metastatic)
Bladder cancer: Dx?
- UA (dipstick, microscopic, & gross examination)
- **CYTOSCOPY (gold standard). Can use for biopsy.
- IVP and/or CT for imaging
Bladder cancer: Tx?
- *TURBT (transurethral bladder resection) for non-muscle invasive OR **Cystectomy for muscle (invasive)
- May have intravesical chemo, systemic chemo, and/or XRT
Prognosis: varied, depending on staging
Bladder cancer: Describe TURBT
A TURBT is a procedure in which bladder tumors can be removed from the bladder wall. This is a procedure performed completely with a scope that is inserted through the urethra into the bladder. It is generally performed in the hospital setting as an outpatient with the patient anesthetized.
MC cancer in men 15-35?
Testicular cancer
Testicular cancer: Risk factors?
- Cryptorchidism
- Caucasian race
Describe cryptorchidism
Condition where testes do not descend into scrotum
Testicular cancer: S/Sx?
- ***Painless mass or swelling in testis
- Some feel a heaviness or ache in lower abdomen. Small percentage feel pain.
Testicular cancer: Dx?
**Scrotal U/S
Testicular cancer: Serum tumor markers?
- AFP
- beta-hCG
- LDH
Testicular cancer: Tx
- Inguinal orchiectomy + surveillance (alone for many with stage 1)
- Add RPLND, XRT and/or platinum-based chemo
Testicular cancer: Prognosis
Good! >95% (80% for metastatic disease)
Ovarian cancer: risk factors
- **Family Hx
- BRCA
- Lynch II syndrome
- Infertility
- PCOS
- Endometriosis
- Smoking
- HRT
- MC in Caucasians
Ovarian cancer: Peak age?
60’s
Ovarian cancer: S/Sx?
- **Abdominal fullness/bloating, nausea, early satiety
- Pelvic or abdominal pain
- Adnexal mass on pelvic exam
- Changes to urinary or bowel patterns
Ovarian cancer: Assessment tools?
- **Pelvic U/S
- CA-125
- CXR
- CT
- (+/-) genetic counseling
What is the CA-125 test?
A CA 125 test measures the amount of the protein CA 125 (cancer antigen 125) in your blood. A CA 125 test may be used to monitor certain cancers during and after treatment. In some cases, a CA 125 test may be used to look for early signs of ovarian cancer in people with a very high risk of the disease.
Ovarian cancer: Dx?
(KNOW!!)
and Tx?
- Unilateral salpingo-oophorectomy
- If pathology shows primary ovarian Ca –> Hysterectomy, contralateral salpingo-oophorectomy, omentectomy, & pelvic node sampling. Then likely platinum-based chemo.
Ovarian cancer: Prognosis?
- Overall poor
- Recurrence in 75% of “complete responders” in 1-4 years
Multiple myeloma: Describe pathology
=***Proliferation of plasma cells producing monoclonal antibody…leading to–>
end organ damage (CRAB)
–> In the bone marrow or as a tumor (plasmacytoma)
Multiple myeloma: What is the mnemonic CRAB helpful for?
MM findings. C = Calcium (elevated) R = Renal failure A = Anemia B = Bone lesions
Multiple myeloma: risk factors?
- African
- M > W
- Obesity
- Older age (most 60s to 70s)
- 1st degree relative with MM
Multiple myeloma: S/Sx?
**Bone pain, **anemia (Rouleaux), **hypercalcemia, fatigue/weakness, weight loss, ↑ Cr
Prone to recurrent infection, esp. encapsulated organisms
Multiple myeloma: Dx
- **Monoclonal spike on SPEP
- **Bence-Jones protein in jurine on UPEP
- Bx of plasmacytoma
- Bone marrow aspirate/biopsy with >- 10% clonal plasma cells
- *Lytic lesions on X-ray (esp. axial skeleton). MRI/CT/PET more sensitive.
- Bone scan is not helpful.
Multiple Myeloma: Tx
Most have induction therapy, then high-dose chemo + autologous hematopoietic stem cell transplantation.
