ONCO Flashcards
1
Q
Hodgkin’s lymphoma is a malignancy of
A
mature B lymphocytes
2
Q
Hodgkin’s lymphoma represents _____ of all lymphomas diagnosed each year
A
~10%
3
Q
Majority of cases of Hodgkin’s lymphoma is
A
Classical HL (cHL)
4
Q
One of the success stories of modern oncology is the success in the therapy of this disease
A
Classical HL (cHL)
5
Q
A subtype of HL that is more related to the indolent B-cell NHLs biologically than it is to cHL
A
Nodular lymphocyte predominant HL (NLPHL)
6
Q
New challenge in the treatment of Hodgkin’s lymphoma
A
late therapy-related toxicity
High rate of secondary malignancies and cardiovascular disease
7
Q
Four distinct subtypes of classical Hodgkin’s lymphoma (cHL) that are differentiated based on their histopathologic features:
A
- Nodular sclerosis
- Mixed cellularity
- Lymphocyte-rich
- Lymphocyte-depleted
8
Q
Classic HL that is more common in the younger age groups
A
Nodular sclerosis
9
Q
Classic HL subtype that is more common in elderly patients, patients infected with HIV, and patients in Third World countries (2)
A
Mixed cellularity
Lymphocyte-depleted
10
Q
Most common subtypes of classic HL (2)
A
nodular sclerosis and mixed cellularity types
11
Q
Risk factors for classic HL (2)
A
- HIV
2. EBV
12
Q
the malignant cells in HL
A
Reed-Sternberg (HRS) cells
13
Q
Diagnostic of cHL
A
Reed-Sternberg (HRS) cells
14
Q
Large cells with abundant cytoplasm with bilobed and/or multiple nuclei seen in cHL
A
Reed-Sternberg (HRS) cells
15
Q
Reed-Sternberg cells express these 2 CD marker in 85 and 100% of cases, respectively
A
CD15 and CD30
16
Q
97% of HRS cells in cHL harbor genetic aberrations in the ____ locus on chromosome ____
A
PD-L1
9p24.1
17
Q
Most common finding in HL
A
Nontender palpable lymphadenopathy
18
Q
Most common locations of palpabale lymph adenopathy in HL (3)
A
neck, supraclavicular area, and axilla
19
Q
½ of patients of HL will have this adenopathy at diagnosis
A
Mediastinal adenopathy
20
Q
Fever that persist for days to weeks, followed by afebrile intervals and then recurrence of the fever
A
Pel-Ebstein fever
In HL
21
Q
Most common HL subtype that may present as FUO
A
mixed-cellularity HL in an abdominal site
22
Q
More accurate than a bone marrow biopsy for evaluation of bone marrow involvement in cHL
A
PET/CT scan
as the bone marrow involvement in cHL tends to be patchy and therefore potentially missed on a unilateral bone marrow biopsy
23
Q
Used for staging of HL
A
Ann Arbor staging system
24
Q
Prognosis of advanced stage of cHL is bets predicted by the
A
International Prognostic Score (IPS)
25
International Prognostic Score (IPS) for cHL gives 1 point for each (7)
1. Male sex
2. Older age (>45 years)
3. Stage IV disease
4. Serum albumin <4 g/dL
5. Hemoglobin <10.5 g/dL
6. White blood cell count ≥15,000/μL
7. Lymphocyte count <600/μL and/or <8% of WBC count
26
Five-year progression-free survival of cHL if with no risk factor or if with 4 and more risk factors:
88%
| 62%
27
Treatment recommendation for cHL
maximize treatment outcome without using radiotherapy
28
Most commonly used regimen in the early stage disease of cHL
ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine)
Given every other week
Each cycle including two treatments
29
Treatment recommendation for favorable early stage disease of cHL
4–6 cycles of ABVD alone
30
Treatment recommendations for unfavorable early stage disease of cHL
1. ABVD x4 cycles followed by involved field radiation therapy
2. ABVD alone for 6 cycles
31
Treatment recommendations for bulky disease of cHL
Combined modality therapy
32
Treatment recommendations advanced stage disease of cHL
chemotherapy alone
ABVD x 6 cycles
Do not benefit from the addition of radiation therapy after a complete response to chemotherapy alone
33
Newer drugs for the treatment of relapsed HL (3)
Brentuximab
Pembrolizumab
Nivolumab
34
