Oncology Exam Flashcards
(170 cards)
1
Q
2 most common presentations of breast cancer
A
mammographic abnormality (screening) palpable mass in breast (provider/pt)
2
Q
2 main types of breast cancer
A
ductal: most common*
lobular
3
Q
how are ductal carcinoma in situ most often identified on mammograms?
A
clustered microcalcifications w/ or w/o a palpable mass
4
Q
Paget’s disease of breast*
A
changes at nipple; early: scaling, later: red lesion, flattening of nipple
95% assoc w/DCIS
5
Q
inflammatory breast cancer
A
cancer cells block lymph vessels, causing severe swelling/redness
can cause peau d’orange
6
Q
chemotherapeutic agents for breast cancer
A
Cyclophosphamide
Methotrexate
5-FU
7
Q
tamoxifen
A
selective estrogen receptor modulators
8
Q
testosterone is metabolized to dihydrotestosterone (DHT)
A
5 alpha reductase
9
Q
70% of prostate cancer and most infections in which zone?**
A
peripheral zone
10
Q
most common prostate cancer cell type**
A
adenocarcinoma 95%
11
Q
most common cancer in males
A
prostate cancer
12
Q
SxS of prostate cancer*
A
may be asymp or mimic BPH
dysfunct urinating, can mets to bone*
13
Q
what PSA level warrants referral for biopsy?
A
> /= 4.0
14
Q
when do you treat high PSA values?
A
only if symptomatic
abnormal DRE
AND likely to cause morbidity/mortality
15
Q
difference in PSA values between ca and BPH
A
Ca: lower free PSA
16
Q
what TNM scores indicate invasion or metastasis?
A
T3, 4 - no cure
T1,2- curable by surgery
17
Q
growth speed of prostate ca
A
slow growing
18
Q
how to cancer cells kill?
A
compete w/normal cells for nutrients
19
Q
oncogenes
A
mutated version of proto-oncogenes (promote cell growth)
20
Q
how does radiation therapy work?
A
damage DNA directly or create free radicals
kills ca cells and damage normal cells
21
Q
1 symptom of esophageal ca*
A
dysphagia; feels like food stuck going down
Esophageal ca until proven otherwise
22
Q
most common type of external radiation therapy
A
3-dimensional conformal radiation therapy (3D-CRT)
but IMRT less S/E
23
Q
when is total body irradiation used?
A
Hematopoietic cell transplantation for leukemias and lymphomas - immunosuppression and eradication of malignant cells
24
Q
brachytherapy
A
internal radiation therapy using “seeds”
25
what cancer is radioresistant to radiation
melanoma
26
Radiation Pneumonitis
```
Onset 4-12 week after chest radiation
Cough, nonproductive
Dyspnea
Fever, low grade
Chest pain
Malaise
Weight loss
Hypoxemia
```
27
known risk factor of testicular ca*
undescended testicle (cryptorchidism)
28
screening for uterine or ovarian ca*
no specific screening; based on pt education
29
False positive of blood in stool*
Vit. C, red beets, Pepto Bismol, red licorice, iron supplements
30
Most common new cancer dx (men)**
prostate > lung > colorectal
31
Most common new cancer dx (women)**
Breast > lung > colorectal
32
Alternative Tx to nausea and vomiting*
ginger, acupuncture
| and THC in cannabinoids; smoked best
33
role of dietary fiber*
bulks up waste, moves it along faster, reduce contact time with intestinal wall, butyrate by-product, reduce inflammation
34
Antioxidants*
scavenge free radicals
foods: Plant-based foods; Fruits, veg, and their juices, whole-grain, nuts, seeds, herbs and spices. chocolate!
protective against cell mutations
35
Vit D in cancer*
low in cancer
| indicator of overall health**
36
Garlic in cancer*
immune boosting
| unprocessed form
37
L-glutamine*
effective for chemo-induced peripheral neuropathy
38
Ganoderma lucidum*
mushroom - inhibit the growth and invasiveness of some cancer cells (lab studies)
effects studied in breast ca
39
butyrate*
by product of fiber break down by bacteria in lower intestines
inhibits growth of tumors in the colon and rectum
40
High fiber diet in ca
protective against colon ca!
