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Clin Med II > Oncology Part 2 > Flashcards

Oncology Part 2 Flashcards

1
Q

What are the most common presenting symptoms of cancers

A

WL

FTT

Anorexia

Malaise

Fever

LAD

Pallor

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2
Q

What is the most common pediatric cancer

A

Acute lymphocytic leukemia

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3
Q

What is the age group most commonly effected by ALL

A

2-5 year olds

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4
Q

What are the s/s of ALL

A

Fatigue

Pallor

Bruising/Bleeding

LAD

Bone pain/tnderness

Painless testicular enlargement

HSM

Fever

Malaise

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5
Q

What tests should be performed when diagnosing ALL

A

CBC with diff and peripheral smear

Bone marrow aspiration to confirm diaganosis

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6
Q

What CBC abnormalities can be present with ALL

A

Anemia

Thrombocytopenia

Predominance of BLasts

WBC NR or slightly elevated (with blasts)

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7
Q

What is the tx for ALL

A

Chemo that is determined by phenotyping

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8
Q

What is the 5 year survival rate of ALL

A

>85%

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9
Q

What is the second most common childhood cancer

A

CNS tumors

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10
Q

What are the s/s of CNS tumors

A

HA

N/V

Ataxia/impaired gait

Impaired vision

Sz

Papilledema

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11
Q

When would macrocephaly be a sign of CNS tumor

A

If the pt is young enough that their cranial sutures haven’t closed

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12
Q

How do you dx CNS tumors

A

MRI is preferred but Bx is needed to make a histological diagnosis

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13
Q

What is the tx for most CNS tumors

A

Open surgical procedure -→also necessary for obtaining dx

Sometimes will give chemo and anticonvulsants for sz

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14
Q

What treatment for CNS tumors is typically avoided in kids

A

radiation therapy

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15
Q

What is the prognosis for CNS tumors

A

Depends on tumor type- overall 5 year survival rate is about 75% but there are common long term sequelae associated with it

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16
Q

How often is retinoblastoma inherited via the RB1 gene

A

about 50% of the time

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17
Q

What are the s/s of retinoblastoma

A

Leukocoria (white red reflex)

strabisumus

Red inflammed eye

nystagmus

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18
Q

How often is retinoblastoma bilateral

A

⅓ of the time and more commonly in heritable forms

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19
Q

What is the first thing you should do if you suspect retinoblastoma

A

refer the pt to optho

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20
Q

What is recommended testing for all pts with retinoblastoma

A

molecular genetic testing

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21
Q

What is the tx for retinoblastoma

A

cryotherapy

local or systemic chemo

laser photocoagulation

enucleation

radiation

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22
Q

What is the surivial rate for pts with retinoblastoma

A

>95% survival rate if caught and addressed within one year

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23
Q

What puts a pt at risk of osetosarcoma

A

most of the time it is sporadic but can be at higher risk if:

Prior radiation or chemo

genetic

paget disease

male

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24
Q

What are the s/s of osteosarcoma

A

Localized pain

soft tissue mass on exam-particularly in long bones

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25
Q

How do you dx osteosarcoma

A

xray showing destructive lesion

Codman triangle

“sunburst” appearance in bone

Biopsy for definitive dx

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26
Q

What is the tx for osteosarcoma

A

almost all get chemo because it has micromets all over the bone

removal of primary cancerous bone growth

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27
Q

What pt population mostly gets osteosarcoma

A

peds

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28
Q

What is the prognosis for osteosarcoma

A

depends on tumor response to chemo

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29
Q

What are the risk factors for ewing sarcoma

A

Male>female

10-20 years old

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30
Q

What are the s/s of ewing sarcoma

A

localized bony pain or swelling over weeks or months

limping

fx

all most commonly along long bones and pelvis

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31
Q

How do you dx ewing sarcoma

A

Start with Xray- should seen onion peel appearance

Confirm with biopsy

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32
Q

What is the best imaging modality to view the extent of ewing sarcoma

A

CT/MRI

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33
Q

What is the tx for ewing sarcoma

A

Almost all need chemo

Local control with surgical resection and radiation therapy

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34
Q

What is the prognosis for mets ewing sarcoma

A

21%

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35
Q

What is the prognosis for nonmetastatic ewing sarcoma

A

55%

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36
Q

What ist he most common renal malignancy in kids

A

WIlms tumor AKA nephroblastoma

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37
Q

What is the most common age group to get Wilm’s Tumor AKA nephroblastoma

A

2-5 years old

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38
Q

What are the risk factors for Wilm’s tumor/Nephroblastoma

A

African

WAGR syndrome

Deny’s-Drash Syndrome

Beckwith-Wiedeman syndrome

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39
Q

What is the presentation of WIlm’s Tumor

A

Abd mass or swelling that is firm, smooth and nontender (typically also unilateral)

