Oncology

What is the definition of cancer?

Uncontrolled growth and proliferation of abnormal cells.

What differentiates benign from malignant tumors?

Benign tumors can become malignant if insulted; malignant tumors invade, metastasize, and evade apoptosis.

What are hallmark signs of cancer cells?

Evasion of apoptosis, atypical energy production, and immune system evasion.

What does cancer remission mean?

Reduction or disappearance of cancer signs and symptoms; not always a cure but indicates less detectable disease.

What are the top 4 most common cancers in the U.S.?

Lung, breast, prostate, colorectal.

Which cancers are most lethal?

Lung, colorectal, pancreatic, and breast cancers.

Which cancers are increasing in men and women?

Men → Prostate; Women → Liver and bile duct.

Which cancers are decreasing in men?

Lung and laryngeal cancers.

What are acquired causes of cancer?

Radiation, chemical carcinogens, viral infections (EBV, HPV).

What are inherited causes of cancer?

Lynch syndrome and other genetic mutations.

List common cancer risk factors.

Age, smoking, obesity, alcohol, sun exposure, gender, diet, occupational exposures.

How does obesity increase cancer risk?

Chronic inflammation and hyperinsulinemia promote abnormal cell growth.

What is the Two-Hit Hypothesis?

1st hit = loss of tumor suppressor gene; 2nd hit = activation of proto-oncogene → tumor formation.

How can drugs affect gene expression in cancer?

By altering methylation or histone modification without changing DNA sequence.

What tests (labs or scans) detect or screen for cancer?

MRI, CT, targeted ultrasound, PET, CBC, hormones, liquid biopsy.

What are common screening tests by cancer type? ( cancer type specific

Mammogram (breast), Pap (cervical), PSA (prostate), colonoscopy (colon).

What is a liquid biopsy?

Blood test detecting circulating tumor cells or cfDNA/RNA for screening and monitoring.

What cell defines Hodgkin lymphoma?

Reed–Sternberg B cells.

What virus is associated with Hodgkin lymphoma?

Epstein–Barr virus (EBV).

What are symptoms of lymphoma?

Fever, night sweats, weight loss, fatigue.

What is multiple myeloma?

Plasma-cell cancer in bone marrow; 60% 5-yr survival; long remission but no cure.

What are sarcomas?

Bone or soft-tissue cancers (osteosarcoma, leiomyosarcoma, liposarcoma, Kaposi).

Which skin cancer is most aggressive?

Melanoma.

What are skin-cancer risk factors?

Fair skin, light hair/eyes, sunburns, arsenic exposure, immunosuppression.

Which type of sunscreen is preferred?

Mineral (physical) sunscreen.

What is chemotherapy?

Nonspecific cytotoxic agents that kill rapidly dividing cells (both cancer and normal).

What is radiation therapy used for?

Local control and pain management; not curative but slows progression.

What cancers use hormone therapy?

Prostate and breast cancers.

What is immunotherapy?

Treatment that stimulates the immune system to attack cancer (CAR-T, checkpoint inhibitors).

What is photodynamic therapy?

Light-activated drugs that destroy cancer cells.

What is the Warburg effect?

Cancer cells use anaerobic glycolysis → lactate buildup → acidic immunosuppressive environment.

Which medication counteracts the Warburg effect?

Metformin.

Which chromosome defines CML?

Philadelphia chromosome (BCR-ABL).

What defines Polycythemia Vera?

Elevated H/H causing hyperviscosity and thrombosis.

List major cancer-prevention strategies.

Exercise, healthy diet, HPV vaccine, sun protection, routine screening, smoking cessation.

Why is DVT in cancer considered provoked?

Due to ↑ factor X, cytokines, platelet activation, and endothelial damage from chemo.

How is cancer-associated DVT treated?

Heparin /LMWH → DOACs (Apixaban 10 mg BID × 10 days then 5 mg BID).

When should Apixaban dose be reduced?

Age ≥ 80, weight < 60 kg, or Cr > 1.5.

What causes pericardial effusion in cancer?

Thoracic malignancy, radiation, or renal impairment.

What is a complication of untreated pericardial effusion?

Cardiac tamponade → needs drainage or pericardial window.

When does febrile neutropenia typically occur post-chemo?

1–2 weeks after chemotherapy.

What is first-line management? for neutropenia fever

Immediate broad-spectrum antibiotics (Zosyn + Vancomycin).

What are the causes of thrombocytopenia?

Consumption (trauma/surgery), destruction (HIT), production failure (bone marrow suppression).

What are hallmark lab findings in TLS?

↑K, ↑Phosphate, ↑Uric acid, ↓Calcium.

When is TLS most likely to occur?

12–72 hours after starting chemo or radiation.

How is TLS managed?

IV hydration, Rasburicase or Allopurinol, phosphate binders, calcium gluconate, dialysis if severe.

What is GVHD?

Immune attack on host tissues after bone-marrow transplant.

What are symptoms of GVHD?

Rash, liver inflammation, diarrhea, GI bleeding.

How is GVHD treated?

Immunosuppression (Tacrolimus, Rituximab).

What causes SVC syndrome in cancer?

Compression by lung cancer, lymphoma, or thrombosis.

What are key symptoms of SVC syndrome?

Facial/upper-body edema, JVD, stridor, seizures.

What is the treatment for SVC syndrome?

Stent placement or radiation therapy.

What characterizes nephrotic syndrome?

Proteinuria > 3.5 g/day, hypoalbuminemia, edema, lipiduria.

How does cancer cause nephrotic syndrome?

Tumor cells clog glomeruli → protein and lipid leakage.

What causes Cushing’s in cancer?

Ectopic ACTH/cortisol production (lung or thyroid cancer).

How is Cushing’s diagnosed?

24-hour urine cortisol and dexamethasone suppression test.

What is the treatment for Cushing’s?

Adrenalectomy or tumor resection.

What serum level defines hypercalcemia of malignancy?

Calcium > 10.5 mg/dL.

What causes hypercalcemia of malignancy?

Tumor secretion of PTH-related peptide (PTHrP) → bone resorption and Ca release.

What are symptoms of hypercalcemia of malignancy?

Weakness, confusion, dehydration, sluggish reflexes, constipation.

How is hypercalcemia treated?

IV fluids, bisphosphonates, calcitonin, glucocorticoids, loop diuretics, rehydration.