Oncology Part 2 Flashcards
What are the most common presenting symptoms of cancers
WL
FTT
Anorexia
Malaise
Fever
LAD
Pallor
What is the most common pediatric cancer
Acute lymphocytic leukemia
What is the age group most commonly effected by ALL
2-5 year olds
What are the s/s of ALL
Fatigue
Pallor
Bruising/Bleeding
LAD
Bone pain/tnderness
Painless testicular enlargement
HSM
Fever
Malaise
What tests should be performed when diagnosing ALL
CBC with diff and peripheral smear
Bone marrow aspiration to confirm diaganosis
What CBC abnormalities can be present with ALL
Anemia
Thrombocytopenia
Predominance of BLasts
WBC NR or slightly elevated (with blasts)
What is the tx for ALL
Chemo that is determined by phenotyping
What is the 5 year survival rate of ALL
>85%
What is the second most common childhood cancer
CNS tumors
What are the s/s of CNS tumors
HA
N/V
Ataxia/impaired gait
Impaired vision
Sz
Papilledema
When would macrocephaly be a sign of CNS tumor
If the pt is young enough that their cranial sutures haven’t closed
How do you dx CNS tumors
MRI is preferred but Bx is needed to make a histological diagnosis
What is the tx for most CNS tumors
Open surgical procedure -→also necessary for obtaining dx
Sometimes will give chemo and anticonvulsants for sz
What treatment for CNS tumors is typically avoided in kids
radiation therapy
What is the prognosis for CNS tumors
Depends on tumor type- overall 5 year survival rate is about 75% but there are common long term sequelae associated with it
How often is retinoblastoma inherited via the RB1 gene
about 50% of the time
What are the s/s of retinoblastoma
Leukocoria (white red reflex)
strabisumus
Red inflammed eye
nystagmus
How often is retinoblastoma bilateral
⅓ of the time and more commonly in heritable forms
What is the first thing you should do if you suspect retinoblastoma
refer the pt to optho
What is recommended testing for all pts with retinoblastoma
molecular genetic testing
What is the tx for retinoblastoma
cryotherapy
local or systemic chemo
laser photocoagulation
enucleation
radiation
What is the surivial rate for pts with retinoblastoma
>95% survival rate if caught and addressed within one year
What puts a pt at risk of osetosarcoma
most of the time it is sporadic but can be at higher risk if:
Prior radiation or chemo
genetic
paget disease
male
What are the s/s of osteosarcoma
Localized pain
soft tissue mass on exam-particularly in long bones
How do you dx osteosarcoma
xray showing destructive lesion
Codman triangle
“sunburst” appearance in bone
Biopsy for definitive dx
What is the tx for osteosarcoma
almost all get chemo because it has micromets all over the bone
removal of primary cancerous bone growth
What pt population mostly gets osteosarcoma
peds
What is the prognosis for osteosarcoma
depends on tumor response to chemo
What are the risk factors for ewing sarcoma
Male>female
10-20 years old
What are the s/s of ewing sarcoma
localized bony pain or swelling over weeks or months
limping
fx
all most commonly along long bones and pelvis
How do you dx ewing sarcoma
Start with Xray- should seen onion peel appearance
Confirm with biopsy
What is the best imaging modality to view the extent of ewing sarcoma
CT/MRI
What is the tx for ewing sarcoma
Almost all need chemo
Local control with surgical resection and radiation therapy
What is the prognosis for mets ewing sarcoma
21%
What is the prognosis for nonmetastatic ewing sarcoma
55%
What ist he most common renal malignancy in kids
WIlms tumor AKA nephroblastoma
What is the most common age group to get Wilm’s Tumor AKA nephroblastoma
2-5 years old
What are the risk factors for Wilm’s tumor/Nephroblastoma
African
WAGR syndrome
Deny’s-Drash Syndrome
Beckwith-Wiedeman syndrome
What is the presentation of WIlm’s Tumor
Abd mass or swelling that is firm, smooth and nontender (typically also unilateral)
Sometimes associated with pain and hematuria, fever, HTN
What is the first imaging study to dx wilm’s tumor
Abd U/S
How do you confirm a dx of wilm’s tumor
biopsy
How do you tx wilm’s tumor
surgical resection for all
