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IPAP > Oncology > Flashcards

Oncology Flashcards

1
Q

Carcinomas are cancers that start ?

Sarcomas are cancers that start ?

Leukemias are cancers that start ?

A

Skin/organ lining (breast/lung)

Bone Fat Cartilage Muscle Vessel CT/Support tissue (osteosarcoma)

Marrow causing abnormal cells to be released

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2
Q

What are the five prefixes of benign tumors?

What are the six prefixes of malignant tumors?

A 
Chondroma- cartilage
Andenoma- glandular
Papilloma- epithelial
Osteoma- bone
Fibroma- connective tissue
Hepatoma- liver
Melanoma- melanocyte skin
Sarcoma- tissue around joint
Leukemia- blood
Lymphoma- lymph tissue
Carcinoma- epithelial
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3
Q

What are the three methods metastases spreads in the body and what type is usually found by each?

A

Seeding- ovarian

Lymph- typical for carcinoma

Hematgoenous- typical for sarcoma; usually to liver/lungs

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4
Q

Define Proto-Oncogenes

Define Oncogenes

A

Codes proteins that stimulate cell division

Cancer causing gene:
Mutation stimulates unregulated/early division

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5
Q

Define Tumor Suppressing Genes

What happens when these genes are mutated?

How do Proto become mutated to Oncogene?

A

Code proteins to suppress oncogenes (cell division)

No inhibition= cancerous growth

Carcinogens: Chemical UV radiation Virus

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6
Q

What are the hallmarks of Ca that are needed for it to develop and survive?

A 
A TRAGEDIES
Activating metastasis
Tumor promoting inflammation
Resisting death
Avoiding destruction
Genome instability/mutation
Evading growth suppressors
Deregulating energetics
Inducing angiogenesis
Enabling immortality
Sustained signaling
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7
Q

Basic Oncology focuses on ? three Dz parts and is instrumental in ?

What are the top three leading causes of death in the US?

A

Patterns, Cause, Effect
Screening, Prevention, Txs

Heart Dz
Cancer
Chronic lower respiratory dz

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8
Q

Only three forms of Ca that are not decreasing in prevalence or death rates?

What forms of Ca remain in the same location of developmental probability between M/F genders

A

Esophageal Pancreatic Hepatocellular

Lung/bronchus
Colon/rectum
Melanomas of skin
Non-Hodgkin lymphoma

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9
Q

What are the top three RFs of cancer for men and women

What are the prevalence of Brca mutation and Ca

A

Smoking Obesity Alcohol

BRCA-1: 85% breast, 50% ovarian

BRCA-2: fe/male breast, ovarian, prostate Ca

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10
Q

What are the different types of MEN

What is the difference between Wermer and Werner

A

MEN 1: Wermer Syndrome; MC, mutated menin gene

MEN 2: Sipple syndrome; mutated ret gene

MEN 3: mutated ret gene

MEN 4: mutated CDKIN1B gene

Wermer- MEN 1
Werner- premature aging

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11
Q

How does MEN 1 present

What is normal life expectancy

A 
Hyperparathyroidism
GEP-NETs 
Pituitary adenomas
Insulinomas
Gastrinomas

55yrs

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12
Q

How does MEN 2 present

A

Medullary thyroid carcinoma
Hyperparathyroidism
Pheochromocytomas
Hirschsprung Dz

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13
Q

Alcohol is linked to ? forms of Ca

Although associated w/ breast Ca, what is the catch w/ alcohol induced Ca?

A

Head Esophageal Liver Neck

Abstinence not linked w/ reduced risk

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14
Q

Radiations are linked to ? types of cancer

Radon is linked to ? type

Vinyl chloride is linked to ? type

A

Leukemia Breast Thyroid Lung

Lung

Hepatic angiosarcoma

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15
Q

Benzene exposure is linked to ? types of Ca

UV light is linked to ? types of Ca

A

AML Lymphoma

All types of skin cancer

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16
Q

USPSTF recommendations for breast Ca screening

Colon Ca screening for average risk PTs?

A

Mammography q2yrs 50-74y/o w/out S/CBE

Start at 50y/o, q10yrs w/ colonoscopy
Start AfAm/NAFLDz PTs at 45y/o

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17
Q

When are colon cancer screenings recommended for PTs w/ +FamHx

A

One FDR or 2+ SDR Dx >60, start at 50

One FDR or 2+ FDR Dx <60, start at 40 or 10yrs prior to Dx, what ever if first

q5yrs there after

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18
Q

What are the US PSTF grading criteria for expected benefit?

A

A: substantial, offer
B: moderate, offer
C: small, selective PTs
D: harms out weigh/no benefit, discourage
I: insufficient evidence to assess harm/benefit

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19
Q

What are the 4 methods of direct visualization for GI oncology?

What are the 3 stool based oncology tests?