-Bisphosphonates can be used to ↓ pathologic fracture
Prognosis: Most relapse. Maintenance chemo used to attempt prevention of relapse.
Prostate Cancer: demographics
-very common!
Risk: Black, high fat diet, FH, increased age
Prostate cancer: S/Sx
Early: - Asymptomatic Later: - (+/-) hematuria - hematospermia - obstructive urinary Sx - Bone pain - Asymmetric induration or nodules on DRE - ****Increased PSA
Prostate cancer: Dx
**Prostate biopsy (usually transrectal). Gleason score for grading
Prostate cancer: Tx
low grade: watchful waiting (esp. if short life expectancy).
vs
Higher stages: radical prostatectomy, brachytherapy, XRT.
Metastatic: Above + castration (physical and/or chemical) + bisphosphonate
“you die with ____ cancer”
Prognosis: Generally very good for most. “You die with prostate cancer, not of it”
Pancreatic cancer: Risk factors?
age, tobacco, chronic pancreatitis, alcohol, FH, obesity, diabetes
Pancreatic cancer: S/Sx
- **Abdominal pain (often gnawing, epigastric)
- **Nausea
- **Weight loss
- Anorexia
- fatigue
- ***Courvoisier sign
- Jaundice
- Steatorrhea
- Dark urine
Describe Courvoisier’s sign. (KNOW THIS FOR THE TEST)
Courvoisier’s sign states that in the presence of a palpably enlarged gallbladder which is non-tender and accompanied with mild painless jaundice, the cause is unlikely to be gallstones.
Describe steatorrhea
Excess fat in stool. Symptom of interrupted lipid digestion/absorption.
Pancreatic cancer: Signs of metastasis?
- Abdominal mass
- Ascites
- Virchow’s node (supraclavicular node)
- **Sister Mary Joseph node (a palpable nodule bulging into the umbilicus as a result of metastasis of a malignant cancer in the pelvis or abdomen)
- Anemia
- Increased bilirubin
- Increased ALP
- Increased Aminotransferases
Pancreatic cancer: Labs?
- LFTs
- Lipase
- Imaging (abdominal U/S or CT)
- -> (+/-) biopsy
- “Double duct sign”
Describe the “double duct sign” (KNOW THIS!)
Dilation of both the pancreatic duct and the common bile duct.
Pancreatic cancer: Tx
- ***Surgical resection (whipple) is the only potential cure.
- Chemo +/- XRT afterwards & for those without resectable tumor
- Palliative care for advanced disease
Pancreatic cancer: What type of patients do not qualify for a Whipple procedure?
Those with metastatic disease.
Pancreatic cancer: Prognosis?
**Very poor. Almost all die from the disease.
Colorectal cancer: Risk factors?
Most in those >50, Lynch syndrome, diet high in meat/fat low in veggies, FH, inflammatory bowel disease
Colorectal cancer: S/Sx?
- Asymptomatic/found on screening
- Frank or occult **blood in stool,
- **Change in bowel habits
- Abdominal pain
- Hematochezia
- Melena
- **Unexplained IDA
- Obstructive Sx
Describe hematochezia
Hematochezia is the passage of fresh blood through the anus, usually in or with stools (contrast with melena)
What does the acronym BRBPR stand for?
Bright red blood per rectum
Describe melena
Melena refers to the dark black, tarry feces that are associated with upper gastrointestinal bleeding.
Rectal cancer: Classic S/Sx?
Tenesmus
- Urgency
- Recurrent hematochezia
Describe tenesmus
A continual or recurrent inclination to evacuate the bowels, caused by disorder of the rectum or other illness.
Colorectal cancer: Dx?
- **Colonoscopy
- **FOBT screening may alert you
Colorectal cancer: Staging?
- C/A/P CT for staging
Colorectal cancer: What can be checked for monitoring but not for screening or diagnosis?
