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Heme/Onc Exam 1 > Primary care presentations > Flashcards

Primary care presentations Flashcards

(55 cards)

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1
Q

T/F When relevant, cancer should
always be in your differential

A

T

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2
Q

3rd leading cause of cancer and cancer deaths in both men and women
(Incidence and death rates have dropped significantly in the last 30 years)

A

Colon cancer

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3
Q

Colon cancer incidence

A

● 149,500 cases in the US in 2021
● 52,980 deaths in the US in 2021

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4
Q

Most colorectal cancer arises from _____

A

adenomatous polyps

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5
Q

Colon cancer risk factors

A

○Lifestyle – diet high in fat, obesity, tobacco use
Hereditary syndrome
○ Familial polyposis of the colon (Polyposis coli)
○ MYH-Associated Polyposis (MAP)
○ Lynch Syndrome – Hereditary Nonpolyposis Colon Cancer (HNPCC)
Inflammatory bowel disease
Streptococcus bovis

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6
Q

Hereditary Nonpolyposis Colon Cancer (HNPCC)

A

Lynch Syndrome

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7
Q

Colon Cancer risk reduction

A

○ ASA
○ Estrogen replacement (risk/benefit)
○ Vit D (promising, still under study)

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8
Q

Prevention for colon cancer

A

○ Colonoscopy
■ Removal of adenomatous polyps
before they become cancerous
■ Detect cancer early

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9
Q

Colon Cancer S/S - Ascending

A

● Less formed stool
○ More likely asymptomatic
○ Less likely to feel obstruction or have
change in bowel habits
● Fatigue, palpitations
● Chronic blood loss → Microcytic anemia
indicative of iron deficiency
● Weight loss (later stages)

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10
Q

Colon cancer S/S - Descending and Sigmoid

A

● More formed stool as it progressives through colon
○ Impede stool → cramping, bowel
obstruction
● Narrow stool
● Hematochezia
● Tenesmus
● Weight loss (later stages)

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11
Q

Colon Cancer - Diagnosis

A

(patient with symptoms)
○ Fecal occult blood
○ Colonoscopy (Gold Standard)
■ Biopsy
○ Barium enema (may be considered)

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12
Q

Colon Cancer staging

A

○ TNM classification
○ CT Chest/Abd/Pelvis
○ Genomic studies and DNA Sequencing

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13
Q

Colon Cancer Treatment

A

○ Treatment and prognosis are based on staging
○ Carcinoembryonic antigen (CEA) Level (tumor marker)
○ CT Chest/Abd/Pelvis
○ Surgical resection – Attempt at total resection
■ Early small non-invasive malignant polyps may be removed with
colonoscopy, but must have clear margins
○ Radiation therapy
○ Chemotherapy – 5-fluorouracil prior to surgery
○ Monoclonal antibodies – cetuximab and panitumumab

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14
Q

Leading cause of female cancers

A

Breast cancer

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15
Q

Breast cancer incidence

A

● 281,550 cases in the US in 2021
● 43,600 deaths in the US in 2021 (decrease by > 1⁄3 in last decades)

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16
Q

Breast Cancer - Risk factors

A

○ Age over 50
○ Familial risk – 1st degree relative
○ Gene Mutations – BRCA1 and BRCA2
○ Hormone-dependent (early menarche, later first pregnancy)
○ Obesity
○ Moderate alcohol intake
○ Chest radiation before age 30 yrs

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17
Q

Breast cancer risk reduction

A

○ Avoidance hormone replacement (HRT)
○ Early menopause
○ Duration of maternal nursing (longer is better)

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18
Q

Breast cancer prevention

A

○ Self awareness – rather than regular breast exams
○ Screening mammograms/MRI
○ Tamoxifen and raloxifene used for
chemoprophylaxis in high risk*
○ Prophylactic mastectomy – high risk individuals

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19
Q

Breast cancer S/S

A

○ Breast mass/nodule (document size and location) - more likely to be painless
○ Dimpling
○ Skin changes “peau d’orange”
○ Nipple discharge or retraction
○ Enlargement or shrinkage of the breast

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20
Q

Breast Cancer Diagnosis

A

○ Diagnostic mammogram (not the same as screening)
■ Takes longer, varied angles, magnification of area of concern
○ Additional imaging usually for higher risk
■ Targeted breast U/S
■ MRI (High sensitivity, but not specific → increased biopsies)
○ Breast biopsy

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21
Q

Breast cancer staging

A

○ TNM classification
○ Genetic test and DNA sequencing with specific gene expression

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22
Q

Breast cancer treatment

A

○ Based on staging and gene expression
■ HER2, ER, PgR
○ Surgical – lumpectomy, partial or complete mastectomy, etc
○ Radiation
○ Systemic treatments
■ Hormone Therapy (selective estrogen-receptor modulators “SERM”)
■ Anti-HER2 – monoclonal antibodies (Herceptin)
■ Chemotherapy

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23
Q

Leading cause of cancer deaths in the US and Europe

24
Q

Lung cancer incidence

Study These Flashcards
A

● 235,760 cases in the US in 2021
● 131,880 deaths in the US in 2021
Increased rates in minority populations – Black, Hispanics, Asian