Antibody against CD30 conjugated to the microtubule inhibitor MMAE that is used for treatment of relapsed HL
Brentuximab
35
Drugs that target the PD-1/PD-L1 axis that used in the treatment of relapsed HL (2)
Pembrolizumab and nivolumab
36
T or F. Relapsed disease of HL can frequently still be cured
True
Usually not curable with subsequent chemotherapy administered at standard doses
37
Standard salvage chemotherapy regimens for relapsed HL (2)
* ICE (ifosfamide, carboplatin, etoposide)
| * GND (gemcitabine, navelbine, doxil)
38
Most serious late side effects of HL chemotherapy (2)
* Second malignancy
| * Cardiac injury
39
Most common second malignancies post HL chemotherapy in the first 10 years in regimens that contain alkylating agents plus radiation therapy
Acute leukemia
40
Most common second malignancies post HL chemotherapy that occur ≥ 10 years after treatment and are associated with use of radiotherapy
Carcinomas
41
Manifested by an “electric shock” sensation into the lower extremities on flexion of the neck that occurs in ~15% of patients who receive thoracic radiotherapy for HL
Lhermitte’s syndrome
42
HL subtype that sometimes transforms to diffuse large B-cell lymphoma
Nodular lymphocyte-predominant HL
43
Ann Arbor stage with Involvement of a single lymph node region or lymphoid structure (e.g., spleen, thymus, Waldeyer’s ring)
Ann Arbor Stage I
44
Ann Arbor stage with Involvement of two or more lymph node regions on the same side of the diaphragm
Ann Arbor Stage II
The mediastinum is a single site; hilar lymph nodes should be considered “lateralized” and, when involved on both sides, constitute stage II disease
45
Ann Arbor stage with involvement of lymph node regions or lymphoid structures on both sides of the diaphragm
Stage III
46
Ann Arbor stage with involvement of lymph node regions or lymphoid structures on both sides of the diaphragm, and with subdiaphragmatic involvement limited to spleen, splenic hilar nodes, celiac nodes, or portal nodes
Stage III-1
47
Ann Arbor stage with involvement of lymph node regions or lymphoid structures on both sides of the diaphragm, and with subdiaphragmatic involvement limited to spleen, splenic hilar nodes, celiac nodes, portal nodes, paraaortic, iliac, or mesenteric nodes
Stage III-2
48
Ann Arbor stage with Involvement of extranodal site(s) beyond that designated as “E”
IV
49
Ann Arbor stage with no symptoms
A
50
Ann Arbor stage with unexplained weight loss of >10% of the body weight during the 6 months before staging investigation, unexplained, persistent, or recurrent fever with temperatures >38°C during the previous month, and recurrent drenching night sweats during the previous month
B
51
Ann Arbor stage with localized, solitary involvement of extralymphatic tissue, excluding liver and bone marrow
E
52
A continuum of discrete tissue and cellular changes over time resulting in aberrant physiologic processes
Carcinogenesis
53
Cancers associated with tobacco:
Aerodigestive cancers, and kidney and bladder
54
Save more lives than any other public health activity
Smoking cessation
55
Smoking cessation results to _____ lower 10-year lung cancer mortality
30-50%
56
Cigars causes what cancers
Oral and esophageal cancer
* 1-2 cigars daily – doubles the risk for oral and esophageal cancer
* 3-4 cigars daily – 8-fold increase in oral cancer, 4-fold increase in esophageal cancer
57
This cancer is linked to carcinogen in smokeless tobacco dissolved in saliva and swallowed
Esophageal cancer
58
Physical activity decrease risk of what 2 cancers
Colon
| Breast
59
High BMI has inverse association with cancers of (2)
Prostate
| Breast (premenopausal)
60
Precursor of squamous cell cancer of the skin
actinic keratoses
61
T or F. Sunscreens reduce risk of melanoma
False. They may prevent burning but may encourage more prolonged exposure to the sun and may not filter out wavelengths of energy that cause melanoma.
