Oncology Flashcards
(38 cards)
Lambert-Eaton myasthenic syndrome
anti-P/Q-type voltage-gated calcium channel Ab, usually caused by small cell lung CA
Hx: progressive proximal muscle weakness, improvement with vigorous brief muscle activation, autonomic dysfunction, CN involvement, respiratory sxs
Dx: CT CAP, FND then MRI cranial and spinal, electrodiagnostic eval, test for Ab,
Txt: must treat underlying malignancy to treat neurological sxs, pyridostigmine, guanidine, if refractory>plasmapheresis
Renal cell carcinoma
men>women (2:1 ratio), 60-70s, smoking, obesity, and hypertension
Hx: incidental finding on imaging or hematuria, flank pain, and an abdominal mass, paraneoplastic signs
Labs: erythrocytosis d/t inc EPO, inc Ca d/t PTHrp
Dx: bx (clear cell most common)
Txt:
small tumor- partial nephrectomy
>7 cm- radical nephrectomy
High-stage/high-grade tumors/Metastatic- interferon alfa alone (not preferred, causes fatigue), bevacizumab and interferon alfa, pazopanib (causes transaminitis), and sunitinib (causes fatigue, hand-foot syndrome, and thrombocytopenia)
Testicular CA
Men 15-35 most common
Hx: history of cryptorchidism and prior orchiopexy
PE: painless mass, lower abdominal or scrotal aching, gynecomastia
Dx: scrotal US/ CT scan
Labs: seminoma-inc beta HcG, non-seminoma- inc alpha fetoprotein and beta HcG (inc LDH)
Pancreatic adenocarcinoma
Hx: nausea, abdominal discomfort, and jaundice. weight loss, anorexia, and fatigue. migratory thrombophlebitis (Trousseaus syndrome)
PE: hepatomegaly, ascites, scleral icterus, peripheral adenopathy, and temporal wasting. palpable nontender gallbladder (Courvoisier sign), Virchows node, sister mary joseph node
Dx: CT AP or endoscopic US, CA 19-9
Txt: biliary obstruction: percutaneous drainage of fluid or by endoscopic stent placement in the bile duct.
Metastatic- palliation or by treatment with a gemcitabine-palliation or, treatment with a gemcitabine-based chemotherapy or folinic acid, irinotecan, oxaliplatin, and fluorouracil.
Endometrial carcinoma
risk factors: Excess estrogen exposure, tamoxifen, chronic anovulation, obesity, early menarche, late menopause, advancing age, and family history
Hx: AUB, 55-65 yo
Dx: endometrial bx
Txt: total abdominal hysterectomy, bilateral salpingo-oophorectomy, and lymph node sampling is the standard initial treatment for women with newly diagnosed uterine cancer. Chemotherapy or radiation PRN
Ovarian cancer
95% epithelial origin, delayed menopause, nulliparity increase risk, OCP dec risk, BRCA1/BRCA2 gene mutations highest risk followed by hereditary nonpolyposis colorectal cancer.
Sxs: vague gastrointestinal symptoms, early satiety, bloating, and dyspepsia
Labs: CA 125
Dx: abdominal CT/US: solid mass or a cyst with thick septations, ascitic fluid or pleural effusion cytology
First line: cisplatin or carboplatin in addition to a taxol-based chemotherapeutic such as paclitaxel
Multiple Myeloma
plasma cell malignancy, anemia, bone pain/lytic bone lesions, hypercalcemia, and kidney disease with >30% plasma cells in the bone marrow or peripheral blood
Labs: peripheral blood smear: Rouleaux formations, Protein electrophoresis UA: Bence-Jones proteins
Dx: Serum or urine electrophoresis that reveals IgM spike, Bone marrow bx: > 30% plasma cells
Txt: induction therapies with bortezomib and dexamethasone, and lenalidomide with autologous stem cell transplantation, which confers a near-complete response rate of 57%, and the prior regimen followed by melphalan and reinfusion of autologous stem cells, which confers a near-complete response rate of 78%. Lenalidomide for maintenance
Prostate CA
older man!, AA, family hx
Sxs: obstructive uropathy and lower back pain
Labs will show PSA > 10 ng/mL
Dx: needle core biopsy, Gleason score used to grade prognosis
Txt: if metastatic androgen deprivation therapy with a medication (leuprolide)
Cardiac atrial myxoma
women, third and sixth decades of life, in the LA, thromboembolism, valvular obstruction, and dysrhythmias, thombus in LA appendage
Sxs: fever, weight loss, TIA
Echo: pedunculated mass with thrombus
Txt: resection
Colon CA screening
first-degree relative diagnosed <60 then begin screening at 40 or 10 years earlier than the age of diagnosis of the youngest affected relative (whichever comes first) with colonoscopy q5 years
In general population: 50-colonoscopy q10 years, guaiac-based fecal occult blood test and fecal immunochemical test annually, or a flexible sig q5 years
IBD: colonoscopy 8 years after the onset of pancolitis or 12–15 years after the onset of left-sided colitis, q1-2 yers
Familial adenomatous polyposis: flexible sig between ages 10 and 12 and undergo colectomies for polyposis on an annual basis.