41
carcinoma of lung types
small cell
| non-small cell
42
primary type of non-small cell lung carcinoma*
adenocarcinoma (from mucus secreting glands)
| other type: Squamous CC
43
imaging modality of choice for smokers or >50yo*
High resolution low dose CT
44
leading cause of ca death both men and women
lung ca
45
epidermal growth factor receptor (EGFR)*
tumor marker currently studied as targeted therapy
mutation can cause lung ca in non-smokers
predominant in adenocarcinoma
46
5 year survival rate for lung ca <2cm
95%!
47
non-small cell lung ca tend to metastasize to...
adrenals, lymphatics in mediastinum, bony mets
48
small cell lung ca tend to metastasize to...
brain
49
mesothelioma
pleural-based lung ca
| from asbestos
50
pancoast tumor
tumor at pulmonary apex
can cause horner's syndrome (bc sympathetic chain; miosis, ptosis, anhidrosis)
usu. NSCLC
51
primary cause of small cell lung cancer*
smoking
52
Small Cell Lung Cancer (oat cell)
Derived from remnants of fetal lung in neuroendocrine cells (Kulchitsky cells)
25% of all primary lung cancers
pt can present as hyponatremic
53
how does smoking cessation help risk of primary lung ca
rate decreases to that of nonsmokers within 10 to 15 years of quitting
54
What dietary supplement should you avoid in lung ca?
Vit A Carotenoid
55
What do carcinoid tumors secrete (lung ca)
bronchial gland tumors that secrete serotonin
pts can exhibit GI Sx (n/v/d)
often in pts w/malignant dz in thorax
56
superior vena cava syndrome
partial or complete obstruction of blood through SVC
57
emergency Tx of superior vena cava syndrome
prednisone: reduce swelling
| radiation therapy to decrease bulk of mass
58
how can lung ca present as pneumonia?
Tumor in bronchus and not exchanging o2 and co2; lung past tumor is not being ventilated --> get atelectasis (collapse of lung tissue) --> get pneumonia
Fever, chills, night sweats, lung sounds
Need repeat CXR after pneumonia for lung ca; can mask ca
59
Endocrine presentations of SCLC
```
Hypercalcemia
SIADH
Cushing's
Hypoglycemia
Galactorrhea
Carcinoid syndrome: serotonin
```
60
Neuromuscular presentation of SCLC
eaton-lambert syndrome: autonomic neuropathy* weak muscles, tingling, etc
61
staging for SCLC
No TNM, just A or B (limited or extensive)
62
distance from incisors to E-G Junction*
35 - 40 cm
63
Esophageal benign tumors
leiomyomas: mid/distal; don't need therapy unless >5cm or symp
polyps: usu. cervical; regurgitating Sx
64
types of esophageal cancer
squamous cell: achalasia (dysmotility), nicotine, tylosis, injury
adenocarcinoma: Barrett's esophagus (GERD); dista; more common now
Adenosquamous, Lymphoma, Melanoma, Oat-cell, Sarcoma
65
esophageal cancer prognosis
depends on lymph involvement
| but usu. <10-15% 5 year survival bc found late
66
gastric cancer prognosis
dismal. unless caught early but unlikely
| >50% have spread at time of Dx
67
most common type of gastric ca
adenocarcinoma 95%
| most common: Polypoid or ulcerative
68
Gastric ca SxS
early satiety
Often asymptomatic until advanced
Anorexia and weight loss most common
abdominal mass 50%
69
what side is virchow's node on
left, take supply from lymph of abdominal cavity
70
Gastric ca Tx
only surgery for cure or palliation
| Sufficient margins: 6cm distal, 3cm proximal (bc lymph)
71
Gastrointestinal Stromal TumorGIST
thought to arise from smooth muscle cells
| no TNM staging
72
adjuvant Tx for gastric ca**
Gleevec – 54% partial response
Extremely helpful in Locally invasive tumor
5 year survival 48%, recurrence 1st 2 years
73
biggest factor for colon ca
family hx but sporatic 75%
74
Lynch Syndrome
Hereditary Nonpolyposis Colorectal Cancer (HNPCC)
Replication error
95% chance of developing colon ca
75
Gardner's syndrome - Familial Polyposis
Osteomas
Epidermoid cysts
Cutaneous fibromas
cancer by age 40, autosomal dominant
76
MUTYH Associated Polyposis (MAP)
Autosomal Recessive
Multiple polyps
40-60 years old
80% will develop colon ca
77
Peutz-Jeghers Syndrome
Autosomal Dominant
Mostly benign hamartomas
Develop Small intestine most common
78
Ulcerative Colitis
Precancerous condition
| Need frequent colonoscopy
79
Colon ca sx
alternating constipation and diarrhea
| hematochezia
80
70 yo w/"appendicitis" or left "inguinal hernia"...
