Oncology Flashcards
(164 cards)
1
Q
Diagnostic study of choice for suspected pancreatic cancer if CT and is negative or equivocal
A
Endoscopic U/S (more sensitive than CT)
2
Q
Major RF for pancreatic cancer
A
Chronic pancreatitis
3
Q
Pancreatic Cancer tx
A
- resection if resectable
- if unresectable -
- -5FU with radiation
- -Gemcitabine alone
- -Radiation alone - Metastatic
- -Gemcitabine chemo
- -Pall
4
Q
HL classic finding on excision biopsy
A
Reed-Sternberg cell (owls eye with prominent eosinophilic inclusion like nucleoli)
5
Q
Do you need whole body CT/PET scan imaging for diagnosis of HL (local and curable)
A
YES, PET scan has replaced staging laparotomy and BM examination
6
Q
HL Tx
- IA, IIA (LN on same side)
- Advanced dz with B symptoms
- CD 20+
- recurrent chemo-sensitive dz
- recurrent chemo-resistant dz
A
- XRT alone or ABVD + XRT
- Chemo + XRT***
- ABVD + Rituximab
- Autologous HSCT
- Allogeneic HSCT
7
Q
HL and breast cancer screening
A
Begin annual mammograms and MRI at age 40 yrs or 8-10 yrs following XRT (whichever comes first)
8
Q
Long term HL Cx after treatment
A
Secondary cancers (breast, lung, skin)
MDS/AML
Hypothyroidism
Infertility
9
Q
4 MC indolent NHL
A
- follicular lymphoma
- mucosa-associated lymphoid tissue (MALToma)
- CLL
- hairy cell leukemia
10
Q
Follicular lymphoma cytogenetic analysis
A
t (14:18)
11
Q
CLL peripheral blood smear
A
Smudge cells (lymphocytes that appears flattened or distorted)
12
Q
Richter’s transformation (involves which malignancy)
A
CLL —> diffuse large B cell lymphoma with aggressive relapse and B symptoms
13
Q
Tx for recurrent infections in patients with CLL if associated with hypogammaglobulinemia
A
IV IG
14
Q
Hairy cell leukemia
- flow cytometry findings
A
CD 103, CD11c, CD25 monoclonal B cells
15
Q
4 MC aggressive NHL types
A
- diffuse large B cell lymphoma
- high grade lymphomas (Burkitt)
- lymphoblastic lymphoma
- mantle cell lymphoma
16
Q
Diffuse large cell lymphoma (aggressive NHL) tx
A
R-CHOP (Rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone)
+/- involved-field XRT (for bulky dz)
If refractory/relapsed - Autologous stem transplantation
17
Q
Which one of the 4 aggressive NHL has significant risk factor for tumor lysis syndrome
A
Burkitt
Lymphoblastic lymphoma
18
Q
Burkitt lymphoma tx
A
aggressive multi-agent chemo
19
Q
Lymphoblastic lymphoma tx
A
same as ALL
20
Q
Mycosis fungoides pathophysiology and symptoms
A
T-cell lymphoma infiltrating skin leading to:
pruritic erythema, raised plaques/lesions, erythroderma
21
Q
Sézary syndrome pathophysiology
A
T-cells circulating in the blood
22
Q
Cutaneous T-cell lymphoma tx
- Early-stage skin dz
- Advanced-stage dz
A
- topical glucocorticoids
- electron-beam XRT, photophresis, monoclonal Abs
Allogeneic HSCT may be curative
23
Q
When to use breast US for evaluation of breast lump
A
age <30 yo
Pregnant
24
Q
Paget disease of the breast dx
A
skin biopsy + mammogram
25
Does a normal mammogram or US rule out breast cancer?
NO; biopsy breast lump
26
When is axillary LN dissection indicated?