A

Colonoscopy- q10yrs
Flex sig w/ FIT- q10y, FIT q1yr
CT colonography- q5yrs
Flex sigmoid- q5yrs

gFOBT: q12mon
FIT: q12mon
FIT-DNA: q1 or 3yrs

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20
Q

What age groups are eligible for PSA screening and what age groups are not recommended for screening?

What groups are cervical cancer screenings not recommended?

A

55-69: recommend, Grade C
+70: not recommended, Grade D

<21, >65, post-hysterectomy

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21
Q

How often are cervical cancer screenings conducted?

A

21-29: q3yrs w/ cytology

30-65: q3yrs w/ cytology or,

q5yrs w/ only hrHPV or,

q5yrs w/ hrHPV and cytology

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22
Q

When is lung cancer screening conducted?

A

55-80y/o w/ 30+ p/year or quit <15yrs: Annual LDCT (Grade B)

Stop once PT has quit for >15yrs or develops health problem that limits life expectancy/ability for surgery

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23
Q

Define Grading

Define Staging

A

Degree of differentiation based on pathology (1-4) w/ description

More predictive:
Severity and metastases; Estimates prognosis/guides Txs

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24
Q

What are the sub staging of T

A 
T= tumor size
TX= cannot be evaluated
T0= no primary evidence
Tis= carcinoma in situ; early, no spread
T1-4= primary tumor size
(small to large)
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25
Q

What are the sub staging of N

What are the sub staging categories of M?

A 
N= number of nodes w/ Ca
NX= can't be evaluated
N0= no regional involvement
N1-N3= extent of spread 
(mild mod severe)
M= distant metastasis 
M0= no metastasis
M1= metastasis
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26
Q

What are the 4 systemic effects of chemo?

What are the 5 types of local toxicity induced by XRT Tx?

A

Neutropenia
V/N
GI/Skin toxicity

Pneumonitis
Infertility
Thyroid Ca, secondary
Colitis  
Hypothyroidism
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27
Q

What biologicals/immunological Txs are used for Ca?

A

Monoclonal Ab therapy:

Rituximab/Rituxan- CD20+ lymphoma

Rastuzumab/Herceptin- HEGFR+ breast cancer

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28
Q

What are the four parts of supportive care?

What lab result may be used for post-tx f/u and prognosis but not for dx/screening?

These can not be used for Dx or screening except for ? exception?

A

Physical Emotion Psych Spirit

Tumor markers

PSA

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29
Q

AFP indicates presence of ? two types of Ca?

CA-125 indicates presence of ? what type of Ca?

A

Hepatocellular
Testicular

Ovarian

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30
Q

CEA indicates presence of ? three types of Ca?

CA 19-9 indicates presence of ? type of cancer?

A

Colon
Pancreatic
Breast

Pancreatic

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31
Q

Define Paraneoplastic Syndrome

A

Set of S/Sxs from malignant tumors release of hormones/proteins

Host Abs meant to kill tumor but damages healthy cells (AutoImm)

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32
Q

What type of cancer is most likely to be associated w/ multiple neoplastic syndromes?

This form of Ca can develop ? 4 syndromes?

A

Small cell lung cancer

Cushings
SIADH
HyperCa
Lambert Eaton syndrome

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33
Q

Define Myelo and Proliferative

Myeloproliferative d/os are ? type of issue

A

Bone marrow, rapid reproduction of cells

Mutated receptor kinase leads to excess activation and pathological cell division

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34
Q

Myeloproliferative d/os can progress into ?

What are the 4 types of myeloproliferative d/os and what cells do they impact?

A

Acute Myeloid Leukemia

Myelofibrosis- potential
PCV- myeloid
Essential/CML- progenator

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35
Q

What are the characteristics of myelofibrosis?

What is the step by step process of myelofibrosis development?

A

Abnormal myeloid proliferation
Atypical megakaryocytes

Clonally expanded megakaryocytes release fibroblast GFs,

Fibrosis of marrow occurs

Extramedullary hematopoiesis leads to splenomegaly

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36
Q

How does myelofibrosis present?

What two uncommon Sxs that don’t show until late/advanced in Dz process?

A

> 50y/o w/ insidious onset
MC fatigue from anemia/satiety from spleno/hepatomegaly

Thrombocytopenia- bleeding Satiety sensation

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37
Q

What presenting issue is a sign of poor prognosis for myelofibrosis?

What are the clincial presenting issues of myelofibrosis?

A

Severe anemia

Splenic infraction
Cachectic upper leg pain
Hematopoiesis- Transverse myelitits Ascites PHTN Esophageal varices

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38
Q

What Trifecta lab results indicates a Dx of myelofibrosis?

What is a fourth finding seen too?

10% of Myelofibrosis PTs will be Triple Negative which means ?

