Principle Onc

Front 1

Leukemia with the most number of new cases per year?

Lukemia with the most deaths per year?

Back 1

A. CLL (most new cases)

B. AML is the deadliest

Front 2

Most common mallignancy of childhood?

Back 2

ALL
Rapid onset and progression however highly curable

(rarely in adults)

Front 3

ALL Sx?

Back 3

Fatige/weakness 70%
Fever, Lymphad, Spleenomeg about 50%

Mediastinal Mass 10% (These are HUGE)

Front 4

ALL Labs

Back 4

Leukocytosis
BLast forms 92%
Anemia
Thrombocytopenia

Front 5

ALL bad prognosticators
-age
WBC
Cells
____involved
No___

Back 5

Over 30yo

WBC >30000

T-cell histology (b-cells good)

SNS involvment

No remission in 4 weeks

Front 6

MOst common form of ALL?

Back 6

ALL L2 french class
65% (rest L1 for most)

Front 7

ALL treatment?
Induction
-
-
Maintenance
-

CNS penetration
-
-

Back 7

Induction
-Vincristiene and Prednisone

Maintenance
-Low dose for 2 years
-Methotrexate and 6MP

CNS therapy
-Methotrexate
-Cytarabine

Front 8

Auer Rods

Back 8

AML****

(not in all cells but if you see that, pick it!)

Front 9

AML is what?

Back 9

Myeloid or monocytic increased bone marrow in blast form

* Auer Rods, (not in all cells)

*Highest number of deaths

Front 10

Predisopisitions to AML

Back 10

increaseing AGE
-Radiation
Chemo
And geentic diseases that cause DNA instability
(Downs, Blooms, Neurofibromatois, Fanconis

Front 11

AML Sx?
-
-
-
-

Back 11

Bleeding

Fever
Weak/fatigue

Cutnaeous Infiltrates

Front 12

AML Dx?

Back 12

Bone marrow biopsy

Front 13

AML French class
Which 2 most common?

***most important one and why?

Back 13

M2, and M4 more common


APL actually (M3)**** bc can be treated with vitamin A** (all-trans-retinoic Acid)
Rembmer APL is a subset of AML

Front 14

AML tx
Induction
-
-
-
Consolidation

Back 14

Induction
7+3
7 days in a row cytrabine
3 days in a row Idarubicin (with the cytrabine)

Consolidation of AML
High dose Cytrabine for 2-4 cycles

Front 15

Why is APL different from AML?
*-Marker?
-
-

Back 15

Specific t(15:17)

High incidence of DIC

Different therapy (Vitamin A APL bc its a defect with the retinoic acid receptor)

Front 16

APL presentation?
-
-
-

Back 16

Bleeding (classic picture of DIC)

Infxn

Fatigue

Front 17

APL treatment
-
-
-*
-

Back 17

Transfuse to support coagulopathy

Heroic measures (call superman)

**ARTA (all Trans retinoic Acid)

Aresnic
and Indarubicin

Front 18

CML what is it?

Back 18

Clonal Stem Cell disoder with incerased prolif of myeloid elements at all stages of differentiation


***Philidelphia chromasome

Front 19

CML gene****

Back 19

TRanslocation from chromosome 9---->22
forms the BCR-ABL gene t(9:22)
The philidelphia Chromasome ***

Front 20

CML labs
-
-
-
-

Back 20

Leukocytosis (150,000 mean**) woah!

THrombocytosis

WBC Differential looks like bone marrow, but there is just a lot of it!

Basophilia

Front 21

CML Tx
Old Best? and MOA?
(now there are two new drugz better?

Back 21

Imatinib Good old favorite and what FA says
MOA: ABL tyrosine Kinase inhibitor

He says
(Dasatinib and Nilotinib are the next gen drugs)
(

Front 22

What is CLL?

Back 22

Accumulation of non proliferating Mature T-cells

(lost ability to die, not hyperproliferative)

Front 23

CLL clinical Features?
Age
Sex
Sx
-
-
-
-

Back 23

Elderly (72 yo is mean)
Men 2:1
Sx
Often asymptomatic
lymphadenopathy is most common
Splenomegally
Infxns
AUtoimmune blood dyscrasis
(ITP and Autoimmune Hemolytic anemia)

Front 24

Smudge cells?

