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Clin Med semester 2 > Oncology 2- Paulson > Flashcards

Oncology 2- Paulson Flashcards

1
Q

Common presenting S/Sx of cancer?

A
  • Weight loss
  • Failure to thrive
  • Anorexia
  • Malaise
  • Fever
  • Lymphadenopathy
  • Pallor
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2
Q

WBC development: Original stem cell?

A

Hemocytoblast

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3
Q

WBC development: Hemocytoblasts develop into what cells?

A
  • Myeloid stem cell

- Lymphoid stem cell

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4
Q

Compare and contrast Leukemias and Lymphomas

A

Leukemias and lymphomas both start in lymphocytes BUT leukemias are mainly affecting bone marrow and blood. Lymphomas mainly affect lymph nodes

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5
Q

What is the MC form of pediatric cancer?

A

Acute lymphocytic leukemia (ALL)

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6
Q

ALL: A characteristic description of ALL is a proliferation of what cell type?

A

lymphoblasts

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7
Q

ALL: What is the peak age of ALL?

A

2-5 YO

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8
Q

ALL: S/Sx?

A

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

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9
Q

ALL: Labs?

A
  • CBC w/ diff peripheral smear

- Bone marrow aspiration

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10
Q

ALL: CBC results?

A
  • Anemia
  • Thrombocytopenia
  • Blasts on peripheral smear
  • (+/-) Elevated WBC
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11
Q

What confirms your Dx of ALL?

A

Bone marrow confirms

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12
Q

ALL: Tx?

A
  • Chemo!!! is Tx of choice

- Specific Tx is determined by phenotyping

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13
Q

ALL: what % have a 5-year survival rate

A

> 85%

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14
Q

What is the 2nd MC childhood cancer?

A

CNS tumors

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15
Q

CNS Tumors: S/Sx?

A
  • 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)

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16
Q

CNS Tumors: Dx?

A
  • **MRI preferred

- Bx needed for histologic diagnosis

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17
Q

CNS Tumors: Tx?

A
  • **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.
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18
Q

CNS Tumors: Prognosis?

A
  • Depends on tumor type.

- 5-year: 74% long-term sequelae common. Late mortality in 15-25% who survive beyond 5 years.

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19
Q

Retinoblastoma: Demographic?

A

Peak: up to age 2

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20
Q

Retinoblastoma: Genetic component to demographic?

A

~1/2 have heritable retinolastoma gene: RB1 gene

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21
Q

Retinoblastoma: S/Sx?

A
  • **Leukocoria
  • Strabismus
  • Red inflamed eye
  • Nystagmus

(leukocoria= white pupillary reflex)

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22
Q

Retinoblastoma: Unilateral or bilateral?

A
  • Can be unilateral (⅔) or bilateral (⅓)
  • **Refer to optho!!
  • Molecular genetic testing recommended for all
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23
Q

Retinoblastoma: Tx?

A

cryotherapy, local or systemic chemo, laser photocoagulation, enucleation, radiation
**>95% survival but if untreated–> deadly!!!

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24
Q

Osteosarcoma: Risk factors?

A
  • In kids, most sporadic
  • Prior irradiation or chemo
  • Genetics
  • Paget disease
  • Male
  • *this is the MC bone malignancy in kids
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25
Q

Osteosarcoma: S/Sx?

A
  • **Localized pain typically lasting months
  • Soft tissue mass on exam
  • Often large & TTP
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26
Q

Osteosarcoma: Common sites?

A

Distal femur, proximal tibia, proximal humerus, middle/proximal femur

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27
Q

Osteosarcoma: Dx? (key words)

A
  • X-ray shows…
  • – Destructive lesion
  • – ** spiculated “sunburst” appearance
  • – **Codman triangle
  • –>Biopsy!!!
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28
Q

Osteosarcoma: Describe “Codman triangle”

A

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

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29
Q

Osterosarcoma: Tx

A

Almost all get chemo. Preop chemo–> surgery –> postop chemo. Radioresistant.

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30
Q

Osteosarcoma: Prognosis?

A

Depends on tumor response (necrosis) to chemo.