A

Poikilocytosis
Giant irregular shapes platelets
Leukoerythroblastic

Tear drop RBCs

No JAK2 CALR MPL mutations
(JAK2 mutated in +half of PTs)

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39
Q

How is Myelofibrosis Tx

A

Splenomegaly= hydroxyurea 1st line Tx

Splenectomy if pain episodes, thrombocytopenia, transfusion requirements

Anemia- tx w/ transfusion
Control w/ Prednisone L-domide Androgens T-domide

Allogenic transplant- potential curative
Ineligible= JAK2 inhibitor (Ruxolitinib)

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40
Q

What is the prognosis for PTs Dx w/ Myelofibrosis?

What usually kills these PTs

A

5yrs if untx

LF AML Bleeding

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41
Q

What type of issue does Polycythemia Vera cause?

Who and how does this usually present?

A

Myeloid cells over produce RBCs*, WBCs, Thrombocytes

60y/o hyperviscous male w/:
HA Dizzy
Blurred vision Erythromelalgia
PUD/Epigastric pain

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42
Q

What will be seen on PE during Polycythemia Vera

Why do PTs w/ Polycythemia Vera have paradoxical bleeding episodes?

A

Splenomegaly
Engorged retinal veins
Thrombosis- MC complication

Acquired von Willenbrand Syndrome/PUD

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43
Q

What lab result is the hallmark for Polycythemia Vera and what other results will be seen?

PTs w/ Polycythemia Vera can develop ? type of anemia?

What ortho issue can PTs w/ PCV develop?

A

Hct: >49%M/>48%F**
Inc B12
Platelets >1M

Hypo Micro
Possible IDA at presentation

Hyperuricemia- gout

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44
Q

How is a PCV Dx confirmed?

What lab results should cause the Dx to be re-considered?

What are the DDx for Polycythemia Vera?

A

JAK2 mutation screening

No Exon 14(MC)/12 mutation

WBC > 30K= CML
Abnormal RBC= Myelofibrosis
Platelet inc- Essential Thromb

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45
Q

How are Polycythemia Vera PTs Tx?

A

Phlebotomy- 500ml/wk Hct <45% (induced IDA- avoid Fe)

Hydroxyurea platelets <500K, neutrophil >2K for PTs w/:
Problematic/high phlebotomy
Intractable pruritis
Thrombocytosis

Hydroxyurea resistant- add Ruxolitinib

ASA 75-81mg
Allopurinol 300mg
Antihistamines

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46
Q

What agents to Polycythemia Vera PTs need to avoid?

What is the prognosis for PTs w/ Polycythemia Vera?

What is the major cause of death?

A

Alkylating agents in chemo, risk for conversion to acute leukemia

> 15yrs

Arterial thrombosis

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47
Q

Over time Polycythemia Vera can develop into ?

Although etiology of Essential Thrombocytosis is unknown, it is known to cause ?

A

Secondary myelofibrosis
AML refractory to therapy
CML

Megakarycyte proliferation
Inc platelets

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48
Q

Essential needs to be a DDx anytime ? is found

How does Essential Thrombocytosis present?

Although usually ASx at presentation, this can present with ?

A

Thrombocytosis

F>M 50-60y/o

Mesenteric Portal Hepatic venous thrombosis

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49
Q

What can be clinical presenting issues of Essential Thrombocytosis?

What will be seen on lab results?

A 
HA
Erythromelalgia
Levido reticularis
Mucosal bleeds
Splenomegaly

Platelet >2M
No Philadelphia mutation
Inc megakaryocyte on biopsy

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50
Q

How is Essential Thrombocytosis Tx

What management must be strictly followed in these PTs?

A

Hydroxyurea/Anagrelide- keep platelets <500K
ASA after r/o VWS, helps erythromelalgia

Control of co-existing CV risk factors

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51
Q

Although there is a normal prognosis, who are ‘high risk’ PTs for death from thrombosis and a Essential Thrombocytosis Dx?

CML issues starts w/ ? cell and effects ? two cells?

A

> 60y/o
11K leukocytes
Thrombosis Hx

Progenator, Myeloblast/Monoblasts

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52
Q

How does CML present?

A

55y/o
Inc WBC induced hyper metabolic state= F/Fatigue/NS
Satiety
Sternal tenderness

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53
Q

Define Sx Hyperleukocytosis

What clinical syndrome does this develop into?

A

Leukostasis:
WBC >100K, <500K in CML

Priapism
Blurred vision
Respiratory distress

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54
Q

Accelerated CML is associated w/ ?

What will be seen on peripheral smears?

What lab test is required for Chronic Phase CML PTs?

A

Fever w/out infection Bone pain
Splenomegaly

L shift w/ Baso/Eosinophils

Marrow biopsy for karyotype/morphological evaluation for phase of dz

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55
Q

What is the hallmark of CML?

Define Accelerated/Blast phase of CML and S/Sxs

A

+bcr/abl gene (Philadelphia) chromosome

Acc: blasts 10-20% (chronic)
Blast: blasts >20% (acute)
Anemia Thrombocytopenia

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56
Q

Early CML must be differentiated from ?