When sentinel node bx is positive
27
HORMONAL therapy for Breast cancer ER/PR receptor positive
- - premenopausal
- - postmenopausal
Premenopausal : Tamoxifen x 5-10 yrs and aromatase inh x 5 yrs when postmenopausal
Postmenopausal : aromatase inh x 5-10 yrs (Anastrozole, exemestane, letrozole)
28
Before starting trastuzumab you need to get baseline function of ?
ECHO - LV function q 3 mos
29
Giving trastuzumab with ------ chemo increases risk of cardiac toxicity
Anthracycline chemo
30
Breast cancer
1. HR positive metastatic dz
2. HR neg metastatic dz or hormone refractory dz
1. Antiestrogen therapy
| 2. Chemo
31
Breast cancer with bone mets tx
Bisphosphonate or Denosumab
Radiation for pain
32
Would a pt benefit from mastectomy in metastatic breast cancer
NO
33
Cervical cancer diagnosis
Punch biopsy
| Colposcopy with biopsy
34
U/S finding suggestive of Endometrial cancer in postmenopausal women
endometrial stripe >4-5mm
35
Prophlyactic BSO indications (2)
1. BRCA +
| 2. mutations that cause HNPCC (Lynch syndrome)
36
Genetic counseling and testing for BRCA1/BRCA2 indications (2)
1. ovarian cancer in younger women
| 2. women with 2/more first degree relatives with BREAST cancer
37
Ovarian cancer tumor marker
CA-125 (sensitive but not specific)
38
High / Low risk score for Prostate cancer
- Gleason
- PSA
LOW:
Gleason score <7
PSA <10
HIGH:
Gleason score 8-10
PSA >20
39
Prostate cancer not candidate for surgery should receive what kind of treatment
ADT (leuprolide, goserelin) + XRT
40
Intermediate risk dz (prostate cancer) mx
Surgery or XRT if life expectancy >10 yrs
41
ADT increases risk for ----. This is prevented by ----
Osteopenia
| Bisophosphonats or Denosumab
42
Mx for metastatic testicular cancer
Orchiectomy + Chemo
43
Tumor markers:
1. Nonseminoma
2. Seminoma
1. AFP + B-hCG
| 2. B-hCG
44
Seminoma Cancer chemo
Carboplatin OR Cisplatin + XRT
45
CRC initiation of screening
| - First degree relative with adenomatous polyp (colon ca) age <60yo
Age 40 yo OR
10 years younger than the earliest diagnosis
q 5 yrs
46
CRC initiation of screening
| - 2 first degree relative with colon ca at any age
Age 40 yo OR
10 years younger than the earliest diagnosis
q 5 yrs
47
CRC initiation of screening
| - HNPCC risk
q 1-2 yrs starting at 20-25y/o OR 2-5yrs earlier than earliest diagnosis in family (whichever is first)
48
CRC initiation of screening
| - PSC (primary sclerosis cholangitis)
at the time of diagnosis and q 1-2 yrs
49
Tumor marker for Hepatocellular carcinoma
a-Fetoprotein
50
Hepatocellular carcinoma finding in contrast enhanced triple phase CT or gadolinium MRI
Arterial hypervascularization with delayed venous contrast washout
51
Is biopsy required with radiographic findings c/w Hepatocellular carcinoma and appropriated clinical setting
NO
52
2 types of Neuroendocrine Tumors
1. Pancreatic - arise from endocrine cells of the pancreas
| 2. GI AKA (CARCINOID TUMORS)- arise from neuroendocrine tissues of the aerodigestive tract
53
2 Symptoms of GI NET
| What is found to be elevated in GI NET
diarrhea and facial flushing
Serotonin
54
Pancreatic NETs can secrete...
