Oncology

Question 1

Common side effect of cyclophosphamide? What is given to prevent it?

Answer 1

Hemorrhagic cystitis –> breakdown product (acrolein) causes bladder epithelium to slough and form thin, vascular, friable mucosal lining.
- Look for hematuria, urinary retention, elevated BP, palpable bladder

*MESNA –> binds to and inactivates acrolein and is peed out

Question 2

What is craniopharyngioma? Common diagnostic clues?

Answer 2

Suprasellar (above optic chiasm) tumor that can cause BITEMPORAL HEMIANOPSIA
- Arises from remnant of Rathke’s pouch

Diagnostic clues:

• Heavy calcifications
• Unilocular/multilocular cysts
• Viscous YELLOW fluid content

Question 3

What types of cancers metastasize to bone?

Answer 3

Prostate, breast, lung, kidney, bladder, thyroid

**MOST COMMONLY prostate, breast, lung

Question 4

Risk factors for hepatocellular carcinoma? What serum marker is specific for this cancer?

Answer 4

Risk factors = any chronic inflammation of liver:

• Viral hepatitis (b,c)
• Alcoholic cirrhosis
• NAFLD
• Hemochromatosis
• Wilson disease
• Alpha-1-antitrypsin
• Aflatoxin exposure

Question 5

S/S of brain tumor?

Most common cause of metastatic tumor to brain?

Answer 5

S/S:

1) HA worsening w/ recumbancy
2) HA wakes patient from sleep
3) HA present in morning after waking up
4) Nausea

MCC = lung cancer

Question 6

Patients undergoing chemo should receive what 2 vaccines? Live or inactivated?

Answer 6

ALWAYS INACTIVATED!!!

*Influenza + Pneumococcal

Question 7

What cancer shows ruptured cells on peripheral smear?

What blood findings correlates with poor prognosis?

Answer 7

CLL (smudge cells)

Low platelets

Question 8

Lynch syndrome is associated with what other type of cancer?

Answer 8

Endometrial cancer

Question 9

Risk factors for colon polyps developing into cancer?

What is the mgmt for hyper plastic polyps?

Answer 9

Villous
Sessile (wide base)
Size > 2.5cm

Hyperplastic = NOTHING!

Question 10

Most common site of colon cancer mets?

What clinical picture suggests metastatic spread?

Answer 10

Liver

Person with long-standing Fe-def anemia and (+) hem occult test who has low grade RUQ pain and slightly elevated LFTs

Question 11

Most common type of CNS tumor in children? Where are they located?

Answer 11

Astrocytoma

Both supratentorial and infratentorial

Question 12

When is brain surgery for cancer indicated?

Answer 12

Solitary metastasis in areas with good performance status (grey-white jxn)

Question 13

Radiation exposure and family hx of thyroid cancer are risk factors for the most common cause of thyroid cancer - what is it?

Answer 13

Papillary carcinoma

Question 14

Cancer-related anorexia can be treated with what?

Answer 14

Progesterone analogs (megestrol acetate)

Question 15

Smudge cells are characteristic of what?

Answer 15

CLL

Question 16

Patients with Hodgkin’s lymphoma are at risk for what complications if treated under 30 yo?

Answer 16

Secondary malignancies –> from radiation and chemotherapy at younger ages

*Common in lung, thyroid, bone, and GI

Question 17

Painless testicular mass with ultrasound findings suggestive of cancer - what is next best step?

Answer 17

Radical orchiectomy

Question 18

Person with UC wants to know when and how often to get colonoscopies?

Answer 18

• UC = increased risk of colon cancer

* Start 8 yrs after diagnosis –> every 1-2 years afterwards

Question 19

Hard, non-tender, solitary lymph node in older male with smoking hx - what are you suspecting?

Answer 19

SCC (head/neck cancer)

Question 20

Only vaccine known to reduce risk of developing cancer?

What cancer?

Answer 20

Hepatitis B vaccine

Reduced hepatocellular cancer

Question 21

Person has unprovoked DVT - what must you consider?

Follow up?

Answer 21

Malignancy!
*Look for wt loss

Detailed age-appropriate screening and CXR

Question 22

This drug can cause peripheral neuropathy?

Answer 22

Vincristine/Vinblastine

Question 23

Most common source for brain metastasis?

Answer 23

Lung

Question 24

Best choice of treatment for chemotherapy-induced N/V?

Mechanism of action?

Answer 24

Serotonin blockers (antagonist) (5HT3 receptors)

Ondansetron

Question 25

What has increased levels of myelocytes?

Promyelocytes?

Tartrate-resistant acid phosphatase?

Answer 25

CML

AML –> look for Auer rods

Hairy cell leukemia

Question 26

What is characterized by increased size of liver/spleen/lymph nodes, fatigue, easy bruisability, headaches/dizziness, and pain/numbness in extremities?

Answer 26

Waldenstrom’s Macroglobulinemia

• Fatigue = anemia
• Demyelinating sensorimotor neuropathy

Question 27

IgM spike + hyperviscotity?

Answer 27

Waldenstrom’s macroglobulinemia

Question 28

How do you differentiate seminoma vs nonseminomatous germ cell tumors?

Answer 28

Seminoma: NO aFP

Nonseminomatous: b-HCG + aFP

Question 29

Solitary, painful lytic bone lesion with overlying swelling and hypercalcemia?

Answer 29

Langerhans cell histiocytosis

Question 30

Person with significant smoking history that now takes up chewing tobacco. He also drinks regularly. He has a white, granular patch over his R inner cheek. What is it?

Answer 30

Leukoplakia

*Smokeless tobacco + EtOH
Progresses to SCC in 10 yrs

Question 31

Unique stain to hairy cell leukemia?

Tx?

Answer 31

Tartrate-resistant acid phosphatase (TRAP) stain

Tx: Cladribine

Question 32

Lab findings in tumor lysis syndrome?

Answer 32

Potassium –> increased
Uric acid –> increased
Phosphate –> released from cells when lysed and bind to Ca
Calcium –> decreased (bound to phosphate)

*Both K and Phos are intracellular ions –> released when cells lyse