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Clin Medicine - Hem/Onc > Oncology > Flashcards

Oncology Flashcards

1
Q

______ ______ ______ is a primary disease of children which effects T or B lymphocytes

A

Acute Lymphocyte Leukemia

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2
Q

What Sx may a patient with ALL experience?

A 
Lymphadenopathy
Malaise
Fever
Bleeding
Hepatosplenomegaly
Weight Lose
Bone Pain
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3
Q

How is ALL treated in general?

A

Aggressive combination chemotherapy

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4
Q

How long is chemo therapy treatment in ALL in the induction phase?

Consolidation phase?

Maintenance phase?

A

Induction: 2 weeks, 4-6 cycles

Consolidation: Several Months

Maintenance: 2 -3 years

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5
Q

What can also be considered when treating ALL?

A

Bone marrow transplant

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6
Q

___% of children with ALL will be cured with chemotherapy

A

80%

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7
Q

T/F: ALL has a higher mortality rate in children than in adults

A

False

It has a higher mortality rate in adults

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8
Q

______ _____ ______ is the most common leukemia which affects people 50 years or older and males more commonly than females.

It is characterized by clonal proliferation and accumulation of mature-appearing B-lymphocytes in blood and lymphoid tissues

A

Chronic Lymphocyte Leukemia

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9
Q

_____ _____ ______ is used for the staging of CLL

A

RAI Staging System

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10
Q

In CLL….

A ___ deletion would be indicative of a worse prognosis

A

17p deletion

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11
Q

25% of CLL patients are asymptomatic….

What Sx could you see in a patient with CLL?

A 
Fatigue 
Night Sweats
Weight Loss
Frequent/Persistent Infection
Lymphadenopathy (Cervical, often painless)
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12
Q

What is commonly seen in a bone marrow biopsy in a patient with ALL?

A

> 20% Lymphoblasts

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13
Q

What would be seen on a peripheral smear in a patient with CLL?

A

Smudge Cells (Fragile B cells)

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14
Q

T/F: A CLL patient may appear anemic on CBC

A

True

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15
Q

In a patient with CLL, what would you expect the lab values to be in a…..

Nuetrophil Count?

A

Low

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16
Q

How do the B lymphocytes appear in a patient with CLL?

A

Small

Abnormal

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17
Q

When is observation consider in treatment of CLL?

A

Observation is considered if the disease is indolent

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18
Q

CLL is considered chronic when lymphocytes are >100,000.

What is the the recommended treatment at this point?

A

Chemotherapy

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19
Q

Radiation is considered in CLL to control what?

When would surgery be considered?

A

Radiation: To control bulky adenopathy

Surgery: Diagnostic only

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20
Q

What is the only curative measure in regards to CLL treatment?

A

Bone Marrow Transplant

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21
Q

______ _________ ______ is the most common form of leukemia in adults and often involves cell deficiency, hyperleukocytosis, CNS leptomenigeal involvement, DIC< or Tumor lysis syndrome.

A

Acute Myelogenous Leukemia

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22
Q

In a patient with AML….

what would the Sx of RBC deficiency be?

Thrombocytopenia?

Neutropenia?

A

RBC: Pallor, fatigue, dyspnea

Thrombocytopenia: Petechiae, hematoma, bleeding

Neutropenia: Sepsis, Cellulitis, PNA

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23
Q

What hyperleukocytosis?

What problems can this cause?

A

Hyperleukocytosis: > 100,000 blasts

This can obstruct capillaries and smaller arteries

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24
Q

In a patient with AML….

What would the Sx of CNS Leptomeningeal involvement be?

A

HA
AMS
Cranial Nerve changes

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25
Q

_____ occurs in any form of leukemia and is common in MS

A

DIC

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26
Q

What is unique on a blood smear in a patient with AML?

A

Auel Rod

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27
Q

What is commonly seen on a CBC in a patient with AML?

A

CBC would show a leukocytosis with WBC >100,000

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28
Q

What would a bone marrow biopsy show in a patient with AML?

