Oncology

Question 1

clinical manifestations of cancer

Answer 1

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)

Question 2

3 most common paraneoplastic syndromes

Answer 2

SIADH- small cell lung cancer
Cushing syndrome (ACTH)
Hypercalcemia (PTHrP and multiple myeloma or bone metastasis)

Question 3

other paraneoplastic syndromes

Answer 3

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)

Question 4

diagnostic image of choice for bone lesions

Answer 4

X ray plain film (for difficult areas use CT)

Question 5

imaging of choice for thyroid tumors/lesions

Answer 5

ultrasound

Question 6

down side of ultrasound

Answer 6

hampered by bone, air fat, and operator dependent

Question 7

imaging of choice for staging

Answer 7

pet/ct

mri for prostate and colorectal cancers

Question 8

winking owl sign

Answer 8

destruction of spinal pedicle by tumor

Question 9

what cancer go to bone

Answer 9

breast, kidney, prostate, lung

Question 10

x rays pro and cons

Answer 10

Simple, inexpensive, readily available, easily interpreted

Radiation, poor tissue contrast, technician dependent, 2D

Question 11

ct scans pro and cons

Answer 11

Rapid, 3D capability, axial imaging, good bony detail

Highest radiation, motion & metal artifact, limited ST contrast

Question 12

bone scans pro and cons

Answer 12

Images metabolic activity, very sensitive in bones, low cost

Non-specific, poor detail, anatomic changes not visualized

Question 13

mri pro and cons

Answer 13

Superior tissue resolution

Expensive, motion & metal artifact, can’t use in some patients

Question 14

pet/ct pro and cons

Answer 14

Combines function and anatomy, best imaging for most cancers

Expensive (pre-authorization)

Question 15

ultrasound pro and cons

Answer 15

Very safe, inexpensive, quick

Small field of view, technician and radiologist dependent, artifacts

Question 16

common imaging for each- brain, breast, lung, gi/abdomen, prostate, bone, thyroid

Answer 16

mri, mammogram, xray/ct, ct, scan for bone mets, xray/ct/bone scan, ultra sound

Question 17

what is most common chemo drug that causes cardio problems

Answer 17

doxyrubicin

Question 18

what drug causes pulmonary fibrosis

Answer 18

bleomycin (don’t let these pts smoke)

Question 19

what drug causes renal problems

Answer 19

cisplatin- decreases gfr

Question 20

what do you need to watch out for on patients on tomoxacin

Answer 20

blood clots (PE are common)

Question 21

osteosarcoma

Answer 21

sunburst pattern, codman triangle

Question 22

ewings

Answer 22

onion skinning, local destruction

Question 23

chondrosarcoma

Answer 23

stippling calcification

Question 24

beware of

Answer 24

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

Question 25

why is staging tumors useful

Answer 25

treatment, prognosis, compare treatments

Question 26

osteosarcoma

Answer 26

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

Question 27

tx of ewing

Answer 27

surgery AND chemo

Question 28

most common malignant bone tumor

Answer 28

metastasis (breast and prostate= 80% of these; lung, thyroid, and kidney also common)

Question 29

most common bone tumor

Answer 29

multiple myeloma- lytic lesions, secrete peptides

Question 30

CML

Answer 30

philadelphia chromosome
Bcr-Abl protein that acts as tyrosine kinase
tx- imatinib (gleevec); allogenic stem cell transplant; IFN alpha based tx

Question 31

AML

Answer 31

auer rod
ppl exposed to radiation get it (bomb in nagasaki)
pancytopenia w/ circulating blasts