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31
Q

Ewing Sarcoma is described as what kind of cell tumor?

A

Small round blue cell tumor

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32
Q

Ewing sarcoma: Demographics?

A

Male>female. Peak: ages 10-20.

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33
Q

Ewing Sarcoma: S/Sx?

A
  • **Localized bony pain or swelling for a few weeks or months
  • Limp
  • Fracture
  • **MOST common in long bones and pelvis
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34
Q

Ewing sarcoma: Dx?

A
  • 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
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35
Q

Ewing sarcoma: Tx?

A
  • Almost all need **chemo

- **Local control with surgical resection + XRT

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36
Q

Ewing sarcoma: Prognosis?

A
  • 5-yr survival: 55% non-metastatic; 21% metastatic
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37
Q

Nephroblastoma: Also known as?

A

Wilms tumor

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38
Q

What is the MC renal malignancy in kids?

A

Wilms Tumor

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39
Q

Nephroblastoma: Peak age? and Risk factors

A
  • 2-5 YO
  • Risk ↑ in African, WAGR syndrome, Denys-Drash syndrome, Beckwith-Wiedemann syndrome .

-dont memorize syndromes

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40
Q

Nephroblastoma: S/Sx?

A
  • **Abdominal mass or swelling
  • Firm, smooth, nontender unilateral mass.
  • (+/-) ABD pain, hematuria, fever, HTN
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41
Q

Nephroblastoma: Imaging?

A
  • **Abdominal U/S (1st imaging study). Also used for screening in high-risk PTs
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42
Q

Nephroblastoma: Dx

A
  • Abdominal U/S (1st imaging study)

- Confirm w/ biopsy

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43
Q

Nephroblastoma Tx:

A

**surgical resection for all, **chemo for almost all, XRT based on stage/histology

-Prognosis: 90% 5 year survival

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44
Q

Bladder Cancer- demographics

A
  • *Men > female. **Smoking ↑↑↑ risk. Animal fat-rich diets also ↑ risk.
  • Most are transitional cell carcinomas
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45
Q

Bladder cancer: S/Sx?

A
  • **Painless hematuria (gross or microscopic)
  • May initially have frequency/urgency/dysuria.
  • Pain usually from spread (local or metastatic)
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46
Q

Bladder cancer: Dx?

A
  • UA (dipstick, microscopic, & gross examination)
  • **CYTOSCOPY (gold standard). Can use for biopsy.
  • IVP and/or CT for imaging
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47
Q

Bladder cancer: Tx?

A
  • *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

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48
Q

Bladder cancer: Describe TURBT

A

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.

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49
Q

MC cancer in men 15-35?

A

Testicular cancer

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50
Q

Testicular cancer: Risk factors?

A
  • Cryptorchidism

- Caucasian race

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51
Q

Describe cryptorchidism

A

Condition where testes do not descend into scrotum

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52
Q

Testicular cancer: S/Sx?

A
  • ***Painless mass or swelling in testis

- Some feel a heaviness or ache in lower abdomen. Small percentage feel pain.

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53
Q

Testicular cancer: Dx?

A

**Scrotal U/S

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54
Q

Testicular cancer: Serum tumor markers?

A
  • AFP
  • beta-hCG
  • LDH
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55
Q

Testicular cancer: Tx

A
  • Inguinal orchiectomy + surveillance (alone for many with stage 1)
  • Add RPLND, XRT and/or platinum-based chemo
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56
Q

Testicular cancer: Prognosis

A

Good! >95% (80% for metastatic disease)

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57
Q

Ovarian cancer: risk factors

A
  • **Family Hx
  • BRCA
  • Lynch II syndrome
  • Infertility
  • PCOS
  • Endometriosis
  • Smoking
  • HRT
  • MC in Caucasians
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58
Q

Ovarian cancer: Peak age?

A

60’s

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59
Q

Ovarian cancer: S/Sx?

A
  • **Abdominal fullness/bloating, nausea, early satiety
  • Pelvic or abdominal pain
  • Adnexal mass on pelvic exam
  • Changes to urinary or bowel patterns
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60
Q

Ovarian cancer: Assessment tools?

