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Heme/Onc Exam 1 > Primary care presentations > Flashcards

Primary care presentations Flashcards

1
Q

T/F When relevant, cancer should
always be in your differential

A

T

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2
Q

3rd leading cause of cancer and cancer deaths in both men and women
(Incidence and death rates have dropped significantly in the last 30 years)

A

Colon cancer

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3
Q

Colon cancer incidence

A

● 149,500 cases in the US in 2021
● 52,980 deaths in the US in 2021

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4
Q

Most colorectal cancer arises from _____

A

adenomatous polyps

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5
Q

Colon cancer risk factors

A

○Lifestyle – diet high in fat, obesity, tobacco use
Hereditary syndrome
○ Familial polyposis of the colon (Polyposis coli)
○ MYH-Associated Polyposis (MAP)
○ Lynch Syndrome – Hereditary Nonpolyposis Colon Cancer (HNPCC)
Inflammatory bowel disease
Streptococcus bovis

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6
Q

Hereditary Nonpolyposis Colon Cancer (HNPCC)

A

Lynch Syndrome

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7
Q

Colon Cancer risk reduction

A

○ ASA
○ Estrogen replacement (risk/benefit)
○ Vit D (promising, still under study)

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8
Q

Prevention for colon cancer

A

○ Colonoscopy
■ Removal of adenomatous polyps
before they become cancerous
■ Detect cancer early

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9
Q

Colon Cancer S/S - Ascending

A

● Less formed stool
○ More likely asymptomatic
○ Less likely to feel obstruction or have
change in bowel habits
● Fatigue, palpitations
● Chronic blood loss → Microcytic anemia
indicative of iron deficiency
● Weight loss (later stages)

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10
Q

Colon cancer S/S - Descending and Sigmoid

A

● More formed stool as it progressives through colon
○ Impede stool → cramping, bowel
obstruction
● Narrow stool
● Hematochezia
● Tenesmus
● Weight loss (later stages)

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11
Q

Colon Cancer - Diagnosis

A

(patient with symptoms)
○ Fecal occult blood
○ Colonoscopy (Gold Standard)
■ Biopsy
○ Barium enema (may be considered)

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12
Q

Colon Cancer staging

A

○ TNM classification
○ CT Chest/Abd/Pelvis
○ Genomic studies and DNA Sequencing

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13
Q

Colon Cancer Treatment

A

○ Treatment and prognosis are based on staging
○ Carcinoembryonic antigen (CEA) Level (tumor marker)
○ CT Chest/Abd/Pelvis
○ Surgical resection – Attempt at total resection
■ Early small non-invasive malignant polyps may be removed with
colonoscopy, but must have clear margins
○ Radiation therapy
○ Chemotherapy – 5-fluorouracil prior to surgery
○ Monoclonal antibodies – cetuximab and panitumumab

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14
Q

Leading cause of female cancers

A

Breast cancer

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15
Q

Breast cancer incidence

A

● 281,550 cases in the US in 2021
● 43,600 deaths in the US in 2021 (decrease by > 1⁄3 in last decades)

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16
Q

Breast Cancer - Risk factors

A

○ Age over 50
○ Familial risk – 1st degree relative
○ Gene Mutations – BRCA1 and BRCA2
○ Hormone-dependent (early menarche, later first pregnancy)
○ Obesity
○ Moderate alcohol intake
○ Chest radiation before age 30 yrs

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17
Q

Breast cancer risk reduction

A

○ Avoidance hormone replacement (HRT)
○ Early menopause
○ Duration of maternal nursing (longer is better)

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18
Q

Breast cancer prevention

A

○ Self awareness – rather than regular breast exams
○ Screening mammograms/MRI
○ Tamoxifen and raloxifene used for
chemoprophylaxis in high risk*
○ Prophylactic mastectomy – high risk individuals

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19
Q

Breast cancer S/S

A

○ Breast mass/nodule (document size and location) - more likely to be painless
○ Dimpling
○ Skin changes “peau d’orange”
○ Nipple discharge or retraction
○ Enlargement or shrinkage of the breast

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20
Q

Breast Cancer Diagnosis

A

○ Diagnostic mammogram (not the same as screening)
■ Takes longer, varied angles, magnification of area of concern
○ Additional imaging usually for higher risk
■ Targeted breast U/S
■ MRI (High sensitivity, but not specific → increased biopsies)
○ Breast biopsy

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21
Q

Breast cancer staging

A

○ TNM classification
○ Genetic test and DNA sequencing with specific gene expression

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22
Q

Breast cancer treatment

A

○ Based on staging and gene expression
■ HER2, ER, PgR
○ Surgical – lumpectomy, partial or complete mastectomy, etc
○ Radiation
○ Systemic treatments
■ Hormone Therapy (selective estrogen-receptor modulators “SERM”)
■ Anti-HER2 – monoclonal antibodies (Herceptin)
■ Chemotherapy

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23
Q

Leading cause of cancer deaths in the US and Europe

A

Lung cancer

24
Q

Lung cancer incidence

A

● 235,760 cases in the US in 2021
● 131,880 deaths in the US in 2021
Increased rates in minority populations – Black, Hispanics, Asian

25
Q

Lung cancer Highly associated with ____ use (known since the 1960s)

A

tobacco

26
Q

Lung cancer screening

A

○ Adults 50 to 80 years with 20 pack-year smoking history and
currently smoke, or have quit within the past 15 years
■ Low-dose computed tomography (CT) every year
○ Stop screening once a person has not smoked for 15 years or has
a health problem that limits life expectancy or the ability to
have lung surgery
○ Grade: B

