1
Q
What are the 3 most common cancers in females? Males?
A
Females: Breast, lung, colorectal
Males: Prostate, lung, colorectal
2
Q
What cancer is the main cause of death in people under 20y?
A
Leukemia for both genders.
3
Q
What is the most common preventable cause of cancer death?
A
Tobacco use.
Tobacco cessation falls under primary prevention.
4
Q
What are the 3 primary prevention methods associated with reducing cancer risk?
A
- Tobacco cessation
- Dietary modifications
- Alcohol reduction/cessation
5
Q
When are mammograms recommended for a typical patient?
A
Over age 40.
6
Q
When is colorectal screening indicated?
A
Over age 45.
7
Q
When should pap smears begin?
A
Age 21, up to age 65.
8
Q
What is the general mnemonic for cancer warning signs?
A
- Change in bowel or bladder habits
- A sore that does not heal
- Unusual bleeding or discharge
- Thickening or lumps in the breast, testicles, or elsewhere.
- Indigestion or dysphagia
- Obvious change in size/color/shape, etc of mouth sore.
- Nagging cough or hoarseness
CAUTION
9
Q
What are the classic general findings associated with cancer?
A
- Nightsweats
- Unexplained weight loss or loss of appetite
- Persistent low-grade fever
- Chronic pain
- Persistent fatigue
- Recurrent infections
10
Q
What is the definitive diagnostic test for cancer?
A
Invasive tissue biopsy is required in nearly all cancers to definitively diagnose.
11
Q
What is the most common psychiatric complaint associated with cancer?
A
Depression.
12
Q
What is the most common staging system for most cancers?
A
- Tumor
- Node
- Metastasis
13
Q
What parts of TNM are associated with metastasis? What rating is considered metastasis?
A
- N1 = metastasis to regional lymph nodes.
- M1: distant metastasis.
14
Q
What is physiologic reserve and how is it measured?
A
- A determinant of a patient’s ability to handle physiologic stress.
- Age
- Karnofsky performance status
- ECOG performance status
< 70 karnofsky or >= 3 ECOG is poor prognosis.
15
Q
Define palliative care.
A
Symptomatic treatment, aimed at improving/preserving quality of life over treating the underlying etiology.
16
Q
What is the primary tumor marker for colon cancer?
A
CA19-9
17
Q
What is the biggest non-modifiable risk factor for cancer?
A
Age
18
Q
What is the progenitor cell of the granulocytes?
A
Myeloblast
19
Q
When are absolute WBC counts most reliable?
A
Pathologic states.
20
Q
Where are most neutrophils typically found?
A
Within bone marrow.
21
Q
What are the primary triggers for neutrophilic shifts?
A
Acute/physical/emotional stress.
22
Q
What are the 3 etiologies associated with true neutrophilia?
A
- Spurious = falsely elevated
- Primary = inherited effect
- Secondary = acquired, usually infectious.
Also known as a left shift.
23
Q
What wound sign can suggest neutropenia?
A
Lack of pus in a wound.
24
Q
What is considered severe neutropenia?
A
ANC < 500
25
When is pseudoneutropenia most commonly seen?
Morning specimens.
| Neutrophils resting within the bone marrow.
26
How can severe neutropenia affect a bacterial infection S/S?
Initial presenting symptoms can be absent.
27
What medications are most commonly known to cause neutropenia?
* Sulfonamides
* PCN
* Cephalosporins
* Methimazole
* Phenytoin
28
What is the mnemonic for Felty Syndrome?
* Splenomegaly
* Anemia
* Neutropenia
* Thrombocytopenia
* Arthritis (Rheumatoid)
| SANTA is felty
## Footnote
Felty syndrome (FS) is a rare extra-articular manifestation of seropositive rheumatoid arthritis (RA) characterized by RA, neutropenia, and splenomegaly. Severe or recurrent infection is of particular concern due to neutropenia, especially in the skin and respiratory system.
29
What is the standard therapy for neutropenia?
Myeloid growth factors.
* G-CSFs (filgrastim, pegfilgrastim)
* GM-CSFs (sargramostim)
30
What is the treatment for autoimmune neutropenia?
* Pulse steroids
* Intermittent myeloid growth factor
31
How and why is a granulocyte transfusion performed?
* Healthy donor given G-CSFs to increase their leukocytes.
* Leukocyte transfusion given to receipient using donor plasma.
* Indicated for bacterial infections with no response to ABX within 24-48 hrs.
32
What is the defining histologic finding of an eosinophil?
Bilobed nucleus.
33
Where are eosinophils typically found during a disease process?
* Target organs include: Skin, airway, and GI.
34
What is the primary udnerlying etiology for eosinophilia?
Dysregulation of IL3, IL5, or GM-CSF.
35
What qualifies as severe eosinophilia?
> 5000
36
How does eosinophilia cause organ damage?
* Release of toxic granules = damage.
* Recruiting inflammatory cells
* Cytokine release leading to fibrosis and remodeling.
37
What does a basophil contain?
* Heparin
* Histamine
38
What is the primary cause of basophilia?
CML
39
Dysfunction of what cell typically results in an autoimmune condition?
Regulatory T-cells.