A
  • **Pelvic U/S
  • CA-125
  • CXR
  • CT
  • (+/-) genetic counseling
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61
Q

What is the CA-125 test?

A

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.

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62
Q

Ovarian cancer: Dx?
(KNOW!!)

and Tx?

A
  • Unilateral salpingo-oophorectomy
  • If pathology shows primary ovarian Ca –> Hysterectomy, contralateral salpingo-oophorectomy, omentectomy, & pelvic node sampling. Then likely platinum-based chemo.
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63
Q

Ovarian cancer: Prognosis?

A
  • Overall poor

- Recurrence in 75% of “complete responders” in 1-4 years

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64
Q

Multiple myeloma: Describe pathology

A

=***Proliferation of plasma cells producing monoclonal antibody…leading to–>
end organ damage (CRAB)
–> In the bone marrow or as a tumor (plasmacytoma)

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65
Q

Multiple myeloma: What is the mnemonic CRAB helpful for?

A 
MM findings.
C = Calcium (elevated)
R = Renal failure
A = Anemia
B = Bone lesions
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66
Q

Multiple myeloma: risk factors?

A
  • African
  • M > W
  • Obesity
  • Older age (most 60s to 70s)
  • 1st degree relative with MM
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67
Q

Multiple myeloma: S/Sx?

A

**Bone pain, **anemia (Rouleaux), **hypercalcemia, fatigue/weakness, weight loss, ↑ Cr
Prone to recurrent infection, esp. encapsulated organisms

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68
Q

Multiple myeloma: Dx

A
  • **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.
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69
Q

Multiple Myeloma: Tx

A

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.

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70
Q

Prostate Cancer: demographics

A

-very common!

Risk: Black, high fat diet, FH, increased age

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71
Q

Prostate cancer: S/Sx

A 
Early:
- Asymptomatic
Later:
- (+/-) hematuria
- hematospermia
- obstructive urinary Sx
- Bone pain
- Asymmetric induration or nodules on DRE
- ****Increased PSA
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72
Q

Prostate cancer: Dx

A

**Prostate biopsy (usually transrectal). Gleason score for grading

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73
Q

Prostate cancer: Tx

A

low grade: watchful waiting (esp. if short life expectancy).
vs
Higher stages: radical prostatectomy, brachytherapy, XRT.

Metastatic: Above + castration (physical and/or chemical) + bisphosphonate

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74
Q

“you die with ____ cancer”

A

Prognosis: Generally very good for most. “You die with prostate cancer, not of it”

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75
Q

Pancreatic cancer: Risk factors?

A

age, tobacco, chronic pancreatitis, alcohol, FH, obesity, diabetes

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76
Q

Pancreatic cancer: S/Sx

A
  • **Abdominal pain (often gnawing, epigastric)
  • **Nausea
  • **Weight loss
  • Anorexia
  • fatigue
  • ***Courvoisier sign
  • Jaundice
  • Steatorrhea
  • Dark urine
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77
Q

Describe Courvoisier’s sign. (KNOW THIS FOR THE TEST)

A

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.

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78
Q

Describe steatorrhea

A

Excess fat in stool. Symptom of interrupted lipid digestion/absorption.

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79
Q

Pancreatic cancer: Signs of metastasis?

A
  • 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
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80
Q

Pancreatic cancer: Labs?

A
  • LFTs
  • Lipase
  • Imaging (abdominal U/S or CT)
  • -> (+/-) biopsy
  • “Double duct sign”
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81
Q

Describe the “double duct sign” (KNOW THIS!)

A

Dilation of both the pancreatic duct and the common bile duct.

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82
Q

Pancreatic cancer: Tx

A
  • ***Surgical resection (whipple) is the only potential cure.
  • Chemo +/- XRT afterwards & for those without resectable tumor
  • Palliative care for advanced disease
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83
Q

Pancreatic cancer: What type of patients do not qualify for a Whipple procedure?

A

Those with metastatic disease.

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84
Q

Pancreatic cancer: Prognosis?