27
Q

Lung cancer risk factors

A

○ Cigarette smoking (greater than a 10 fold increase)
■ Former smokers are at reduced risk compared to current smokers
○ Second-hand smoke
○ Asbestos, arsenic, chemical exposure
○ Low fruit and vegetable intake
○ Ionizing radiation
○ Chronic lung disease – TB, emphysema
○ Certain inherited genetic traits may be a factor

28
Q

Lung cancer S/S

A

○ Cough 8-75%
○ Weight Loss 0-68%
○ Dyspnea 3-60%
○ Chest pain 20-49%
○ Hemoptysis 6-25%
○ Fever 0-10%
○ Weakness 0-10%

29
Q

Lung cancer Findings Suggestive of Metastasis

A

○ Weight loss > 10 lbs
○ Neurological – HA, syncope, seizure,
altered mental status
○ Bone pain
○ Lymphadenopathy (SVCS)
○ Hoarseness
○ Pancoast tumor
○ Papilledema
○ Malignant pleural effusion

30
Q

___ (tumor of the lung apex) can
cause pain down the arm in an ulnar
distribution, and can cause Horner syndrome

A

Pancoast tumor

31
Q

Horner Syndrome

A

○ Sympathetic nerve palsy
■ Enophthalmos
■ Ptosis
■ Miosis
■ Anhidrosis

32
Q

Lung Cancer diagnosis

A

○ Imaging – CXR, CT, MRI
○ Sputum cytology – low yield
○ Biopsy – bronchoscopy, percutaneous image
guided FNA
■ Type of cancer based on morphology and cytology

33
Q

Lung Cancer - Four major types

A

■ Small Cell Carcinoma: Common with tobacco use, more aggressive
■ Large Cell Carcinoma
■ Squamous Cell Carcinoma: Common with tobacco use
■ Adenocarcinoma: More common as smoking rates have decreased

34
Q

Lung Cancer Staging

A

○ TNM classification – ie. lymph node sampling, metastatic spread, etc.
○ “Physiologic staging” – Tx tolerance? Consider comorbidities
○ Genetic testing and DNA Sequencing

35
Q

Lung Cancer Treatment – NSCLC

A

○ Surgical resection
○ Radiation and/or chemotherapy if more advanced
○ Immunotherapy based on specific gene expression
■ T cells become active against tumor cells

36
Q

Lung Cancer Treatment – SCLC

A

○ More highly aggressive form of cancer, high relapse potential
○ Chemotherapy and/or radiation as first line
○ Surgery is not often indicated

37
Q

Most common gynecologic malignancy

A

Uterine cancer

38
Q

Uterine cancer incidence

A

● 66,570 cases in the US in 2021
● 12,940 deaths in the US in 2021

39
Q

Different types of tumors of the uterus

A

○ Benign – uterine fibroid (leiomyoma)
○ Malignant (leiomyosarcoma)
■ Most (80%) are endometrial adenocarcinomas

40
Q

Uterine cancer Risk Factors

A

○ Obesity
○ Postmenopausal estrogen treatment
○ Lynch Syndrome
○ Long-term use of Tamoxifen

41
Q

Tamoxifen BBW

A

Tamoxifen antiestrogenic in the breast but is associated with weak estrogenic effects in uterine epithelium→ increased risk of endometrial cancer

42
Q

Uterine cancer S/S

A

○ Postmenopausal bleeding
○ Premenopausal women – atypical bleeding between cycles
○ Pelvic mass…with or without bleeding
○ Pelvic pain (+/-)

43
Q

Uterine cancer Diagnosis

A

○ Imaging – Ultrasound
○ Biopsy – endometrial biopsy w/o or
w/ Hysteroscopy

44
Q

Uterine cancer staging

A

○ TNM
○ 75% of disease is localized to the
uterus (Stage 1)
○ Genetic testing – Lynch

45
Q

Uterine cancer treatment

A

○ Hysterectomy with removal of
ovaries and fallopian tubes
■ Stage 1
○ Chemotherapy for later stages
■ Node involvement
○ Immunotherapy

46
Q

Two main categories of lymphoma

A

○ Hodgkin’s Lymphoma
○ Non-Hodgkin’s Lymphoma

47
Q

Lymphoma Risk Factors

A

○ Epstein Barr, HHV-8, HTLV-1
○ H. pylori and MALT
○ Acquired or inherited immunodeficiency – HIV (17x higher)
○ Autoimmune diseases
○ Organ transplant

48
Q

____ _ is bimodal peak at 20’s and 50’s +, enlarge lymph node
typically found in upper body, presence of _____ , easier
recognize and treat

A

Hodgkins; Reed-Sternberg Cells

49
Q

_____ rates rise with age >40, but still common in children and
young adults, depending on the type, arise anywhere in the body, less
predictable, harder to treat

A

Non-hodgkin’s

50
Q

T/F Non-hodgkin’s is easier to treat

A

F

51
Q

Lymphoma S/S

A

○ Painless, firm, “rubbery” lymph nodes
■ May become painful after alcohol consumption
○ Fatigue
○ Pallor
○ Fever
○ Night sweats
○ Hepatosplenomegaly
○ Generalized pruritus

52
Q

Lymphoma Diagnosis

A

○ Imaging – U/S, CT
○ Excisional biopsy
○ Bone marrow biopsy

53
Q

Lymphoma Staging

A

○ Varies based on type – DNA analysis
○ Blood levels – Peripheral blood blast counts and Lactate dehydrogenase,
etc

54
Q

Lymphoma Treatment

A

○ Chemotherapy
○ Bone marrow transplant
○ Immunotherapy
○ Surgery if indicated (based on type)

55
Q

Lymphoma monitoring

A

○ Imaging – PET/CT, CT, MRI
○ Possible bone marrow or tissue Bx (depending on cancer involvement)

Heme/Onc Exam 1 (7 decks)

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