chemo for almost all
radiation depending on stage/size
What is the prognosis for WIlm’s Tumor
90% 5 year survival rate
What are the risk factors for bladder cancer
Men>female
Smoking
Animal fat rich diets
What are the most common types of bladder cancers
transitional cell carcinomas
What are the s/s of bladder cancer
hematuria- painless
What is the gold standard for diagnosing bladder cancer
cystoscopy
What are the diagnostic tests for bladder cancer
UA→then cystoscopy for viewing and bx
What is the tx for bladder cancer
TURBT (transurethral resection of bladder tumor) for nonmuscle invasive
Cystectomy for muscle invasive
can also have chemo or radiation
What is the prognosis for bladder cancer
varied depending on staging
What is the most common cancer in men ages 15-35
Testicular cancer
What are the risk factors associated with testicular cancer
Cryptorchidism
caucasian
What are the s/s of testicular cancer
painless mass or swelling of testis
some feel a heaviness or ache in lower abd
How do you dx testicular cancer
scrotal US
What labs can be used to aid in dx testicular cancer
FP
Beta HCG
LDH
What is the tx for testicular cancer
Inguinal orchiectomy + surveillance alone for many with stage 1
Add RPLND and XRT (Radiation) if needed
What is the prognosis for testicular cancer
>95% survival rate
80% for mets
What are the risk factors associated with ovarian cancer
Family hx
BRCA gene
Lynch II syndrome
Infertility
PCOS
Endometriosis
Smoking
HRT (hormone replacement therapy)
What is the normal age range for ovarian cancer
60s
What are the s/s of ovarian cancer
abd fullness
nausea
early satiety
abd and pelvic pain
changes to urinary and bowel patterns
What is the initial evaluation for ovarian cancer
pelvic u/s
What are some secondary tests that can be performed to dx or confirm dx of ovarian cacner
CA-125
CXR
CT
Genetic counseling
How do you dx ovarian cancer
Unilateral salpingo-oophorectomy
How do you tx ovarian cancer
hysterectomy
contralateral salpingo-oopherectomy
omentectomy
pelvic node sampling
platinum based chemo
What is the prognosis for ovarian cancer
overall poor, recurrence is 75% even if complete response, within 1-4 years
What is the cause of multiple myeloma
Proliferation of plasma cells producing monoclonal leading to end organ damage
What is CRAB and what is it associated with
Calcemia (hyper)
Renal Disease
Anemia
Bone disease
-All associated with multiple myeloma
What puts a pt at risk of multiple myeloma
African
Male
Obese
Older age
1st degree relative with it
WHat are the s/s of multiple myeloma
bone pain
anemia
hypercalcemia
fatigue
WL
increased Creatinine
recurrent infxn
How do you dx Multiple Myeloma
Monoclonal spike on SPEP
Bence Jones on UPEP
Bx of plasmacytoma (tumor)
Bone marrow aspirate with >10% clonal plasma cells
Lytic lesions on Xray
What test is NOT helpful in dx multiple myeloma and why
Bone scan→it uptakes osteoclastic activity but there is no osteoclastic activity in MM it is breakdown due to lesions→scan will be negative
What is the tx for MM
Most have induction therapy then high dose chemo with autologous hematopoietic stem cell transplant
Bisphosphonates can be used to prevent pathological fx
What is the prognosis for MM
Most relapse sos maintenance hcemo is used to prevent it
What are the risk factors for prostate cancer
Black
high fat diet
Fhx
Increased age
What are the s/s of prostate cancer
early: asx
later: possible hematuria, obstructive urinary sx, bone pain, and asymmetric induration or nodules on DRE
Increased PSA
What is the dx for prostate cancer
prostate bx (usually transrectal)
What is the Gleason score
What of rating prostate cancer
WHat is the tx for low grade prostate cancer
watchful waiting→especially with a short life expectancy
What is the tx for higher grade prostate cancer
radical prostatectomy
brachytherapy
XRT
What is the tx for mets prostate cancer
Castration+bisphosphonate
What is the prognosis for prostate cancer
very good for most
What are the risk factors associated with pancreatic cancer
age
tobacco
chronic pancreatitis
ETOH
Fhx
Obesity
