Oncology Flashcards
Diagnosis of AML
> 20%blast cells (if less, called myelodysplastic syndrome)
Unless typical translocations
Noonan at higher risk of which myeloid leukemia
JMML
NF1 at higher risk of which myeloid leukemia
JMML
Investigation of leukemia
Morphology
Fish (look for known translocations)
Cytogenetics
Flow cytometry (aml or all; can be sent with peripheral blood)
+/- next generation sequencing
Why do flow cytometry
Diagnosis
MRD estimation
LAIP
Mutations of AML
Type 1 promote proliferation - mutations in growth factor signalling
Type 2 block normal myeloid development
Need both
Favourable cytogenetics in AML
T(8;21) Inversion 16 CEBPA NPM1 FLT3 negative
RARA - 15;17 APML
Management of Poor risk cytogenetics in AML
BMT despite MRD
CNS treatment for AML. Does it affect survival?
No evidence that it does
Prognostic factors for AML
Age Race BMI Down syndrome and <4yo WCC at diagnosis - higher risk of thrombosis and coagulopathy FAB subtype Cytogenetics MRD (most important)
5 year survival in aml
60%
Liposomal anthracyclines
Less cardiotoxic
Induction for aml
Cytarabine
Anthracycline
Etoposide
4 cycles total max
Anthracycline SE
Cardiotoxic
Breast cancer
VOD risk factors
Pre existing liver injury
Conditioning regimen
- Cyclophosphamide
- Busulfan (but iV better)
- Sirolimus
Haemorrhagic cystitis is complication of which chemo agent
Cyclophosphamide (alkylating agent)
Doxorubicin
Anthracycline
Neuroblastoma vs wilms tumour
Neuroblastoma
calcification very common: 90%
encases vascular structures but does not invade them
younger age group (<2 years of age)
poorly marginated
elevates the aorta away from the vertebral column
more commonly crosses the midline, especially behind the aorta2
more common to have extension into the chest
Wilms tumor
calcification uncommon: 10-15%
displaces adjacent structures without insinuating between them
slightly older age group: peak 3-4 years of age
well circumscribed
claw signwith the kidney
extension into IVC/renal vein
MIBG scan indicated for
neuroectodermally derived tumors, including pheochromocytoma, ganglioneuroma, ganglioneuroblastoma, paraganglioma, carcinoid tumor and neuroblastoma.
Sirolimus is
Mtor inhibitor
Tacrolimus and cyclosporine mechanism of action
Inhibit calcineurin which is responsible for transcription of IL2
Lower T cell activity
Azathioprine, 6MP are
Purine analog
What is symptomatic hyperleukocytosis
Aka leukostasis
- microvascular thrombosis by white cells
- neurological and respiratory symptoms
- most commonly seen in acute myeloid leukemia
characterized by
- extremely elevatedblast cellcount and
- symptoms of decreasedtissue perfusion
What is symptomatic hyperleukocytosis
Aka leukostasis
- microvascular thrombosis by white cells
- neurological and respiratory symptoms
- most commonly seen in acute myeloid leukemia
characterized by
- extremely elevatedblast cellcount and
- symptoms of decreasedtissue perfusion