Sometimes associated with pain and hematuria, fever, HTN

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40
Q

What is the first imaging study to dx wilm’s tumor

A

Abd U/S

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41
Q

How do you confirm a dx of wilm’s tumor

A

biopsy

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42
Q

How do you tx wilm’s tumor

A

surgical resection for all

chemo for almost all

radiation depending on stage/size

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43
Q

What is the prognosis for WIlm’s Tumor

A

90% 5 year survival rate

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44
Q

What are the risk factors for bladder cancer

A

Men>female

Smoking

Animal fat rich diets

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45
Q

What are the most common types of bladder cancers

A

transitional cell carcinomas

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46
Q

What are the s/s of bladder cancer

A

hematuria- painless

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47
Q

What is the gold standard for diagnosing bladder cancer

A

cystoscopy

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48
Q

What are the diagnostic tests for bladder cancer

A

UA→then cystoscopy for viewing and bx

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49
Q

What is the tx for bladder cancer

A

TURBT (transurethral resection of bladder tumor) for nonmuscle invasive

Cystectomy for muscle invasive

can also have chemo or radiation

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50
Q

What is the prognosis for bladder cancer

A

varied depending on staging

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51
Q

What is the most common cancer in men ages 15-35

A

Testicular cancer

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52
Q

What are the risk factors associated with testicular cancer

A

Cryptorchidism

caucasian

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53
Q

What are the s/s of testicular cancer

A

painless mass or swelling of testis

some feel a heaviness or ache in lower abd

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54
Q

How do you dx testicular cancer

A

scrotal US

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55
Q

What labs can be used to aid in dx testicular cancer

A

FP

Beta HCG

LDH

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56
Q

What is the tx for testicular cancer

A

Inguinal orchiectomy + surveillance alone for many with stage 1

Add RPLND and XRT (Radiation) if needed

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57
Q

What is the prognosis for testicular cancer

A

>95% survival rate

80% for mets

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58
Q

What are the risk factors associated with ovarian cancer

A

Family hx

BRCA gene

Lynch II syndrome

Infertility

PCOS

Endometriosis

Smoking

HRT (hormone replacement therapy)

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59
Q

What is the normal age range for ovarian cancer

A

60s

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60
Q

What are the s/s of ovarian cancer

A

abd fullness

nausea

early satiety

abd and pelvic pain

changes to urinary and bowel patterns

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61
Q

What is the initial evaluation for ovarian cancer

A

pelvic u/s

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62
Q

What are some secondary tests that can be performed to dx or confirm dx of ovarian cacner

A

CA-125

CXR

CT

Genetic counseling

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63
Q

How do you dx ovarian cancer

A

Unilateral salpingo-oophorectomy

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64
Q

How do you tx ovarian cancer

A

hysterectomy

contralateral salpingo-oopherectomy

omentectomy

pelvic node sampling

platinum based chemo

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65
Q

What is the prognosis for ovarian cancer

A

overall poor, recurrence is 75% even if complete response, within 1-4 years

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66
Q

What is the cause of multiple myeloma

A

Proliferation of plasma cells producing monoclonal leading to end organ damage

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67
Q

What is CRAB and what is it associated with

A

Calcemia (hyper)

Renal Disease

Anemia

Bone disease

-All associated with multiple myeloma

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68
Q

What puts a pt at risk of multiple myeloma

A

African

Male

Obese

Older age

1st degree relative with it

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69
Q

WHat are the s/s of multiple myeloma

A

bone pain

anemia

hypercalcemia

fatigue

WL

increased Creatinine

recurrent infxn

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70
Q

How do you dx Multiple Myeloma

A

Monoclonal spike on SPEP

Bence Jones on UPEP

Bx of plasmacytoma (tumor)