CEA levels (Carcinoembryonic antigen (CEA) is a protein normally found in very low levels in the blood of adults. The CEA blood level may be increased in certain types of cancer and non-cancerous (benign) conditions. A CEA test is most commonly used for colorectal cancer.)
Colorectal cancer: Tx?
- **Surgical resection + **chemo (for many)
- XRT usually added for rectal tumors
Colorectal cancer: Prognosis?
5-yr survival:
- Stage 4: 5-7%
- Stage I: >90%
- Rectal cancer has worse prognosis at each stage
Hepatocellular Carcinoma (HCC): Risk factors
- Cirrhosis (80%)
- Male
- *HCV (hep C)
- *HBV (hep B)
- Obesity
- Asian
- Hispanic
- Age > 55 YO
- Diabetes
Hepatocellular carcinoma (HCC): S/Sx?
- Usually asymptomatic except for Sx of their chronic liver dz
- Abdominal pain
- New decompensation of cirrhosis
- paraneoplastic syndromes
- Hepatic bruit
Hepatocellular carcinoma (HCC): Dx
- U/S (used for screening of high-risk)
- -> then CT or MRI
- AFP (alpha-fetoprotein) testing helpful
- Biopsy only if imaging uncertain (risk for tumor seeding)
Hepatocellular carcinoma (HCC): Tx?
- Surgical resection if liver function preserved
- (or) liver transplant if advanced cirrhosis
If Pt is not a surgical candidate: ablation, alcohol injection, cryotherapy, transarterial chemoablation, chemotherapy, XRT
Melanoma: Risk factors
- **UV light exposure
- Highest in *Caucasian
- **Large number of moles
- Increasing age
Melanoma: S/Sx
- Skin lesion with recent change in appearance
- ABCDE rule
List the Four types of Melanoma
- Superficial spreading
- Nodular melanoma
- Lentigo maligna
- Acral lentiginous
Melanoma: Dx?
and Tx?
Dx: biopsy
Tx:Excision with margins= SLNE= sentinel lymph node excision) depending on thickness
Melanoma: What procedure is done for staging?
- Sentinel lymph node excision (SLNE) for staging
Melanoma: What procedures and tests can be added with metastatic disease?
- Interferon alpha
- Immune therapy
- Chemo
Melanoma prognosis?
- Tumor thickness (Breslow stage) is most important prognostic factor.
Squamous cell carcinoma (SCC): Risk factors?
- UV light
- Smoking
- Immunosuppression
- Chronic ulcer
- M > F
- Increasing age
Squamous cell carcinoma (SCC): Distribution?
- MC in sun-exposed areas (**Head and neck MC, also on top of pinna, dorsum of hands, lip). ***Often begins with actinic keratosis. Scaly patch, plaque, or nodule, or ulceration with irregular borders that can bleed or crust.
Squamous cell carcinoma (SCC): Dx?
- Shave
- Punch
- Excisional biopsy
Squamous cell carcinoma (SCC): Tx?
Depending on depth, may include…
- 5-FU
- Imiquimod
- Electrodessication & curettage
- Excision
- Mohs, radiation, chemo
Squamous cell carcinoma (SCC): Prognosis?
Overall good
- 5-yr survival: >90%
Basal cell carcinoma (BCC): Risk factors
- UV light
- Fair skin
- FH
- Hx irradiation
- M > W
- Increasing age
Basal cell carcinoma (BCC): Distribution?
- *Head & neck (85%)
- **Nose is MC site
Basal cell carcinoma (BCC): Appearance?
- Pearly papule with telangiectasia
- (+/-) *central ulceration (“rodent ulcer”)
- Superficial: circumscribed, scaling lesion with raised pearly-white border.
Basal cell carcinoma (BCC): Morpheaform BCC appearance?
Morpheaform BCC is a variant of BCC.
- Flat or slightly raised
- Yellowish/white lesion
- Scarlike with waxy surface
Basal cell carcinoma (BCC): Dx?
- Biopsy (shave or punch)
Basal cell carcinoma (BCC): Tx?