Diabetes
What are the s/s of pancreatic cancer
abd pain
nausea
WL
anorexia
fatigue
corvoisier sign
jaundice
steatorrhea
dark urine
What are the signs of mets from pancreatic cancer
abd mass
ascites
Virchows node (left cervical LAD)
Sister mary joseph node
anemia
bilirubin increase
increase ALP
increase aminotransferases
How do you dx pancreatic cancer
initial labs: lfts, lipase and imagine (abd u/s or CT)
+/- bx
double duct sign (obstruction of both bile and pancreatic duct)
What is courvoisier sign
ability to feel a pts gallbladder
WHat is the tx for pancreatic cancer
surgical resection (whipple) is the only potential cure
When is chemo and xrt a tx choice for pts with pancreatic cancer
after whipple, or if pt has a nonresectable tumor
What is the tx for advanced pancreatic cancer
palliative care
What is the prognosis for pancreatic cancer
very poor, almost all die from the disease
What are the risk factors for colorectal cancer
>50 years old
lynch syndrome
diet high in meat low in veggies
Fhx
inflammatory bowel disease
What are the s/s of colorectal cancer
Asx and found on screening
change in bowel habits
blood in stool
abd pain
hematochezia
melena
unexplained IDA
obstructive sx
What are sx specific to rectal cancer
tenesmus
urgency
recurrent hematochezia
What is the diagnosis for colorectal cancer
colonoscopy
FOBT screening
C/A/P Ct for staging
CEA levels can be used for monitoring but not screening dx
What are CEA levels used for
to monitor NOT dx colorectal cancer tx
What is the tx for colorectal cancer
surgical resection
chemo
XRT for rectal tumors
What is the 5 year survival rate for stage 4 colorectal cancer
5-7%
What is the 5 year survival rate for stage I colorectal cancer
90%
What puts a pt at risk of hepatocellular carcinoma
cirrhosis (80%)
male
HCV or HBV
obesity
asian
hispanic
age >55
diabetes
What are the s/s of hepatocellular carcinoma
asymptomatic except for sx of liver disease if present
abd pain
new decompensation of cirrhosis
paraneoplastic syndromes
abd bruits
How do you dx hepatocellular carcinoma
U/S (screening tool for high risk)→CT/MRI as follow up
AFP can be helpful for high risk pts
Bx only if imaging is uncertain
What is the tx for hepatocellular carcinoma
If pt is able to have surgery-
surgical resection if liver function is preserved
Liver transplant if pt has advanced cirrhosis
How do you tx hepatocellular carcinoma in pts who are unable to get surgery
ablation
ETOH injection
cryotherapy
Transarterial chemoablation
chemo
xrt
What is the prognosis for hepatocellular carcinoma
poor- less than 5 year survival rate for 5-70% of pts
What puts a pt at risk of melanoma
UV light exposure
Caucasian
Large number of moles
Increasing age
What are the s/s of melanoma
skin lesion with recent change in appearance- ABCDE rule
What are the 4 types of melanoma
Superficial spreading
Nodular melanoma
Lentigo maligna
Acral lentiginous- most common in black pop
How do you dx melanoma
bx
How do you tx melanoma
Excision with margins depending on thickness
-IF METS: can add interferon alpha, immune therapy, and chemo
What is the prognosis for melanoma dependent on
Breslow stage (tumor thickness)
What puts a pt at risk for SCC
UV light
smoking
immunosuppression
chronic ulcer
male>female
Increasing age
What are the s/s of SCC
Scaly patch, plaque, or nodule with irregular borders that can bleed or crust in sun-exposed areas (like head and neck)
How do you dx SCC
Shave, punch or excisional bx
What does tx of SCC depend on
depth
What are the tx options for SCC
5-FU
Imiquimod
Electrodessication and curettage
excision
Mohs
Radiation
CHemo
What is the 5 year survival rate for SCC
>90%
What puts a pt at risk for Basal Cell Carcinoma
UV light
fiar skin
Hx of irradiation
Men
increasing age
What are the s/s of basal cell
Pearly papule with telangiectasia→most commonly on nose but 85% on head and neck
How do you dx basal cell carcinoma
bx→shave or punch
How do you tx basal cell carcinoma
Mohs has the highest cure rates
Other options: excision, radiotherapy, curettage, intralesional interferon