```
Insulin
Gastrin
Glucagon
Somatostatin
Vasoactive intestinal peptide
```
55
Pancreatic NET is associated with which MEN syndrome
MEN 1
56
MC site of mets for NET
Liver
57
Positive Somatostatin R NET tx if not surgically amenable
Octreotide or Lanreotide
58
Tx for pancreatic NET
Sunitinib + Everolimus
59
SCLC staging studies
CT C/A/P
Whole-body bone scintigraphy OR CT/PET scan
MRI brain
60
SCLC Paraneoplastic syndromes
- SIADH-induced hypoNa
- ACTH-induced hypercortisolism
- Lambert-Eaton syndrome
- Cortical cerebellar degeneration
- Limbic encephalitis
- Peripheral neuropathy
61
NSCLC Paraneoplastic syndrome
PTH-rP
62
Epidural spinal cord compression tx
Decompression surgery + XRT
Glucocorticoids (if pt is not a surgical candidate)
63
Which one of the below has dose-related HF complication ?
Doxorubicin
Trastuzumab
Doxorubicin
64
Breast exam reveals small and palpable mass + mammogram is indeterminate ..... Next step is ?
- biopsy
- US of the mass
U/S of mass
65
BRAF gene mutation is seen in (2)
Papilary thyroid cancer
| Melanoma
66
increased CEA and calcitonin levels are seen in
Medullary thyroid cancer
67
Can you treat medullary thyroid cancer with radioactive iodine
NO; it is not taken up by parafollicular cells (C cells)
68
HTLV-1 infection is associated with which malignancy
Adult T cell leukemia / lymphoma
69
Diagnosis consideration in a pt with absolute neutropenia, fever, poorly localized abd pain is
Typhlitis (necrotizing enterocolitis)
70
High-Risk Febrile Neutropenia Empiric abx tx:
--cultures never positive, no source of infection, temp normal, WBC < 500
What do you do with abx tx?
Cont empiric abx until WBC >500
71
Cisplatin AE
tinnitus / ototoxicity
Nephrotoxicity
Renal Mg wasting
72
CMO AE is seen with which chemo agent
Trastuzumab
| Anthracycline
73
Blemoycin AE
Pulmonary fibrosis
74
SIADH, myelosuprpression, and neurotoxicity is seen with which chemo agent
Vinorelbine, vinca alkaloid
75
Mucositis, myelosuprpression, and cerebellar ataxia is seen with which chemo agent
5-FU (pyrimidine analog agent)
76
Ovarian ca RF
Increased ovulatory cycles
- late menopause
- no pregnancies (nulliparity)
+FHx
BRCA1 or 2 gene +
Lynch synd
77
peripheral neuropathy, prox muscle weakness AE is seen with which chemo agent
Vincristine
78
Cyclophosphamide AE
hemorrhagic cystitis
79
Cisplatin is typically used for which cancers
Testicular
Ovarian
Bladder
Head and Neck
80
3 important serum markers used in the evaluation and staging of testicular cancer
AFP
hCG
LDH ***
81
How do you treat VTE in pt with active malignancy
Initiate AC with LWMH or Unfractionated hep (contraindicated in GFR <30%)
82
NHL poor prognostic indicators (6)
- - > 60 yo
- - Inc LDH
- - > 1 extra nodal site involvement
- - Involvement crossing the diaphragm (mediastinum and abd paraaortic nodes)
- - BM involvement
- - Low Life function performance
83
Hairy cell leukemia is a neoplasm of ---
mature B lymphocytes
84
HCL presenting triad
Pancytopenia
Splenomegaly
Inaspirable bone marrow
---> hyper cellular BM but dry aspirate which is due to increased reticulin
85
How do you differentiate CML from Hairy cell leukemia when both present with splenomegaly?
CML - inc WBC
| HCL - pancytopenia
86
Ovarian tumor TUMOR MARKERS
- epithelial cell origin
- germ cell origin
- Epith : CA-125
| - Germ cell : CA-125, AFP, hCG
87
Tx to reduce risk of invasive cancer in patients with lobular carcinoma in situ (LCIS) or atypical ductal hyperplasia
Tamoxifen (Est R modular) prophylaxis x 5 yrs
88
Which one of the testicular cancer is more aggressive..
| Nonseminomas or Seminomas
Nonseminomas
89
Testicular cancer cure rate is
90-95%
90
What kind of bone malignancy is associated with Hereditary retinoblastoma?
