Onc cumulative

I def put too much information on here srry

what are the tumor marks for breast cancer?

• CA 15-3

• CA 27-29

• CEA

What are the tumor markers for ovarian cancer?

CA 125

what are the tumor markers for testicular cancer?

• AFP

• beta-hCG

• LDH

what are the tumor markers for prostate cancer?

PSA

what are the tumor markers for lung cancer?

CEA

what are the tumor markers for stomach cancer?

• CEA

• CA 19-9

what are the tumor markers for pancreatic cancer?

CA 19-9

what are the tumor markers for gallbladder cancer?

• CEA

• CA 19-9

What are the tumor markers for colorectal cancer?

CEA

what are the tumor markers for hepatocellular cancer?

AFP

What are the screening guidelines for colorectal cancer?

regular risk pts should start at age 45 and continue until age 75 w/ one of the following

• colonoscopy x 10 yrs (preferred)

• flex sigmoidoscopy x 5 yrs

• double contrast barium enema x 5 yrs

what are risk factors for CRC?

• increasing age (>50 in 90% cases)

• inflammatory bowel dz (highest risk factor)

  • ulcerative colitis

  • Crohn’s dz

• FHx (inc risk if under 45)

• diets high in fats/red meats

• african Americans & ashkenazi jews

What are the recommended screening guidelines for breast cancer in an average risk patient?

• 45-54: yearly mammograms

• 55+: every 2 yrs

• screenings should continue as long as in good health and expected to live at least 10 more years

A yearly MRI + mammogram is recommended for high risk individuals if they meet what criteria?

• lifetime risk >20%

• known BRCA1/BRCA2 mutation

• 1st degree relative w/ gene mutation

• hx XRT to chest b/t ages 10-30

• have (or 1st degree relative) w/ syndrome like cowden syndrome

what are risk factors for breast cancer?

• Phx, FHx brest or ovarian cancer

• dense breasts

• > 55 y/o

• menarche < 12 or menopause > 55

• age at first birth > 30 or nulliparous

• obese / sedentary

• alcohol intake > 2-5 drinks daily

• HRT/OCP use (estrogen ± progestin)

• hx XRT to chest

• DES exposure

What are the screening guidelines for prostate cancer?

informed decision through discussion w/ PCP ab risks/benefites, w/ an OFFER for PSA and DRE

• average risk: 54-69 every 2+ yrs

• high risk: 40-54

  • AA, fix in first degree relative dx < 65

• not recommended in >70 or less than 10-15 yr life expectancy

what are risk factors for prostate cancer?

• older age; >50

• FHx

  • 1st degree inc risk 2 fold

  • two 1st degree inc risk 9 fold

  • hereditary cancer develops earlier (< 50)

  • risk is higher w/ affected brother than an affected father

• BRCA1 / BRCA2 mutations

• Lynch syndrome

• african american

• high sat fat diet

Auer rods seen on a peripheral smear is indicative of what type of leukemia?

AML

what leukemia is most common in adults (>60)?

AML

what is the presentation of AML?

• fatigue, SOB, fever

• night sweats, bone/joint pain

• increased infx

• increased bruising/bleeding (epistaxis, gingival bleeding, menorrhagia)

• petechiae/purpura

• pallor

• stomatitis, gingival hyperplasia, myeloid sarcome, leukemia cutis

• ± LAD, hepatosplenomegaly

How would labs look in AML?

• anemia, neutropenia, thrombocytopenia

• blasts on differential; BM bx >20% myeloblasts

• auer rods on peripheral smear

APL is a medical emergency and requires immediate treatment with what?

all trans retinoid acid (ATRA)

Which leukemia is associated w/ Philadelphia chromosome, t(9;22), and is often asymptomatic and has 3 phases- chronic, accelerated, and blast crisis?

CML

which leukemia was revolutionized by the discovery of PH and creation of BRC-ABL inhibitors?

CML

what is CML treated with?

• tyrosine kinase inhibitors (TKIs)

  • Imatinib (Gleevec)

  • Dasatinib (Sprycel)

• allogeneic transplant for those who fail TKI

• incurable, but highly controllable; goal is to control chronic phase and prevent progression to blast crisis

what is the most common childhood malignancy?

ALL

what cancer has a bimodal distribution, peaking under 5 yrs and again over 50?

ALL

what is the clinical presentation of ALL?

• acute onset

  • fever

  • fatigue

  • inc infx

  • inc bruise/bleed

  • focal neuro deficitis / seizures due to CNS involvement

• petechiae, pallor

• hepatomegaly, splenomagly

• LAD

what would a bone marrow biopsy in ALL show?

> 20% lymphoblasts

what is treatment for ALL?

• children: intensive combo chemo

• adults: less intense combo chemo

• both require CNS prophylaxis due to high prevalence of CNS dz

• stem cell transplant for specific cases (more adults)

what is the most common leukemia overall?

