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Heme/onc > oncology > Flashcards

oncology Flashcards

1
Q

morbidity and mortality from multiple myeloma results from…

A

malignant cells in bone, cause bone destruction, anemia, and hypercalcemia

production of large amounts of Ig, causing renal failure and other organ damage

infections d/t dec. production of normal Ig’s

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2
Q

multiple myeloma epidemiology

A

2nd most common hematological cancer after non-hodgkin lymphoma

M>F

blacks>whites

median age diagnosis is 62

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3
Q

diagnostic criteria for symptomatic multiple myeloma

A

M-protein in serum or urine

bone marrow clonal plasma cells or plasmacytoma

**most important: organ damage or tissue impairment

  • CRAB: hyperCalcemia, Renal insufficiency, Anemia, Bone lesions

M protein is most commonly IgG

  • next most common is IgA and free light chain disease
  • IgE and IgD are less common
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4
Q

diagnostic criteria for smoldering myeloma

A

M protein in serum at myeloma levels (>30mg/dL)

and/or

  • 10%+ clonal plasma cells in bone marrow
  • no related organ or tissue impariment (absent CRAB)
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5
Q

clinical presentation of symptomatic multiple myeloma

A

Pain (pathologic fractures, bone lesions)

  • osteolytic bone lesions common; visualized with plain skeletal films

Fatigue due to anemia (marrow replacement by plasma cells, EPO production by kidneys)

Fatigue due to uremia and renal failure (2/2 nephropathy due to light chain deposition, nephrocalcinosis, or amyloidosis)

Recurrent or lingering infection (impaired humoral immunity)

mental status changes (dehydration, hypercalcemia)

mental status changes, headache, renal failure, bleeding, visual changes, CHF (hyperviscosity)

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6
Q

radiographic findings in symptomatic multiple myeloma

A

lytic lesions

osteoporosis

fractures

assoc w/ bone pain, hypercalcemia

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7
Q

clinical presentation of smoldering myeloma

A

asymptomatic multiple myeloma

no lytic bone lesions, anemia, renal insufficiency, or hypercalcemia

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8
Q

risk of progression of smoldering myeloma

A

10% for year for first 5 years

3% per year for next 5 years

1.2% per year for next 10 years

(vs MGUS which has no time-dependent change in risk)

risk of progression related to quantity of M-protein (>3mg/dl) and amount of plasma cells in bone marrow (>10%)

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9
Q

multiple myeloma bone marrow evaluation

A

typically heavily infiltrated with plasma cells (usually exceed 10% but don’t have to, some symptomatic pts have <10%)

IHC: CD38, kappa, lambda light chains

sheets of plasma cells

aberrant immunophenotype

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10
Q

lab diagnosis of multiple myeloma

A

Serum protein electrophoresis and Immunofixation or urine protein are used to detect and characterize monoclonal bands or M-protein bands

also lab tests to measure concentration of free (unbound) light chain in serum and urine

  • kappa:lambda free light chain ratio used to diagnose and monitor MM
  • useful for “non-secretory” myelomas
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11
Q

staging and prognosis of multiple myeloma

A

Durie Salmon Myeloma Staging System

helpful in predicting outcome

Stage 1: less severe anemia, normal calcium, fewer bone lesions, and lower amounts of paraprotein

Stage 2: doesn’t fit stage 1 or 3

Stage 3: 1+ of anemia, hypercalcemia, bone fractures large amounts of paraprotein

staging modified by renal failure (measure creatinine), renal failure indicates poor prognosis

B2-microglobulin can also predict prognosis (inc. w/ poor prognosis)

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12
Q

cytogenetic abnormaliteis

unfavorable vs favorable abnormalities

A

Unfavorable risk:

  • deletion 13 or aneuploidy by metaphase analysis
  • t(4;14), t(14;16), t(14;20) by FISH
  • deletion 17p13 by FISH
  • hypodiploidy

Favorable risk:

  • absence of unfavorable risk factors
  • hyperdiploidy
  • t(11;14), t(6;14) by FISH

Gene expression profiling is a better test than FISH for cytogenetics and identifying high risk patients