Osteogenic sarcoma AKA Osteosarcoma
91
Brain mets stereotactic radio surgery indications
3 or less brain lesions
| All lesions < 3 cm in size
92
Hypercalcemia (paraneoplastic syndrome) can be associated with which cancers (3)
Any Squamous cell carcinoma
Breast ca
RCC
93
Hypercalcemia EKG changes
shortened QT inteval
PR prolongation
Brady
Hyporeflexia
94
Hypercalcemia tx after IVF hydration
2. Calcitonin (binds osteoclasts --> inh bone reabsorption)
3. Bisphosphonates*** (inh osteoclast action)
Steroids (useful in MM and lymphoma)
95
Which Bisphosphonates are used in paraneoplastic hypercalcemia mx and to prevent skeletal events in solid tumors ?
Zoledronic acid > Pamidronate
96
Tx to prevent skeletal events in solid tumors - monoclonal ab to RANKL
Denosumab
97
SIADH is caused by
- - malignancy?
- - which medication?
SCLC
Cyclophophamide
98
severe SIADH tx when fluid restriction is not appropriate in oncologic pts with FTT
- - acute
- - chronic
acute- IV CONIVAPTAN (ADH R Ag)
chronic - DEMECLOCYCLINE (decreases sensitivity of distal tubules to ADH)
99
Cushing syndrome (ectopic ACTH production) is commonly caused by
SCLC
Carcinoid tumor
MEN 1 synd
100
Paraneoplastic Cushing syndrome tx
1. tx underlying tumor
| 2. inhibitors of steroid synthesis - KETOCONAZOLE or AMINOGLUTETHIMIDE
101
Dermatomyositis paraneoplastic syndrome is associated with which malignancy (1)
Visceral adenocarcinoma
102
Hypertrophic Osteoarthropathy (periosteal proliferation and clubbing) Is associated with which malignancy (1) and 3 other conditions)
Lung cancers
Chronic lung infections
CF
IBD
103
Lambert-Eaton Syndrome is associated (weakness of prox muscles which improve with exercise) is associated with which malignancy (1)
SCLC
104
Prophylactic treatment given to prevent bone fractures after bone mets
Bisphosphonates
Denosumab
Osteoclast inhibitors
105
Diagnosis of choice when you are suspecting spinal cord compression
MRI c/t/l
106
Brain Mets tx
1. single lesion
2. ≤ 3 brain mets and ≤3cm in size
3. more extensive lesions
4. after any resection
1. resection or stereotactic tx
2. stereotactic radiosurgery
3. whole brain radiation
3. whole brain radiation
107
Breast cancer screening
50-74 ys biennial vs annual
108
Breast cancer risk
Anything that inc Estrogen
- - early menarche
- - late menopause
- - fewer pregnancies
- - late first pregnancy or nulliparity
- - exogenous Est
109
Benign breast diseases that inc the risk of subsequent breast cancer
- - atypical ductal hyperplasia
- - DCIS
- - LCIS
110
Cancerous Axillary LN (adenocarcinoma) but NEG MAMMO/breast MRI..
Next step
Treat as breast cancer; don't look somewhere else
111
Breast cancer prognosis determined by
Poor prognosis...