A

**Very poor. Almost all die from the disease.

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85
Q

Colorectal cancer: Risk factors?

A

Most in those >50, Lynch syndrome, diet high in meat/fat low in veggies, FH, inflammatory bowel disease

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86
Q

Colorectal cancer: S/Sx?

A
  • Asymptomatic/found on screening
  • Frank or occult **blood in stool,
  • **Change in bowel habits
  • Abdominal pain
  • Hematochezia
  • Melena
  • **Unexplained IDA
  • Obstructive Sx
87
Q

Describe hematochezia

A

Hematochezia is the passage of fresh blood through the anus, usually in or with stools (contrast with melena)

88
Q

What does the acronym BRBPR stand for?

A

Bright red blood per rectum

89
Q

Describe melena

A

Melena refers to the dark black, tarry feces that are associated with upper gastrointestinal bleeding.

90
Q

Rectal cancer: Classic S/Sx?

A

Tenesmus

  • Urgency
  • Recurrent hematochezia
91
Q

Describe tenesmus

A

A continual or recurrent inclination to evacuate the bowels, caused by disorder of the rectum or other illness.

92
Q

Colorectal cancer: Dx?

A
  • **Colonoscopy

- **FOBT screening may alert you

93
Q

Colorectal cancer: Staging?

A
  • C/A/P CT for staging
94
Q

Colorectal cancer: What can be checked for monitoring but not for screening or diagnosis?

A

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.)

95
Q

Colorectal cancer: Tx?

A
  • **Surgical resection + **chemo (for many)

- XRT usually added for rectal tumors

96
Q

Colorectal cancer: Prognosis?

A

5-yr survival:

    • Stage 4: 5-7%
    • Stage I: >90%
  • Rectal cancer has worse prognosis at each stage
97
Q

Hepatocellular Carcinoma (HCC): Risk factors

A
  • Cirrhosis (80%)
  • Male
  • *HCV (hep C)
  • *HBV (hep B)
  • Obesity
  • Asian
  • Hispanic
  • Age > 55 YO
  • Diabetes
98
Q

Hepatocellular carcinoma (HCC): S/Sx?

A
  • Usually asymptomatic except for Sx of their chronic liver dz
  • Abdominal pain
  • New decompensation of cirrhosis
  • paraneoplastic syndromes
  • Hepatic bruit
99
Q

Hepatocellular carcinoma (HCC): Dx

A
  • 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)
100
Q

Hepatocellular carcinoma (HCC): Tx?

A
  • 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

101
Q

Melanoma: Risk factors

A
  • **UV light exposure
  • Highest in *Caucasian
  • **Large number of moles
  • Increasing age
102
Q

Melanoma: S/Sx

A
  • Skin lesion with recent change in appearance

- ABCDE rule

103
Q

List the Four types of Melanoma

A
  • Superficial spreading
  • Nodular melanoma
  • Lentigo maligna
  • Acral lentiginous
104
Q

Melanoma: Dx?

and Tx?

A

Dx: biopsy

Tx:Excision with margins= SLNE= sentinel lymph node excision) depending on thickness

105
Q

Melanoma: What procedure is done for staging?

A
  • Sentinel lymph node excision (SLNE) for staging
106
Q

Melanoma: What procedures and tests can be added with metastatic disease?

A
  • Interferon alpha
  • Immune therapy
  • Chemo
107
Q

Melanoma prognosis?

A
  • Tumor thickness (Breslow stage) is most important prognostic factor.
108
Q

Squamous cell carcinoma (SCC): Risk factors?

A
  • UV light
  • Smoking
  • Immunosuppression
  • Chronic ulcer
  • M > F
  • Increasing age
109
Q

Squamous cell carcinoma (SCC): Distribution?

A
  • 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.
110
Q

Squamous cell carcinoma (SCC): Dx?

A
  • Shave
  • Punch
  • Excisional biopsy
111
Q

Squamous cell carcinoma (SCC): Tx?

A

Depending on depth, may include…

    • 5-FU
    • Imiquimod
    • Electrodessication & curettage
    • Excision
    • Mohs, radiation, chemo
112
Q

Squamous cell carcinoma (SCC): Prognosis?