What lab results prove there is no CML?

A

Reactive leukocytosis from infection

WBCs <50K
No splenomegaly
No bcr/abl gene

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57
Q

How is leukostasis of CML Tx?

How is the chronic phase Tx?

How is accelerated/blast phase Tx?

A

Emergent pheresis
Supression (Hydroxyurea)

Tyrosine kinase inhibition:

1st: Imatinib
2nd: Nilo/Dasatinib

TKI and/or chemo
Consider stem cell transplant

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58
Q

How long does it take for CML chronic phase Sxs to improve after Tx starts?

What are the 5 age categories for probability of developing invasive leukemia cancer?

What is the relative survival rate?

A

Blood/splenomegaly- 3mon
Cytogenic- 3-6mon
Molecular- 12mon

Birth - 49
50-59
60-69
70+
Birth - Death

5yrs

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59
Q

What are the different types of lymphocytes and the type of immunity/defense they offer?

A

Cell mediated- release of cytokines (ICLIT)

Humoral- Bcells destroy bacteria, produce Abs

T-cells: destroy Fungi Transplant Virus Cancer cells

NKCs- destroy Infectious Malignant cells

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60
Q

Clinical manifestations of leukemia are due to ?

What 3 events occur due to the manifestations?

A

Over proliferation of immature cells

Marrow replacement
Organ infiltration
Activation of coagulation

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61
Q

What are the etiologies of CLL/ALL?

What are the causes of AML?

A

Unknown

Prior chemo
Radiation 
Drugs: Chlorophenicol/quine
Benzene
Marrow d/o: (myeloproliferative)
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62
Q

What type of leukemia has the highest estimated death rate?

Fact comparison of AML and ALL

A

AML

AML: peak 60y/o
80% of adult leukemia
M>F

ALL: peaks 3-7y/o
80% of childhood leukemia

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63
Q

What are the presenting Sxs of acute leukemia?

What Sxs do they present w/ if they have impaired circulation?

What is a less common presentation?

A

Bleeding Fever Anorexia Bone pain

SoB HA Confusion

DIC in APL- acute promyelocytic leukemia

64
Q

What are common presenting infections of acute leukemia?

What microbe causes these?

What fungal infections can be seen?

A

Perirectal Cellulitis Pneumonia

Klebsiella E Coli Pseudomonas

Candidia Aspergillus

65
Q

Acute leukemia infection risk increases when neutrophil levels fall below ?

What bones may hurt upon PE?

Why will a Hx potentially be difficult to get?

A

<500

Femur Tibia Sternum

Stomatitis d/t mast cell reaction
Gingival hypertrophy

66
Q

What will be seen on lab results in the acute leukemia?

How is it Tx?

Why is Tx needed so promptly?

A

Hyperleukocytosis >100K
HA Confusion Dyspnea

Emergent Chemo w/ pheresis

Death <48hrs w/out Tx

67
Q

What is the hallmark lab finding for acute leukemia?

Define Aleukemic Leukemia

A

Pancytopenia w/ circulating blasts

No blast cells in peripheral smear

68
Q

How do peripheral smear results differ between ALL/AML

What finding is pathognemonic for AML?

A

ALL- lymphoblasts
AML- myeloblasts

Auer rods

69
Q

If acute leukemia is present with DIC, what will lab results show?

What work up must be done ASAP during acute leukemia work ups?

A

Dec fibrinogen
Prolonged PT
Pos D-dimer

Marrow biopsy
LP for ALL, commonly has CNS involvement

70
Q

Define Induction of acute leukemia Tx

Post-remission therapy is given w/ ? intent and includes ? Txs

What is the CNS prophylaxis for ALL?

A

Induction of remission; aggressive chemo to destroy visible leukemia cells

Given w/ curative intent:
Standard chemo w/ stem cell transplant

Intrathecal chemo

71
Q

Leukemia PTs up to ? age are Tx w/ objective of cure?

What is the first step in Tx

A

60y/o

Induction chemo to achieve complete remission

72
Q

What is the remission criteria for acute leukemia?

How to Tx Philadelphia pos ALL

A

Normal peripheral blood
Dec/no marrow blasts
Normal clinical status

Combo chemotherapy
Tyrosine kinase inhibitor
CNS prophlyaxis

73
Q

What type of Tx provides the best benefit for ALL in PTs <39y/o?

PTs w/ ? 3 things tend to have low prognosis?

What is the MC cause of leukemia in Western countries and affects ? gender?

A

Pediatric protocol of Chemo/transplant

Older age
Poor chemo response
Adverse cytogenics

CLL
M>F +70y/o

74
Q

How do PTs w/ CLL present

CLL clinical manifestations are related to ? three events?