Sunscreens – decrease risk of actinic keratoses (precursor of squamous cell cancer)
62
Risk factors for melanoma (3)
1. Propensity to sunburn
2. Large number of benign melanocytic nevi
3. Atypical nevi
63
T or F. Patients cured of squamous cell cancers of the lung, esophagus, oral cavity, and neck are at risk of developing second cancers of the upper aerodigestive tract
True
64
T or F. Smoking cessation decrease the cured cancer patients’ risk of second malignancy
False.
Lowers the cancer risk in those who have never developed a malignancy
65
This virus increases risk for cancers of the oropharynx
HPV-16
66
Oral premalignant lesion commonly found in smokers
Oral leukoplakia
67
Drugs that may cause regression of oral leukoplakia
High, relatively toxic doses of isotretinoin
68
In the ATBC Lung Cancer Prevention Trial and CARET trial, this substance was found to have caused harm
β-carotene
α-tocopherol/β-carotene (ATBC) Lung Cancer Prevention Trial
β-Carotene and Retinol Efficacy Trial (CARET)
69
These group of drugs may prevent adenoma formation or cause regression of adenomatous polyps
NSAIDs
Other chemoprevention:
Diets high in calcium
Estrogen plus progestin
70
An antiestrogen with partial estrogen agonistic activity in some tissues, such as endometrium and bone that decreased the risk of developing breast cancer by 49%
Tamoxifen
Small increase in risk of endometrial cancer, stroke, pulmonary emboli, and DVT
71
Selective estrogen receptor modulator used in chemoprevention of breast CA and with no risk of endometrial CA and with only fewer thromboembolic events
Raloxifene
Both tamoxifen and raloxifene have been approved by US FDA for reduction of breast cancer in women at high risk for the disease
72
More effective than tamoxifen in adjuvant breast cancer therapy
Aromatase inhibitors
It has been hypothesized that they would be more effective in breast cancer prevention
73
Inhibit conversion of testosterone to dihydrotestosterone (DHT) – a potent stimulator of prostate cell proliferation
5-α-reductase inhibitors (Finasteride and dutasteride)
74
T or F. Finasteride and dutasteride are approved as chemoprevention of prostate cancer.
False. Based on trials, use of 5-α-reductase inhibitor for prostate cancer chemoprevention would result in one additional high-grade (Gleason score 8-10) prostate cancer for every 3-4 lower-grade (Gleason score <6) tumors averted.
75
T or F. A trend toward a decreased risk of developing prostate cancer was observed for those men taking Vitamin E alone as compared to the placebo arm
False. Increased risk.