Bone marrow aspirate with >10% clonal plasma cells

Lytic lesions on Xray

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71
Q

What test is NOT helpful in dx multiple myeloma and why

A

Bone scan→it uptakes osteoclastic activity but there is no osteoclastic activity in MM it is breakdown due to lesions→scan will be negative

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72
Q

What is the tx for MM

A

Most have induction therapy then high dose chemo with autologous hematopoietic stem cell transplant

Bisphosphonates can be used to prevent pathological fx

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73
Q

What is the prognosis for MM

A

Most relapse sos maintenance hcemo is used to prevent it

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74
Q

What are the risk factors for prostate cancer

A

Black

high fat diet

Fhx

Increased age

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75
Q

What are the s/s of prostate cancer

A

early: asx
later: possible hematuria, obstructive urinary sx, bone pain, and asymmetric induration or nodules on DRE

Increased PSA

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76
Q

What is the dx for prostate cancer

A

prostate bx (usually transrectal)

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77
Q

What is the Gleason score

A

What of rating prostate cancer

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78
Q

WHat is the tx for low grade prostate cancer

A

watchful waiting→especially with a short life expectancy

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79
Q

What is the tx for higher grade prostate cancer

A

radical prostatectomy

brachytherapy

XRT

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80
Q

What is the tx for mets prostate cancer

A

Castration+bisphosphonate

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81
Q

What is the prognosis for prostate cancer

A

very good for most

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82
Q

What are the risk factors associated with pancreatic cancer

A

age

tobacco

chronic pancreatitis

ETOH

Fhx

Obesity

Diabetes

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83
Q

What are the s/s of pancreatic cancer

A

abd pain

nausea

WL

anorexia

fatigue

corvoisier sign

jaundice

steatorrhea

dark urine

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84
Q

What are the signs of mets from pancreatic cancer

A

abd mass

ascites

Virchows node (left cervical LAD)

Sister mary joseph node

anemia

bilirubin increase

increase ALP

increase aminotransferases

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85
Q

How do you dx pancreatic cancer

A

initial labs: lfts, lipase and imagine (abd u/s or CT)

+/- bx

double duct sign (obstruction of both bile and pancreatic duct)

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86
Q

What is courvoisier sign

A

ability to feel a pts gallbladder

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87
Q

WHat is the tx for pancreatic cancer

A

surgical resection (whipple) is the only potential cure

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88
Q

When is chemo and xrt a tx choice for pts with pancreatic cancer

A

after whipple, or if pt has a nonresectable tumor

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89
Q

What is the tx for advanced pancreatic cancer

A

palliative care

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90
Q

What is the prognosis for pancreatic cancer

A

very poor, almost all die from the disease

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91
Q

What are the risk factors for colorectal cancer

A

>50 years old

lynch syndrome

diet high in meat low in veggies

Fhx

inflammatory bowel disease

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92
Q

What are the s/s of colorectal cancer

A

Asx and found on screening

change in bowel habits

blood in stool

abd pain

hematochezia

melena

unexplained IDA

obstructive sx

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93
Q

What are sx specific to rectal cancer

A

tenesmus

urgency

recurrent hematochezia

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94
Q

What is the diagnosis for colorectal cancer

A

colonoscopy

FOBT screening

C/A/P Ct for staging

CEA levels can be used for monitoring but not screening dx

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95
Q

What are CEA levels used for

A

to monitor NOT dx colorectal cancer tx

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96
Q

What is the tx for colorectal cancer

A

surgical resection

chemo

XRT for rectal tumors

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97
Q

What is the 5 year survival rate for stage 4 colorectal cancer

A

5-7%

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98
Q

What is the 5 year survival rate for stage I colorectal cancer

A

90%

99
Q

What puts a pt at risk of hepatocellular carcinoma

A

cirrhosis (80%)