chronic lymphocytic leukemia, CLL
Txt: frail patients with significant comorbidities, patients >65, and patients < 65 with significant comorbidities is ibrutinib or obinutuzumab and chlorambucil. First-line therapy for patients <65 who do not have significant comorbidities is fludarabine, cyclophosphamide, and rituximab. Ibrutinib may be continued for maintenance therapy after remission.
Sxs: B sxs
Labs: WBC>50,000, anemia, thombocytopenia, peripheral smear: isolated lymphocytosis, smudge cell
PE: splenomegaly, LAD
Txt: early stage-observation, purine analogs (fludarabine), Ab (rituximab, alemtuzumab), alkylating agents (chloroambucil), cyclophosphamide, IVIG for hypogammagloubulinemia and infxn
Non-Hodgkin’s lymphoma
Higher risk with connective tissue disorders and immunocompromised, infxn with H.pylori, Borrelia burgdorferi, Chlamydia psittacosis, Coxiella burnetii, EBV
Sxs: painless LAD, fevers, night sweats, weight loss, pruritus, and fatigue
Dx: absence Reed-Sternberg cells on lymph node biopsy, noncontiguous spread, extra nodal involvement
Txt: Rituximab + chemotherapeutics
Superior pulmonary sulcus tumor or Pancoast tumor
non-small cell lung cancer
Sxs: ipsilateral shoulder and arm pain, hand muscle weakness/pain and sensory abnormalities of the axilla and medial upper arm, Horner syndrome, supraclavicular LAD, weight loss, cough and hemoptysis may not be present until later in the disease course
Txt: chemoradiation, surgical resection
acute myeloid leukemia (AML)
age >65
Sxs: bone marrow suppression (fatigue due to anemia, bleeding due to thrombocytopenia), fever, infections
Dx: Auer rods on pathology, cytogenetics translocation between chromosomes 8 and 21, mutations in the NPM1 gene and FLT3 gene, >20% blasts on peripheral smear or bone marrow biopsy
PE: petechiae and bleeding mucosa, gingival hypertrophy, typically no lymphadenopathy or hepatosplenomegaly
Txt: cytarabine and an anthracycline (daunorubicin) during induction and then undergo consolidation therapy with conventional chemotherapy or allogenic hematopoietic stem cell transplantation depending on genetic risk profile and various other patient factors
Non-APL: cytarabine and anthracycline induction
Acute Promyelocytic Leukemia (APL) - t(15;17) translocation, associated with DIC and significant bleeding>Tx: All-trans retinoic acid (ATRA) or arsenic trioxide
Li-Fraumeni syndrome
Rare autosomal dominant disorder associated with increased risk of developing breast cancer, osteosarcoma, and soft tissue sarcomas like rhabdomyosarcoma . It is due to genetic mutations of tumor suppressor genes TP53 and/or the CHEK2 genes.
Can see brain tumors, leukemias, and adrenal cortical carcinoma. Screen with strong personal and/or family history of cancers associated with Li-Fraumeni syndrome
Dx: proband with sarcoma before 45, first degree relative with any cancer before 45, first/second degree relative with any cancer before 45 or sarcoma at any age
Txt: genetic counseling should be advised for consideration of confirmatory genetic testing.
Esophageal CA
Mostly adenocarcinoma, in the lower esophagus and is primarily associated with GERD and Barrett’s esophagus then SCC, in the upper esophagus and is primarily associated with HPV infection and smoking
Sxs: dysphagia, weight loss, and regurgitation
Dx: endoscopic biopsies and then followed by a CT or PET scan of the chest and upper abdomen for staging
Txt: surgery, radiation, and chemotherapy.