A

Fatigue
Adenopathy- painless, mobile
Hepato/Splenomegaly

Marrow failure
ImmSuppression
Organ infiltration

75
Q

Rai Classification System for CLL staging

A

0: lymphocytosis- low risk
1: lymphocytosis + adenopathy- low risk
2: lymphocytosis + organmegaly +/-adenopathy- intermediate risk
3: lymphocytosis + anemia- high risk
4: lymphocytosis and thrombocytopenia- high risk

76
Q

What is the hallmark of CLL

What is seen on lab smears?

When/how is this Tx

A

Isolated lymphocytosis- >20K

Small, mature lymphocytes

Rai 0-1: Observe
Rai 2-4 w/ FLAT Tx w/ Chemo:
Fludarabine Cyclophasphamide Rituximab

Chemo avoidance/refractory/recurrent: Ibrutinib

Non-responsive to therapy- allogeneic transplant

77
Q

What is the prognosis for CLL and which stage doesn’t have a prognosis?

Some PTs w/ CLL will progress into ?

A

0-1: 10-15yrs
3-4: 2yrs

Lymphoproliferative d/o- 
Richters transformation
Prolymphocytic leukemia
Hodgkin lymphoma
Multiple myeloma
78
Q

Define Richter’s Syndrome

How does it present?

What is the prognosis?

A

CLL progression w/ isolated node becoming diffuse large B cell Lymphoma

Spleneomegaly Adenopathy LDH Anemia Thrombocytopenia

5-8mon

79
Q

Define Lymphoma

This type of cancer involves ? cells

A

Heterogenous tumors in immune system, turn lymphocytes into malignant cells

T B NK
MC- B

80
Q

What is the difference between HL and NHL

What is the MC lymphoma

A

HL: Reed-Sternberg (large binucleated) cells

Non-Hodgkin w/ B cell origin

81
Q

What are the MC subtypes/presentations of NHL?

What are the chronic inflammation etiologies of NHL?

What are the chronic infection etiologies of NHL?

A

Follicular- indolent/low grade
Aggresive: diffuse large B-cell

Sjogrens RA Celiac

Hep B EBV TLV Hep C HIV
BETCH

82
Q

H Pylori is a known etiology to what sub-type of NHL?

EBV (Mono) is known to cause what type of lymphoma especially where in the world

What chemicals can cause NHL?

A

Indolent B Cell MALT lymphoma

Burkitt- aggressive B Cells, Africa; tonsil abdomen neck

Pesticides Hair dyes

83
Q

How do the slow indolent/follicular forms of NHL present?

How do aggressive forms present?

A

Diffuse adenopathy
Rarely w/ systemic Sxs
+ marrow involvement
+ hepatosplenomegaly

Primary/Extranodal
Rapid, painless progression w/ systemic Sxs

84
Q

Aggressive NHLs can present as a ? Dz

What is the MC initial finding seen on CBCs?

After lab work, what is the definitive way to Dx?

A

Skin
Extranodal- GI tract (MC)
Testis Marrow Kidneys

Anemia

Excisional biopsy

85
Q

What part of lab results correlates w/ the overall prognosis in NHL PTs?

After NHL Dx, refer to IMC where they will do ? tests

A

LDH levels

PET scan
CT w/ contrast on neck, chest, abdomen and pelvis
Marrow biopsy

86
Q

What are the two types of cytogenetic translocations seen in NHL?

How is NHL staged?

A

14: 18- MC, follicular
8: 14- Burkitts

Ann Arbor-
A: no B Sxs
B: B Sxs w/in 6mon of staging

87
Q

What are the 3 initial B Sxs seen in NHL

What two bodily structures are of importance in the Ann Arbor staging system?

A

Fever > 100.4
Weight loss >10% of baseline
Recurrent night sweats

Diaphragm
Lymphatic system

88
Q

What are the 4 stages of Ann Arbor staging

A

1: single node region/ single extra lymphatic site
2: +2 regions on same side of diaphragm (2) or local extralymph extension/more nodal regions on same side of diaphragm (2E)
3: both sides of diaphragm (3), extralymph extension (3E)
4: one or more extralymphatic organs/sites

89
Q

What are the 4 Ann Arbor classification annotations

A

A: no B Sxs

B: One B Sx in past 6mon

E: extension to extra lymph organ adjacent to known involved site

X: bulky dz >10cm or mediastinal mass >1/3 transverse diameter

90
Q

How are indolent lymphomas Tx

A

Chemo/Rituximab combo
Acid blockage
Pylori ABX

Alternative: radiotherapy

91
Q

How are aggressive lymphomas Tx

A

Diffuse large B: Innunochemotherapy

Relapse of large B cell: autologous transplant

Bulky/Extranodal Dz: nodal radiotherapy

Mantle: rarest B cell Ca in older men; stem cell transplant

92
Q

How is aggressive primary CNS lymphoma Tx

How is aggressive high-grade lymphoma like Burkitt/Lymphoblastic Tx

A

IV Methotrexate + Rituximab

Cyclic chemo
Intrathecal chemo for CNS prophylaxis

93
Q

Why is IV Methotrexate and Rituximab preferred for aggressive primary CNS lymphoma?