male

HCV or HBV

obesity

asian

hispanic

age >55

diabetes

100
Q

What are the s/s of hepatocellular carcinoma

A

asymptomatic except for sx of liver disease if present

abd pain

new decompensation of cirrhosis

paraneoplastic syndromes

abd bruits

101
Q

How do you dx hepatocellular carcinoma

A

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

102
Q

What is the tx for hepatocellular carcinoma

A

If pt is able to have surgery-

surgical resection if liver function is preserved

Liver transplant if pt has advanced cirrhosis

103
Q

How do you tx hepatocellular carcinoma in pts who are unable to get surgery

A

ablation

ETOH injection

cryotherapy

Transarterial chemoablation

chemo

xrt

104
Q

What is the prognosis for hepatocellular carcinoma

A

poor- less than 5 year survival rate for 5-70% of pts

105
Q

What puts a pt at risk of melanoma

A

UV light exposure

Caucasian

Large number of moles

Increasing age

106
Q

What are the s/s of melanoma

A

skin lesion with recent change in appearance- ABCDE rule

107
Q

What are the 4 types of melanoma

A

Superficial spreading

Nodular melanoma

Lentigo maligna

Acral lentiginous- most common in black pop

108
Q

How do you dx melanoma

A

bx

109
Q

How do you tx melanoma

A

Excision with margins depending on thickness

-IF METS: can add interferon alpha, immune therapy, and chemo

110
Q

What is the prognosis for melanoma dependent on

A

Breslow stage (tumor thickness)

111
Q

What puts a pt at risk for SCC

A

UV light

smoking

immunosuppression

chronic ulcer

male>female

Increasing age

112
Q

What are the s/s of SCC

A

Scaly patch, plaque, or nodule with irregular borders that can bleed or crust in sun-exposed areas (like head and neck)

113
Q

How do you dx SCC

A

Shave, punch or excisional bx

114
Q

What does tx of SCC depend on

A

depth

115
Q

What are the tx options for SCC

A

5-FU

Imiquimod

Electrodessication and curettage

excision

Mohs

Radiation

CHemo

116
Q

What is the 5 year survival rate for SCC

A

>90%

117
Q

What puts a pt at risk for Basal Cell Carcinoma

A

UV light

fiar skin

Hx of irradiation

Men

increasing age

118
Q

What are the s/s of basal cell

A

Pearly papule with telangiectasia→most commonly on nose but 85% on head and neck

119
Q

How do you dx basal cell carcinoma

A

bx→shave or punch

120
Q

How do you tx basal cell carcinoma

A

Mohs has the highest cure rates

Other options: excision, radiotherapy, curettage, intralesional interferon

121
Q

What is the prognosis for basal cell carcinoma

A

Excellent for most

Slow growing and mets is very rare but removing can be disfiguring

122
Q

What puts a pt at risk of endometrial carcinoma

A

obesity

advancing age

unopposed estrogen therapy

PCOS

early menarche

Late menopause

Nulliparity

Fhx

Tamoxifen

Lynch syndorme

Diabetes

White

123
Q

What things are protective against endometrial cancer

A

combo OCPs

Smoking

124
Q

What are the s/s of endometrial carcinoma

A

Abnormal uterine bleeding- typically after menopause

abnormal vaginal discharge

abnormal cervical cytology

125
Q

How do you dx endometrial carcinoma

A

endometrial bx or D&C (scraping out endometrial lining)

126
Q

How do you tx endometrial carcinoma

A

Hysterectomy and bilateral salpingo-oopherectomy with lymph node assessment

127
Q

When would progestin therapy be indicated for pts with endometrial carcinoma

A

if a pt wants to try and preserve fertility

128
Q

What is the prognosis for endometrial carcinoma

A

Good, since most present with early stage disease

129
Q

What puts a pt at risk of developing cervical cancer

A

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

130
Q

What are the s/s of cervical cancer

A

most are asx and found on screening, but if advanced abnormal discharge and bleeding

131
Q

What is the dx for cervical cancer

A

pap test

if abnormal repeat or get colposcopy/bx

132
Q

What is the tx for cervical cancer

A

depends on the stage:

LEEP

Ablation

Conization

Hysterectomy and pelvic LAD

Radiation

Chemo

133
Q

What is the prognosis for cervical cancer

A

Early >90% survival

Stage 4- <15%

134
Q

What are the risk factors associated with vulvar cancer

A

age >70

infxn with high risk HPV types

HSV

Immunosuppresion

Smoking

135
Q

What are the s/s of vulvar cancer

A

pruritis

visible lesions

possible pain, bleeding, and ulcerations

136
Q

How do you dx vulvar cancer

A

vulvar bx

→5% acetic acid soln for visualization with colposcope→ if any lesions turn white they should be bx

137
Q

What is the tx for vulvar cancer

A

wide local excision

topical 5-fu

laser therapy for early

possible chemo/radiation etc.