What is the prognosis for basal cell carcinoma
Excellent for most
Slow growing and mets is very rare but removing can be disfiguring
What puts a pt at risk of endometrial carcinoma
obesity
advancing age
unopposed estrogen therapy
PCOS
early menarche
Late menopause
Nulliparity
Fhx
Tamoxifen
Lynch syndorme
Diabetes
White
What things are protective against endometrial cancer
combo OCPs
Smoking
What are the s/s of endometrial carcinoma
Abnormal uterine bleeding- typically after menopause
abnormal vaginal discharge
abnormal cervical cytology
How do you dx endometrial carcinoma
endometrial bx or D&C (scraping out endometrial lining)
How do you tx endometrial carcinoma
Hysterectomy and bilateral salpingo-oopherectomy with lymph node assessment
When would progestin therapy be indicated for pts with endometrial carcinoma
if a pt wants to try and preserve fertility
What is the prognosis for endometrial carcinoma
Good, since most present with early stage disease
What puts a pt at risk of developing cervical cancer
Having HPV (esp. 16 and 18)
Mulitple sex partners
SMoking
early age at first sexual intercourse
early childbearing
low socioeconomic status
hx of sti
black>hispanic>white
What are the s/s of cervical cancer
most are asx and found on screening, but if advanced abnormal discharge and bleeding
What is the dx for cervical cancer
pap test
if abnormal repeat or get colposcopy/bx
What is the tx for cervical cancer
depends on the stage:
LEEP
Ablation
Conization
Hysterectomy and pelvic LAD
Radiation
Chemo
What is the prognosis for cervical cancer
Early >90% survival
Stage 4- <15%
What are the risk factors associated with vulvar cancer
age >70
infxn with high risk HPV types
HSV
Immunosuppresion
Smoking
What are the s/s of vulvar cancer
pruritis
visible lesions
possible pain, bleeding, and ulcerations
How do you dx vulvar cancer
vulvar bx
→5% acetic acid soln for visualization with colposcope→ if any lesions turn white they should be bx
What is the tx for vulvar cancer
wide local excision
topical 5-fu
laser therapy for early
possible chemo/radiation etc.
What is the prognosis for vulvar cancer
stage I-II: 70-90% survival
Stage IV as low as 16%
What is the leading cause of cancer death caused by
lung cancer
What are the risk factors associated with lung cancer
smoking
radiation therapy
pulmonary fibrosis
environmental toxins
What are the s/s associated with lung cancer
new or changed cough
hemoptysis
chest pain
dyspnea
WL
What are the two major categories of lung cancer
SCLC (oat cell)
NSCLC
What type of lung cancer originates centrally, and mets early/is aggresive
SCLC
What are the different types of NSCLC
SCC
adenocarcinoma
large cell carcinoma
Which is slower growing: NSCLC or SCLC
NSCLC
How do you dx lung cancer
may be found incidentally on CXR or CT but require histological confirmation
How can you histologically confirm the presence of lung cancer
sputum cytology
bronchoscopy
pleural fluid examination
bx
How do you tx NSCLC
Surgical resection if possible +/- XRT
How do you tx SCLC
Chemo
XRT often added
What is the prognosis for lung cancer
overall poor- 5 year survival rate of 15%
What are the risk factors associated with renal cell carcinoma
men>women
Age >55
smoking
American indian
Hereditary RCC
HTN
obesity
Polycystic kidney disease
What are the s/s of renal cell carcinoma
many asx
hematuria
pain or mass
WL
paraneoplastic sx
classic triad (on another notecard)
What is the classic sx triad associated with renal cell carcinoma
hematuria
flank pain
palpable mass
How do you dx renal cell carcinoma
1st test is abd CT (sometimes u/s)
Nephrectomy or partial nephrectomy to get histo dx
How do you tx renal cell carcinoma
partial or radical nephrectomy
advanced may require immunotherapy and meds inibiting VEGF
What treatment is generally not advised for renal cell carcinoma (because it doesn’t work)
chemo
What is the 5 year survival rate for renal cell carcinoma
10%-90%
What is the most common cancer in women
breast
What is the most common type of breast cancer
Infiltrating ductal carcinoma
WHat are the types of breast cancer
ductal or lobar