40
What does a monoclonal lymphocytosis suggest in terms of etiology?
Benign or lymphoproliferative disorder
41
What does a polyclonal lymphocytosis suggest in terms of etiology?
* Infectious
* Transient
* Reactive
* Benign
42
What is unique about monoclonal lymphocytosis in terms of S/S?
* Lack of the usualy S/S, such as LAN, HSM, cytopenia, or fever
43
What is the most common infectious cause of polyclonal lymphocytosis?
Mononucleosis.
44
What is the typical initial workup for lymphocytosis?
* Repeat CBC w/ diff to r/o lab error
* Peripheral smear
* Flow cytometry unless viral infection is highly indicated.
45
What is the biggest risk associated with leukopenia?
Infection
46
What is the most common etiology for lymphocytopenia?
HIV
47
Where are most monocytes stored?
Spleen
48
What is the most common cause of monocytosis?
Bacterial infections complicated with neutropenia.
| Generally transient.
49
What are the primary treatment options for leukopenia?
* Broad spectrum ABX
* Myeloid growth factors for neutropenia and monocytopenia.
* Corticosteroids for immune-mediated.
* Splenectomy for chronic, refractory neutropenia.
50
What physical exam should never be performed on a neutropenic patient? Why?
DRE, due to the breakage of tissue and impaired ability to fight infection.
51
What peripheral smear finding is most commonly associated with a megaloblastic anemia or myeloproliferative disorder?
Hypersegmentation
52
What peripheral smear findings are commonl associated with infection?
* Granulation (bacterial)
* Dohle body
53
What is the hallmark peripheral smear finding in CLL?
Smudge/basket cell
| Ruptured cell fragment associated with fragile lymphocytes.
54
What is platelet satellitosis indicative of?
EDTA anticoagulation artifact.
55
What is the primary function of flow cytometry?
Detecting antigens/markers on cells to differentiate benign from malignant.
56
What is the primary goal of radiation therapy?
Depriving cancerous cells of the ability to proliferate.
| Cancer cells also cannot repair themselves as easily from damage.
57
What are the three primary ways radiation is delivered?
* Teletherapy: focused beams at a distance.
* Brachytherapy: encapsulated/sealed sources of radiation placed into patient tumor or adjacent to tumor.
* Systemic therapy: radionucleotide use delivered to site (i.e. radioactive iodine)
| Teletherapy via x-ray or gamma is the MC radiation therapy
58
What are the primary symptoms of radiation therapy?
* Fatigue (most common)
* Anorexia
* N/V
* Skin conditions
59
What are the two mechanisms by which chemotherapy treats cancer?
* Inducing cancer cell death.
* Inducing cancer cell differentiation/dormancy.
60
Describe the MOA of methotrexate and 5-FU.
Antimetabolites
5-FU prevents thymidine formation.
Methotrexate causes folic acid deficiency in cells.
61
What are the common SEs associated with mitotic spindle inhibitor use?
* Alopecia
* Neuropathy
* Myelosuppression
62
What are the common SEs associated with cisplatin, an akylating agent?
* Neurotoxicity in a stocking glove pattern.
* Hearing loss
* Renal failure
63
What is the primary SE of doxorubicin, an anthracycline?
Cardiotoxicity
64
What is the primary SE of etoposide, a DNA topoisomerase inhibitor?
Secondary leukemia in high doses.
65
What is the primary treatment for chemo-induced N/V?
Ondansetron
66
What is the primary treatment for chemo-induced mucositis?
Magic mouthwash
67
What is the primary treatment for 5-FU induced diarrhea?
1. Loperamide/immodium
2. Octreotide if no response.
68
What are the primary endocrinopathies that result from paraneoplastic syndrome?
* Hypercalcemia
* Hypoglycemia
* GnRH secretion
* Cushing's syndrome
* SIADH
69
What are the neurologic syndromes associated with paraneoplastic syndrome?
* Lambert-Eaton (muscle weakness of extremities)
* Subacute cerebellar syndrome (dizziness, nausea, vertigo, tremor, and sometimes dysphagia and blurry vision)
70
What skin condition is common in both paraneoplastic syndrome and diabetes mellitus?
Acanthosis nigricans
71
What is the criteria/definition of neutropenic fever?
* Recurrent temps above 38C
* Single temp above 38.3C in the presence of severe ANC.
72
Describe the preliminary workup for a neutropenic fever.
1. Cultures of multiple sites
2. CXR
3. Labs (CBC w/ diff, CMP, coags, and UA)
4. Empiric ABX of vanco, antipseudomonal, and aminoglycosides.
73
What is the typical clinical presentation of spinal cord compression?
* Back pain at level of the tumor mass.
* Mixed nerve root and spinal cord symptoms.
| Generally begins with extremity weakness, followed by hypperreflexia.
74
How is spinal cord compression diagnosed and treated?
MRI of the spine.
High dose IV corticosteroids, surgical decompression, and radiation of tumor.
75
What cancers are the most common culprits for hypercalcemia?
* Myeloma
* Breast cancer
* NSCLC
76
What is the treatment for hypercalcemia?
* Hydration with forced diuresis
* Bisphosphonates
* Calcitonin
* Hemodialysis
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