Pts w/ aggressive peripheral T-cell lymphomas usually have what other underlying issues?

Because of this, what Tx is added to their regime as first line?

A

Better results
Less cognitive impairment

Advanced nodal and extranodal dz

Autologous stem cell transplant

94
Q

What is the average survival time for indolent lymphomas?

Why is this time span limited?

A

10-15yrs

Becomes chemo refractory

95
Q

What are the International Prognostic Index categories for poor prognosis of aggressive lymphomas?

How do these categories correlate to cure rates?

A 
>60y/o
>1 extranodal site
Poor performance status
Inc LDH
AA Stage 3-4

Low risk: 0 factors, 80%
High risk: +4 factors, 50%

96
Q

? type of lympoma has bimodal age distribution?

Although no clear etiology exists for this form, what is it linked w/?

A

HL- 20s and >55y/o

Same sex siblings
HIV Autoimmune EBV

97
Q

How does HL present?

What other presenting Sx may be noted?

A

Painless single lymph node, MC cervical/mediastinal/hilar
Possible in supraclavicular and axilla w/ orderly spread

B Sxs
Nodal pain w/ alcohol ingestion

98
Q

DDxs that can mimic HL presentation w/ a reactive lymph node

How is HL Dx?

A

Cat scratch
Other malignancy
Mono
Phenytoin reactions

Excisional biopsy w/ Reed Sternberg cells

99
Q

What are the four other sub-classical classifications of HL?

All of the classical classification of HL will have ? commonality?

A

Lymphocyte rich/depleted
Mixed cellularity
Nodular sclerosis

Reed sternberg cells

100
Q

What is the non-classical classification of HL?

How is HL Tx

A

No Reed-Sternberg cells
Nodular lymphocyte predominant

AA Stages 1-2: short chemo and nodal radiotherapy or,
Full chemo course alone

Mediastinal/Bulky 2, 3-4: ABVD course

101
Q

What is the risk of PTs undergoing ABVD Tx regimens for HL?

How is HL Tx if Pt is relapsing after chemo/radiation?

A

Pulmonary toxicity leading to fibrosis/death

Autologous transplant

102
Q

What are the 7 factors that confer poor prognosis for HL?

How do these factors correlate into cure rates?

A 
Gender M
Age >45
Stage
Hbg <10.5
Lymphocyte <600
Albumin <4
WBC <15k

0-2 factors= 75%
3 or more= 55%

103
Q

What are the prognosis rates for HL

Where does Myeloma Cadevelop

A

1/2A: Excellent
3-4: half reach 10yrs

Plasma cells anywhere in marrow

104
Q

How does marrow change w/ age?

What cell is the precursor to plasma cells?

A

Older= yellow replaces red

B-lymphocytes

105
Q

Plasma cell myeloma is characterized by ? three things

What PT population does this usually present

A

Infiltration of marrow
Bone destruction
M-proteins (paraprotein)

65y/o AfAm male

106
Q

How is Plasma Cell Myeloma Dx

A

Monoclonal plasma cell in marrow,
Tumor (plasmacytoma) or
Both w/ end organ damage

Or

Serum free kappa to lambda ratio >100 or <0.01 regardless of end organ damage

107
Q

What type of end organ damage signifies Plasma Cell Myeloma

Define Smoldering Myeloma

A

HyperCa
Anemia
Lytic bone lesions
Kidney injury

Plasma cell myeloma w/:
10-59% clonal plasma cells
Serum paraprotein >3g
Both w/out end organ damage

108
Q

How does Plasma Cell Myeloma present in clinic?

A

Fxs= cord compression
Anemia
Bone pain

Hyperviscosity
Infection: Spneumo/HInfluenza
Kidney Dz
Soft tissue masses

109
Q

What is seen on lab results of Plasma Cell Myeloma

What two lab results are ordered on top of blood tests?

What finding is the hallmark of PCM Dx

A

Anemia
HyperCa
AKI

Serum/Urine electrophoresis

Monoclonial spike w/ G*/B component

110
Q

Electrophoresis separates proteins into what components?

What will be seen on peripheral smear in Plasma Cell Myeloma

A

Gamma
Albumin
Beta-1/2
Alpha-1/2

Rouleaux- stacked RBCs w/ immunoglobulins as glue
Not definitive Dx/exclusion

111
Q

What images are ordered for Plasma cell myeloma?

Why are radionucleotide bone scans not useful?

A

Whole body CT w/out contrast
Whole body PET
Whole body MRI

No osteoblastic component

112
Q

Plasma Cell Melanoma Dx requires what 3 components

What are the 3 stages of PCM?

A

M-protein in serum/urine
Marrow aspirate +10% plasma cells
Plasma cell induced end organ damage

1: B2 <3.5, albumin >3.5
2: B2 3.5-5.5
3: B2 >5.5

113
Q

What is the mnemonic OLD CRAB mean

A

Plasma Cell myeloma presentation:
OLD Ca elevated RF
Anemia Bone lesions

114
Q

How is Plasma cell myeloma Tx

What is the median survival rate?