A

Overall good

- 5-yr survival: >90%

113
Q

Basal cell carcinoma (BCC): Risk factors

A
  • UV light
  • Fair skin
  • FH
  • Hx irradiation
  • M > W
  • Increasing age
114
Q

Basal cell carcinoma (BCC): Distribution?

A
  • *Head & neck (85%)

- **Nose is MC site

115
Q

Basal cell carcinoma (BCC): Appearance?

A
  • Pearly papule with telangiectasia
  • (+/-) *central ulceration (“rodent ulcer”)
  • Superficial: circumscribed, scaling lesion with raised pearly-white border.
116
Q

Basal cell carcinoma (BCC): Morpheaform BCC appearance?

A

Morpheaform BCC is a variant of BCC.

  • Flat or slightly raised
  • Yellowish/white lesion
  • Scarlike with waxy surface
117
Q

Basal cell carcinoma (BCC): Dx?

A
  • Biopsy (shave or punch)
118
Q

Basal cell carcinoma (BCC): Tx?

A 
- *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

119
Q

What is 5-FU?

A

Fluorouracil is also known as FU or 5FU and is one of the most commonly used drugs to treat cancer

120
Q

Endometrial carcinoma: Risk factors?

A
  • Obesity
  • Advancing age
  • unopposed estrogen therapy
  • PCOS
  • Early menarche
  • Late meopause
  • Nulliparity
  • FH
  • Tamoxifen
  • Lynch syndrome
  • Diabetes
  • White > Black
121
Q

Endometrial carcinoma: Protective factors?

A

Combination OCPs and smoking protective

122
Q

Endometrial carcinoma: S/Sx?

A
  • Abnormal uterine bleeding
  • MC in postmenopausal women
  • Abnormal vaginal discharge
  • May have abnormal cervical cytology
123
Q

Endometrial carcinoma: Dx?

A
  • Endometrial biopsy or D&C

In postmenopausal women, transvaginal u/s often done to evaluate the endometrial thickness

124
Q

Endometrial carcinoma: Tx

A
  • 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)

125
Q

Cervical cancer: Risk factors?

A
  • 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
126
Q

Cervical cancer: S/Sx?

A
  • Most asymptomatic
  • Found on screening
    If advanced:
  • Abnormal vaginal bleeding or discharge
127
Q

Cervical Cancer: Dx?

A

Pap test (may have HPV co-testing) if abnormal, may repeat or move to colposcopy + biopsy.

128
Q

Cervical Cancer: Tx?

A

Depending on stage, could include LEEP, ablation, conization, hysterectomy & pelvic lymphadenopathy, radiation, chemotherapy

129
Q

Cervical cancer prognosis

A

Best when there is early detection by Pap. Early stages: >90% Stage IV: <15%

130
Q

Vulvar cancer: Risk factors?

A

Age. Most >70. Infection with high-risk HPV types, HSV, immunosuppression, smoking

131
Q

Vulvar cancer: S/Sx

A

Pruritis, visible lesion. May have pain, bleeding, ulceration

132
Q

Vulvar Cancer: Dx?

A

Vulvar biopsy. Can use 5% acetic acid solution/visualization with colposcope  acetowhite lesions should be biopsied

133
Q

Vulvar cancer: Tx?

A

Wide local excision, topical 5-FU, laser therapy for early lesions. May need radical partial or complete vulvectomy ± SLNB/lymphadenectomy ±chemo/radiation

134
Q

Vulvar cancer: prognosis

A

Generally good for stage I-II: 75-90%. As low as 16% for IV.

135
Q

What does the acronym SLNB stand for?

A

Sentinel Lymph Node Biopsy

136
Q

What type of cancer is the leading cause of cancer deaths?

A

Lung cancer

137
Q

Lung cancer: Risk factors?

A

Smoking, radiation therapy, pulmonary fibrosis, environmental toxins

138
Q

Lung cancer: S/Sx

A
  • New or changed cough
  • Hemoptysis
  • Chest pain
  • Dyspnea
  • Weight loss
139
Q

Lung cancer: What are the two major categories?