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13
Q

MGUS

A

presence of M protein in pts w/o evidence of plasma cell myeloma, waldenstrom macroglobulinemia, primary amyloidosis

expanded clone of Ig secreting cells

pts are asymptomatic, M-protein discovered during routine lab work

3% of people >50 (5%>70), M>F, AA>White

risk of progression overall is 1% per year (assoc. w/ specific monoclonal proteins (IgA>IgG), amount of M-protein >1.5mg/dL, abnormal free light chain raiot)

Clinically:

  • M-protien present but less than myeloma <30g/L
  • Bone marrow clonal plasma cells<10%
  • no lytic bone lesions
  • no end organ damage or myeloma related symptoms (CRABS)
  • no evidence of other B-cell lymphomas
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14
Q

plasma cell leukemia

A

peripheral involvement w/ plasma cell myeloma is rare

>20% plasma cells in peripheral blood

renal failure, lymphadenopathy, and organomegaly are common

survival is short

higher proportion light chain, IgD, and IgE (vs IgG and IgA myeloma)

higher incidence of unfavorable genetic abnormalities

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15
Q

non-secretory myeloma

A

3% plasma cell myelomas show absence of M-protein

85% of these have cytoplasmic M-protein w/ impaired Ig secretion

15% show no Ig synthesis

acquired mutations in Ig light chain

2/3 have evidence of elevated serum free light chain and/or abnormal free light chain ratio

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16
Q

plasmacytoma

A

localized tumor composed of neoplastic plasma cells

solitary or manifestation of systemic plasma cell myeloma

solitary assoc. w/ bone or soft tissue but occur in absence of clinical features of plasma cell myeloma

17
Q

good prognostic factors in AML

A

t(8;21)

t(15;17),

inv(16)

trisomy 21

18
Q
A
19
Q

squamous cell lung cancer

A

subtype of NSCLC

• arise in epithelium of proximal bronchi

• microscopic: keratinized pearls, intercellular bridges
-irritation → metaplasia: transformation from ciliated to squamous epithelium

• hypercalcemia is common
-due to PTH-like substances

• least likely to metastasize (stays confined in lungs)

  • 50% confined to thorax
  • only 13% have brain mets (= comparatively low)

• immunohistochemical markers for SCC

  • CK5/6
  • p63
20
Q

adenocarcinoma of lung

A

• precursor = atypical adenomatous hyperplasia
-thickening of alveolar walls

• usually found at PERIPHERY

• commonly metastasize → liver, adrenal, bone, CNS
-brain is involved 50% of time

  • may secrete GH, corticotropin, calcitonin, FSH
  • hypertrophic osteopathy is more frequent with adenocarcinoma
  • immunohistochemical markers for lung adenocarcinoma
  • CK7+
  • CK20(-), positive in mucinous adenocarcinoma
  • TTF-1+: primary lung cancer (distinguish from mets)
  • napsin A+
21
Q

SCLC chest x-ray

A

o rapidly enlarging hilar/perihilar mass
o hilar/mediastinal adenopathy
o rarely solitary or peripheral

22
Q

squamous cell carcinoma of lung chest xray

A

o centrally located → obstruction
o atelectasis
o pneumonitis
o hilar adenopathy
o cavitation

23
Q

adenocarcinoma of lung chest x-ray findings

A

o nodule
o peripherally located
o pleural/chest wall
o hilar adenopathy

24
Q

bronchoalveolar cell lung carincoma chest x-ray findings

A

o peripheral mass
o pneumonic pattern
o multicentric

25
Q

pancoast tumor

A

superior sulcus of lung

• by definition: T3 +/- nodal involvement
o 2-5% patients with bronchogenic cancer
o usually SCC, rarely SCLC

  • initial symptom = pain +/- upper extremity weakness
  • invasion of brachial plexus in 40% at presentation

• Horner’s syndrome: seen in 62%
o cervical SNS involvement → ptosis, miosis, anhidrosis

26
Q

SVC syndrome

A

lung cancer

  • most commonly by bronchogenic carcinoma
  • early symptoms: facial fullness; face/arm edema
  • dilated veins @ anterior chest, jugular veins, veins of arm/face
  • good response with treatment of underlying cancer (chemo or XRT)
27
Q

which lung cancer can cause hypercalemia

A

squamous cell carcinoma produces PTH like substance

Heme/onc (5 decks)

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