r/o colon ca
81
what should you always do on someone w/rectal bleeding?
digital rectal exam
82
Left colon ca Sx
Constipation
Diarrhea
Hematochezia
Tenesmus
83
Right colon ca Sx
Vague abdominal pain
| Palpable mass in 33%
84
image modality of choice of colon ca
Barium enema w/distal endoscopy
85
most common area of distribution
distal left/sigmoid 29%
| cecum 26%
86
most common type of colon ca
adenocarcinoma (columnar --> gland)
87
most commonly used chemotherapeutic agent for colon ca**
Antimetabolites (5-flourouracil)**
88
most common form of cancer in children
acute leukemia (particularly acute lymphoblastic leukemia)
89
induction chemotherapy
reduce tumor load w/o intention of cure
| 1st line
90
consolidation chemotherapy
induce remission; also not cure
91
intensification
chemo after complete remission w.higher doses to inc cure rate/prolong remission
92
adjuvant
short course chemo after RT/chemo/surgery to destroy low number of residual ca cells
93
neoadjuvant
chemo in pre or post operative period
94
salvage
potentially curative, high dose combo regime for someone who failed a prior regimen or had recurrence
95
flow cytometry
identify circulating myeloblasts (stem cell of granulocytes) through surface antigens
determine if it's ca
96
gold standard for Dx of leukemias*
bone marrow biopsy/aspiration
| at posterior superior iliac spine
97
best drug for nausea and vomiting**
dexamethasone (Decadron)
| ondansetron (Zofran) also works well - 5-HT3 recep antag
98
what should you check stool for pts who receive chemotherapy?
C. diff (pts have diarrhea)
99
ANC* (absolute neutrophil count)
Total WBC x (% of segs + bands)
100
neutropenia
ANC <1500
101
febrile neutropenia
pt undergoing chemo who develops temp but not enough WBC to fight infection; susceptible to infection
102
Tx for pseudomonas in febrile neutropenia
Cefepime (4th gen cephalosporin) - gram neg
103
Tumor lysis**
complication of chemo, can lead to kidney failure
tumor lysis releases K, PO4, nucleic acids into systemic circulation. Break down of nucleic acid to uric acid and precipitation in renal tubules
occurs in rapidly dividing ca like lymphomas
Sx: N/V/D, anorexic lethargy, hematuria, HF, renal failure, arrhythmias, etc.