A
  • Small cell lung cancer (SCLC, Oat Cell)

- Non-small cell lung cancer (NSCLC)

140
Q

Lung cancer: NSCLC is composed of what types of lung cancer?

KNOW this!

A
  • Squamous-cell carcinoma (SCC)
  • Large cell carcinoma (LCC)
  • Adenocarcinoma

**NSCLC is slower growing

141
Q

Lung cancer: SCLC is also known as…

A

oat cell

142
Q

Lung cancer: Characteristics of SCLC? (**KNOW THIS)

A
  • Originates centrally
  • Metastasizes early
  • Is aggressive
143
Q

Lung cancer: Characteristics of NSCLC?

A
  • Slower growing

- Includes SCC, LCC, and adenocarcinoma

144
Q

Lung cancer: Dx?

A
  • May be found incidentally on CXR or CT
  • -> **Needs histologic confirmation: (via one of the following)*
  • Sputum cytology
  • Bronchoscopy
  • Pleural fluid examination
  • (or) biopsy
145
Q

Lung cancer: NSCLC Tx?

A
  • **Surgical resection if possible

- May also have chemo +/- XRT

146
Q

Lung cancer: SCLC Tx?

A
  • **Chemotherapy

- XRT often added

147
Q

Lung Cancer: Prognosis?

A

Poor. Overall 5 year survival: 15%

148
Q

Renal cell carcinoma (RCC): Risk factors?

A
  • Men > women
  • Age > 55 YO
  • Smoking
  • Native American / Alaskin natives
  • Hereditary RCC
  • HTN
  • Obesity
  • Polycystic kidney disease
149
Q

Renal cell carcinoma (RCC): S/Sx

A
  • Many asymptomatic, diagnosed incidentally.
  • Hematuria
  • Pain or mass
  • Weight loss
  • Paraneoplastic symptoms
  • **Classic triad:
150
Q

Renal cell carcinoma (RCC): What is the classic triad associated with RCC?

A

hematuria, flank pain, palpable mass

151
Q

Renal cell carcinoma (RCC): Dx?

A
  • Abdominal CT (1st test)
  • Sometimes U/S done 1st
  • Nephrectomy or partial nephrectomy to obtain tissue for histologic dx
152
Q

Renal cell carcinoma (RCC): Tx?

A
  • 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%

153
Q

What is the acronym VEGF for?

A

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

154
Q

Breast cancer: What are the two main types? which is MC?

A
  • Ductal
  • Lobular

Infiltrating ductal carcinomas most common type.

155
Q

Breast cancer: Risks?

A
  • Increasing age
  • BRCA
  • Nulliparity
  • early menarche
  • Menopause
  • Delayed childbearing
  • Radiation exposure
  • Long-term estrogen use.
156
Q

Breast cancer: S/Sx?

A
  • SINGLE, NONTENDER, FIRM, IMMOBILE MASS.

- Most in upper outer quadrant. Commonly asymptomatic, (no palpable nodule) but seen on mammogram.

157
Q

Breast cancer: Rare S/Sx?

A
  • Nipple discharge
  • Retraction
  • Peau d’orange
  • Eczematous changes (Paget disease)
  • Pain
  • Axillary LAD
158
Q

Breast cancer: Dx?

A
  • MAMMOGRAPHY then–> *stereotactic or excisional core-needle biopsy**
  • need to check estrogen & progesterone receptor analysis + histology of specimen
159
Q

Breast cancer: Tx?

A
  • 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.
160
Q

Breast cancer: Prognosis?

A

Early stage: excellent, close to 100%. ER/PR positive favorable.

161
Q

Thyroid cancer: What are the types?

A
  • Papillary
  • Follicular
  • Anaplastic
  • Medullary
162
Q

Thyroid cancer: RF?

A
  • W > M
  • Childhood head/neck irradiation
  • FH
  • MEN Type II
163
Q

Thyroid cancer: S/Sx?

A
  • Painless neck swelling
  • Palpable single firm nodule
  • **MOST asymptomatic
164
Q

Thyroid cancer: Dx?