- *Mohs* has highest cure rates Other options: - Excision/suturing - Radiotherapy - Curettage/electrodeesication - Intralesional interferon - 5-FU
Prognosis: Excellent for most. Slow-growing and mets very rare. Can disfigure
What is 5-FU?
Fluorouracil is also known as FU or 5FU and is one of the most commonly used drugs to treat cancer
Endometrial carcinoma: Risk factors?
- Obesity
- Advancing age
- unopposed estrogen therapy
- PCOS
- Early menarche
- Late meopause
- Nulliparity
- FH
- Tamoxifen
- Lynch syndrome
- Diabetes
- White > Black
Endometrial carcinoma: Protective factors?
Combination OCPs and smoking protective
Endometrial carcinoma: S/Sx?
- Abnormal uterine bleeding
- MC in postmenopausal women
- Abnormal vaginal discharge
- May have abnormal cervical cytology
Endometrial carcinoma: Dx?
- Endometrial biopsy or D&C
In postmenopausal women, transvaginal u/s often done to evaluate the endometrial thickness
Endometrial carcinoma: Tx
- Hysterectomy + BSO with lymph node assessment.
- (+/-) postop chemo (+/-) radiation.
-**For those wanting to preserve fertility, progestin therapy
Prognosis: Generally good, since most present with early stage disease (3/4)
Cervical cancer: Risk factors?
- HPV (esp. type 16 & 18)
- Multiple sexual partners
- Smoking
- Early age at 1st sexual intercourse
- Early childbearing
- Low socioeconomic status
- Hx STI
- African american > Hispanic > White
Cervical cancer: S/Sx?
- Most asymptomatic
- Found on screening
If advanced: - Abnormal vaginal bleeding or discharge
Cervical Cancer: Dx?
Pap test (may have HPV co-testing) if abnormal, may repeat or move to colposcopy + biopsy.
Cervical Cancer: Tx?
Depending on stage, could include LEEP, ablation, conization, hysterectomy & pelvic lymphadenopathy, radiation, chemotherapy
Cervical cancer prognosis
Best when there is early detection by Pap. Early stages: >90% Stage IV: <15%
Vulvar cancer: Risk factors?
Age. Most >70. Infection with high-risk HPV types, HSV, immunosuppression, smoking
Vulvar cancer: S/Sx
Pruritis, visible lesion. May have pain, bleeding, ulceration
Vulvar Cancer: Dx?
Vulvar biopsy. Can use 5% acetic acid solution/visualization with colposcope acetowhite lesions should be biopsied
Vulvar cancer: Tx?
Wide local excision, topical 5-FU, laser therapy for early lesions. May need radical partial or complete vulvectomy ± SLNB/lymphadenectomy ±chemo/radiation
Vulvar cancer: prognosis
Generally good for stage I-II: 75-90%. As low as 16% for IV.
What does the acronym SLNB stand for?
Sentinel Lymph Node Biopsy
What type of cancer is the leading cause of cancer deaths?
Lung cancer
Lung cancer: Risk factors?
Smoking, radiation therapy, pulmonary fibrosis, environmental toxins
Lung cancer: S/Sx
- New or changed cough
- Hemoptysis
- Chest pain
- Dyspnea
- Weight loss
Lung cancer: What are the two major categories?
- Small cell lung cancer (SCLC, Oat Cell)
- Non-small cell lung cancer (NSCLC)
Lung cancer: NSCLC is composed of what types of lung cancer?
KNOW this!
- Squamous-cell carcinoma (SCC)
- Large cell carcinoma (LCC)
- Adenocarcinoma
**NSCLC is slower growing
Lung cancer: SCLC is also known as…
oat cell
Lung cancer: Characteristics of SCLC? (**KNOW THIS)
- Originates centrally
- Metastasizes early
- Is aggressive
Lung cancer: Characteristics of NSCLC?
- Slower growing
- Includes SCC, LCC, and adenocarcinoma
Lung cancer: Dx?