CLL

which leukemia is a “disease of the elderly (71)”?

CLL

Smudge cells on a peripheral smear indicate what type of leukemia?

CLL

what is the treatment for CLL?

• active surveillance- watch and wait

• initiate tx only when sx

• chemo- FCR, Ibrutinib

• allogeneic stem cell transplant (reserved for aggressive dz in young pts)

what is a leukomoid reaction?

• elevated WBC due to prolonged, severe infx

  • ex: intra-abdominal abscess

• similar to CML/Acute leukemia but

  • WBC >50,000

  • predominantly neutrophils and bands

  • no blasts are present

  • no PH

large, bi nucleate cells w/ an owl’s eye appearance are called _____ and associated with ______ ?

Reed Sternberg cells; hodgkin lymphoma

which lymphoma has a bimodal distribution, peaking bt 15-30 and >50?

HL

which lymphoma is assoc w/ EBV and HIV?

HL

what is the clinical presentation of HL?

• asymptomatic, non tender lump

• B sx- fever, night sweats, wt loss (slightly worse prognosis)

• pruritius

• pain w/ drinking alcohol

• cervical LAD

• leukocytosis / eosinophilia

how do you diagnose hodgkin lymphoma (HL)?

• excisional bx (core needle + FNA not sufficient)

• CBC

• PET, CT

• BM bx if advanced

what staging does HL use?

modified Ann Arbor

what is the treatment for hodgkin lymphoma?

chemo → ABVD x 6 cycles (pulm/cardio toxicity; get echo + PFTs first)

± XRT, brentuximab, autologous transplant, allogeneic or immunotherapy nivolumab

Before treating HL w/ ABVD, what is required?

echo and PFT’s due to cardio and pulmonary toxicity

Which cancer best matches the following description?

• 90% B cell in origin

• peaks 20-40 y/o

• is a CLASSIFICATION, not a DIAGNOSIS

NHL

What are the categorizations of NHL?

• indolent: “watch and wait” if no sx

  • CLL/SLL; follicular lymphoma

• intermediate

  • DLBCL

• agressive

  • ALL, burkitt lymphoma

what is the clinical presentation of NHL?

• painless enlargement of LN

• B sx: fever, night sweats, wt loss

• extrinsic compression if advanced

  • SVC syndrome

  • airway obstruction

  • cord compression

  • gastric outlet obstruction

How do you dx NHL?

• LN bx - excisional preferred, core acceptable

• PET or CT

• BM bx

• CBC, LDH

• lumbar puncture if sinus, testicular, orbital, epidural, or BM involvement

How is NHL staged?

lugano classification (derived from Ann Arbor)

Indications for tx of follicular lymphoma (FL) or indolent lymphoma?

• symptomatic / bulky LAD

• significant B sx

• significant cytopenia

• transformation to aggressive NHL

• tx w/ chemo → rituximab, R-CHOP, R-ICE

• goal of tx to achieve longer remission

what is the most common NHL?

DLBCL

diffuse large b-cell lymphoma (DLBCL)?

• intermediate agressive lymphoma

• MC NHL

• tx: R-CHOP

  • goal → cure

What cancer is a very aggressive tumor of immature B-cells characterized by diffuse infiltration of small non-cleaved lymphocytes mixed w/ large cells?

burkitt lymphoma

what is pathognomic to burkitt lymphoma?

starry sky appearance - diffuse infiltration of small non-cleaved lymphocytes mixed w/ large cells

Treatment for burkitt lymphoma?

aggressive combo chemo similar to leukemia; highly curable

How does burkitt lymphoma present as the endemic form in children in Africa?

local tumor to jaw w/ metastases to kidney, ovaries, and CNS

strong EBV association

burkitt lymphoma presentation in western countries?

rapidly dividing tumor of abdominal LN

strong HIV association, not EBV

What are the 2 most common types of cutaneous T-cell lymphoma?

mycosis fungoides (MC) → patches, plaques, or tumors

sezary syndrome → presence of lymphoma cells in blood; extensive thin, red itchy rashes cover >80% of body

Rare type of NHL that affects B cells in the process of developing into plasma cells (similar to MM) that also has the name of waldenstroms macroglobulinemia?

lymphoplasmacytic lymphoma

Malignant plasma cells over produce ____ which is responsible for sx of MM

antibodies / M protein

what is the clinical presentation of multiple myeloma (MM)?

• bone pain; pathologic fractures

• pallor

• fatigue

• ARF

• infx (inability to make normal abs)

• hyper viscosity syndrome → mucosa bleeding, vertigo, N, vision probs, AMS

  • (d/t extreme levels of abs creating smudging of blood)

What would an evaluation of multiple myeloma (MM) look like?