138
Q

What is the prognosis for vulvar cancer

A

stage I-II: 70-90% survival

Stage IV as low as 16%

139
Q

What is the leading cause of cancer death caused by

A

lung cancer

140
Q

What are the risk factors associated with lung cancer

A

smoking

radiation therapy

pulmonary fibrosis

environmental toxins

141
Q

What are the s/s associated with lung cancer

A

new or changed cough

hemoptysis

chest pain

dyspnea

WL

142
Q

What are the two major categories of lung cancer

A

SCLC (oat cell)

NSCLC

143
Q

What type of lung cancer originates centrally, and mets early/is aggresive

A

SCLC

144
Q

What are the different types of NSCLC

A

SCC

adenocarcinoma

large cell carcinoma

145
Q

Which is slower growing: NSCLC or SCLC

A

NSCLC

146
Q

How do you dx lung cancer

A

may be found incidentally on CXR or CT but require histological confirmation

147
Q

How can you histologically confirm the presence of lung cancer

A

sputum cytology

bronchoscopy

pleural fluid examination

bx

148
Q

How do you tx NSCLC

A

Surgical resection if possible +/- XRT

149
Q

How do you tx SCLC

A

Chemo

XRT often added

150
Q

What is the prognosis for lung cancer

A

overall poor- 5 year survival rate of 15%

151
Q

What are the risk factors associated with renal cell carcinoma

A

men>women

Age >55

smoking

American indian

Hereditary RCC

HTN

obesity

Polycystic kidney disease

152
Q

What are the s/s of renal cell carcinoma

A

many asx

hematuria

pain or mass

WL

paraneoplastic sx

classic triad (on another notecard)

153
Q

What is the classic sx triad associated with renal cell carcinoma

A

hematuria

flank pain

palpable mass

154
Q

How do you dx renal cell carcinoma

A

1st test is abd CT (sometimes u/s)

Nephrectomy or partial nephrectomy to get histo dx

155
Q

How do you tx renal cell carcinoma

A

partial or radical nephrectomy

advanced may require immunotherapy and meds inibiting VEGF

156
Q

What treatment is generally not advised for renal cell carcinoma (because it doesn’t work)

A

chemo

157
Q

What is the 5 year survival rate for renal cell carcinoma

A

10%-90%

158
Q

What is the most common cancer in women

A

breast

159
Q

What is the most common type of breast cancer

A

Infiltrating ductal carcinoma

160
Q

WHat are the types of breast cancer

A

ductal or lobar

161
Q

What are the risk factors for breast cancer

A

increasing age

BRCA

nulliparity

early menarche

Late menopause

delayed childbreaing

radiation exposure

long term estrogen use

162
Q

What are the s/s of breast cancer

A
  • single, nontender, firm, immobile mass
  • can be asx
163
Q

What is the most common site of breast cancer

A

upper outer quadrant

164
Q

What are some rare presentations of breast cancer

A

nipple discharge

retraction of nipple

peau d’orange

eczematous changes (paget’s disease)

pain

axillary LAD

165
Q

How do you dx breast cancer

A

mammography→stereotatic or excisional core-needle bx

166
Q

Why do you check for estrogen and progesterone receptors of breast malignancy

A

It can help target tx for pts→ if receptors are present the pt is more likely to respond to tx

167
Q

What is the tx for breast cancer

A

Lumpectomy with sentinel lymph node bx (SLNB)

or

mastectomy

XRT

Adjuvent chemo

168
Q

What tx can be utilized if a pt has progesterone or estrogen receptors on the breast cancer

A

erimidex/temoxifen or raloxifene

169
Q

What tx can be utilized for pts with breast cancer that are HER-2 pos

A

herceptin

170
Q

What is the prognosis for breast cancer

A

if caught early up to 100%

171
Q

What are the different types of thyroid cancer (in order from least to most harmful)