104
how to prevent tumor lysis
pre-chemo IV hydration and Tx of elevated uric acid
| pt clotting and bleeding at the same time
105
most common acute leukemia
acute myelogenic leukemia
106
Acute Myelogenic Leukemia
rapidly lethal unless Tx w/intensive chemo or other targeted therapies together w/supportive care
Sx: weakness, infection, bleeding
bone marrow blood smear: dark purple AML cells
risk: exposure to radiation or chemo*, rare familial Dz
107
presenting Sx of AML
Sx usu. minimal
Fatigue most common and precedes diagnosis by a number of months
Weakness, shortness of breath, DOE,
Complications of pancytopenia (anemia, infections, bleeding [gingival, ecchymosis, epistaxis or menorrhagia])
Pallor
Fever (usually caused by actual infection)
Splenomegaly or hepatomegaly (present 10% in each)
Up to 10% patients with AML, will have extramedullary disease - cutaneous or gingival infiltration
108
Lab findings in AML**
Auer Rods** 50% on smear (fused lysosome rod in myeloblast)
| WBC <5 50%
109
AML Tx
7+3 (7 days of cytarabine (cytosine arabinoside), and 3 days daunorubicin)
110
CNS leukemia commonly affect which cranial nerves?**
CN 3, 6**
| >5% of AML
111
AML prognosis
<60 yo: 5 yr survival rate 48% w/&+3 tx
| 0 SURVIVAL IN PTS >60yo w/chemo
112
Acute v Chronic leukemia
acute: inpatient, aggressive IV Tx, fast growing
chronic: outpatient, pill Tx, slow growing
113
Acute Promyelocytic Leukemia (APL)
HEMATOLOGIC EMERGENCY, TX RIGHT AWAY
form of AML, most malignant
hemorrhage in brain or lungs untreated
Tx: &+3 and ATRA (88-94% complete remission)
114
Differentiation Syndrome**
aka Retinoid Acid Syndrome or cytokine storm
Tx complication of APL
can mimic sepsis or PE
Tx: dexamethasone
don't treat w/leukapheresis - inc coagulopathy
115
Chronic Myelogenous Leukemia
uncontrolled production of maturing and mature granulocytes predominately neutrophils, but also basophils and eosinophils
rarely seen in children, avg age 64yo
116
HALLMARK OF CML**
```
Absolute basophilia (> 20% on diff)
Absolute eosinophilia is seen on 90% of cases
Absolute = total # x total WBC
```
117
Untreated CML leads to...
Triphasic course:
1. chronic
2. accelerated: B symptoms (fever, sweats, weight loss)
3. blastic: resember acute leukemia; die w/o Tx; 20% blasts peripheral/marrow
118
what occurs in 95% of Chronic Myelogenous leukemia***
Philadelphia Chromosome: BCR-ABL fusion gene* (between chromosome 9 and 22)
119
Philadelphia chromosome indicates poor prognosis in what dz?
acute lymphocytic leukemia
| Acute Lymphoblastic Leukemia/LBL
120
CML Tx
TKI: disease control, eg Gleevec (imatinib, Spyrcel, Taiga, Bosulif) - only affects ca cells, NOT cure
potential cure w/allo hematopoietic transplant
121
Acute Lymphoblastic Leukemia/Acute Lymphoblastic Lymphoma
```
more common in children
>85% overall 5 year survival rate
types:
B Cell: most common***
T cell: more favorable prognosis
Tx depends on cell type (All B cell same, All T same)*
```
122
Difference between ALL, LBL
ALL: >25% bone marrow blasts
LBL: <25% bone marrow blasts with a mass lesion
123
Most common childhood malignancy**
ALL/LBL (75% in children), peak 2-5yo
124
ALL/LBL presentation in children
```
hepatomegaly, splenomegaly
fever
lymphadenopathy, painless
bleeding
PLT <100,000
pallor, fatigue from anemia
musculoskeletal pain
```
125
What lab test is assoc w/ALL/LBL
Eosinophilia
126
Philadelphia neg ALL/LBL Tx adult
Hyper CVAD (cytoxan vincristine, daunorubicin, dexamethasone, alternating with methotrexate, cytarabine), nasty tx
Tx CNS w/methotrexate and cytarabine
G-CSF daily injection
127