- May be found incidentally on CXR or CT
- -> **Needs histologic confirmation: (via one of the following)*
- Sputum cytology
- Bronchoscopy
- Pleural fluid examination
- (or) biopsy
Lung cancer: NSCLC Tx?
- **Surgical resection if possible
- May also have chemo +/- XRT
Lung cancer: SCLC Tx?
- **Chemotherapy
- XRT often added
Lung Cancer: Prognosis?
Poor. Overall 5 year survival: 15%
Renal cell carcinoma (RCC): Risk factors?
- Men > women
- Age > 55 YO
- Smoking
- Native American / Alaskin natives
- Hereditary RCC
- HTN
- Obesity
- Polycystic kidney disease
Renal cell carcinoma (RCC): S/Sx
- Many asymptomatic, diagnosed incidentally.
- Hematuria
- Pain or mass
- Weight loss
- Paraneoplastic symptoms
- **Classic triad:
Renal cell carcinoma (RCC): What is the classic triad associated with RCC?
hematuria, flank pain, palpable mass
Renal cell carcinoma (RCC): Dx?
- Abdominal CT (1st test)
- Sometimes U/S done 1st
- Nephrectomy or partial nephrectomy to obtain tissue for histologic dx
Renal cell carcinoma (RCC): Tx?
- Partial or radical nephrectomy
- For advanced disease, immunotherapy (not particularly effective) and meds inhibiting VEGF (promising) may be used.
- Chemotherapy generally unhelpful
Prognosis: 5 year survival 10->90%
What is the acronym VEGF for?
Vascular endothelial growth factor (VEGF), originally known as vascular permeability factor (VPF), is a signal protein produced by cells that stimulates the formation of blood vessels
Breast cancer: What are the two main types? which is MC?
- Ductal
- Lobular
Infiltrating ductal carcinomas most common type.
Breast cancer: Risks?
- Increasing age
- BRCA
- Nulliparity
- early menarche
- Menopause
- Delayed childbearing
- Radiation exposure
- Long-term estrogen use.
Breast cancer: S/Sx?
- SINGLE, NONTENDER, FIRM, IMMOBILE MASS.
- Most in upper outer quadrant. Commonly asymptomatic, (no palpable nodule) but seen on mammogram.
Breast cancer: Rare S/Sx?
- Nipple discharge
- Retraction
- Peau d’orange
- Eczematous changes (Paget disease)
- Pain
- Axillary LAD
Breast cancer: Dx?
- MAMMOGRAPHY then–> *stereotactic or excisional core-needle biopsy**
- need to check estrogen & progesterone receptor analysis + histology of specimen
Breast cancer: Tx?
- Lumpectomy with SLNB*
- Mastectomy
- XRT
- Adjuvant chemo
- Arimidex, tamoxifen, or raloxifene for those positive for hormone receptors. Add the med Herceptin for those who are HER-2 positive.
Breast cancer: Prognosis?
Early stage: excellent, close to 100%. ER/PR positive favorable.
Thyroid cancer: What are the types?
- Papillary
- Follicular
- Anaplastic
- Medullary
Thyroid cancer: RF?
- W > M
- Childhood head/neck irradiation
- FH
- MEN Type II
Thyroid cancer: S/Sx?
- Painless neck swelling
- Palpable single firm nodule
- **MOST asymptomatic
Thyroid cancer: Dx?
- **Ultrasound
- -> *FNA (fine needle aspiration) (U/S guided)
Thyroid cancer: Tx?
- **Surgical resection*
- May use **Radioactive iodine (RAI) for residual tumor*
- Will need thyroid replacement for life
Thyroid cancer: Tx for anaplastic?
Anaplastic has no Tx. Palliation is recommended. Chemo + XRT for pts who desire to try tx.
Thyroid cancer: Prognosis for papillary?
excellent!
Follicular: Still relatively good but more aggressive, more metastatic disease. Medullary: Good for most.
Anaplastic: Poor, extremely aggressive.
NHL: What does NHL stand for?