A

Chemo +/- transplant
Local radiation- bone pain
HyperCa/Uric acid Tx
Bisphosphonates for Fx Tx

7yrs

115
Q

Why is a MGUS Dx significant?

What are the criteria for Dx?

A

Precursor to PCM

<10% marrow plasma cells
M-protein <3g
No end organ damage

116
Q

What are the two most frequent M-proteins found in MGUS?

What is done for MGUS managed

A

IgG, IgA

F/u q 3-6mon w/:
Ca
Hgb/Hct
One marrow biopsy
Renal panel 
Electrophoresis
117
Q

What are two types of local oncology emergencies?

What are two types of systemic emergencies?

A

Obstruction
Pressure

Metabolic complication
Hormonal complication

118
Q

What is the first and second MC cause of HyperCa?

PTs experience Sxs when serum Ca levels exceed ?

A

1: hyper parathyroid
2: Ca- PCM, Breast, NSCLC (squamous)

> 15mg

119
Q

What are the S/Sxs of HyperCa

If PTs are low on ? protein their total serum Ca will be underestimated?

How is the corrected Ca calculated?

A

Stones Bones Moans Pyschic groans

Albumin

(Ca - albumin) + 4 or,
Free ionized Ca

120
Q

How does HyperCa reflect on EKG?

When does HyperCa become deadly?

A

Short QTc

Corrected Ca >12 d/t
Arrhythmia/asystole

121
Q

Cancer associated hyperCa will cause ? level of PTH and what f/u order is done?

True hyperparathyroidism will have ? lab results

A

Low, order PTHrP

Inc PTH and Ca

122
Q

How is HyperCa Tx

What is used if Hyper Ca is refractory?

What is used if kidney function is reduced?

A 
NS 100-300mL/hr
IV furosemide-hypervolemic
IV bisphosphonates: 
Zoledronic 4mg 15min 
Ibandronate 2-4mg 2hrs
Pamidronate 60-90mg 2-4hr

Calcitonin 4-8 IU/kg q12hrs
Denosumab 120mg qWeeks x 4wks then monthly

Denosumab

123
Q

When/why would CCS be added to HyperCa Tx?

HPV is linked to ? types of Ca

EBV is linked to ? types

A

PCM/Lymphoma

Laryngeal Anal Cervical

B-Cell Nasopharyngeal PO Hiary leukoplakia

124
Q

H Pyloris is associated w/ ? types of Ca

Schistosoma is associated w/ ? type

A

Gastric
MALT lymphoma

Bladder

125
Q

HHV-8 is assicated w/ ? types of Ca

HIV is associated w/ ? types?

A

Kaposi sarcoma

Lymphoma (HL/NHL)

126
Q

Sjogrens is associated to ? type of Ca due to inflammation

Dermatomyositis is associated w/ ? type of cancer MC

A

Lymphoma

Ovarian

127
Q

Colorectal screenings are recommended for ? age groups w/ ? grade recommendation?

This decision becomes strictly up to the PT past ? age and have ? grade recommendation?

A

50-75, Grade A

76-85y/o, Grade C

128
Q

Cervical cancer screenings fall into what grade of recommendation?

What score does lung cancer screenings have?

A

21-65y/o: A
>65 <21 post-hysterectomy: D

55-80y/o: B

129
Q

Secondary myelofibrosis occurs as a result of ? disorders?

What are the 3 zones of a B-cell?

A

Any myeloproliferative d/o

Mantle Germinal Marginal

130
Q

IgM:

Heavy Chain

% in serum

Fixed complement

Function

A

u (mu)

6%

Yes

Primary response
B-cell receptor

131
Q

IgG:

Heavy Chain

% in serum

Fixed complement

Function

A

y (gamma)

80%

Yes

Main blood Ab
Neutralizes toxins
Opsonization

132
Q

IgA:

Heavy Chain

% in serum

Fixed complement

Function

A

A (alpha)

13%

No

Sevreted into mucus, tears, salia

133
Q

IgE:

Heavy Chain

% in serum

Fixed complement

Function

A

e (epsilon)

0.002%

No

Ab of allergy/parasitic

134
Q

IgD:

Heavy Chain

% in serum

Fixed complement

Function

A

d (delta)

1%

No

B cell receptor

135
Q

What are the heavy chained immunoglobulins

What are the light chained immunoglobulins?

A

GAMED

Kappa/Lambda

136
Q

What’s the only Dx to order CMP for during work up?

MGUS marrow, clinical picture and therapy

A

Plasme Cell Myeloma

<10% plasma cells
ASx, no organ damage
Observation

137
Q

Smolder MM marrow, clinical picture and therapy

MM marrow, clinical picture and therapy

A

10% or more plasma cells
ASx, no organ damage
Observe

10% or more plasma cells
Sxs w/ organ damage
Therapy req’d

138
Q

What two types of Ca can secrete PTHrP

What is the 2nd MC complication of Ca?