1. size > 2 cm
2. # of involved axillary nodes
3. HER2/neu overexpression
4. ER/PR Receptor neg - higher incidence of recurrence
112
Aromatase inhibitor mechanism of action
Prevent conversion of adrenally produced androgen into estrogens BUT do not prevent ovarian estrogen production
113
Aromatase inhibitor AE
OP, fractures, musculoskeletal symptoms
Less risk of endometrial cancer and VTE compared to Tamoxifen
114
Breast cancer CHEMO tx indications
HIGH RISK pt:
LN +
Large tumor > 1cm
High risk Oncotype
115
Medication that target HER2 / neu + tumors
Trastuzumab
116
Breast ca Metastatic dz
1. HR +, Bone/soft tissue/LN mets
2. HR - , Visceral organ
1. Endocrine
- -if bone add Bisphosponates
2. Chemo
117
Benign DCIS tx
Surgery + Endocrine if HR is positive
118
Benign LCIS tx
Marker for cancer development in either breast
Mx is from observation to Tamoxifen/Raloxifene/Aromatase inhibitors to bilateral mastectomy
119
Cervical cancer screening
1. start at what age
2. 21-30yo
3. >30 yo
4. stop at what age
1. 21
2. q 3 yrs
3. q 3 yrs if cytology alone OR q 5 yrs if cytology + HPV
4. 65
120
Colposcopy results revealing
1. CIN I
2. CIN II
3. CIN III
1. observation vs cryotherapy
2. ablation or excision
3. ablation or excision
121
Which 2 tumors will lead to seeding after needle biopsy
Testicular
| Ovarian
122
Ovarian cancer protective factors
```
Decreasing ovulation:
OCP
Breastfeeding
Early menopause
Multiple pregnancies
```
123
Ovarian cancer histology (2)
1. epithelial tumors (adenocarcinoma)
| 2. germ cell tumors (rare)
124
Ovarian mass staging includes (3)
CA-125
CT c/a/p
Surgical exploration (remove as much cancer as you can and biopsy peritoneum)
NO NEEDLE BIOPSY
125
Ovarian cancer that is advanced require tx with
Cisplatin - systemic or intraperitoneal infusion
No radiation
126
In men age >50 yo consider testicular mass to be ------- until proven otherwise
Testicular Lymphoma
127
Testicular ca RF
Cryptorchidism
Testicular feminization syndrome (Klinefelter)
Personal and Fhx of testicular cancer
HIV (seminoma and ovarian)
128
Combination chemo sometime required on top of inguinal orchiectomy in testicular cancer
BEP (bleomycin, etoposide, cisplatin)
129
Testicular cancer late sequelae complications
```
Infertility
Second primary germ cell tumor
Secondary AML
Secondary GI malignancies
Pulmonary toxicity
```
130
Prostate cancer RF
Age
FHx of prostate cancer
African American
High animal fat intake
NOT BPH, cigarette smoking
131
PSA level that is abnormal
Gleason score that is abnormal
> 4
≥ 7
132
Work up for Abnormal DRE or PSA
TRUS biopsy
133
Palliative / Hormal manipulation for prostate cancer can be achieved with (3)
Antiandrogens
LHRH A
Orchiectomy
134
Androgen depriviation AE
OP
Loss of muscle mass
Sexual dysfunction
Inc CVM morbidity
135
Mx when prostate cancer becomes resistant to androgen deprivation
Immunothepry
Chemo
Steroids
Ketoconazole
136
Finasteride 5a reductase inhibitor benefits and Risks
DEC risk prostate ca by 25 %
Inc percentage of high grade cancers
137
Head and Neck cancer associated with which viral infections (2)
EBV
| HPV 16 and 18
138
H/N ca evaluation
Pan-EGD
| CT H/N
139
Carcinoid Syndrome is usually found in
Appendix
| Small bowel
140
NET can secrete which substances (4)
Serotonin
Kinin
Histamine
Prostaglandins
141
Carcinoid Syndrome dx
24-hr urine for 5-HIAA (5-hydroxyindoleacetic acid) end product of serotonin metabolism
Serum chromogranin A levels (peptide/amines in NET)
142
Carcinoid Syndrome tx
- -early
- -metastatic (liver or lung)
--resection
--no curative tx - supportive with antidiarrheal and cyproheptadine (antihistamine)
--Octreotide (somatostatin analog) : can slow progression of tumor and hormonal secretion
143
Lung cancer tx
1. early and local
2. locally advanced and unresectable
3. metastatic
1. resection +/- adjuvant
2. chemo + XRT
3. chemo
144
Pancoast tumor tx (Horner, shoulder pain)
Chemo + XRT followed by resection
145
von hippel lindau (characterized by visceral cysts and benign tumors) is associated with which malignancy
RCC
146
RCC paraneoplastic synd (4)
Eryhtrocytosis
HTN
HyperCa
Amyloidosis
147
CRC tx
1. early stage
2. later stage with LN involvement
3. metastatic
1. resection is curative
2. resection + adjuvant
3. consider resection but primary tx is CHEMO; FOLFOX or FOLFIRI
148
Most important prognostic factor in Melanoma is
Depth of invasion
149
Melanoma immunotherapy targeted to inhibit which mutations (2)
BRAF
| MEK
150
1. Tumor lysis syndrome can be prevented by
| 2. Pt's with evidence of uric acid nephropathy requires which tx?