Selenium and Vitamin E Cancer Prevention Trial (SELECT)
76
Prophylactic bilateral mastectomy has _______reduction in breast CA risk
90-94%
77
Proportion of persons with the disease who test positive in the screen
Sensitivity
True-positive rate
78
Ability of the test to detect disease when it is present
Specificity
1 minus the false-positive rate
79
Ability of a test to correctly indicate that the disease is not present
Specificity
80
Proportion of persons who test positive that actually have the disease
Positive predictive value
Depend strongly on the prevalence of the disease
81
Proportion testing negative that does not have the disease
Negative predictive value
Depend strongly on the prevalence of the disease
82
Bias of screening tests that occurs whether or not a test influences the natural history of the disease and patient is merely diagnosed at an earlier date
Lead time bias
Screening test only prolongs the time the subject is aware of the disease and spends as a patient
83
Bias that occurs because screening tests generally can more easily detect slow-growing, less aggressive cancers than fast-growing cancers
Length-biased sampling
84
Extreme form of length bias sampling
Overdiagnosis
85
Bias that occurs because the population most likely to seek screening often differs from the general population to which the screening test might be applied
Selection bias
86
Screening test that is known to decrease the mortality rate of the cervical cancer
Papanicolaou (Pap) smears
87
Regular Pap testing for all women who have reached the age of ___
21
before this age, even in individuals that have begun sexual activity, screening may cause more harm than benefit
88
Pap smear + HPV testing is done beginning at age
30
89
Screening for cervical cancer may be stopped if (2)
1. Age 65 years with no abnormal results in the previous 10 years
2. Hysterectomy with cervical excision for non-cancerous reasons
90
Interval of screening with sigmoidoscopy
5 years
91
Some observational studies suggest that the efficacy of colonoscopy to decrease colorectal mortality is primarily limited to the ____ side of the colon
Left
92
Test that has higher sensitivity for colorectal cancer than nonrehydrated FOBT tests
Fecal immunohistochemical tests
93
Screening tests for ovarian CA (3)
1. Adnexal palpation
2. Transvaginal USD
3. Serum CA-125 assay
94
Most common prostate cancer screening modalities:
1. DRE
| 2. Serum PSA assay
95
1. DRE
| 2. Serum PSA assay
1. Acute myeloid leukemia
| 2. Bladder cancer
96
Neoplasm associated with androgens
Prostate CA
97
Neoplasm associated with aromatic amines (dyes)
Bladder CA
98
Neoplasm associated with arsenic (2)
1. Lung CA
| 2. Skin CA
99
Neoplasm associated with asbestos (3)
1. Lung
2. Pleura
3. Peritoneum
100
Neoplasm associated with benzene
AML
101
Neoplasm associated with chromium
Lung CA
102
Neoplasm associated with diethylstilbestrol
Clear cell vaginal cancer
103
Neoplasm associated with EVB (2)
1. Burkitt’s lymphoma
| 2. Nasal T cell lymphoma
104
Neoplasm associated with estrogens (3)
1. Endometrium
2. Liver
3. Breast
105
Neoplasm associated with ethyl alcohol (4)
1. Breast
2. Liver
3. Esophagus
4. Head and neck
106
Neoplasm associated with HIV (3)
1. NHL
2. Kaposi’s sarcoma
3. Squamous cell CA (esp in urogenital tract)
107
Neoplasm associated with HPV (3)
1. Cervix
2. Anus
3. Oropharynx
108
Neoplasm associated with immunosuppressive agents
NHL
109
Neoplasm associated with nitrogen mustard gas (3)
1. Lung
2. Head and neck
3. Nasal sinuses
110
Neoplasm associated with nickel dust (2)
1. Lung
| 2. Nasal sinuses
111
Neoplasm associated with diesel exhaust
Lung (miners)
112
Neoplasm associated with phenacetin (2)
1. Renal pelvis
| 2. Bladder
113
Neoplasm associated with polycyclic hydrocarbons (2)
1. Lung
| 2. Skin (squamous cell carcinoma of scrotal skin)
114
Neoplasm associated with radon gas
Lung
115
Neoplasm associated with vinyl chloride
Liver cancer (angiosarcoma)
116
Screening mammography should begin at what age and how often
May start at 40
40–44 years: Provide the opportunity to begin annual screening
45–54 years: Screen annually
≥55 years: Transition to biennial screening or have the opportunity to continue annual screening
117
MRI screening plus mammography for breast CA is done when
Women with >20% lifetime risk of breast cancer: Screen with MRI plus mammography annually
Women with 15–20% lifetime risk of breast cancer: Discuss option of MRI plus mammography annually
Women with <15% lifetime risk of breast cancer: Do not screen annually with MRI
118
Interval of pap smear as screening test
Every 3 years
119
HPV testing as screening test for cervical CA is done every
5 years
120
FOBT and FIT as screening test is started at what age and how often?
≥50 years old
Every year
121
Sigmoidoscopy as screening test is started at what age and how often?
≥ 50 years old
Every 5 years
122
Colonoscopy as screening test is started at what age and how often?
≥ 50 years old
Every 10 years
