Oncology Review + Antineoplastic Agents

Front 1

Distinguish leukemoid rxn from CML

Back 1

aka: "left shift" ↑ leukocyte alkaline phosphatase [both have ↑neutrophils and band cells]

Front 2

Hodgkin's staging. A vs B?

Back 2

I: single LN. II: >1LN III: >1LN both sides diaphragm IV: metastasis out of LNs

A = no constitutional sx
B = constitutional sx

Front 3

Hodgkins 1) localized or not 2) contiguous or non contiguous 3) characteristic cells 4) can be associated with

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1) localized 2) Contiguous 3) RS cells 4) EBV

Front 4

Hodgkins more common in men or women

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men except for nodular sclerosing type (equal)

Front 5

Better prognosis to have more lymphocytes or RS cells in hodgkins?

Back 5

lymphocytes

Front 6

RS cells

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bilobed, owl's eyes, CD30+15+ necessary but not sufficient for diagnosis of hodgkin's

Front 7

Best prognosis hodgkins

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nodular sclerosing form

Front 8

t(8;14)

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Burkitt's lymphoma (cMyc & heavy chain Ig translocation)

Front 9

t(11;14)

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Mantle cell (translocation of cyclin D1 & heavy chain Ig)

Front 10

t(14;18)

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follicular cell lymphoma (translocation of heavy chain Ig & bcl-2)

Front 11

Sheets of lymphocytes, interspersed macrophages

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starry sky appearance of burkitt's

Front 12

endemic form vs sporadic form of burkitts

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endemic: jaw lesion Africa sporadic: pelvis or abdomen

Front 13

Most common adult non hodgkin lymphoma

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Diffuse large b cell. Mature T cell origin sometimes

Front 14

CD5+ non hodgkins lymphoma

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mantle cell

Front 15

cutaneous lesions, aggressive NHL

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adult t cell

Front 16

cutaneous patches/nodules, NHL, CD4+ cells, cerebriform nuclei

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Mycosis fungoides/Sézary syndrome

Front 17

Multiple Myeloma: think CRAB

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hyperCalcemia, Renal insufficiency, Anemia, Bone lytic lesions/Back pain

Front 18

Monoclonal spike in MM

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M spike of IgG or IgA

Front 19

High yield associations with MM

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Primary amyloidosis (RF), LYTIC bone lesions, M spike, Ig light chains (bence jones), Rouleaux formation

Front 20

Plasma cells with clock face chromatin and intracytoplasmic inclusions

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MM

Front 21

if M spike = IgM?

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waldenstrom's macroglobulinemia. HYPERVISCOSITY symptoms, no lytic bone lesions

Front 22

Trisomy 21 is associated with what leukemia

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ALL

Front 23

Smudge cells.

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CLL

Front 24

<15 yo, mediastinal mass, ↑lymphoblasts in peripheral smear and BM

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T cell ALL

Front 25

Translocation in ALL with better prognosis

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t(12;21)

Front 26

ALL cells are + for what markers

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TdT+ (preB and preT cells) & CALLA+

Front 27

>60 yo, autoimmune hemolytic anemia, smudge cells

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CLL

Front 28

SLL

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same as CLL except CLL has ↑ lymphocytosis

Front 29

Mature b cell tumor in elderly that is TRAP positive

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hairy cell leukemia

Front 30

Tx for hairy cell

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cladribine (adenosine analog)

Front 31

DIC is a common presentation in

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AML [auer rods release)

Front 32

t(15;17)

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AML auer rods vit A tx DIC ↑myeloblasts on smear

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↑neutrophils, metamyelocytes, BASOPHILS, very low leukocyte alkaline phosphatase

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CML (9;22, bcrabl philadelphia chromosome, etc)

Front 34

blast crisis

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CML transforms to AML or ALL, quick death

Front 35

peroxidase positive cytoplasmic inclusions

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Auer bodies

Front 36

t(11;22)

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ewing sarcoma (EWS/FLI fusion protein)

Front 37

Lytic bone lesions, skin rash, S100 & CD1a cells

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Langerhan's cell histiocytosis (birbeck "tennis rackets" on EM)

Front 38

JAK2 is involved in

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myelofibroproliferative disorders (other than CML such as PV, ET, myelofibrosis)

