Spicy Flashcards
MC CA in males?
Prostate
MC CA in females?
Breast
Top three CA’s for men
- Prostate
- Lung and bronchus
- Colon and rectum
Top three CA’s for women
- Breast
- Lung and bronchus
- Colon and rectum
Most lethal CA for men and women?
Lung and bronchus
Pathogens and which CA they correlate to
HPV - cervical, anal, laryngeal
EBV - nasopharygneal, B-cell lymphomas, oeal hairy leukoplakia
H. pylori - gastric, MALT lymphoma
Schistoma - bladder
HHV-8 - Kaposi sarcoma
HIV - lymphoma
Screening for colorectal CA ages 50 to 75 (average risk):
Fecal immunochemical every year
OR
Flex sig every 5 years
OR
Colonoscopy every 10 years (GOLD STANDARD)
Colorectal CA screening adults over age 76:
Nah
FHx FDR for CRC Dx’d > 60yrs OR two or more SDR - screening guidelines:
No change - begin screening at 50 , and do every 5 years instead of every 10
FHx FDR for CRC Dx’d < 60yrs OR 2 or more FDR- screening guidelines:
Begin at 40, or 10 years younger than the age of Dx for affected relative (whichever comes first) and screen every 5 years instead of every ten
CRC screening for blacks or non-alcoholic fatty liver dz?
Consider starting at age 45
Cervical CA screening guidelines - age 21-65
Pap q3 yrs
Once you’re 30, can do co-testing q5 yrs instead of pt wants
Cervical CA screening < 21 yrs?
Nope
Women over 65 who’ve taken care of themselves in the past (good routine medical care) and are not high risk, OR have has hysterectomy with removal of cervix - cervical CA screening guidelines ?
Do not screen
Stages of CA
0 - carcinoma in situ 1 - localized 2 - early locally advanced 3 - late locally advanced 4 - metastasized
Adjuvant vs neoadjuvant chemo:
Adjuvant - after surg
Neo - before surg
Tumor markers ands their associated tumor cells:
Alpha fetoprotein (AFP) - hepatocellular, testicular
CA-125 - Ovarian
Carcinoembryonic antigen (CEA) - colon
CA 19-9 - pancreatic
Which CA is most likely to be associated with paraneoplastic syndromes?
Small-cell lung CA
Cushing, SIADH, hypercalcemia, etc…
JAK-2 mutation, think:
Polycythemia vera (PCV)
Which myeloproliferative disorder has the lowest risk of progression to AML?
Essential thrombocytosis
What is the specific chromosomal abnormality associated with chronic myelogenous leukemia (CML)?
Philadelphia chromosome translocation between 9 (abl) and 22 (bcr) -> (bcr/abl) which possess tyrosine kinase activity
Leads to unregulated production of myeloid cells
How do tyrosine kinase inhibitors work in treating CML?
They induce apoptosis in cells expressing BRC-ABL
1st line treatment
What medication is really good (98%) at achieving control of the chronic phase of CML?
Imatinib
If it’s Imatinib-resistant, use Dasatinib
Difference between acute and chronic bone marrow blasts percentages?
Acute - > 20% blasts
Chronic - < 20% blasts
Which acute leukemia is associated with DIC?
M3 AML Acute promyelocytic leukemia
If you see lymphoblasts on smear, think:
Acute lymphoblastic leukemia
If you see myeloblasts on smear, think:
Acute myelogenous leukemia
Which leukemia is a relative emergency?
AML
What does remission look like?
Normal peripheral blood, normal bone marrow (decreased blast to no blast), normal clinical status (disappearance of all signs and sxs)
Richter’s syndrome?
Transformation from CLL
Aggressive, diffuse large B cell lymphoma
Kills you quick
Picture stable CLL patient that goes to shit quickly
See Reed-Sternberg? Think:
Hodgkin’s Lymphoma
Owl cells
NHL - elevated LDH?
Reflects tumor cell proliferation and burden
Corresponds with overall prognosis
What is R-CHOP or R-CVP?
I have no idea, but it’s related to treatment of NHL (maybe it’s a type of chemo)
What disease can make your lymph nodes hurt if you drink booze?
Hodgkin’s Lymphoma
AE of Bleomycin/radiation?
Risk of pulmonary toxicity leading to fibrosis and death
Txt for classical HL
MGUS
Like a milder MM - at anytime it could progress to MM
Most notable features of MM?
Bone pain - back, hips, ribs
Pathologic fx’s (femoral neck, vertebrae)
Imaging for MM
Skeletal survey, NOT bone scan, to visualize LYTIC lesions of MM
MRI and CT/PET = demonstrates extent of disease ONCE DX’d
3 things required for MM Dx
- M-protein
- Bone marrow aspirate > 10% plasma cells
- End-organ damage from plasma cells (at least one of the CRAB things)
CRAB
MM
C - hyperCalcemia
R - renal injury
A - anemia
B - lytic Bone lesion
Big differences between MM and Waldenstrom Macroglobulinemia
No bone pain with WM
No kidney dz with WM
MCC of elevated CA:
Primary hyperparathyroidism (outpatient)
Malignancy (inpatient)
MC CA’s associated with high Ca++
Lung (squamous cell)
Breast
MM
What is HHM?
Humoral hypercalcemia of malignancy
Mediated by secretion of PTHrP which causes increased bone
resorption
Most common cause of hypercalcemia in CA patient
Other than HHM, causes of high Ca++ in CA?
Activation of osteoclast by cytokines released from CA cells (20%)(breast/MM)
1,25-OH2 Vit D secretion by CA cells (lymphomas, granulomatous disease)
In HHM, the tumor itself secretes:
PTHrP (it acts like PTH, increases CA++ reabsorption)
Imaging of choice for known CA patient with new onset back pain?
MRI (emergently if neuro changes)
IMMEDIATE steroids while you’re waiting for the MRI
Absolute neutrophil count
ANC = WBC (total) x neutrophil (%)
*don’t need to memorize for exam but a good pimp question for Phase 2
Criteria for febrile neutropenia?
Fever >100.4 for >1hr OR a single temp >101.0 in the setting of ANC < 1500
SVC Syndrome is MC’ly associated with:
Lung CA
When does tumor lysis syndrome most commonly occur?
When treating heme malignancies or any rapidly proliferating tumor that is sensitive to chemo
The big four things to look out for with tumor lysis syndrome?
Hyperuricemia
Hyperphosphatemia
Hypocalcemia
Hyperkalemia