This 2nd MC is more likely to occur w/ ? types?

A

Breast
Lung- squamous

Cord compression

Lung Breast Prostate
Renal Lymphoma

139
Q

What is the MC neurological complication of Ca?

Why can Ca related cord compression result in permanent damage?

A

Brain metastasis

Myelin sheath damage

140
Q

What PE Sx precedes neurological Sxs of cord compression d/t Ca?

What are two late findings?

A

Back pain

Bowel/bladder Sxs

141
Q

What is the image modality of choice for Ca PTs w/ new onset back pain?

What image is ordered if back pain Sxs are nonspecific?

A

Entire spine MRI

Whole body PET scan w/ F-2-deoxyglucose

142
Q

How is spinal cord compression d/t Ca Tx

A

Known Ca Dx:
1st- Dexameth 10-100mg then 4-6mg q4-6hrs

Solid tumor/single compression:
Decompression then radiation therapy

Multiple vertebral body involvement:
Fractional radiation therapy

No Ca Dx:
No CCS, straight to emergent surgery

143
Q

Define Febrile Neutropenia

What is the equation for an absolute neutrophil count

A

Fever >100.4 >1hr or,
Fever of 101 w/ neutrophil count <1500

ANC= WBC x (N% + Segment band %)
Norm= 1.5-8
144
Q

What part of the PE must be avoided during febrile neutropenia?

What are the MC cause of these infections?

A

DRE unless abscess/prostatitis suspicion, give ABX first

Gram+ but, Gram- more serious/life threatening

145
Q

What labs are ordered for febrile neutropneia?

What images are ordered?

A

CBC w/ Diff
CMP
Blood Urine Sputum cultures

CXR, CT

146
Q

PTs w/ neutropenia and abdominal pain need to have ? DDx considered?

How are febrile neutropenia PTs Tx

A

Neutropenic enterocolitis- thick bowels seen on CT

Empiric ABX w/in 60min of presentation:
Cefepime- injectable
Carbapenem- beta lactam
PiperTazo- PCN beta lactam

147
Q

How long are Febrile Neutropenia ABX given?

What if no improvement is seen and fever persists on ABX?

What phone call is made?

A

Neutrophils >1500 and
Afebrile x 48hrs

Antifungals:
Caspfungin
Itraconazole
Amphotericin B

Infectious Dz consult

148
Q

SVC syndrome is associated w/ ? two MC causes?

What can be seen as provocative/pallative complaints on PE?

A

Lung cancer
Lymphoma

Bending/laying- worse
Sitting quiet- better

149
Q

What procedure can and can NOT be done for PTs w/ SVC d/t lung cancer?

What is the Tx procedure of choice for SVCS?

A

+ bronchoscopy
- transcbronchial biopsy

Balloon angioplasty w/ stent placement

150
Q

Tumor lysis sydrome occurs after Tx of ? hematologic malignancies?

TLS develops due to the release of ? cellular contents?

A

ALL
Burkitt

Nucelic acid
Protein
PO4
K+

151
Q

Sequence of events leading to TLS

A 
Release of DNA
Purine catabolism
Hyperuricemia 
Uric acid crytals 
AKI

Release of DNA
Neucleotides develop hyperphosphatemia
Ca/PO4 imbalance
AKI

Cell material released
HyperK
Neuromuscular irritability
Arrhythmia

152
Q

How is TLS avoided

What is the next step if urine output dec, SrCr/K inc or phyperphosphatemia persists?

A

Hydrate prior/after Chemo
Allopurinol 800mg q8hrs
Rasburicase- not in pregnant/lactating/G6PD

Nephrology, dialysis

153
Q

How does superficial somatic pain present

How does deep somatic pain present?

How does nociceptive pain present?

A

Sharp/throb

Aching

Pressure Ache Cramp Squeeze

154
Q

What are the 3 approaches to controlling Ca pain

What is the key to opioid use?

A

Block transmission
Alter perception
Modify source

Education

155
Q

WHO pain ladder

A 
Pain
Non-opioid/adjuvants
Opioid- mild/mod
Opioid- mod/sev
Pain management referral
156
Q

Hallmarks of Ca

Hallmark of Myeloproliferative D/o

Hallmark of CML

Hallmark of acute leukemia

Hallmark of CLL

Hallmark of PCD

A

A TRAGEDIES

Inc HCt 49/48%

bcr/abl gene (philadelphia)

Pancytopenia w/ circulating blasts

Isolated lymphocytosis

Monoclonial spike on electorphoresis

157
Q

Classifications

A

Rai- CLL (0-4, lymphocytosis + AOAT)

Ann Arbor- NHL (A/B FWNS)
1-4/ABEX

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