Philadelphia pos ALL/LBL adult tx*
Add TKI*
128
How to Dx ALL/LBL
Lumbar puncture
129
New treatments for relapsed or refractory B-Cell ALL
CART-T: Chimeric antigen receptor T cells
130
most common leukemia in the western world*
Chronic Lymphocytic Leukemia
131
The only leukemia that is not associated with exposure to radiation***
Chronic Lymphocytic Leukemia
132
Chronic Lymphocytic Leukemia (CLL) presentation
Waxing and waning painless lymphadenopathy (often in cervical area)*; Enlarged nodes firm, rounded, discrete, non tender, and mobile (50-90%)
133
CLL Labs
smear: "basket" or "smudge" cells
Hypogammaglobulinemia
lymphocytosis
134
CLL malignant transformation
Richter’s transformation: transformation to a highly aggressive non-Hodgkin lymphoma
135
CLL Tx
depends on indolent or active progression
cannot be cured
radiation therapy if localized
no single agreed upon Tx
70-95% CR (complete remission) rate with Fludarabine, cyclophosphamide, rituximab/Rituxan
and ibrutinib/Imbruvica
136
types of lymphomas
Non Hodgkin Lymphoma (NHL): 5yr survival 75%
Hodgkin Lymphoma (HL): 11%
95% in adults, 65-74yo
137
Non-Hodgkins Lymphoma
Viral etiology implicated in Burkitts, Mediterranean, and T cell, B cell lymphoma/leukemia
chromosome 8, 12
138
NHL presentation
aggressive: B symptoms (47%), rapidly growing mass, elevated LD or LDH, elevated uric acid; 50% in western
or indolent: eg hairy cell leukemia
painless lymphadenopathy --> check***
139
NHL complications
Epidural spinal cord compression (up to 6%)
Pericardial tamponade
Superior or inferior vena cava obstruction (3-8%)
Hypercalcemia (adult T-cell lymphoma/leukemia)
Acute airway obstruction (mediastinal)
Obstructive uropathy/Renal involvement (2-14%)
Lymphomatous meningitis
Hyperurcemia
Severe autoimmune hemolytic anemia
Hyperviscosity syndrome
Intestinal obstruction, intussusception
Venous thromboembolic disease
140
PE of hairy cell leukemia
80-90% splenomegaly
141
hairy cell leukemia Labs
anemia
low PLT
dec WBC
monocytopenia
142
Tx of Hairy cell leukemia
no cure, just observe initially
Chemo with cladribine (preferred) or pentostatin
interferon alfa if severe
good response
143
Hairy Cell Leukemia
B cell lymphoproliferative disorder
almost never in children, usu. 50-55y; more males
indolent lymphoma
144
Diffuse large B-cell**
Aggressive NHL
35% of all lymphomas (40% of NHL in central/south america)
AIDS defining malignancy
median age 64
145
Highly Aggressive NHL
Adult T-cell lymphoma/leukemia caused by HTLV1 virus
| Burkitt’s lymphoma (B-cell)
146
Burkitt Lymphoma
Three forms
1. Endemic (African): jaw or facial bone tumor; EBV
2. Non-endemic (sporadic): USA usually in abdominal; 30% pediatric lymphomas
3. Immunodeficiency-related (AIDS, immunodeficiency or solid organ transplantation)
involves lymph, nasopharynx, GI
rapid growing tumor, tumor lysis
LDH elevated
rapid tumor doubling time
147
NHL ChemotherapyIndolent lymphomas*
CHOP or R-CHOP*** (rituximab/Rituxan, Cyclophosphamide, doxorubicin, vincristine, prednisone)
148
NHL ChemotherapyAggressive Lymphomas
R-CHOP (FIRST LINE) rituximab, cyclophosphamide, doxorubicin, vincristine & prednisone
First line treatment for Activated B cell DLBCL: R-CHOP plus lenalidomide or ibrutinib or bortezomib
GAZYVA/(Obinutuzumab): showing better results than Rituxan
149
what do you have to evaluate for before using Rituxan
Hep B or C, can reactivate
150
Hodgkin Lymphoma*
75% curable worldwide
10% of all lymphomas
familial Hx HIGH INHERITANCE*
Reed-Sternberg cells*
151
Peak age of Hodgkin Lymphoma*
Two peak ages: approximately 20 yo, and 65 yo*
152
