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Clin med sem 2 > Oncology- adults > Flashcards

Oncology- adults Flashcards

1
Q

Pulmonary mets- epidemiology

A

Any primary Ca can metastasize to lung

Vascular, lymph, or direct spread

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2
Q

Pulmonary mets- s/s

A 
Cough 
Hemoptysis
Dyspnea 
Hypoxia 
Pleural effusion
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3
Q

Brain mets- epidemiology

A

Common: Lots of Bad Stuff Kills Carlos
- Lung, breast, Skin (melanoma), kidney, colorectal

Hematogenous spread

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4
Q

Brain mass- s/s

A 
HA
Focal neurologic dysfunction 
Cognitive dysfunction 
Seizure 
Stroke
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5
Q

Brain mass- labs & imaging

A

MRI w contrast- gatalinium

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6
Q

Brain mets- tx

A 
Surgery
Stereotactic radiosurgery (SRS) 
Whole brain radiation (WBRT) 
- Multiple large tumors 
- Prophylact- Alzheimer med
- 40-50% response 
- Early S/E- alopecia, fatigue
- Late S/E- brain atrophy 
Steroids
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7
Q

Bone mets- epidemiology

A

Common- PT Barnum loves kids

- Prostate, thyroid, breasts, lung, and kidney

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8
Q

Bone mets- s/s

A

Asymptomatic or very painful
Hypercalcemia
Pathologic fracture, pain, spinal cord compression

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9
Q

Bone mets- labs & imaging

A 
Xray 
CT
MRI
Bone scan 
PET/CT
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10
Q

Bone mets- tx

A

Observation

Opioids - help w/ pain

Bisphosphonates - inhibit osteoclast
- dec skeletal related events: fractures, compression, hypercalcemia

External Beam Radiation - decreases pain

Stereotactic body radiotherapy (SBRT)

Surgery

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11
Q

Esophageal cancer- epidemiology

A 
Smoking 
Alcohol 
HPV 
Barret's- GERD 
M>F 
50-70yo
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12
Q

Esophageal cancer- s/s

A 
Sticking of food 
Retrosternal discomfort 
Regurg
IDA- chronic blood loss
Advanced- dysphagia, weight loss, odynophagia
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13
Q

Esophageal cancer- dx

A

Endoscopic biopsy

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14
Q

Esophageal cancer- labs & imaging

A

Barium Esophogram- visualize

CT- staging

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15
Q

Esophageal cancer- tx

A 
Surgery
Chemo
Radiation 
Nutritional support 
Airway management
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16
Q

Esophageal cancer- prognosis

A

5y <20% survival

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17
Q

Brain tumor- epidemiology

A

Family

Ionizing radiation

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18
Q

Brain tumor- s/s

A 
Focal deficit 
HA
Seizures 
N/V
Syncope 
Cognitive dysfunction 
Personality change 
Aphasia 
Hallucination 
Ataxia 
Sensory deficit 
Weakness 
Visual spatial dysfunction
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19
Q

Brain tumor- dx

A

MRI w gadolinium

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20
Q

Brain tumor- labs & imaging

A

CT-2nd

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21
Q

Brain tumor- tx

A 
Surgery 
Radiation 
Chemo 
Corticosteroids- reduce edema 
Anticonvulsants
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22
Q

Brain tumor- prognosis

A

Depends

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23
Q

Acute lymphatic leukemia (ALL)- epidemiology

A

Ionizing radiation
Chemo
White > black

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24
Q

Acute lymphatic leukemia (ALL)- s/s

A 
Fatigue 
Pallor
Bruising 
Bleeding petechiae 
Bone pain 
Leukemia cutis 
Infection
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25
Q