Front 39

Intense itching after hot shower

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Polycythemia Vera (↑Hct)

Front 40

↑ plts and JAK2 involved

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Essential thrombocytosis

Front 41

teardrop cells

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myelofibrosis

Front 42

relative polycythemia

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↑ plasma volume

Front 43

Lung disease, CHF, high altitude: type of polycythemia

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appropriate absolute (↑ RBC ↓O2 saturation makes it 'appropriate')

Front 44

RCC, Wilm's tumor, cyst, HCC, hydronephrosis: type of polycythemia

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Inappropriate absolute (↑RBC mass no change in O2 sat)

Front 45

↑ plasma volume and ↑↑ RBC mass, EPO low =

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PV [EPO low b/c prolif w/o stimulation]

Front 46

Antidote for methotrexate

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leucovorn (folinic acid)

Front 47

5-FU antidote

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Thymidine

Front 48

Doxorubicin antidote

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dexrazoxane

Front 49

Cyclophosphamide antidote

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Mesna

Front 50

Cisplatin antidote

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Arnifostine

Front 51

Hodgkin's lymphoma tx antidote

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GM-CSF (molgramostim)

Front 52

antineoplastic drug resistance via

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MDR-1 ATP dependent efflux pump

Front 53

MTX moa

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inhibit dihydrofolate reductase.

Front 54

non neoplastic uses MTX

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abortion, ectopic pregnancy, rheumatoid, psoriasis

Front 55

5-FU moa

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thymidylate synthase ↓ dTMP ↓ DNA

Front 56

Cytarabine (Ara-C) MOA

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pyrimidine analog inhibits DNA pol

Front 57

Azathioprine, 6 MP, 6 TG moa

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purine analogs ↓ de novo purine synthesis and activated by HGPRT (Do not give with allopurinol except 6-TG)

Front 58

antimetabolite antineoplastic agents work on which phase of cell cycle

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S phase

Front 59

cross BBB and enter CNS, tx for brain tumors

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nitrosoureas (-ustine ending)

Front 60

Alkylating agent

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cyclophosphamide and cisplatin, busulfan

Front 61

intercalating agents

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daunorubicin & doxorubicin & dactinomycin D

Front 62

Uses of dactinomycin D

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wilm's tumor, ewing's sarcoma, rhabdomyosarcoma

Front 63

Vincristine vs vinblastine S/E

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vincristine: neurotoxicity, vinblastine blasts your BM

Front 64

vincristine vinblastine moa

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block MT polymerization

Front 65

paclitaxel moa, use

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hyperstabilize MTs in M phase, used for ovarian and breast CA

Front 66

testicular carcinoma tx

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cisplatin

Front 67

moa etoposie

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inhibit topoII

Front 68

hydroxyuria moa

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increases HbF, and decreases DNA synthesis.

Front 69

Tamoxifen s/e

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increased risk of endometrial cancer

Front 70

trastuzumab moa

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mab against her2

Front 71

Imatinib

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against bcr-abl philadelphia chromosome. CML and GI stromal tumors

Front 72

Rituximab

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mab against CD20, non hodgkins lymphoma and rheumatoid arthritis

Front 73

Vemurafenib

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inhibits b-raf kinase with v600e mutation (metastatic melanoma)

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Bevacizumab

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mab against VEGF.

Front 75

toxicity of cisplatin/carboplatin

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acoustic nerve damage and nephrotoxicity

Front 76

Vincristine s/e

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peripheral neuropathy

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bleomycin, busulfan s/e

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pulmonary fibrosis (& skin hyperpigmentation with bleomycin)

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doxorubicin s/e

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cardiotoxicity

Front 79

trastuzumab s/e

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cardiotoxicity

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cyclophosphamide s/e

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hemorrhagic cystitis

Front 81

5-FU, 6-MP, MTX s/e

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myelosuppression

Front 82

Preventing tumor lysis syndrome

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allopurinol or rasburicase

Front 83

Pure red cell aplasia 1) characterized by 2) associated with

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1) Marrow failure with severe hypoplasia of erythroid elements, with normal granulopoiesis and thrombopoeisis 2) assoc with Thymoma, lymphocytic leukemias, and parvo B19 infection