Basal cell carcinoma of skin
Sxs: nodular or cystic raised mass that is red, pearly, and translucent and has telangiectasias on the periphery on sun-exposed areas of the body
Risk factors for metastasis include neglect, perineural invasion, tumor size greater than 10 cm, and basosquamous or morphoeic subtypes.
Txt: surgical excision, radiotherapy, cryotherapy, photodynamic therapy, or treatment with imiquimod.
Primary central nervous system lymphoma (PCL)
uncommon variant of extranodal non-Hodgkin lymphoma, primary risk factor is immunodeficiency, EBV
Sxs: confusion, lethargy, memory loss, hemiparesis, aphasia, and seizures, B sxs
Dx: CT scan or MRI showing one or multiple well-defined focal lesions in the corpus callosum, periventricular or periependymal areas, differentiate between PCL and toxoplasmosis, CSF cytology, Epstein-Barr virus DNA, toxoplasmosis serology, an empiric trial of antibiotics, and stereotactic brain biopsy
Txt: methotrexate-based chemotherapy regimens given in conjunction with radiation therapy, steroids and anti-retroviral therapy
Inflammatory breast CA
Sxs: three to six months, pain, itching, erythema of at least one-third of the breast, edema, and warmth. There is classically a peau d’orange appearance of the breast, Nipples may appear flat, retracted, or crusted, and a palpable underlying mass may or may not be present, axillary LAD
rapidly progressive with frequent visceral metastasis and associated poor prognosis.
Dx: mammography, breast ultrasound, and biopsy
Txt: neoadjuvent chemo >masectomy with node dissection> post masectomy chest wall radiation if not metastatic
Hodgkin’s lymphoma
four classical histologic subtypes: nodular sclerosis, mixed cellularity, lymphocyte-rich and lymphocyte-depleted, non-classical subtype: nodular lymphocyte-predominant
Sxs: painless LAD, mediastinal mass >dyspnea, cough, and obstruction of SVC, B sxs, hepatosplenomealy, pruritis
Dx: PET CT
Txt: no B symptoms>radiation alone or radiation combined with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). Advanced disease or those with B sxs >ABVD.
chronic myelogenous leukemia (CML)
translocation of the long arms of chromosome 9 and 22, creating BCR-ABL gene
Sxs: fatigue, night sweats, weight loss, LUQ pain or discomfort, and splenomegaly
Dx: Fluorescent in situ hybridization (FISH) may be used to detect the translocation, conventional cytogenetics not as good
chronic phase>accelerated phase>blast crisis phase
Chronic: <10% blasts
Accelerated phase: 10–19% myeloblasts in peripheral blood or in the bone marrow, >20% basophils in peripheral blood.
Blast crisis: > 20% myeloblasts in peripheral blood or bone marrow
Txt: tyrosine kinase inhibitor (dasatinib, imatinib, or nilotinib), can discontinue therapy when molecularly undetectable disease. Allogenic HSCT for young patients in chronic phase
Cervical CA
HPV 16 and 18
Sxs: asx, vaginal bleeding and dyspareunia
Txt: Stage IA1: conization>Stage IA2: hysterectomy. Stage IB (cervix only): radical hysterectomy (preserve ovarian function) or by primary radiotherapy> Stage IIA and higher: chemotherapy and radiation therapy (Cisplatin and paclitaxel)
Oral CA
SCC most common
Risk factors: tobacco (especially chewing tobacco or snuff) and alcohol use, HIV, sunlight exposure, and hyperplastic oral candidiasis, HPV 16
Sxs: originate from a premalignant disorder such as erythroplakia (older, smoke, drink), leukoplakia, or lichen planus, ulcerations with indurated borders or nonhealing masses
Dx: biopsy
Txt: surgical excision
spermatocytic tumor
Types:
Germ cell tumors: seminomas (inc HCG) and nonseminomas (inc HCG and possibly AFB, younger age, types include embryonal carcinoma, yolk sac carcinoma, choriocarcinoma, teratoma, and teratoma with malignant transformation, and mixed tumor types)
Dx: radical inguinal orchiectomy
Txt:
stage I seminomas: radical inguinal orchiectomy then active surveillance
stage I non-seminoma: radical inguinal orchiectomy w/ close observation or retroperitoneal LN dissection with 1-2 cycles of bleomycin, etoposide, and cisplatin.
stage II: combination of radiotherapy to the para-aortic and iliac lymph nodes, retroperitoneal LN dissection, and bleomycin, etoposide, and cisplatin depending on the histology, stage, and patient and physician preference.
Stage III and metastatic: chemotherapy