Acute lymphatic leukemia (ALL)- dx

A

BMB/A- >20% blasts- cytogenetics/ immunophenotyping

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26
Q

Acute lymphatic leukemia (ALL)- labs & imaging

A

CBC- pancytopenia

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27
Q

Acute lymphatic leukemia (ALL)- tx

A

<60yo- combo chemo and + Philadelphia chromosome- add tyrosine kinase inhibitor

> 60yo- tyrosine kinase inhibitor + prednisone

after remission- CNS prophylaxis –> chemo or BMT

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28
Q

Acute lymphatic leukemia (ALL)- prognosis

A

Worse- adults

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29
Q

Chronic lymphocytic leukemia (CLL)- epidemiology

A

Clonal malignancy of B lymphocytes

M>W
Increasing age
White

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30
Q

Chronic lymphocytic leukemia (CLL)- s/s

A 
Asymptomatic 
Lymphocytosis
Lymphadenopathy 
Recurrent infections 
HSM 
8 symptoms 
Leukemia cutis
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31
Q

Chronic lymphocytic leukemia (CLL)- dx

A

Flow cytometry

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32
Q

Chronic lymphocytic leukemia (CLL)- labs & imaging

A

CBC w diff and peripheral smear- lymphocytosis- smudge cells

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33
Q

Chronic lymphocytic leukemia (CLL)- tx

A

Early- observe
Stage 1-2- local radiation
Stage >2- chemo

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34
Q

Chronic lymphocytic leukemia (CLL)- prognosis

A

Early- 10yr
III, IV- 2 yr

Cannot be cured

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35
Q

Acute myelogenous leukemia (AML)- epidemiology

A

Clonal proliferation of myeloid precursors w dec ability to differentiate into mature cells

Chemo
Ionizing radiation
Chemical exposure
60yo

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36
Q

Acute myelogenous leukemia (AML)- s/s

A 
Fatigue 
Weakness 
Gingival bleeding 
Ecchymosis 
Epistasis 
Anemia 
Thrombocytopenia 
Pallor
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37
Q

Acute myelogenous leukemia (AML)- dx

A

BMB >20% blasts

Presence- Auer rods, myeloperoxidase or markers on phenotyping

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38
Q

Acute myelogenous leukemia (AML)- labs & imaging

A

CBC w diff and peripheral smear- blasts

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39
Q

Acute myelogenous leukemia (AML)- tx

A

Induction therapy–> consolidation (chemo or BMT)

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40
Q

Acute myelogenous leukemia (AML)- prognosis

A

65% remission- depends on age

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41
Q

Chronic myelogenous leukemia (CML)- epidemiology

A

young- middle aged adults
M>F
Ionizing radiation

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42
Q

Chronic myelogenous leukemia (CML)- s/s

A 
Asymptomatic- found in lab work 
Fatigue 
Abdominal fullness 
Anorexia 
Weight loss 
Low-grade fever
Excess sweating (worse than blast crisis)
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43
Q

Chronic myelogenous leukemia (CML)- dx

A

BMB- Philadelphia chromosome

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44
Q

Chronic myelogenous leukemia (CML)- labs & imaging

A

CBC- leukocytosis

PCR- BCR- ABL gene

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45
Q

Chronic myelogenous leukemia (CML)- tx

A

Chronic- Gleevec
Accelerated- Allo
Blast crisis- induction chemo –> Allo

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46
Q

Chronic myelogenous leukemia (CML)- prognosis

A

Chronic- 25yr
Accelerated- 5 yr
Blast- 1 yr

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47
Q

Hodgkin lymphoma- epidemiology

A

Biomodal peak- 20-65yr
M>F
EBV
Immunodeficient

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48
Q

Hodgkin lymphoma- s/s

A

Painless localized peripheral lymphadenopathy- cervical
Mediastinal mass
B symptoms
Post partying

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49
Q

Hodgkin lymphoma- dx

A

Lymph node biopsy
Reed Sternberg cells
PET/CT and BM- staging

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50
Q

Hodgkin lymphoma- tx

A

Combo chemo
ABBVD + radiation
Refractory- auto

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51
Q

Hodgkin lymphoma- prognosis

A

Very good

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52
Q

Non-Hodgkin lymphoma- epidemiology

A 
Inc age 
HIV 
Toxin eposure 
Autoimmune 
EBV
Obesity 
White
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53
Q

