Oncology 2- Paulson (ADULT Cancers) Flashcards
A 63 year old male with a 12 year smoking hx presents to your clinic with painless hematuria. What cancer is this likely caused by?
Bladder CA
What is the gold standard diagnostic test for bladder CA?
Cytoscopy
What is the mainstay treatment for bladder CA?
TURBT (Trans urethral resection of bladder tumor) or cystectomy for muscle invasive
Cryptochidism is a big RF for what type of CA?
Testicular
A 19 y.o. male presents to clinic with a painless mass in his testis and also a lower abdominal ache. What is the first and BEST test you should order to confirm your dx of testicular cancer?
Scrotal u/s
A 60 year old female patient presents with abdominal fullness and bloating and also states she gets full really easily after eating. She attributes these symptoms to her GI problems but they just have not improved. What test should we do for inital eval?
Pelvic u/s
What test or procedure would we do to diagnose ovarian cancer?
Unilateral salpingo-oophorectomy and if path shows primary ovarian CA then do hysterectomy
This is a POOR prognosis and can recur
This type of cancer involves proliferation of plasma cells producing monoclonal antibodies –> end organ damage (CRAB)
Multiple myeloma
What does CRAB stand for in multiple myeloma?
C- calcemia
R- renal dz
A- Anemia
B- bone dz
These are signs and symptoms of what type of cancer?
Anemia (rouleaux), bone pain and hypercalcemia
Multiple myeloma
Serum electrophoresis shows and M spike and urine protein electrophoresis shows Bence Jones proteins in which type of CA?
Multiple myeloma
To diagnose Multiple myeloma what type of imaging should you get and what would you see?
Xray & lytic lesions
What imaging is NOT helpful in Multiple myeloma?
Bone scan
This is the mc cause of cancer in men and has been controversial on whether or not to get a bx?
Prostate CA
How would we diagnose prostate CA?
Prostate bx
T/F: Prostate CA has good prognosis
True
T/F: ovarian CA has good prognosis
false- POOR
A 45 year old male presents to your clinic with abdominal pain that has been worsening, nausea, and weight loss. Upon examination, you can palpate his gallbladder (Courvosier sign). What type of cancer is this most commonly associated with?
Pancreatic cancer
What does your workup for pancreatic cancer include?
LFTs, lipase, + abdomnial U/s or CT. There will also be “Double duct sign” (dilation of common bile and pancreatic duct)
What is the only potential cure for Pancreatic cancer
Whipple (for those without metastatic disease)
Advanced need pallative care and almost all die
A patient presents to your clinic with blood in stool for the past few days as well as change in bowel habits. Upon further testing you notice the patient has iron deficient anemia but the patient is a male and this cannot be explained well. What type of cancer could the patient have?
Colorectal
What tests could be used to dx your patient with colorectal CA?
Colonoscopy or FOBT screening card.
How do you treat colorectal cancer and also which cancer could cause a metastases to colorectal cancer?
Surgical resection and chemo and brain mets
You have a regular patient who comes in to treat liver cirrhosis with HCV and HBV co-infection (Hep B & C). If you start to become suspicious of cancer in this patient, What two tests would confirm your suspicion?
Liver u/s and AFP testing
What are the two treatment options for a patient with hepatocellular carcinoma?
Surgical resection or liver transplant for advanced cirrhosis
This is the leading cause of skin cancer death and RFs include UV light exposure, large # of moles and caucasian patients?
Melanoma
How to we diagnose and treat melanoma?
Bx and excision with margins
The most important prognostic factor in melanoma is ___________ (Breslow stage)
tumor THICKNESS
This skin cancer can form due to UV light exposure and often is on the head and neck and comes from actinic keratosis. Starts as a scaly plaque that can bleed or crust.
Squamous cell carcinoma
T/F the prognosis for squamous cell carcinoma is overall good
T
This type of cancer beings on the nose with a pearly papule with telangictasia.
Basal Cell Carcinoma
The Mohs has the highest cure rates in which type of cancer?
Basal Cell Carcinoma
This 60 year old female patient presents to your clinic because she has been through menopause and thinks she recently got her period again. What is the first test you perform and what are you concerned about?
Endometrial bx or D & C. Worried about endometrial CA
What is the best treatment for endometrial CA?
hysterectomy + bilateral salpingo-oophorectomy
You worry about what type of cancer in a young woman who is asymptomatic with HSV?
cervical cancer
A pap smear is used to detect which type of cancer?
cervical
An 80 year old woman presents with intense vulvar itching. What test would confirm your suspected dx of vulvar cancer?
vulvar bx with acetic acid solution
This is the leading cause of cancer deaths due to smoking
Lung CA
T/F: SCLC (oat cell) originates centrally, metastasizes early and is aggressive?
T
T/F: NSCLC is less aggressive than SCLC
T
Squamous cell carcinoma, adenocarcinoma and large cell carcinoma are from what type of cancer?