A

Papillary

Follicular

Medullary

Anaplastic

172
Q

What are the risk factors associated with thyroid cancer

A

women>men

childhood head/neck irradiation

Fhx

MEN II

173
Q

How do you dx thyroid cancer

A

U/S

Fine needle aspiration (U/S guided)

174
Q

What are the s/s associated with thyroid cancer

A

Painless neck swelling

palpable single firm nodule

-most are actually asx-

175
Q

What is the tx for thyroid cancer

A

surgical resection

radioactive iodine for residual tumor

176
Q

What follow up tx will pts with thyroid cancer need

A

They will need thyroid replacement permanently after tx of cancer

177
Q

What thyroid cancer does not have an effective tx and requires pallative care

A

anaplastic

178
Q

What is the prognosis for papillary thyroid cancer

A

very good

179
Q

What is the prognosis for follicular thyroid cancer

A

still relatively good but more aggressive, and at higher risk of metastatic disease

180
Q

What is the typical prognosis for anaplastic thyroid cancer

A

very poor, a couple months to live

181
Q

What are the risk factors for non-hodgkin lymphoma

A

increasing age

HIV

Toxin exposure

autoimmune dz

EBV

obesity

white

182
Q

What are the s/s associated with indolent non-hodgkin lymphoma

A

painless, persistent LAD

HSM

Cytopenia

183
Q

What are the s/s associated with aggressive non-hodgkin lymphoma

A

rapidly growing mass

fever

night sweats

WL

Increase LDH

Increase uric acid

184
Q

What are common extranodal sites for non-hodgkin lymphoma

A

GI tract

skin

bone

bone marrow

185
Q

How do you dx non-hodgkin lymphoma

A

bx of involved nodes

bone marrow bx in order to stage

186
Q

What is the tx for indolent non-hodgkin lymphoma

A

radiation alone

187
Q

What is the tx for intermediate-high grade non-hodgkin lymphoma

A

chemo

immunotherapy (rituximab)

stem cell transplant

188
Q

What is the prognosis for non-hodgkin lymphoma

A

complete remission in up to 50% with aggressive

long survival for indolent

worst for HIV related non hodgkins lymphoma

189
Q

What puts a pt at risk of hodgkin lymphoma

A

being around 20 years old or >60 years old

Male>female

EBV

Immunodeficiency

190
Q

What are the s/s of hodgkin lymphoma

A

painless localized peripheral LAD (usually cervical)

Mediastinal mass

May have B sx

191
Q

What disease process are Reed-Sternberg cells associated with

A

hodgkin lymphoma

192
Q

How do you dx hodgkin lymphoma

A

lymph node bx shoing reed-sternberg cells

PET/CT and bone marrow bx for staging

193
Q

How do you tx hodgkin lymphoma

A

combo chemo for most

ABVD chemo and XRT

194
Q

When would a hodgkin lymphoma pt need an autologous stem cell transplant

A

When they have refractory disease

195
Q

What is the prognosis for a pt with hodgkin lymphoma

A

very good, even with advanced disease

196
Q

What is CML

A

Chronic Myelogenous leukemia→myeloproliferative disorder

197
Q

What are the three phases of CML

A

chronic

accelerated

acute (blast crisis)

198
Q

What are the risk factors for getting CML

A

young middle aged adults

male>female

ionizing radiation

199
Q

What are the s/s of CML

A

many are asx and found incidentally

fatigue

anorexia

WL

low-grade fever

excessive sweating

abd fullness

200
Q

How do you dx CML

A

CBC with leukocytosis

Bone marrow bx

201
Q

How do you tx chronic CML

A

Gleevec

202
Q

How do you tx accelerated CML

A

allogenic bone marrow transplantation

203
Q

How do you treat acute CML (blast crisis)

A

Conventional induction chemo then stem cell transplantation

204
Q

What is the prognosis for chronic CML

A

>/=25 years median survival

205
Q

What is the prognosis for accelerated CML

A

5 years survival

206
Q

What is the prognosis for blast crisis CML

A

about 1 year

207
Q

What is AML

A

Actue Myelogenous Leukemia

208
Q

What is acute myelogenous leukemia

A

clonal proliferation of myeloid precursors with decreased differentiation to mature cells