Non-Hodgkin lymphoma- s/s

A 
Indolent - painless lymphadenopathy 
HSM
Cytopenia
Aggressive - rapidly growing mass
Fever
Night sweats
Weight loss
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54
Q

Non-Hodgkin lymphoma- dx

A

Biopsy- nodes

BM- staging

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55
Q

Non-Hodgkin lymphoma- labs & imaging

A

LDH- inc

Uric acid- inc

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56
Q

Non-Hodgkin lymphoma- tx

A

Indolent- radiation

Intermediate- high grade- chemo, immunotherapy, BMT

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57
Q

Non-Hodgkin lymphoma- prognosis

A

HIV - worse
Indolent- long survival
Aggressive- 50%

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58
Q

Thyroid cancer- epidemiology

A 
M>W
Childhood head/neck radiation 
Family hx 
MEN type II
- Papillary 
- Follicular 
- Medullary
- Anaplastic
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59
Q

Thyroid cancer- s/s

A

Painless neck swelling
Palpable single, firm nodule
Asymptomatic

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60
Q

Thyroid cancer- dx

A

U/S–> FNA

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61
Q

Thyroid cancer- tx

A 
Surgery 
Radioactive iodine (RAI)

Need thyroid replacement for life

Anaplastic - no effective tx- palliative care- Chemo + radiation for those who want to try

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62
Q

Thyroid cancer- prognosis

A

P, F, M- good

A- very bad

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63
Q

Breast cancer- epidemiology

A 
Inc age 
BRCA
Nulliparity 
Early menarche
Late menopause 
Delayed childbearing
Radiation exposure 
Long-term estrogen use
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64
Q

Breast cancer- s/s

A

Single, nontender, firm immobile mass
- upper outer quadrant
Asymptomatic
Rare- nipple discharge, retraction, peau deorange, eczematous change (Paget discharge), pain, axillary lymphadenopathy

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65
Q

Breast cancer- dx

A

Stereotactic

Excisional core needle biopsy

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66
Q

Breast cancer- labs & imaging

A

Mammogram- check estrogen and progesterone receptor

67
Q

Breast cancer- tx

A 
Lumpectomy w/ Sentenal lymph node biopsy
Mastectomy
Radiation + Chemo
Hormone receptors - Arimidex, tamoxifen, raloxifene
Her-2 - Herceptin
68
Q

Breast cancer- prognosis

A

Early- great

ER/PR pos- better

69
Q

Renal cell carcinoma- epidemiology

A 
M>F 
>55yo 
Smoking 
American Indian/ Alaska 
Hereditary 
HTN
Obesity 
Polycystic kidney disorder
70
Q

Renal cell carcinoma- s/s

A 
TRIAD- hematuria, flank pain, palpable mass
Asymptomatic	
Incidental diagnosed 
Weight loss 
Paraneoplastic symptoms
71
Q

Renal cell carcinoma- dx

A

Nephrectomy or partial- obtain tissue

72
Q

Renal cell carcinoma- labs & imaging

A

Abdominal CT

U/S

73
Q

Renal cell carcinoma- tx

A

Partial/radical nephrectomy
Advanced- immunotherapy and meds
Inhibiting VEGF
Chemo unhelpful

74
Q

Renal cell carcinoma- prognosis

A

5y 10-90%

75
Q

Lung cancer- epidemiology

A 
Leading cause of cancer deaths 
Smoking 
Radiation therapy 
Pulmonary fibrosis 
Environmental toxins
76
Q

