Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
25 Cards in this Set
- Front
- Back
|
Lecture 24 – lymphoma
|
ok
|
|
|
Hodgkin’s disease – epidemiology:
Clear bimodal distribution -Early peak in the mid to late ... - Second peak after .... -Rarely seen in children less than 5 ... cure rate (overall 80-90%) -Very effective therapies for several decades -Have been able to see late effects in cancer survivors |
20’s
50 High |
|
|
Hodgkin’s disease – clinical presentation:
Painless supraclavicular or cervical adenopathy -Firm, “rubbery” lymph nodes, ... ... lymphadenopathy -Present in at least 2/3 of patients -Other symptoms of tracheal or bronchial compression. - Anesthesia evaluation should take place prior to any sedation “...” symptoms -Fever >38 without source -Weight loss of > 10% in the past 6 months, -Drenching night sweats -Pain and pruritus are occasionally noted. Non-specific symptoms -Fatigue, malaise, anorexia |
usully non-tender
Mediastinal B |
|
|
Hodgkin’s disease – diagnosis:
... presentation Imaging -... – look for mediastinal widening -CT of neck/chest/abdomen (needs to include Waldeyer’s ring) Labwork: Non-specific changes -ESR is usually elevated and may be used in follow-up ... confirms diagnosis and histology Staging of disease -Surgical staging occasionally required |
Clinical
CXR Biopsy |
|
|
Hodgkin’s disease –... cells:
Considered pathognomonic Suspected lymphocytic origin -Expresses surface markers consistent with a B/T cell lineage Histologic features -Large ,abundant ... -Multiple/multilobed ... -Dark nuclear membrane -Prominent nucleoli with halo-like clear zone |
Reed-Sternberg
cytoplasm nuclei |
|
|
Hodgkin’s disease – treatment:
Combination therapy with ... and ... for most patients Radiation therapy in Hodgkin’s disease -Selected patients with localized disease may be treated with radiation alone -When combined with chemotherapy effective radiation dose can be ... Chemotherapy in Hodgkin’s disease -Multiple cycles of ABVD (adriamycin/bleomycin/vinblastine/dacarbazine) -Additional drugs used for patients with advanced disease |
radiation
chemotherapy reduced |
|
|
Hodgkin’s disease – prognosis:
Many of these are interrelated (e.g. histologic type and clinical stage) Clinical stage – The less extensive the disease, the ... the prognosis Histologic type – LP & NS >MC>LD Tumor cell burden – Bulky disease ... Systemic symptoms – “B” symptoms --> ... outcome Age – Patients over 40 have a ... prognosis |
better
worse poorer poorer |
|
|
Hodgkin’s disease – late effects:
Chemotherapy-related effects -... malignancies *Risk is around 4% at 5 years and 11% at 10 years following therapy *... agents such as mechlorethamine, chlorambucil and procarbazine have been implicated in the development of secondary AML in a dose-dependent manner -Cardiotoxicity: Anthracycline-related cardiomyopathy -Pulmonary ... due to bleomycin -Impaired ... due to alkylating agents Radiation-related effects -Impaired bone ... in pre-pubertal patients -Chronic damage to lung and cardiac tissues -Some increased risk of solid tumors within treatment field |
Secondary
Alkylating fibrosis fertility growth |
|
|
Burkitt’s lymphoma – cytogenetic abnormalities:
Approximation of immunoglobulin gene enhancers to the ... gene -Marked overexpression of the ... transcription factor -Maintains the cell in a proliferative state Translocations resulting in this abnormality -(8:14), 85% of Burkitt’s cases -(2;8) and (8;22), 15% of Burkitt’s cases One of these translocations is almost invariably present in Burkitt’s lymphoma |
c-myc
c-myc |
|
|
Burkitt’s lymphoma:
Clinical and laboratory findings: Clinical findings: -... of jaw or neck Symptoms of ... obstruction -Pain, nausea, vomiting -Intussusception, -Palpable abdominal mass Lab findings: -... LDH -Electrolytes may reveal elevated potassium -Elevations in uric acid and phosphorus also common -Examination of marrow and CSF **High risk of tumor ... syndrome** |
Swelling
intestinal Elevated lysis |
|
|
lecture 28 – oncologic emergencies
|
ok
|
|
|
Cardiorespiratory emergencies: Superior vena cava syndrome:
Definition -Constellation of symptoms arising from external ... or thrombosis of the SVC -“Superior ... syndrome” *Refers to compression of the trachea in addition to the SVC Occurrence in cancer patients -Most common in the ... and ... -Often the presenting sign in childhood lymphoblastic lymphoma |
blockage
mediastinal leukemias and lymphomas |
|
|
Cardiorespiratory emergencies: Superior vena cava syndrome:
Predisposition of the SVC to compression -Thin, compliant endothelial wall -Adjacent ... of mediastinum/thymus Mechanism -External ... of the SVC by tumor cells leads to restriction of venous return from the head and neck -Tracheal compression can also occur *More pronounced in ... patients |
lymph nodes
compression younger |
|
|
Neurologic emergencies in cancer patients: Cord compression
May be the main presenting sign at diagnosis Can occur with almost any neoplasm ... pain in any patient with cancer should always be taken seriously -May reflect ... disease (adults) -May reflect ... tumor (children) Clinically presents as back pain (80%) -Advancing weakness, parasthesias, over time -Once overtly symptomatic, changes may be permanent |
Back
metastatic primary |
|
|
Cord compression:
Management -High-dose ... (usually IV) *Given based on history/physical *Unavailability of prompt imaging not a reason to defer Prompt imaging of spinal cord via MRI Definitive therapies -...: (especially if diagnosis not known) -...: (if diagnosis known and tumor responsive) -...(for leukemias/lymphomas) |
dexamethasone
Surgery Radiation Chemotherapy |
|
|
Tumor lysis syndrome:
Tumor lysis syndrome (TLS) refers to the ... abnormalities resulting from massive tumor cell death at the onset of therapy, with associated complications Leukemias/lymphomas are associated with TLS: -T-cell ALL -Lymphoblastic lymphoma -Burkitt’s lymphoma -AML with ... WBC count High S phase cell fraction in lymphomas and leukemias -Massive death of tumor cells at ... of therapy -Release of cellular contents into the bloodstream |
electrolyte
high onset |
|
|
Electrolyte disturbances in tumor lysis syndrome:
... -Rapid increase in potassium may lead to cardiac arrest ... -Uric acid crystals form in renal tubules --> renal failure ... -Precipitates out in small vessels and renal tubules (CaPO4) ... – this is a consequence of Hyperphosphatemia and should not be treated unless it is symptomatic |
Hyperkalemia
Hyperuricemia Hyperphosphatemia Hypocalcemia |
|
|
Lecture 29 – advances in cancer therapy
|
ok
|
|
|
Principles of chemotherapy:
Single vs. ... -agent chemotherapy ... chemotherapy -Chemotherapy following surgery/radiation -Goal is to treat small “micrometastases” -Neo-adjuvant therapy for some tumors Dose intensity -Chemotherapy given at ... tolerated dose ... in treatment also a factor |
multi
Adjuvant highest Timing |
|
|
Principles of chemotherapy: Dose intensity:
... doses of chemotherapy than previously = more effective treatment Possible because of -Discovery/therapeutic use of ... (shortens time of neutropenia) -Improvements in ... medicine -Improved drug ... -Stem cell ... or marrow transplant - “Antidotes” such as leucovorin, MESNA |
Higher
G-CSF transfusion delivery rescue |
|
|
Immunotherapy and cancer:
... therapy -Antigen-specific T-cells grown in vitro, reinfused -Success with EBV-associated post-transplant lymphoproliferative disorders |
Adoptive
|
|
|
... in cancer therapy:
Erbitux -Binds to EGF-R, prevents activation of receptor -Some benefit in colorectal, head and neck cancers Herceptin -Binds to HER2 (EGF-R family) -Some benefit in refractory breast cancer Rituximab -Monoclonal antibody against CD-20 B-cell surface antigen -Mechanisms of action *Complement-mediated cell lysis *ADCC *Binding to B-cells can induce apoptosis -Addition of ... to chemotherapy more effective than chemotherapy alone |
Monoclonal antibodies
rituximab |
|
|
Examples of ... therapies:
Antisense nucleotides Tyrosine kinase inhibitors -Example: imatinib (Gleevec) *Specific inhibitor of the BCR/ABL fusion protein *Also inhibits activity of PDGF, KIT receptors *Very effective in CML, gastrointestinal stromal tumors Angiogenesis inhibitors |
molecular
|
|
|
Clinical trials:
Rationale -Cancers are life-threatening diseases -Treatments are expensive, with significant morbidity -Need to have a system for evaluating how cancer is treated -Need to avoid unnecessary toxicity Allow new therapies to be tested in a ... manner -Safety -Anti-tumor activity -Comparison with standard treatments Multicenter studies -Large numbers of patients provides statistically relevant data -Ability to ... patients to new or standard therapy -Can address several questions within a single study |
controlled
randomize |
|
|
Know the commonly recognized late effects of cancer therapy:
... – skin rash (may progress to blistering) ... - (diarrhea, pain, nausea) ... - (Cholestasis, Veno-occlusive disease) |
GVH
GI Liver |