A

> 20% Myeloblasts

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29
Q

What is the treatment of choice in a patient with AML?

What treatment option can be considered?

A

Chemotherapy

Stem Cell Transplant

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30
Q

_____ _____ _____ is a lethal complication of chemotherapy that results in metabolic abnormalities and often renal failure

A

Tumor Lysis Syndrome

31
Q

__________ ________ _______ is a slower progressing disease when compared to AML where too many WBCs are made in the bone marrow.

A

Chronic Myelogenous Leukemia

32
Q

What are the THREE phases of CML?

A
  1. Chronic
  2. Accelerated
  3. Acute
33
Q

In a patient with CML….

What would the blood smear show?

What additional “lab findings” may be positive or present

A

Blood Smear: Philadelphia Chromosome

FISH for bcr/abl (quantitative)
RT-PCR for bcr/abl (qualitative)

Tumor marker and causative lesion

34
Q

What is the only curative treatment for CML?

A

Allogeneric bone marrow transplantation

35
Q

What class of medications can be used to treat CML

A

Tyrosine Kinase Inhibitors (Imatinib)

36
Q

T/F: Chemotherapy can be used to treat CML

A

True

37
Q

_______ ________ is most common in men ages 20-40 then >50 (bimodal) and is commonly associated with EBV.

This is a result of immune dysfunction and an infectious cancer commonly referred to as “next-door disease”.

A

Hodgkin’s Lymphoma

38
Q

________ lymphoma is commonly associated with EBV

________ lymphoma is commonly associated with H pylori infection

A

Burkitt’s Lymphoma

MALT Lymphoma

39
Q

Hodgkin’s Lymphoma refers to a group of cancers characterized by what THREE things?

A
  1. Lymphadenopathy
  2. Hepatosplenomegaly
  3. Reed-Sternberg Cells
40
Q

Where may a patient with Hodgkin’s lymphoma experience PAINLESS lymphadenopathy?

What other Sx are present?

A

Cervical, Supraclavicular, Mediastinal

Fever
Weight Loss
Night Sweats
SOB

41
Q

A excisional lymphode biopsy in Hodgkin’s Lymphoma would show what?

A

Reed-Sternberg Cells

42
Q

What may a CXR show in a patient with Hodgkin’s lymphoma?

A

A Mediastinal Mass

43
Q

How is Hodgkin’s lymphoma treated?

When should scans be ordered after treatment is initiated?

When is radiation started?

A

Chemo therapy

Re-scan in 2-3 weeks to determine response

Radiation should always follow chemotherapy

44
Q

If a hodgkin’s lymphoma patient relapses after treatment what should be considered?

A

High dose chemotherapy and stem cell transplant

45
Q

What side effect of radiation should be watched out for?

A

Neutropenia

46
Q

Which is more highly curable, hodgkins or non-hodgkin’s lymphoma

A

Hodgkins

47
Q

Symptoms and presentation of Non-hodgkin’s lymphoma are fairly similar.

However, patient with Non-hodgkin’s lymphoma have _______ lymphadenopathy which causes what?

A

Bulk lymphadenopathy

Jaundice
Hydronephrosis
SVC Syndrome
Bowel Obstruction
Wasting
48
Q

T/F: Anemia, leukopenia, and thrombocytopenia are not common in non-hodgkin’s lymphoma but may be present

A

True

49
Q

About 90% of non-hodgkin’s lymphomas are derived from __ lymphocytes

A

B-lymphocytes

50
Q

When evaluating for Hogdkin’s or Non-Hodgkin’s lymphoma what diagnostic tests should be run?

A
  1. CT Chest/Abdomen/Pelvis
  2. PET Scan
  3. BMBx
51
Q

Treatment for non-hodgkins lymphoma varies….

Describe some of the ways non-hodgkin’s lymphoma can be treated

A

Watch and wait
Invasive chemotherapy (w/ or w/o radiation)
Bone Marrow trasplantation
Tumor lysis prophylaxis

52
Q

What classes of medications are often used in the treatment of non-hodgkin’s lymphoma?