What are the risk factors for breast cancer
increasing age
BRCA
nulliparity
early menarche
Late menopause
delayed childbreaing
radiation exposure
long term estrogen use
What are the s/s of breast cancer
- single, nontender, firm, immobile mass
- can be asx
What is the most common site of breast cancer
upper outer quadrant
What are some rare presentations of breast cancer
nipple discharge
retraction of nipple
peau d’orange
eczematous changes (paget’s disease)
pain
axillary LAD
How do you dx breast cancer
mammography→stereotatic or excisional core-needle bx
Why do you check for estrogen and progesterone receptors of breast malignancy
It can help target tx for pts→ if receptors are present the pt is more likely to respond to tx
What is the tx for breast cancer
Lumpectomy with sentinel lymph node bx (SLNB)
or
mastectomy
XRT
Adjuvent chemo
What tx can be utilized if a pt has progesterone or estrogen receptors on the breast cancer
erimidex/temoxifen or raloxifene
What tx can be utilized for pts with breast cancer that are HER-2 pos
herceptin
What is the prognosis for breast cancer
if caught early up to 100%
What are the different types of thyroid cancer (in order from least to most harmful)
Papillary
Follicular
Medullary
Anaplastic
What are the risk factors associated with thyroid cancer
women>men
childhood head/neck irradiation
Fhx
MEN II
How do you dx thyroid cancer
U/S
Fine needle aspiration (U/S guided)
What are the s/s associated with thyroid cancer
Painless neck swelling
palpable single firm nodule
-most are actually asx-
What is the tx for thyroid cancer
surgical resection
radioactive iodine for residual tumor
What follow up tx will pts with thyroid cancer need
They will need thyroid replacement permanently after tx of cancer
What thyroid cancer does not have an effective tx and requires pallative care
anaplastic
What is the prognosis for papillary thyroid cancer
very good
What is the prognosis for follicular thyroid cancer
still relatively good but more aggressive, and at higher risk of metastatic disease
What is the typical prognosis for anaplastic thyroid cancer
very poor, a couple months to live
What are the risk factors for non-hodgkin lymphoma
increasing age
HIV
Toxin exposure
autoimmune dz
EBV
obesity
white
What are the s/s associated with indolent non-hodgkin lymphoma
painless, persistent LAD
HSM
Cytopenia
What are the s/s associated with aggressive non-hodgkin lymphoma
rapidly growing mass
fever
night sweats
WL
Increase LDH
Increase uric acid
What are common extranodal sites for non-hodgkin lymphoma
GI tract
skin
bone
bone marrow
How do you dx non-hodgkin lymphoma
bx of involved nodes
bone marrow bx in order to stage
What is the tx for indolent non-hodgkin lymphoma
radiation alone
What is the tx for intermediate-high grade non-hodgkin lymphoma
chemo
immunotherapy (rituximab)
stem cell transplant
What is the prognosis for non-hodgkin lymphoma
complete remission in up to 50% with aggressive
long survival for indolent
worst for HIV related non hodgkins lymphoma
What puts a pt at risk of hodgkin lymphoma
being around 20 years old or >60 years old
Male>female
EBV
Immunodeficiency
What are the s/s of hodgkin lymphoma
painless localized peripheral LAD (usually cervical)
Mediastinal mass
May have B sx
What disease process are Reed-Sternberg cells associated with
hodgkin lymphoma
How do you dx hodgkin lymphoma
lymph node bx shoing reed-sternberg cells
PET/CT and bone marrow bx for staging
How do you tx hodgkin lymphoma
combo chemo for most
ABVD chemo and XRT
When would a hodgkin lymphoma pt need an autologous stem cell transplant
When they have refractory disease
What is the prognosis for a pt with hodgkin lymphoma
very good, even with advanced disease
What is CML
Chronic Myelogenous leukemia→myeloproliferative disorder
What are the three phases of CML
chronic
accelerated
acute (blast crisis)
What are the risk factors for getting CML
young middle aged adults
male>female
ionizing radiation
What are the s/s of CML
many are asx and found incidentally
fatigue
anorexia
WL
low-grade fever
excessive sweating