A
  • **Ultrasound

- -> *FNA (fine needle aspiration) (U/S guided)

165
Q

Thyroid cancer: Tx?

A
  • **Surgical resection*
  • May use **Radioactive iodine (RAI) for residual tumor*
  • Will need thyroid replacement for life
166
Q

Thyroid cancer: Tx for anaplastic?

A

Anaplastic has no Tx. Palliation is recommended. Chemo + XRT for pts who desire to try tx.

167
Q

Thyroid cancer: Prognosis for papillary?

A

excellent!

Follicular: Still relatively good but more aggressive, more metastatic disease. Medullary: Good for most.
Anaplastic: Poor, extremely aggressive.

168
Q

NHL: What does NHL stand for?

A

Non-Hodgkin Lymphoma

169
Q

NHL: Risk factors?

A
  • Increasing age
  • HIV
  • Toxin exposure
  • Autoimmune dz
  • EBV
  • Obesity
  • White
170
Q

NHL: How can you categorize NHL based off of the S/Sx?

A
  • Indolent vs Aggressive
171
Q

NHL: Indolent S/Sx?

A
  • **Painless
  • **Persistant LAD (diffuse or isolated
  • HSM
  • Cytopenia
172
Q

NHL: Aggressive S/Sx?

A
  • **Rapidly growing mass
  • ** Fever
  • **Night sweats
  • **Weight loss
  • Elevated LDH
  • Elevated Uric acid

Common extranodal sites: GI tract, skin, bone, bone marrow

173
Q

NHL: Dx?

A
  • *Biopsy of involved nodes. **

* Should have bone marrow bx before starting tx as part of staging.

174
Q

NHL: Tx?

A

If indolent with a few nodes: Radiation alone

-If intermediate-high grade: Chemo, immunotherapy (often rifuximab), & stem cell transplantation

175
Q

NHL: Prognosis?

A
  • Worst for those within HIV-related NHL
  • Complete remission for up to 50% with aggressive NHL
  • If indolent: long survival
176
Q

Hodgkin Lymphoma (HL): Risk factors & demographics

A

Bimodal peak: 20 years, 65 years old. Male> female, EBV, immunodeficiency

177
Q

Hodgkin Lymphoma S/Sx:

A
  • *Painless localized peripheral lymphadenopathy, typically cervical.
  • Mediastinal mass on CXR also common presentation. May have B symptoms.
178
Q

Hodgkin Lymphoma: dx ?

A
  • Lymph node bx showing REED-STERNBERG CELLS

* Should do PET/CT and bone marrow biopsy for staging

179
Q

Hodgkin Lymphoma: Tx?

A
  • **Combination chemo for most. ABVD chemo (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) + XRT.
  • Refractory disease may add in autologous stem cell transplant.
180
Q

Hodgkin Lymphoma: Prognosis?

A

Very good, with excellent response to tx, even for those with advanced disease

181
Q

Describe the growth (progression) of a Blood stem cell

A
  1. 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
182
Q

Chronic Myelogenous Leukemia (CML): What kind of disorder is this?

A

Myeloproliferative disorder

183
Q

Chronic Myelogenous Leukemia (CML): What are the three phases?

A
  • Chronic
  • Accelerated
  • Acute (blast crisis)
184
Q

CML: RF?

A
  • Young-middle aged adults
  • M>F
  • Ionizing radiation
185
Q

CML: S/Sx

A
  • 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
186
Q

CML: Dx?

A
  • CBC with leukocytosis
  • Bone marrow biopsy
  • Bone marrow cytogenetics: PHILADELPHIA CHROMOSOME,
  • PCR for BCR-ABL gene
187
Q

CML: Tx in chronic phase?

A
  • *Gleevec (chemotherapy drug) is standard
188
Q

CML: Tx in accelerated phase?

A
  • **Allogenec bone marrow transplantation.
189
Q

CML: Tx in blast crisis? (KNOW THIS)

A
  • *Conventional induction chemo then Stem cell transplantation
190
Q

CML: Prognosis?