Non-Hodgkin Lymphoma
NHL: Risk factors?
- Increasing age
- HIV
- Toxin exposure
- Autoimmune dz
- EBV
- Obesity
- White
NHL: How can you categorize NHL based off of the S/Sx?
- Indolent vs Aggressive
NHL: Indolent S/Sx?
- **Painless
- **Persistant LAD (diffuse or isolated
- HSM
- Cytopenia
NHL: Aggressive S/Sx?
- **Rapidly growing mass
- ** Fever
- **Night sweats
- **Weight loss
- Elevated LDH
- Elevated Uric acid
Common extranodal sites: GI tract, skin, bone, bone marrow
NHL: Dx?
- *Biopsy of involved nodes. **
* Should have bone marrow bx before starting tx as part of staging.
NHL: Tx?
If indolent with a few nodes: Radiation alone
-If intermediate-high grade: Chemo, immunotherapy (often rifuximab), & stem cell transplantation
NHL: Prognosis?
- Worst for those within HIV-related NHL
- Complete remission for up to 50% with aggressive NHL
- If indolent: long survival
Hodgkin Lymphoma (HL): Risk factors & demographics
Bimodal peak: 20 years, 65 years old. Male> female, EBV, immunodeficiency
Hodgkin Lymphoma S/Sx:
- *Painless localized peripheral lymphadenopathy, typically cervical.
- Mediastinal mass on CXR also common presentation. May have B symptoms.
Hodgkin Lymphoma: dx ?
- Lymph node bx showing REED-STERNBERG CELLS
* Should do PET/CT and bone marrow biopsy for staging
Hodgkin Lymphoma: Tx?
- **Combination chemo for most. ABVD chemo (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) + XRT.
- Refractory disease may add in autologous stem cell transplant.
Hodgkin Lymphoma: Prognosis?
Very good, with excellent response to tx, even for those with advanced disease
Describe the growth (progression) of a Blood stem cell
- Blood stem cell—> (splits into) Myeloid stem cells or Lymphoid stem cells—> Lymphoid stem cell goes to lymphoblast then a WBC. Myeloid stem cells have 3 routes–> they become RBCs, Platelets, and Myeloblasts. myeloblasts–> turn to WBCs
Chronic Myelogenous Leukemia (CML): What kind of disorder is this?
Myeloproliferative disorder
Chronic Myelogenous Leukemia (CML): What are the three phases?
- Chronic
- Accelerated
- Acute (blast crisis)
CML: RF?
- Young-middle aged adults
- M>F
- Ionizing radiation
CML: S/Sx
- Many asymptomatic (found on lab-work)
- **Fatigue
- Anorexia
- Weight loss
- Low-grade fever
- Excess sweating
- **Abdominal fullness (splenomegaly)
- Symptoms develop gradually until a blast crisis
CML: Dx?
- CBC with leukocytosis
- Bone marrow biopsy
- Bone marrow cytogenetics: PHILADELPHIA CHROMOSOME,
- PCR for BCR-ABL gene
CML: Tx in chronic phase?
- *Gleevec (chemotherapy drug) is standard
CML: Tx in accelerated phase?
- **Allogenec bone marrow transplantation.
CML: Tx in blast crisis? (KNOW THIS)
- *Conventional induction chemo then Stem cell transplantation
CML: Prognosis?
- Chronic phase on Tx = >25 years median survival.
- Accelerated: 5 years
- Blast crisis: 1 yr.
Acute Myelogenous Leukemia (AML): what is this disorder?
Clonal proliferation of myeloid precursors w/ ↓ ability to differentiate to mature cells
Acute Myelogenous Leukemia (AML): risks
chemo, ionizing radiation, chemical exposure. Median age of onset: 60
Acute Myelogenous Leukemia (AML): Sx
- *Fatigue
- pallor
- *weakness,
- gingival bleeding, -ecchymosis,
- *epistaxis
- ** anemia,
- thrombocytopenia
Acute Myelogenous Leukemia (AML): Dx
- *Presumptive with myeloblasts on CBC/diff/peripheral smear.
