Oncology Part 2 - Paulson (Exam 1) Flashcards
Very generally speaking, what do leukemias and lymphomas have in common, and how are they different?
- Both start in lymphocytes
- Leukemias mainly affect bone marrow and blood
- Lymphomas mainly affect lymph nodes
p.s. For this deck I really focused on the bold and underlined info from the powerpoint, so it’s relatively skimmed down from the lecture. Feel free to add more info if you’d like!
Acute Lymphocytic Leukemia (ALL) is the most common form of pediatric cancer and peaks in ages 2-5. It involves the proliferation of lymphoblasts. Name some of the important S/S, diagnostic tests, and tx of choice.
- S/S: lymphadenopathy, HSM, fever
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Tests:
- CBC/diff: anemia, thrombocytopenia
- Peripheral smear: blasts
- Bone marrow confirms dx
- Tx: chemo
The most deadly childhood cancer is:
A) Leukemia
B) Lymphoma
C) CNS tumors
D) Retinoblastoma
C) CNS Tumors
CNS tumors are the 2nd most common childhood cancer and the prognosis depends on tumor type. Name some of the important S/S, Dx, and Tx.
- S/S: HA, N/V, macrocephaly
- Dx: MRI preferred, Bx needed for histological dx
- Tx: Open surgical procedure. Avoid XRT in those <3 if possible. May do chemo.
Retinoblastoma peaks up to age 2, and about half have heritable retinoblastoma (RB1 gene). It has >95% survival rate, but can metastasize to the brain and become deadly pretty quickly if left untreated. Name some of the important S/S, Dx, and Tx.
- S/S: Leukocoria (white reflex)
- Dx: check for presence of red light reflex
- Tx: Refer to optho!
Osteosarcoma mostly occurs sporadically in kids, although some risks include prior irradiation or chemo, genetics, Paget disease, and male. Name some of the important S/S, Dx, and Tx.
- S/S: Localized pain (common sites: femur, tibia, humerus) typically lasting months
-
Dx:
- XR: Codman triangle (tumor grows and pushes out the periosteum); Spiculated “sunburst” appearance
- Biopsy
- Tx: Almost all get chemo and surgery. Radioresistant (don’t respond to radiation).
Ewing sarcoma, AKA small round blue cell tumor, is more common in males and peaks in ages 10-20. Name some of the important S/S, Dx, and Tx.
- S/S: Localized bony pain or swelling, most commonly in long bones and pelvis
-
Dx:
- XR: “onion peel” is classic. Real life: destructive lesion (“moth-eaten” or “permeative”) with poor margins
- Confirm with Bx
- Tx: Almost all need chemo. Local control w/ surgical resection and XRT
Wilms Tumor, aka nephroblastoma, is the most common renal malignancy in kids. It peaks in ages 2-5 and is more common in African kids. It has a 90% 5 yr survival rate. Name some of the important S/S, Dx, and Tx.
- S/S: abdominal mass or swelling
- Dx: Abdomnal U/S. Confirm with Bx.
- Tx: Surgical resection for all, chemo for almost all, XRT based on stage/histology
Describe the typical bladder cancer pt
>60 y/o male smoker with hematuria
What are the important S/S, Dx, and Tx for bladder cancer?
- S/S: Painless hematuria
- Dx: Cystoscopy is gold standard. Also UA.
- Tx: Transurethral resection of bladder tumor (TURBT) for non-muscle invasive or cystectomy for muscle-invasive
Testicular cancer is the most common cancer in men 15-35, but prognosis is very good (>95%, or 80% for metastatic dz). Risk factors include cryptochordism and Caucasian race. What are some of the important S/S, Dx, and Tx?
- S/S: painless mass or swelling in testis
- Dx: scrotal U/S
- Tx: inguinal orchiectomy
Ovarian cancer peaks in 60s and is more common in Caucasians. It has a poor prognosis. Risk factors include family history (BRCA gene), PCOS, and HRT. What are some of the important S/S, Dx, and Tx?
- S/S: abdominal fullness/bloating, nausea, early satiety
- Dx: pelvic U/S
- Tx: unilateral salpingo-oophorectomy. If pathology shows primary ovarian ca, then hysterectomy, contralateral salpingo-oophorectomy, omentectomy, likely chemo
Multiple myeloma is described as the proliferation of plasma cells producing monoclonal antibodies. This causes end organ damage as described by CRAB. What does CRAB stand for?
Hypercalcemia
Renal dz
Anemia
Bone
What are some important S/S of multiple myeloma?
Bone pain, anemia (Rouleaux), hypercalcemia
How do you diagnose multiple myeloma?
- Monoclonal spike on SPEP
- Bence-Jones protein on UPEP
- Lytic lesions on XR
- Bone scan is not helpful. XR is best.
How do you tx multiple myeloma?
- Most have induction therapy, then high-dose chemo and stem cell transplant
- Bisphosphonates to help prevent pathologic fx
- Prognosis: most relapse
Prostate cancer is very common and prognosis is generally very good for most. “You die with prostate cancer, not of it.” What are some of the important S/S, Dx, and Tx?
- S/S: increased PSA. Can be asymptomatic early on, then possibly hematuria or obstructive urinary sx, or nodules on DRE
- Dx: prostate Bx. Gleason score for grading.
-
Tx:
- Low grade: watchful waiting
- Higher stages: brachytherapy (you remember the picture….)
- Metastatic: castration
T/F: 75% of pancreatic cancers occur in the head of the pancreas
True
Name two lymph nodes that are a very bad sign for pancreatic cancer (indicative of mets)
- Virchow’s node (supraclavicular)
- Sister Mary Joseph node (palpable periumbilical node)
What is Courvoisier sign?
Palpable gallbladder. Indicative of pancreatic cancer.
Pancreatic cancer has a very poor prognosis. Almost all die from the dz. Name some of the important S/S.
- Gnawing, epigastric abd pain
- Nausea
- Wt loss
- Courvoisier sign
- Virchow’s node and Sister Mary Joseph node
How do you diagnose pancreatic cancer? What about tx?
-
Dx:
- LFTs
- Lipase
- Abd U/S or CT: “double duct sign” = dilation of common bile duct and pancreatic duct
- Tx: Whipple procedure - only potential cure