Cellular distinction of hodgkin lymphoma*
Reed-Sternberg cells: "bull's eyes"
153
Hodgkin lymphoma presentation
asymp lymphadenopathy, rubbery nodes 70%, most common cervical or supraclavicular
nephrotic syndrome
hypercalcemia
anemia
eosinophilia
Leukocytosis, thrombocytosis, lymphopenia
Hypoalbuminemia
154
most common type of classic Hodgkin Lymphoma
nodular sclerosis 70%
155
Hodgkin Lymphoma Tx
-Radiation therapy (stage I & II and some stage IIIa)ABVD (doxorubicin, bleomycin, vinblastine, decarbazine)
-Chemo for stage III b and IV
ABVD* (BIG DRUG THAT IS USED)
FAVORABLE PROGNOSIS; more relapse in stage 3,4
156
Largest non-cancerous cause of death in Hodgkin survivors.**
Cardiac deaths 3.9% with an average of 9.5 years of follow up
157
Hodkin Lymphoma tx longterm toxicities
MDS/Myelodysplastic syndrome (maximum risk occurs between 5-9 years)
Infertility (80% males, 50% females)
Pulmonary toxicity (bleomycin) 37% decline in pulmonary function
Cardiomyopathy (doxorubicin) but rarely seen in patients treated with less than 400mg/m2
Cardiac deaths 3.9% with an average of 9.5 years of follow up. Largest non-cancerous cause of death in Hodgkin survivors.
Stroke risk in increase to 2 to 6 fold compared to general population. Risk of stroke in lifetime of a person >25 yo is 25%.
Radiation induced hypothyroidism (30-60%)
Mental health issues, neurocognitive problems, & impaired quality of life are prevalent in survivors
158
Multiple Myeloma*
malignancy of the plasma cell (produce immunoglobulins)
5yr survival 52%
median age 66yo
overproduction of a single antibody
proliferate in bone marrow, often results in extensive skeletal destruction w/osteolytic lesions, osteopenia and/or pathological fractures.
159
SxS multiple myeloma
Pallor (most frequent physical finding)
| hypercalcemia 28%
160
Dx criteria of Multiple myeloma***
CRAB
1. HyperCalcemia (Ca++ >11)
2. Renal insufficiency (creatinine >2 or creatinine clearance <40)
3. Anemia (hemoglobin <10)
4. Bone lesions >4mm in size on Xray/CT/MRI
161
Dx test for multiple myeloma**
S-PEP (serum protein electrophoresis
162
DDx of multiple myeloma
Acute renal failure
| Monoclonal gammopathy of undetermined significance or MGUS
163
Tx of multiple myeloma
if "smoldering", observe
normally, immediate tx required or die in 6mon**
eval for transplantation
3 drug regime: Bortezomib/Velcade, plus Lenalidomide/Revlimid plus dexamethasone/Decadron (VRd)
164
complications of multiple myeloma inducing death
Most common bacterial (50%) and renal failure (28%)
165
POEMS SYNDROME(Osteosclerotic Myeloma)
Associated with Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy and Skin changes.
NOT associated with multiple myeloma
plasma cell dysplasia
liver, lymph, spleen involved
166
"apple core" lesion on film in abdomen
near complete obstruction of large bowels; need surgical intervention
167
small cell lung cancer
```
15% of all lung ca
rapidly metastasizes
brain mets 50% at Dx
cure rate 5%
need chemo, radiation to brain
"coin lesion", pleural effusion, pancoast's tumor, horner's
```
168
ONCOLOGY EMERGENCIES***
A. SPINAL CORD COMPRESSION
B. TUMOR LYSIS SYNDROME
C. HYPERCALCEMIA
D. SUPERIOR VENA CAVA (OBSTRUCTION) SYNDROME
169
superior vena cava syndrome
Runs close to apex and median of right upper lobe; tumor here causes --> Blood return here is being cut off and squeeze off slowly; bright red face, swollen arms/head, big blue veins on chest
SX: SOB, chest pain, cough, dysphagia
170
prostate ca Tx
Options: Surgery, radiation therapy (external or brachytherapy), or watch and await/ or supervised watchful wait