Lung cancer- s/s

A 
Cough 
Hemoptysis 
Chest pain 
Dyspnea 
Weight loss
77
Q

Lung cancer- dx

A

Histologic confirm

  • sputum cytology
  • bronchoscopy
  • pleural fluid examination
  • biopsy
78
Q

Lung cancer- labs & imaging

A

CXR

CT

79
Q

Lung cancer- tx

A

NSCLC- surgery—> chemo +/- radiation

SCLC- chemo, radiation

80
Q

Lung cancer- prognosis

A

Poor, 5y 15%

81
Q

Lung cancer- SCLC

A

Oat cell

  • central
  • Mets early
  • aggressive
82
Q

Lung cancer- NSCLC

A

SCC
Adenocarcinoma
Large cell carcinoma
- slow growing

83
Q

Vulvar cancer- epidemiology

A 
>70 
Infection- high risk HPV 
HSV 
Immunosuppression 
Smoking
84
Q

Vulvar cancer- s/s

A 
Pruritus
Visible lesion 
Pain 
Bleeding 
Ulceration
85
Q

Valvular cancer- dx

A

Biopsy-

  • 5% acetic acid solution
  • visualize
  • acetowhite lesion biopsy
86
Q

Vulvar cancer- tx

A

Excision- wide and local
Topical 5-FU
Early- laser therapy
Radical- partial or complete vulvectomy +/- SLNB/ lymphadenectomy +/- chemo/radiation

87
Q

Vulvar cancer- prognosis

A

Good
1-2 75-90%
4- 16%

88
Q

Cervical cancer- epidemiology

A 
HPV- type 16 & 18 
Multiple sexual partners 
Smoking 
Early age of 1st sexual intercourse 
Early childbearing 
Low socioeconomic status 
STI hx 
AA>Hispanic>white
89
Q

Cervical cancer- s/s

A

Asymptomatic- found on screening

Advanced- vaginal bleeding or discharge

90
Q

Cervical cancer- dx

A

Pap —> abnormal:

  • repeart
  • colposcopy + biopsy
91
Q

Cervical cancer- tx

A 
Loop electro surgical excision procedure (LEEP) 
Ablation
Conization 
Hysterectomy 
Pelvic lymphadenopathy 
Radiation 
Chemo
92
Q

Cervical cancer- prognosis

A

Early- >90%

IV- <15%

93
Q

Endometrial carcinoma- epidemiology

A 
Unopposed estrogen therapy 
Obesity
Age
PCOS
Early menarche, late menopause
Nulliparity
Family hx
Tamoxifen, Lynch syndrome 
DM
White>Black
PROTECTIVE:: Combo OCPs and smoking
94
Q

Endometrial carcinoma- s/s

A

Abdominal uterine bleeding
Post menopausal women
Abnormal vaginal discharge
Abnormal cervical cytology

95
Q

Endometrial carcinoma- dx

A

Endometrial biopsy

D&C

96
Q

Endometrial carcinoma- labs & imaging

A

Transvaginal u/s- determine thickness and prevent need for biopsy

97
Q

Endometrial carcinoma- tx

A

Hysterectomy + bilateral salphingo-oophorectomy (BSO)
May need chemo + radiation
Progress in therapy- preserve fertility

98
Q

Endometrial carcinoma- prognosis

A

Good- usually present w early stage

99
Q

Basal cell carcinoma- epidemiology

A 
UV light 
Fair skin 
Family hx 
Radiation hx 
M>F 
Inc age
100
Q

Basal cell carcinoma- s/s

A

85% on head and neck- NOSE
Nodular- pearly papule w telangiectasia0- central ulceration
Superficial- circumscribed, scaling lesion w raised pearly white border
Morpheaform- flat or slightly raised yellow/white lesion, scar like w waxy surface

101
Q

Basal cell carcinoma- dx

A

Shave or punch

102
Q

Basal cell carcinoma- tx

A 
Mohs 
Excision/suturing 
Radiotherapy 
Curettage/electrodessication 
Intralesional infereon
5-FU
103
Q

Basal cell carcinoma- prognosis

A

Good

Slow growing- no Mets

104
Q

Squamous cell carcinoma- epidemiology

A 
UV light 
Smoking 
Immunosuppression 
Chronic ulcer 
M>F 
Inc age
105
Q

Squamous cell carcinoma- s/s

A

Sun-exposed areas - head/neck
Actinic keratosis
Scaly patch, plaque or nodule
Ulceration w/ irregular borders - bleed or crust