25
Lung cancer Highly associated with ____ use (known since the 1960s)
tobacco
26
Lung cancer screening
○ Adults 50 to 80 years with 20 pack-year smoking history and currently smoke, or have quit within the past 15 years ■ Low-dose computed tomography (CT) every year ○ Stop screening once a person has not smoked for 15 years or has a health problem that limits life expectancy or the ability to have lung surgery ○ Grade: B
27
Lung cancer risk factors
○ Cigarette smoking (greater than a 10 fold increase) ■ Former smokers are at reduced risk compared to current smokers ○ Second-hand smoke ○ Asbestos, arsenic, chemical exposure ○ Low fruit and vegetable intake ○ Ionizing radiation ○ Chronic lung disease – TB, emphysema ○ Certain inherited genetic traits may be a factor
28
Lung cancer S/S
○ Cough 8-75% ○ Weight Loss 0-68% ○ Dyspnea 3-60% ○ Chest pain 20-49% ○ Hemoptysis 6-25% ○ Fever 0-10% ○ Weakness 0-10%
29
Lung cancer Findings Suggestive of Metastasis
○ Weight loss > 10 lbs ○ Neurological – HA, syncope, seizure, altered mental status ○ Bone pain ○ Lymphadenopathy (SVCS) ○ Hoarseness ○ Pancoast tumor ○ Papilledema ○ Malignant pleural effusion
30
___ (tumor of the lung apex) can cause pain down the arm in an ulnar distribution, and can cause Horner syndrome
Pancoast tumor
31
Horner Syndrome
○ Sympathetic nerve palsy ■ Enophthalmos ■ Ptosis ■ Miosis ■ Anhidrosis
32
Lung Cancer diagnosis
○ Imaging – CXR, CT, MRI ○ Sputum cytology – low yield ○ Biopsy – bronchoscopy, percutaneous image guided FNA ■ Type of cancer based on morphology and cytology
33
Lung Cancer - Four major types
■ Small Cell Carcinoma: Common with tobacco use, more aggressive ■ Large Cell Carcinoma ■ Squamous Cell Carcinoma: Common with tobacco use ■ Adenocarcinoma: More common as smoking rates have decreased
34
Lung Cancer Staging
○ TNM classification – ie. lymph node sampling, metastatic spread, etc. ○ “Physiologic staging” – Tx tolerance? Consider comorbidities ○ Genetic testing and DNA Sequencing
35
Lung Cancer Treatment – NSCLC
○ Surgical resection ○ Radiation and/or chemotherapy if more advanced ○ Immunotherapy based on specific gene expression ■ T cells become active against tumor cells
36
Lung Cancer Treatment – SCLC
○ More highly aggressive form of cancer, high relapse potential ○ Chemotherapy and/or radiation as first line ○ Surgery is not often indicated
37
Most common gynecologic malignancy
Uterine cancer
38
Uterine cancer incidence
● 66,570 cases in the US in 2021 ● 12,940 deaths in the US in 2021
39
Different types of tumors of the uterus
○ Benign – uterine fibroid (leiomyoma) ○ Malignant (leiomyosarcoma) ■ Most (80%) are endometrial adenocarcinomas
40
Uterine cancer Risk Factors
○ Obesity ○ Postmenopausal estrogen treatment ○ Lynch Syndrome ○ Long-term use of Tamoxifen
41
Tamoxifen BBW
Tamoxifen antiestrogenic in the breast but is associated with weak estrogenic effects in uterine epithelium→ increased risk of endometrial cancer
42
Uterine cancer S/S
○ Postmenopausal bleeding ○ Premenopausal women – atypical bleeding between cycles ○ Pelvic mass...with or without bleeding ○ Pelvic pain (+/-)
43
Uterine cancer Diagnosis
○ Imaging – Ultrasound ○ Biopsy – endometrial biopsy w/o or w/ Hysteroscopy
44
Uterine cancer staging
○ TNM ○ 75% of disease is localized to the uterus (Stage 1) ○ Genetic testing – Lynch
45
Uterine cancer treatment
○ Hysterectomy with removal of ovaries and fallopian tubes ■ Stage 1 ○ Chemotherapy for later stages ■ Node involvement ○ Immunotherapy
46
Two main categories of lymphoma
○ Hodgkin's Lymphoma ○ Non-Hodgkin's Lymphoma
47
Lymphoma Risk Factors
○ Epstein Barr, HHV-8, HTLV-1 ○ H. pylori and MALT ○ Acquired or inherited immunodeficiency – HIV (17x higher) ○ Autoimmune diseases ○ Organ transplant
48
____ _ is bimodal peak at 20’s and 50’s +, enlarge lymph node typically found in upper body, presence of _____ , easier recognize and treat
Hodgkins; Reed-Sternberg Cells
49
_____ rates rise with age >40, but still common in children and young adults, depending on the type, arise anywhere in the body, less predictable, harder to treat
Non-hodgkin's
50
T/F Non-hodgkin's is easier to treat
F
51
Lymphoma S/S
○ Painless, firm, “rubbery” lymph nodes ■ May become painful after alcohol consumption ○ Fatigue ○ Pallor ○ Fever ○ Night sweats ○ Hepatosplenomegaly ○ Generalized pruritus
52
Lymphoma Diagnosis
○ Imaging – U/S, CT ○ Excisional biopsy ○ Bone marrow biopsy
53
Lymphoma Staging
○ Varies based on type – DNA analysis ○ Blood levels – Peripheral blood blast counts and Lactate dehydrogenase, etc
54
Lymphoma Treatment
○ Chemotherapy ○ Bone marrow transplant ○ Immunotherapy ○ Surgery if indicated (based on type)
55
Lymphoma monitoring
○ Imaging – PET/CT, CT, MRI ○ Possible bone marrow or tissue Bx (depending on cancer involvement)

Heme/Onc Exam 1 (7 decks)

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