NSCLC
What is the treatment for NSCLC? What is the treatment for SCLC?
surgical resection, chemo
*poor prognosis
This is a classic triad of what type of cancer?
Hematuria, flank pain, palpable mass
Renal cell carcinoma
A patient presents with hematuria and flank pain. What is the first diagnostic test you should order? What cancer are you concerned about?
Abdominal CT, renal cell carcinoma
What type of treatment is used in renal cell carcinoma?
Partial or radial nephrectomy
A 30 year old female is showering when she notices a single, nontender and palpable mass in the upper outer quadrant of her breast. A few weeks later, her breast starts having the appearance of an orange peel. What are you concerned about and what is the best test to confirm the dx?
Breast cancer.
Mammogram and stereotactic or excisional core-needle bx
Why do we do stereotactic or excisional core-needle bx in a patient with suspected breast cancer?
We need to check estrogen and progesterone receptor analysis (if the cells have estrogen receptors, this is good because we can give meds to help)
What are two mainstays of breast cancer treatment?
Lumpectomy with sential lymph node bx and mastectomy
If a patient has breast cancer and is positive for hormone receptors, what three meds could be appropriate?
Armidex, tamoxifen, raloxifene
In patients with breast cancer who are HER-2 positive, what is the best treatment?
Herceptin
What is the mnemonic for thyroid cancer types?
Please Feel My Ass
papillary (best), follicular, medullary, anaplastic (worst)
What are two symptoms of thyroid cancer?
Painless neck swelling and single, firm nodule. Most are ASYMPTOMATIC
How do we diagnose thyroid CA?
U/S and then FNA (u/s guided)
What treatment options are available to patients with thyroid cancer (except for anaplastic)?
Surgical resection (may use RAI for residual tumor) and thyroid replacement for life
T/F: There is no effective treatment for anaplastic thyroid cancer?
T
What are the two types of non-hodgkins lymphoma? What are the symptoms of each?
Indolent (Slow growing with painless, persistent LAD)
Aggressive (rapidly growing, fever, night sweats, chills, weight loss)
What is the way to dx non-hodgkins lymphoma?
biopsy of involved nodes
A patient presents with painless localized LAD. You get a chest xray and discover the patient has a mediastinal mass. You go ahead and decide to do a lymph node biopsy. What cells do you expect to find?
Reed-Sternberg Cells
What is the tx for hodginks lymphoma?
combination chemo and the prognosis is GOOD!
This type of leukemia has three phases: chronic, accelerated and acute (blast crisis) and proliferates from myeloid precursor cells
Chronic Myelogenous leukemia (CML)
Symptoms of fatigue and abdominal fullness (splenomegaly) are common symptoms of what leukemia?
Chronic Myelogenous leukemia (CML) although many are asymptomatic
CBC with leukocytosis is in what leukemia?
Chronic Myelogenous leukemia (CML)
You do PCR in a patient with Chronic Myelogenous leukemia (CML). What gene are you looking for on PCR?
BCR-ABL gene
Treatment for chronic phase of Chronic Myelogenous leukemia (CML)?
Gleevec (type of chemo)
Treatment for accelerated phase of Chronic Myelogenous leukemia (CML)?
Allogenic bone marrow transplant (uses healthy blood stem cells from a donor to replace your diseased or damaged bone marrow.)
Treatment for acute (blast crisis) phase of Chronic Myelogenous leukemia (CML)?
Two stages of chemo: induction & consolidation. Conventional induction chemo then stem cell transplantation (consolidation) (worse prognosis)
Goal is to get blasts to <5% and do it 2 x then do bone marrow bx. Consolidation gets rid of any cancer cells to prevent remission
When you see “smudge cells” what type of cancer do you think of?
Chronic lymphocytic leukemia (CLL)
This method is used in CLL to send all cells through a machine and then separate out cells
Flow cytometry
An asymptomatic patient comes to your office and you end up doing labwork for some reason. The labs show lymphocytosis. What are you concerned about?
Chronic lymphocytic leukemia (CLL)
How would you diagnose ALL (acute lymphocytic leukemia)? And what is the treatment?
Bone marrow aspiration and biopsy showing blasts > 20%. May be pancytopenic (low counts of all three types of cells- RBC, WBC, Platelets) with blasts on CBC Also needs cytogenetics phenotyping.
Tx: combo chemo
This type of tumor can cause a focal deficit, HA, seizures (early morning HA with N & V)
Brain tumor
What test would help dx a brain tumor in adults?
MRI with gadolinum
If you want to reduce edema in a patient with a brain tumor, what is the best treatment?
Corticosteroids
How would you treat a brain tumor?
Surgical resection if possible and also give corticostreoids for edema and or anticonvulsants
What are the two main RFs for esophageal cancer?
Smoking and alcohol (also HPV and Barrett’s from GERD)
A patient presents with “sticking of food” to back of throat and retrosternal discomfort, burning and regurgitation. What is the next test you will perform? and what cancer are you likely concerned about?
Endoscopic bx and esophageal cancer