106
Q

Squamous cell carcinoma- dx

A

Shave, punch, or excisional biopsy

107
Q

Squamous cell carcinoma- tx

A

Depends on depth

5-FU, imiquimod, electrodessication, curettage, excision, Mohs, radiation, chemo

108
Q

Squamous cell carcinoma- prognosis

A

Good

5y > 90%

109
Q

Melanoma- epidemiology

A

UV light exposure
Caucasian
Large number of moles
Inc age

110
Q

Melanoma- s/s

A

Skin lesion- recent changes in appearance

111
Q

Melanoma- dx

A

Biopsy

112
Q

Melanoma- tx

A

Excision w margins
Sentinel lymph node excision- staging
Mets- interferon alpha, immune therapy, chemo

113
Q

Melanoma- prognosis

A

Tumor thickness dependent- Breslow stage

114
Q

Melanoma- types

A

Superficial spreading
Nodular melanoma
Lentigo maligna
Acral lentiginous

115
Q

Hepatocellular carcinoma- epidemiology

A 
Cirrhosis 
M 
HCV, HBV
Obesity 
Asian, Hispanic 
>55yo 
DM
116
Q

Hepatocellular carcinoma- s/s

A

Asymptomatic- sx of chronic liver dx
Abdominal pain, new decompensation of cirrhosis, paraneoplastic syndrome, hepatic bruit- signs of progression
Skin lesion- recent changes in appearance

117
Q

Hepatocellular carcinoma- dx

A

U/S

Biopsy- if image not conclusive- risk of tumor seeding

118
Q

Hepatocellular carcinoma- labs & imaging

A

CT/MRI

AFP

119
Q

Hepatocellular carcinoma- tx

A 
Surgical resection- live function preserved 
Liver transplant- advanced cirrhosis 
Ablation
Alcohol injection
Cryotherapy
Tranarterial chemoablation
Chemotherapy
Radiation - if surgery not an option
120
Q

Hepatocellular carcinoma- prognosis

A

Poor

5y 5-70%

121
Q

Colorectal cancer- epidemiology

A 
>50yo 
Lynch syndrome
Diet high in meat/fat, low veggies 
Family hx 
Inflammatory bowel disease
122
Q

Colorectal cancer- s/s

A 
Asymptomatic- found on screening 
Blood in stool- frank or occult 
Change in bowel habits 
Unexplained IDA 
Abdominal pain
Hematochezia 
Melena
123
Q

Colorectal cancer- dx

A

Colonoscopy

FOBT screening- Amy alert

124
Q

Colorectal cancer- labs & imaging

A

C/A/P CT

CEA- monitoring

125
Q

Colorectal cancer- tx

A

Surgery + chemo

Radiation- if rectal cancer

126
Q

Colorectal cancer- prognosis

A

5 y stage 1 >90%

5 y stage 4 5-75%

127
Q

Colorectal cancer & rectal cancer- s/s

A

Tenesmus, urgency, recurrent hematochezia

128
Q

Pancreatic cancer- epidemiology

A 
Age 
Tabacco 
Chronic pancreatitis 
Alcohol 
Family hx 
Obesity 
Diabetes
129
Q

Pancreatic cancer- s/s

A 
Abdominal pain- gnawing, epigastric 
Nausea 
Weight loss 
Courvoisier sign- palpable gallbladder 
Anorexia 
Fatigue 
Jaundice
Steatorrhea 
Dark urine
130
Q

Pancreatic cancer- dx

A

Biopsy

131
Q

Pancreatic cancer- labs & imaging

A

LFTs
Lipase
Abdominal U/S or CT
- double duct sign- dilation of pancreatic and hepatic duct

132
Q

Pancreatic cancer- tx

A

Whipple- w/o metastatic dx
Chemo+/- radiation- after & w/o resectable tumor
Pallative care- advanced

133
Q

Pancreatic cancer- prognosis

A

Very poor- almost all die

134
Q

Prostate cancer- epidemiology

A

Black
High fat diet
Family hx
Inc age

135
Q

Prostate cancer- s/s

A

Early- asymptomatic
Late- hematuria, hematospermia, obstructive urinary sx, bone pain, asymmetric induration or nodules on DRE
Inc PSA