- **Definitive with bone marrow bx.
AML: What would you find on bond marrow bx or with peripheral blood?
> 20% BLASTS
Acute Myelogenous Leukemia (AML): Tx:
2 stages of chemo:
- **Induction therapy (generally very aggressive)
- Then **Consolidation (Consolidation could include further chemo or stem cell transplant)
-Prognosis: About 65% attain complete remission. Remission rates inversely related to age
Chronic Lymphocytic Leukemia (CLL): describe this disorder and the risk factors
Clonal malignancy of B lymphocytes
-Risks: men> women, increasing age, white
CLL: S/Sx
- **Most are asymptomatic
- & Discovered with lymphocytosis on labs
- LAD (lymphadenopathy) (2nd MC)
- Recurrent infections
- HSM
- B symptoms
- leukemia cutis
CLL: Dx?
- ** LYMPHOCYTOSIS with “smudge cells” on CBC/diff/peripheral smear**
- *FLOW CYTOMETRY needed to determine immunophenotype & demonstrate clonality
CLL: Tx
Tx: Early stage/asymptomatic: observation recommended. Stage I-II: local radiation ≥Stage II w/ sx: chemo. CLL can’t be cured by current tx options (?SCT poss. exception)
Prognosis: Early stage >10 years, Stage III-IV about 2 years
Acute Lymphocytic leukemia (ALL): Risks and Sx
ionizing radiation, chemo, white>black
Sx: Fatigue, pallor, bruising, bleeding, petechiae, bone pain, leukemia cutis, infections
ALL: Dx?
- Bone marrow aspiration & bx showing BLASTS > 20%*
- **May be Pancytopenic with blasts on CBC
- Also need **Cytogenics,
- immunophenotyping
ALL: Tx if < 60 YO?
combo chemotherapy. If + for Philadelphia chromosome, add tyrosine kinase inhibitor.
-If Pt is older than 60: tyrosine kinase inhibitor + prednisone (no chemo). After remission –>CNS prophylaxis, then further chemo or SCT.
Prognosis: Worse for adults than children
Half of brain tumors are _____
gliomas. Others include meningioma, pituitary adenoma, neurofibroma, others
Risk: Some have familial basis, ionizing radiation
Brain tumor: S/sx
- *Focal deficit depending on location,
- *headache,
- *seizures,
- n/v, syncope, cognitive dysfunction, personality change, aphasia, hallucination, ataxia, sensory deficit, weakness, visual spatial dysfunction
Brain tumor: Dx
MRI with gadolinium. CT 2nd choice
Brain tumor: Tx
- **includes surgical removal if possible,
- radiation,
- chemo,
- *corticosteroids to reduce edema,
- -anticonvulsants commonly given
Prognosis: Depends upon type.
Esophageal Cancer: risks
- **Smoking
- **Alcohol consumption
- Diet low in fruit/vegetables
- HPV
- Barret’s from GERD
- M>W
- 50-70 YO
Esophageal cancer: S/Sx?
- Sticking of food
- Retrosternal discomfort or burning
- **Regurgitation of saliva or food
- IDA from chronic blood loss is common
- Advanced cancer Sx: progressive dysphagia/weight loss, odynophagia
Esophageal cancer: Dx?
- Endoscopic biopsy
- Barium esophogram helpful for visualization
- Staging with CT to eval for metastatic disease
Esophageal cancer: Tx?
- May include surgery, chemo, radiation. May need nutritional support. Airway management
- Prognosis: Overall 5 year survival <20% Many present at advanced stages.
Are bone scans useful for Multiple Myeloma?
NO!!! in the realm of oncology a bone scan only shows areas of osteoblastic activity
Patient presents with painless localized lymphadenopathy. He also recalled after drinnking last night that his neck hurt (near virchow’s nodes (lymph nodes)). What might you expect to see on biopsy?
Lymph node biopsy showing Reed-Sternberg cells. HODGKIN lymphoma!!