• CBC: anemia, thrombocytopenia

• CMP: hypercalcemia, elevated sCr

• proteinuria

• SPEP: elevated M spike

• UPEP: bence jones proteins

• skeletal survey: lyrics lesions, moth eaten appearance

• BM bx: plasma cell infiltration

• CRAB criteria → end organ damage

What is the CRAB criteria for diagnosis MM related to end organ damage?

• hypercalcemia: >11

• renal insufficiency: high serum Cr >2 or CrCl < 40

• anemia: Hgb < 10

• lytic bone lesions

RBC’s stacking together in long chains when serum proteins/plasma proteins are high is known as _____

rouleux formation

treatment for MM?

• incurable- goal to prolong remission and inc QOL

• triple therapy chemo

• XRT for pain control of bony lesions

• BiTE therapy for refractory

Why is bony disease common in MM?

plasma cell activation of osteoclasts and inhibition of osteoblasts

What is an asymptomatic, premalignant state of myeloma that’s common in adults over 70?

monoclonal gammopathy of undetermined significance (MGUS)

How is MGUS different from MM?

BM plasma cells < 10% WITHOUT end organ damage (CRAB criteria)

MM → BM plasma cells _____

MGUS → BM plasma cells _____

MM ≥10%, MGUS < 10%

Which kind of breast cancers more often recur and are more aggressive?

HER2 oncogene

clinical presentation of breast cancer?

• most often: single, nontender, firm, immobile mass MC in upper outer quadrant

• less often:

  • peau dorange skin thickening/changes (immediate surgical onc referral)

  • nipple discharge or retraction

  • breast enlargement or shrinkage

  • palpable axillary or supraclavicular LNs

which of the following is a selective estrogen receptor modulator (SERM) than can treat ER-positive breast cancer?

Tamoxifen

what staging system does breast cancer use?

TNM

(ipsilateral axilla staged w/ sentinel node bx)

Breast cancer w/ HER2 biomarkers should be treated with ____

trastuzumab

what type of breast cancer is the most aggressive w/ the worst survival, higher likelihood of metastatic disease, and limited treatment options?

triple negative - ER, PR, HER2

which treatment is best to treat breast cancer in women before AND after menopause?

SERM- Tamoxifen

which of the following is the best to treat breast cancer in post menopausal women?

Aromatase inhibitor - exemastane

what are risk factors for ovarian cancer?

• FHX

• age

• hereditary- BRCA1, BRCA2, Lynch syndrome

• nulliparity (pregnancy is protective)

• HRT

what has replaced cervical cancer as the leading cause oaf death from genital cancer?

ovarian cancer

evaluation of ovarian cancer?

• presents w/ vague abdominal sx

• Ca 125 level (95% predictive of recurrence)

• genetic testing- BRCA gene

• transvaginal u/s

• abdominal/pelvic CT

what is recommended for women between 35-40 who are high risk for ovarian cancer (with FHX ovarian/breast cancer or BRCA mutations)?

prophylactic oophorectomy or salpingo-oophorectomy

Treatment for ovarian cancer?

• surgery → surgical staging; TAH w/ BSO w/ omentectomy

• chemo- cisplatin + paclitaxel or docetaxel

• XRT

what factors offer protection for ovarian cancer?

• child bearing

• oral contraceptives containing estrogen and progesterone x 5 yrs

• breast feeding x 1 yr

what accounts for 95% of testicular cancers?

germ cell tumors (GCT) divided every bt seminomas and nonseminomas

how does testicular cancer present?

• nodule or painless swelling in 1 testicle noted incidentally

• dull ache or heavy sensation in lower abdomen, perianal, or scrotum

• acute pain and gynecomastia (uncommon)

In any man w/ a solid firm mass w/in the testis, what must be considered the diagnosis until proven otherwise?

testicular cancer

why do you not biopsy germ cell tumors?

high risk of spreading cancer cells

what staging does testicular cancer use?

TNM

what is the most common non skin cancer in men?

prostate cancer

what PSA level would lead to a diagnosis of prostate cancer?

> 4.0 ng/mL

How high of an increase in PSA per year would require a referral?

> 0.75 ng/mL

what is the gold standard for prostate cancer dx?

prostate biopsy; 12-14 cores

Gleason score isn used for _____

prostate cancer

what is the most common kidney cancer?

renal cell carcinoma (RCC)

what is the classic triad presentation of RCC?

flank pain, hematuria, and palpable abdominal renal mass

what is the most common subtype of RCC?

clear cell

What staging system does RCC use?

TNM

treatment for RCC?

can be curative w/ localized disease w/ surgical resection- radical or partial nephrectomy

what accounts for 90% of bladder cancers?

urothelial (previously transitional cell)

what is the most important risk factor for the development of bladder cancer?

cigarette smoking

what is the most common presenting symptom of bladder cancer?

painless intermittent gross hematuria present throughout micturition