Oncology Flashcards
Pt with neurologic symptoms (paraneoplastic syndrome) and anti-Hu and anti-Yo Abs
Small cell lung cancer (SCLC)
Assoc with smoking
Tx - platinum agent (ie carboplatin, cisplatin) with etopside
What is the best way to assess prognosis for melanoma?
The depth
Vertical growth
What cancers are associated with multiple endocrine neoplasia (MEN) type 1?
3 P’s
- Pancreas = Zollinger-Ellison
- Pituitary = elevated prolactin
- Parathyroid = Hx of renal stones and a neck nodule
A pt with Down syndrome is at an increased risk for which cancer?
ALL
Fatigue, easy bruising, weight loss, fever
Most common cause of firm fixed lumps in the axillary lymph nodes
Invasive ductal carcinoma
Overexpress HER2/neu
Bx = anastomising sheets of pleomorphic cells
Pt presents with high WBC count with basophilia. See PMNs at all stages of maturity. Immature myelocytes and segmented PMNs. Dx and Tx?
Chronic myelogenous Leukemia (CML)
Tx - Imatinib
t(9;22) Philadelphia chromosome; Bcr-Abl
Contituitively active tyrosine kinase
A pt has worsening vision in his right eye. He has angiomas over the retina and a small hemangioblastoma in the cerebellum. Dx and what else might they develop?
von Hippel-Lindou Hematuria AD, VHL deletion on chr 3 Retinal, medullary, and cerebellar angiomas Bilateral renal cell carcinoma
Which two sites are common sites of metastasis?
Liver - GI tract drains to hepatic poratal
Lung
Due to high blood volume in both
A pt reports new onset tonic-clonic seizure and 4 month history of bloody stools
Turoct syndrome AD Colorectal and brain tumors APC gene = polyposis and medulloblastoma hMLH1 = DNA mismatch repair causring polyposis and glioblastoma multiforme
What are the 3 most common causes of cancer death in men?
- Lung
- Prostate
- Colorectal
A pt presents with crippling back pain. CT shows lesions in the spine Hgb - 10.2 Calcium - 13.1 Increased total protein Dx?
Multiple Myeloma
Increased total protein = IgG
Decreased levels of normal Ig’s make them prone to infections
Back pain = lytic bone lesions
30 y/o female presents with severe knee pain x months but does not recall an injury. PE = effusiion. XR fx at the epiphyseal end of the femur. What cancer is associated?
Giant cell tumor
Benign primary bone tumor, but locally aggressive. Usually distal femur or proximal tibia
On XR = double bubble or soap bubble sign
Bx = oval or spindle-shaped cells along with scattered multinucleated cells
20-40 y/o women
Bone tumor in the metaphysis of long bones in males 10-20 y/o
Osteosarcoma
Raises the periosteum causing either a triangular periosteal shadow (Codman triangle) or radial reactive bone formation (sunburst growth pattern)
A pt with Small cell Lung Carcinoma is at risk of which paraneoplastic syndrome?
Overproduction of ACTH and ADH
ACTH increases glucocorticoids causing Cushings syndrome (weight gain, redistribute body fat, striae, moon facies, poor wound healing)
Pt is post-menopausal, 40pack year hx presents with progressive constipation and frequent urination. CXR shows circular lesion overlying the left hilum. Decreased serum phosphorus
Central bronchogenic carcinoma
progressive constipation and frequent urination = hypercalcemia, suggests a cancer producing parathyroid homone-related peptide (PTHrP)
Squamous cell carcinoma is a bronchogenic carcinoma that produces excess PTHrP
pt presents with RUQ pain and a bruit over the liver. On bx = lack of portal areas, trabeculae are composed of multiple layers of malignant hepatocytes with high nuclear-to-cytoplasm ratio and pleiomorphic
Hepatocellular Carcinoma
Bruit is heard if tumor partially obstructs a. flow to the liver.
HCC assoc with elevated alpha-fetoprotein levels
Chronic HCV and/or HBV -> cirrhosis -> predisposes individual to HCC
What is primary biliary cirrhosis?
Autoimmune
Lymphocytic infiltrates and granulomas in the biliary tract
Increased mitochondrial Ab associated with CREST syndrome, RA, and celiac
What is the normal function of Rb?
Prevents cell-cycle progression past the G1/S checkpoint
Normally binds the E2F transcription factor in quiescent cells
LOF is associated with osteosarcoma and retinoblastoma
50 y/o female presents with HA localizing to the right side of her head. MRI shows a tumor attached to the dura mater. Bx confirms tumor arises from arachnoid. Dx and additional histology?
Meningioma
psammoma bodies, synctial, fibroblastic, transitional, secretory, and microcystic
Pt presents with fatigue, weakness, weight loss x 4 mo. Vision is deteriorating, several severe nosebleeds. PE hepatosplenomegaly, increased total protein level. Electrophoresis reveals a large spike in the gamma region. No skeletal changes
Waldenstrom macroglobulinemia
Weakness, weight loss, hyperviscosity
B cell neoplasm with IgM overproduction leads to:
impaired cranial blood flow (HAs), impaired ocular blood flow (visual disturbances)
NO bone lesions or renal dysfunction
monoclonal “M spike”
How do you distinguish Waldenstrom macroglobulinemia from Multiple myeloma?
Waldenstrom has syx of hyperviscosity (HA, vision changes)
Multiple myeloma = has bone and renal abnormalities
Which dz have a M spike on electrophoresis?
Waldenstrom macroglobulinemia
plasma cell dyscrasias
multiple myeloma
monoclonal gammopathy of undetermined significance (MGUS)
How do you identify Monoclonal gammopathy of undetermine significance from other dz’s with M spike?
asymptomatic due to lower levels of protein in the serum (no viscosity syx)
Some pts may experience polyneuropathy
Premalignant lesion that may progress to multiple myeloma
7 y/o presents with ataxia and labs show HCT 55%. Gadolinium scan reveals a primary brain tumor. Bx = foamy stromal cells within a highly vascular neoplasm. Dx?
von Hippel-Lindau (VHL)
AD, chr 3
brain tumor = hemangioblastoma, primary brain tumor found in the cerebellum of children
VHL will have increased erythropoietin producing a secondary polycythemia