136
Q

Prostate cancer- dx

A

Biopsy- transrectal

137
Q

Prostate cancer- tx

A

Low grade- watchful waiting
Higher stages- radical prostatectomy, brachytherapy, radiation
Metastatic- above + castration (physical and/or chemical) + bisphosphonate

138
Q

Prostate cancer- prognosis

A

Good

139
Q

Prostate cancer- grading

A

Gleason score

140
Q

Multiple myeloma- epidemiology

A

Proliferation of plasma cells producing monoclonal antibodies
BM or plasmacytoma

141
Q

Multiple myeloma- s/s

A 
Bone pain 
Anemia- roulexaux 
Hypercalcemia 
Fatigue/weakness 
Weight loss 
Inc creatinine 
Prone to recurrent infection- encapsulated organisms
142
Q

Multiple myeloma- dx

A

Biopsy plasmacytoma

BMA/B >10% plasma cells

143
Q

Multiple myeloma- labs & imaging

A

SPEP- M spike
Bence-Jones- UPEP
X ray- lytic lesions
MRI/CT/PET- bone scan not helpful

144
Q

Multiple myeloma- tx

A

Induction therapy- high dose chemo + autoBMT

Bisphosphonates- dec pathologic fracture

145
Q

Multiple myeloma- prognosis

A

Most relapse

Maintenance chemo to prevent this

146
Q

Multiple myeloma- CRAB

A

C- hypercalcemia
R- renal disease
A- anemia
B- bone disease

147
Q

Ovarian cancer- epidemiology

A 
Family hx 
BRCA
Lynch II 
Infertility 
PCOS 
Endometriosis 
Smoking 
HRT
60 
Caucasian
148
Q

Ovarian cancer- s/s

A 
Abdominal fullness/bloating 
Nausea
Early satiety 
Pelvic/abdominal pain 
Adrenal mass on pelvic exam 
Changes in urinary or bowl patterns
149
Q

Ovarian cancer- dx

A

Unilateral

Salpingo-oophorectomy

150
Q

Ovarian cancer- labs & imaging

A 
Pelvic U/S
CA-125
CXR 
CT 
Genetic counseling
151
Q

Ovarian cancer- tx

A

Pathy shows Ca- hysterectomy, contralateral salpingo-oophorectomy, omentectomy and pelvic node sampling
THEN chemo

152
Q

Ovarian cancer- prognosis

A

Poor

75% reoccur in 1-4 yrs

153
Q

Testicular cancer- epidemiology

A

M
15-35yo
Cryptorchidism- testes didn’t drop
Caucasian

154
Q

Testicular cancer- s/s

A

Painless mass or swelling in testis

Heaviness or ache in lower abdomen, pain

155
Q

Testicular cancer- dx

A

Scrotal U/S

156
Q

Testicular cancer- labs & imaging

A

Tumor markers- AFP, beta-hCG

LDH

157
Q

Testicular cancer- tx

A

Inguinal orchiectomy + surveillance- stage 1

Plus RPLND, radiation, and platinum- based chemo- stage 2+

158
Q

Testicular cancer- prognosis

A

> 95%

159
Q

Bladder cancer- epidemiology

A

M>F
Smoking
Animal fat- rich diets
Most- transitional cell carcinoma

160
Q

Bladder cancer- s/s

A

Painless hematuria- gross or microscopic

Frequency/urgency/dysuria- pain from spread- locally or metastatic

161
Q

Bladder cancer- dx

A

Cystoscopy- biopsy

162
Q

Bladder cancer- labs & imaging

A

UA
Cystoscopy
IVP- contrast agent to see dark/light spaces
CT

163
Q

Bladder cancer- tx

A

Transurethral resection of bladder (TURBT)- non-muscle invasive
Cystectomy- muscle invasive

164
Q

Bladder cancer- prognosis

A

Varied- depends on stage

Clin med sem 2 (30 decks)

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