A
  • Chronic phase on Tx = >25 years median survival.
  • Accelerated: 5 years
  • Blast crisis: 1 yr.
191
Q

Acute Myelogenous Leukemia (AML): what is this disorder?

A

Clonal proliferation of myeloid precursors w/ ↓ ability to differentiate to mature cells

192
Q

Acute Myelogenous Leukemia (AML): risks

A

chemo, ionizing radiation, chemical exposure. Median age of onset: 60

193
Q

Acute Myelogenous Leukemia (AML): Sx

A
  • *Fatigue
  • pallor
  • *weakness,
  • gingival bleeding, -ecchymosis,
  • *epistaxis
  • ** anemia,
  • thrombocytopenia
194
Q

Acute Myelogenous Leukemia (AML): Dx

A
  • *Presumptive with myeloblasts on CBC/diff/peripheral smear.
  • **Definitive with bone marrow bx.
195
Q

AML: What would you find on bond marrow bx or with peripheral blood?

A

> 20% BLASTS

196
Q

Acute Myelogenous Leukemia (AML): Tx:

A

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

197
Q

Chronic Lymphocytic Leukemia (CLL): describe this disorder and the risk factors

A

Clonal malignancy of B lymphocytes

-Risks: men> women, increasing age, white

198
Q

CLL: S/Sx

A
  • **Most are asymptomatic
  • & Discovered with lymphocytosis on labs
  • LAD (lymphadenopathy) (2nd MC)
  • Recurrent infections
  • HSM
  • B symptoms
  • leukemia cutis
199
Q

CLL: Dx?

A
  • ** LYMPHOCYTOSIS with “smudge cells” on CBC/diff/peripheral smear**
  • *FLOW CYTOMETRY needed to determine immunophenotype & demonstrate clonality
200
Q

CLL: Tx

A

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

201
Q

Acute Lymphocytic leukemia (ALL): Risks and Sx

A

ionizing radiation, chemo, white>black

Sx: Fatigue, pallor, bruising, bleeding, petechiae, bone pain, leukemia cutis, infections

202
Q

ALL: Dx?

A
  • Bone marrow aspiration & bx showing BLASTS > 20%*
  • **May be Pancytopenic with blasts on CBC
  • Also need **Cytogenics,
  • immunophenotyping
203
Q

ALL: Tx if < 60 YO?

A

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

204
Q

Half of brain tumors are _____

A

gliomas. Others include meningioma, pituitary adenoma, neurofibroma, others
Risk: Some have familial basis, ionizing radiation

205
Q

Brain tumor: S/sx

A
  • *Focal deficit depending on location,
  • *headache,
  • *seizures,
  • n/v, syncope, cognitive dysfunction, personality change, aphasia, hallucination, ataxia, sensory deficit, weakness, visual spatial dysfunction
206
Q

Brain tumor: Dx

A

MRI with gadolinium. CT 2nd choice

207
Q

Brain tumor: Tx

A
  • **includes surgical removal if possible,
  • radiation,
  • chemo,
  • *corticosteroids to reduce edema,
  • -anticonvulsants commonly given

Prognosis: Depends upon type.

208
Q

Esophageal Cancer: risks

A
  • **Smoking
  • **Alcohol consumption
  • Diet low in fruit/vegetables
  • HPV
  • Barret’s from GERD
  • M>W
  • 50-70 YO
209
Q

Esophageal cancer: S/Sx?

A
  • 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
210
Q

Esophageal cancer: Dx?

A
  • Endoscopic biopsy
  • Barium esophogram helpful for visualization
  • Staging with CT to eval for metastatic disease
211
Q

Esophageal cancer: Tx?

A
  • May include surgery, chemo, radiation. May need nutritional support. Airway management
  • Prognosis: Overall 5 year survival <20% Many present at advanced stages.
212
Q

Are bone scans useful for Multiple Myeloma?

A

NO!!! in the realm of oncology a bone scan only shows areas of osteoblastic activity

213
Q

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?

A

Lymph node biopsy showing Reed-Sternberg cells. HODGKIN lymphoma!!

Clin Med semester 2 (24 decks)

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