209
Q

What puts a pt at risk of AML

A

chemo

ionizing radiation

chemical exposure

median age of onset 60

210
Q

What are the s/s of AML

A

fatigue

pallor

weakness

gingival bleeding

ecchymosis

epistaxis

anemia

thrombocytopenia

211
Q

How do you dx AML

A

presumptive with myeloblasts on cbc/diff/smear

definitive dx with bone marrow bx (>20% blasts present)

212
Q

What are some smear findings for pts with AML

A

Auer rods

Myeloperoxidase

213
Q

What is the tx for AML

A

2 stages of chemo→induction therapy (aggressive) then consolidation (may include stem cell transplant)

214
Q

What is the prognosis for AML

A

about 65% attain complete remission, but remission rates are inversely related to age

215
Q

What is chronic lymphocytic leukemia

A

clonal malignancy of B lymphs

216
Q

What are the risk factors associated with CLL

A

Men>women

increases with age

white

217
Q

What are the s/s associated with CLL

A

most are asx and lymphocytosis is found on routine labs

or

LAD

recurrent infxn

HSM

B sx

leukemia cutis

218
Q

How do you dx CLL

A

lymphocytosis with smudge cells on CBC /Diff/Peripheral smear

flow to determine immunophenotype and show clonality

219
Q

How do you tx early stage CLL

A

observation only

220
Q

How do you tx stage 1-2 CLL

A

local radiation

221
Q

How do you treat stages three or four of CLL

A

chemo, but it is not curable

222
Q

What is the prognosis for early stage CLL

A

10 years or more

223
Q

What is the prognosis for CLL that is in stage 3-4

A

about 2 years

224
Q

What are the risk factors for ALL (acute lymphocytic leukemia)

A

ionizing radiation

chemo

white

225
Q

What are the s/s associated with ALL

A

fatigue

pallor

bruising

bleeding

petechiae

bone pain

leukemia cutis

infxn

226
Q

How do you dx ALL

A

bone marrow aspiration and bx showing blasts >20%

Can be pancytopenic on CBC

Must have cytogenetics and immunophenotyping for dx

227
Q

How do you tx ALL if a pt is <60 years old

A

chemo combo therapy

228
Q

How do you tx ALL in pts >60 years old

A

tyrosine kinase inhibitor and prednisone (no chemo)

229
Q

What is the follow up tx for ALL in pts in remission

A

CNS prophylaxis then further chemo or SCT

230
Q

When do you add tyrosine kinase inhibitor to ALL tx

A

if a pt is >60 years old or + for philadelphia chromosome

231
Q

Is the prognosis for ALL worse in kids or adults

A

adults

232
Q

What type of tumor are about 50% of brain tumors

A

gliomas

233
Q

What are the risk factors for brain tumors

A

Fhx

Ionizing radiation

234
Q

What are the s/s of brain tumors

A

focal deficits→location dependent

HA

Sz

N/V

syncope

cognitive dysfunction

personality change

aphasia

hallucination

ataxia

sensory deficit

weakness

visual spatial dysfunction

235
Q

How do you dx brain tumors

A

MRI with gadolinium contrast is the first choice

CT is the second choice

236
Q

What is the tx for brain tumors

A

surgical removal if possible first

radiation

chemo

steroids for edema

anticonvulsants to prevent sz

237
Q

What is the prognosis for brain tumors

A

depends on the type- glioblastoma is the worst

238
Q

What are the risk factors associated with esophageal cancer

A

smoking

etoh

diet low in produce

HPV

Barrett’s from GERD

men>women

ages 50-70

239
Q

What are the s/s of esophageal cancer

A

sensation of food sticking

retrosternal discomfort/burning

regurgitation of saliva or food

IDA from chronic blood loss

240
Q

What are the advanced stage s/s of esophageal cancer

A

progressive dysphagia

WL

odynophagia

241
Q

How do you dx esophageal cancer

A

endoscopic bx

barium esophagram for visualization

stage with CT

242
Q

How do you tx esophageal cancer

A

Can include:

sx

chemo

radiation

nutritional support if indicated

243
Q

What is the prognosis for esophageal cancer

A

overall 5 year survival of 20%→usually presents in late stages

Clin Med II (8 decks)

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