A

Protease Inhibitors
HDAC Inhibitors
TK Inhibitors

53
Q

_____ _______ is a malignancy of plasma cells

A

Multiple Myeloma

54
Q

What is the “classic triad” in a patient with multiple myeloma?

A
  1. Plasmacytosis (BMBx showing >5% plasma cells)
  2. Bone lytic lesions on XR (no on PET scan)
  3. “M-protein” in serum/urine (SPEP/UPEP)
55
Q

What Sx my a patient with multiple myeloma be experiencing?

A
  1. BACK PAIN
  2. Fatigue (anemia)
  3. Renal insufficiency
56
Q

What labs should be ordered in a patient with multiple myeloma?

A
  1. CBC
  2. CMP (need to assess Ca2+)
  3. Albulmin
  4. Serum-free light chains
  5. Quant IgG
  6. SPEP/UPEP
57
Q

What studies (imaging, procedures) should be done?

A
  1. BMBx

2. Skeletal Survey

58
Q

In a patient with multiple myeloma…..

What would be seen on blood smear?

On serum protein electrophoresis (SPEP)? (this is the hallmark of the disease)

In the urine?

A

Blood Smear: Rouleaux Formation

SPEP: “M-spike”

Urine: Bence-Jones proteins

59
Q

How is multiple myeloma primarily treated?

When is radiation considered?

A

Chemotherapy

Radiation is used for pain management

60
Q

What is the only effective treatment for long term survival?

A

Autologous bone marrow transplantation

61
Q

This oncologic emergency is commonly associated with lung cancer.

Sx include….

Orthopnea
Cervico facial edema
Fatigue
Cyanosis of the face
Horner's Syndrome
A

Superior vena cava (SVC) syndrome

62
Q

What might a CXR showed in a patient with SVC syndrome?

A

Right sided mediastinal mass

63
Q

In a patient with SVC syndrome, why would an MRI be ordered

A

To assess for obstruction or clot

64
Q

How is SVC syndrome treated?

A
  1. Radiation
  2. Chemotherapy
  3. Anti-coagulation
  4. Steroids
  5. Stenting
  6. Possible bypass
65
Q

______ ______ ________ is an oncologic emergency that commonly involves breast, lung, thyroid, kidney, and prostate cancers.

Sx include….

Progressively worsening Back Pain (>90%)
Weakness
Bladder/Bowel dysfunction
Sensory loss

A

Spinal Cord Compression

66
Q

In a patient with spinal cord compression, what is the most concerning symptom that would signal urgent intervention?

A

Weakness

67
Q

What imaging study can Dx spinal cord compression 90% of the time?

What is the most sensitive study?

A

Xray

MRI

68
Q

How is spinal cord compression managed?

A
  1. Dexamethasone (immediately)
  2. Consult Neurosurgery
  3. Consult radiation oncology
69
Q

_____ ______ is an oncologic emergency that occurs in ~30% of cancer patients primarily in the cerebral hemisphere.

Sx include….

Headache
Focal Weakness
Seizure
Cognitive changes
Edema
A

Brain Metastases

70
Q

What two imaging studies should be done in a patient with brain metastases?

A
  1. CT Head (w. and w/o contrast)

2. MRI (w/ contrast)

71
Q

How are brain metastases treated?

A
  1. Steroids
  2. Consult radiation oncology
  3. Neurosurgery
72
Q

______ _______ is an oncologic emergency commonly associated with lymphoma, leukemia, and melenoma.

Sx include….

Nervous system involvement
Headache
Numbness
Vision changes

A

Carcinomatous Meningitis

73
Q

How is carcinomatous meningitis diagnosed?

A

Lumbar puncture showing….

Opening pressure >160 mm
Elevated CSF protein
Decreased CSF glucose
Increase CSF WBCs

74
Q

How is carcinomatous meningitis treated?

A

Intrathecal chemotherapy

Radiation

Clin Medicine - Hem/Onc (2 decks)

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