cancer pt 2

Question 1

ovarian cancer basics

Answer 1

difficult to detect until advanced state
often postmenopausal women

epithelial, stromal, germ cell cancers

Question 2

ovarian cancer RF

Answer 2

age >30
family hx
genetics - breast and ovarian cancer syndrome, Lynch II syndrome
never used oral contraceptives
menopausal hormones
nulliparity or fist pregnancy >35
obesity

Question 3

ovarian cancer screening

Answer 3

only high risk patients - genetics, fam hx

tumor marker : CA-125

pelvic US

Question 4

ovarian ca s/s

Answer 4

GI symptoms ( consipation, bloating, urinary changes), pelvic pressure/back pain

heartburn, nausea, early satiety, abd pain, ascites, increased abd girth

adnexal mass on pelvic exam

advanced disease - pleural effusions, bowel obstruction, lower extremity edema/DVT

Question 5

ovarian CA dx

Answer 5

transvaginal US

if mass, CT scan

CA 125

Question 6

ovarian CA mgmt

Answer 6

ref to gyn onc

surgical removal of cancerous tissue

salpingo-ooophorectomy w hysterectomy, omentectomy

chemo w platinum therapy (cisplatin/carboplatin)

Question 7

types of lung cancer

Answer 7

non small cell - (squamous cell, adenocarcinoma, large cell carcinoma) majority of cases, tx w surgery

small cell (oat cell cancer) - tx w chemo/radiation, high smoking link

Question 8

lung cancer s/s

Answer 8

cough - new or change
anorexia, weight loss
gen weakness/fatigue
dyspnea
chest pain
hemoptsis
paraneoplastic syndromes

wheezing
stridor
asymmetric breath sounds
hoarseness
lymphadenopathy

pan coast tumor - tumor in lung apex - neuro sx + Horner’s syndrome (ptosis, mitosis, anhidrosis)

Question 9

lung CA diagnostics

Answer 9

CXR
CT scan - for staging
tissue or cytology specimen (Thoracentesis vs thorascopy vs bronchoscopy vs VATS)

PET

PFTs

Question 10

lung CA screening

Answer 10

low dose CT for

age 50-74 plus 30 pack/year smoking history (current or quit in past 15 years)

Question 11

malignant effusion

Answer 11

pleural, pericardial, peritoneal

result from direct neoplastic involvement of serous surface or obstruction of lymphatic drainage

normally exudative - send culture for cytology

treatment = drainage

Question 12

hypercalcemia

Answer 12

occurs 2/2 tumor secretion of PTHrP

paraneoplastic syndrome

early s/s : anorexia, nausea, fatigue, constipation, polyurria

late : muscular weakness, hyporeflexia, confusion, psychosis,, tremor, lethargy

tx: volume replacement!!!, bisphosphonates, HD, steroids, treat cancer

Question 13

tumor lysis syndrome

Answer 13

2/2 release of tumor contents into blood stream following anticancer therapy (heme malignancies common, SCLC, DLBCL)

hyperuricemia, hyperphosphatemia, hyperK, hypoCa

dx based on Cairo-Bishop criteria

tx - IVF, allopurinol

s/s: urate nephropathy, seizures, cardiac arrhythmias/death

Question 14

spinal cord compression

Answer 14

physical damage to spinal cord from edema, hemorrhage, pressure induced ischemia

back pain -> neuro complaints

MRI

tx w steroids, surgical decompression/radiation

Question 15

neutropenic infection

Answer 15

rf: cytotoxic cancer therapy, immunosuppression, hematologic malignancies, solid tumor malignancy w bone marrow involvement, impaired defense mechanism(foley, impaired mucosa)

neutropenia = ANC <500

fever 101 (38.3)

if fever & neutropenia - pan cx

tx w empiric abx, hospital admit, monitor for sepsis, consider antifungalss