abd fullness
How do you dx CML
CBC with leukocytosis
Bone marrow bx
How do you tx chronic CML
Gleevec
How do you tx accelerated CML
allogenic bone marrow transplantation
How do you treat acute CML (blast crisis)
Conventional induction chemo then stem cell transplantation
What is the prognosis for chronic CML
>/=25 years median survival
What is the prognosis for accelerated CML
5 years survival
What is the prognosis for blast crisis CML
about 1 year
What is AML
Actue Myelogenous Leukemia
What is acute myelogenous leukemia
clonal proliferation of myeloid precursors with decreased differentiation to mature cells
What puts a pt at risk of AML
chemo
ionizing radiation
chemical exposure
median age of onset 60
What are the s/s of AML
fatigue
pallor
weakness
gingival bleeding
ecchymosis
epistaxis
anemia
thrombocytopenia
How do you dx AML
presumptive with myeloblasts on cbc/diff/smear
definitive dx with bone marrow bx (>20% blasts present)
What are some smear findings for pts with AML
Auer rods
Myeloperoxidase
What is the tx for AML
2 stages of chemo→induction therapy (aggressive) then consolidation (may include stem cell transplant)
What is the prognosis for AML
about 65% attain complete remission, but remission rates are inversely related to age
What is chronic lymphocytic leukemia
clonal malignancy of B lymphs
What are the risk factors associated with CLL
Men>women
increases with age
white
What are the s/s associated with CLL
most are asx and lymphocytosis is found on routine labs
or
LAD
recurrent infxn
HSM
B sx
leukemia cutis
How do you dx CLL
lymphocytosis with smudge cells on CBC /Diff/Peripheral smear
flow to determine immunophenotype and show clonality
How do you tx early stage CLL
observation only
How do you tx stage 1-2 CLL
local radiation
How do you treat stages three or four of CLL
chemo, but it is not curable
What is the prognosis for early stage CLL
10 years or more
What is the prognosis for CLL that is in stage 3-4
about 2 years
What are the risk factors for ALL (acute lymphocytic leukemia)
ionizing radiation
chemo
white
What are the s/s associated with ALL
fatigue
pallor
bruising
bleeding
petechiae
bone pain
leukemia cutis
infxn
How do you dx ALL
bone marrow aspiration and bx showing blasts >20%
Can be pancytopenic on CBC
Must have cytogenetics and immunophenotyping for dx
How do you tx ALL if a pt is <60 years old
chemo combo therapy
How do you tx ALL in pts >60 years old
tyrosine kinase inhibitor and prednisone (no chemo)
What is the follow up tx for ALL in pts in remission
CNS prophylaxis then further chemo or SCT
When do you add tyrosine kinase inhibitor to ALL tx
if a pt is >60 years old or + for philadelphia chromosome
Is the prognosis for ALL worse in kids or adults
adults
What type of tumor are about 50% of brain tumors
gliomas
What are the risk factors for brain tumors
Fhx
Ionizing radiation
What are the s/s of brain tumors
focal deficits→location dependent
HA
Sz
N/V
syncope
cognitive dysfunction
personality change
aphasia
hallucination
ataxia
sensory deficit
weakness
visual spatial dysfunction
How do you dx brain tumors
MRI with gadolinium contrast is the first choice
CT is the second choice
What is the tx for brain tumors
surgical removal if possible first
radiation
chemo
steroids for edema
anticonvulsants to prevent sz
What is the prognosis for brain tumors
depends on the type- glioblastoma is the worst
What are the risk factors associated with esophageal cancer
smoking
etoh
diet low in produce
HPV
Barrett’s from GERD
men>women
ages 50-70
What are the s/s of esophageal cancer
sensation of food sticking
retrosternal discomfort/burning
regurgitation of saliva or food
IDA from chronic blood loss
What are the advanced stage s/s of esophageal cancer
progressive dysphagia
WL
odynophagia
How do you dx esophageal cancer
endoscopic bx
barium esophagram for visualization
stage with CT
How do you tx esophageal cancer
Can include:
sx
chemo
radiation
nutritional support if indicated
What is the prognosis for esophageal cancer
overall 5 year survival of 20%→usually presents in late stages