1. Hydration + Rasburicase or Allopurinol
2. Rasburicase
Rasburicase reduce serum rate levels but Allopurinol has no effect on existing hyperuricemia.
151
Condition that occurs after prolonged neutropenia and pxs with abd pain and bloody diarrhea
Neutropenic Colitis / Typhlitis
152
Autologous transplant indications
-- hematologic malignancies (lymphoma, leukemia, MM)
-- only 1 solid tumor: relapsed testicular cancer
153
Why does Allogeneic HPSCT is less likely to lead to relapsed dz than Autologous
Allogenic also has graft vs. tumor effect (GV"T")on top of GVHD that autologous "self" HPSCT does not have
154
Allogeneic transplant AE
1. Veno-occlusive disease of the liver - fatal
2. GVHD
3. GV"T"
155
After inguinal orchiectomy and pathological diagnosis revealing testicular seminoma. Pt's tumor markers is consistently elevated for AFP and normal for B-hCG. What do you do ?
Treat as Nonseminoma
156
Testicular cancer staging
```
Stage I - confined to testicle
Stage IIA - LN mass <2 cm
Stage IIB - LN mass 2-5cm
Stage IIC - LN mass > 5 cm
Stage III - distant mets or elevation of tumor markers
```
157
Osteosarcoma - sclerotic changes without clear margins and new periosteal formation causing classic Codman triangle in XR imaging. What is the additional work up ?
- -MRI of the tumor site
- -Bone scan
- -CT chest for staging ***
158
Which adjuvant chemo agent causes diffuse acneiform skin rash
Epidermal GF R (EFGR) inhibitors - cetuximab or erlotinib
159
Which Antidepressant medication can be used in conjunction with tamoxifen without impacting its efficacy?
Venlafaxine SNRI
160
1. Tx of SVC syndrome 2/2 to SCLC
2. Tx of SVC syndrome 2/2 to NSCLC
3. Tx of SVC syndrome if secondary cause is lymphoma
4. Tx of SVC syndrome if secondary cause is unclear
5. Tx of SVC syndrome with life-threatening symptoms
1. SCLC is chemosensitve so tx with chemo first; if it does not respond XRT
2. NSCLC is XRT-sensitive
3. Steroid sensitive
4. biopsy
5. emergent endovascular stent for symptomatic relief
161
Ipilimumab (metastatic melanoma) toxicity - severe diarrhea, autoimmune hepatitis - tx
Supportive care (IVF)
High-dose IV Glucocorticoids *** reverse the damage (need immunosuppressive therapy as this medications work by exaggerating the immune response)
162
Greatest influence on the prognosis in NHL patient
revised International Prognostic index (r-IPI)
163
In NSCLC its important to identify which mutation.
EGFR mutation
| --->improved survival when txed with EGFR TK inhibitor
164
What to do during Doxorubicin induced HF?
- -reduce dose
- -cont at the same dose
- -discontinue
IF patient developed cardiotoxicity despite a low risk (1%) medication must be discontinued indefinitely
