Oncology Flashcards
clinical manifestations of cancer
loss of tissue integrity (blood in urine or stool) development of effusions (pleural think lung cancer or lymphoma; peritoneal fluid think ovarian cancer) cachexia and anorexia (decreased food intake, hyper metabolic state, cancer consumes a lot of glucose; this is opposite for breast cancer; w/ cachexia liver mass increases which is different from starvation where liver mass decreases) fatigue and sleep disorders (characterized by tiredness, lack of energy, and weakness; not relieved by rest such as in healthy person) paraneoplastic syndromes (symptoms that occur due to substances prod by cancer; most commonly associated w/ breast, lung, and hematologic) anemia (related to hemolysis, blood loss, impaired prod, or tx effects; TX w/ epogen; if find anemia need to work up and make sure not cancer)
3 most common paraneoplastic syndromes
SIADH- small cell lung cancer
Cushing syndrome (ACTH)
Hypercalcemia (PTHrP and multiple myeloma or bone metastasis)
other paraneoplastic syndromes
acanthosis nigricans (USUALLY ASSOCIATED W/ OBESITY, adenocarcinoma of GI tract; adenocarcinoma of lung, breast, ovary, hematologic ) Lambert eaton syndrome (small cell lung cancer) Myasthenia Gravis (thymoma) (fatiguability, ptsosis, antibodies bind to acetylcholine receptors)
diagnostic image of choice for bone lesions
X ray plain film (for difficult areas use CT)
imaging of choice for thyroid tumors/lesions
ultrasound
down side of ultrasound
hampered by bone, air fat, and operator dependent
imaging of choice for staging
pet/ct
mri for prostate and colorectal cancers
winking owl sign
destruction of spinal pedicle by tumor
what cancer go to bone
breast, kidney, prostate, lung
x rays pro and cons
Simple, inexpensive, readily available, easily interpreted
Radiation, poor tissue contrast, technician dependent, 2D
ct scans pro and cons
Rapid, 3D capability, axial imaging, good bony detail
Highest radiation, motion & metal artifact, limited ST contrast
bone scans pro and cons
Images metabolic activity, very sensitive in bones, low cost
Non-specific, poor detail, anatomic changes not visualized
mri pro and cons
Superior tissue resolution
Expensive, motion & metal artifact, can’t use in some patients
pet/ct pro and cons
Combines function and anatomy, best imaging for most cancers
Expensive (pre-authorization)
ultrasound pro and cons
Very safe, inexpensive, quick
Small field of view, technician and radiologist dependent, artifacts
common imaging for each- brain, breast, lung, gi/abdomen, prostate, bone, thyroid
mri, mammogram, xray/ct, ct, scan for bone mets, xray/ct/bone scan, ultra sound
what is most common chemo drug that causes cardio problems
doxyrubicin
what drug causes pulmonary fibrosis
bleomycin (don’t let these pts smoke)
what drug causes renal problems
cisplatin- decreases gfr
what do you need to watch out for on patients on tomoxacin
blood clots (PE are common)
osteosarcoma
sunburst pattern, codman triangle
ewings
onion skinning, local destruction
chondrosarcoma
stippling calcification
beware of
Night pain, constant pain, unusual symptoms, no improvement with conservative management, or general symptoms such as fever, malaise, weakness
X-ray findings with lytic or blastic bone changes, soft tissue calcification or periosteal reaction
Unexplained mass, especially in the thigh
Painless soft-tissue mass > 5 cm and deep to the fascia
why is staging tumors useful
treatment, prognosis, compare treatments
osteosarcoma
located in areas of high growth (shoulder and knee)
peak is males in 2nd decade
tx- surgery; limb sparing if possible
radiotherapy is NOT helpful
tx of ewing
surgery AND chemo
most common malignant bone tumor
metastasis (breast and prostate= 80% of these; lung, thyroid, and kidney also common)
most common bone tumor
multiple myeloma- lytic lesions, secrete peptides
CML
philadelphia chromosome
Bcr-Abl protein that acts as tyrosine kinase
tx- imatinib (gleevec); allogenic stem cell transplant; IFN alpha based tx
AML
auer rod
ppl exposed to radiation get it (bomb in nagasaki)
pancytopenia w/ circulating blasts