Back 24

CLL or artifact

Front 25

CLL tx?

Back 25

Usually tx symptoms, since old
and not curable

1. FCR
(fludarabin/cytoxan/rituximab)
+ others on slide

Front 26

Hairy Cell Lukemia
What is it?
Sex?
Age?
Clinical Features?

Back 26

Rare B-cell lukemia
Men 4:1 (men are hiary)
Older men

Clinical
Pancytopenia, splenomegally
Recurrent infections
Inaspirable bone marrow
TRAP (Tartrate resistant acid phosphatasis)

Front 27

Dx test for Hair cell leukemia?


What is tx?

Back 27

TRAP
(Tartrate resistant acid phsosphatase)


2CdA (chlorodeoxyadenosine)
1 course cures

Front 28

Non-Hodgkins Fast Facts
A. 85% are___cell line
B. Prevalence?
C. MC form in kids?
D. MC form in adults?

Back 28

A. B-cell mostly

B. Common

C. Burkitts Lymphoma (t 18:14 cmyc)

D. Diffuse B-Cell lymphoma

Front 29

Name the Non-Hodgkins T Cell lymphomas
-
-
-

Back 29

Lymphoblastic Lymphoma
Peripheral T-cell NHL
Mycoses FUngoides

(Most NHL are B-cell)

Front 30

Hodkins and Non-Hodgkins are staged the same
List the Critear for Stage
I
II
III
IV

Back 30

I - single node or region
II - two or more nodal regions on one side of the diaphragm
III - nodal involvement on both sides of the diaphragm
IV - diffuse involvement of an extranodal organ

Front 31

Indolent Lymphomas
A.Example in class
- special marker for it?
B. Speed of growht?
C.curable?
D.Tx ?

Back 31

A. Mantel cell Lymphoma
- ( Cyclin D1) over expressed and CD5+

Front 32

A. Intermediat NHL example givin in class?
B. Is it common?
C. curable?
D. Tx?

Back 32

A. Diffuse Large Cell lymphoma
B. Very common
C. 45% cured
D. CHOP and Ritximab
(cytoxan, Adriamycin, Vincristine, Prednisone)

Front 33

Agressive Non -Hodgkins Lymphoma examples covered in class
-
-

Back 33

Burkits (kids)

Lymphoblastic Lymphoma
(T-cell)

Front 34

Burkitts Buzz words

Back 34

NHL #1 in kids especially blacks

t(8;14) c-myc gene

-Lump Jaw, Africa, EBV and Starry skies

Front 35

Burkits Lymphoma Tx?

Back 35

Chemo is needed
50% cure

No Maintenance

Front 36

A.t(15;17) translocation

B.t(8;14) translocation

C. t(9;22) translocation

Back 36

A. Codes for APL (all-trans-retinoic acid

B. Birkits Lymphoma (c-myc gene)



C. Phlidelphia Chromasome for CML (Bcr-abl)
B.

Front 37

Cutaneous T-Cell Lymphoma
A. What is it?
B. aka?
C.Rare, higher in what race?
D.Long____phase
E. ____--->____--->
F.____Cells
G.Tx? (general)

Back 37

A.A NHL of the CD4+ T-cell (indolent)
B.Mycoses Fungoides
C. Blacks
D. pre-diagnosis (bc indolent)
E. Pigmentation--->Plagues---> tumor

F.Sezary Cells
G. Tx but no cure

Front 38

Bilobed cell (mirror image) that are CD30+ and CD 15+(b-cell origin).

What are they and what are they buzz word for?

Back 38

Reed Sternberg cells

Hodgkins lymphoma
(Necessary but not sufficient for a diagnosis)

Front 39

Most Common type of Hodkins lymphom?

Back 39

Nodular Sclerosing (70%)

Front 40

Things you need to see in your bone marrow to diagnose hodkins?

Back 40

Plasma cells
Eosinophils
Reed Sternbergs**

Front 41

Sx of Hodgkins lymphoma?
-Asymptomatic or adenopathy 2/3

Other sx
-
-
-

Back 41

Weigt loss
SOaking night sweat
Fever



(alcohol node pain and itching is weak)

Front 42

Most common Nodes involved in Hodgkins lymphoma?

Back 42

Left Supraclavicular
then right (60-70%)

Mediastium 60%

Front 43

Hodgkins staging studies
Immaging
-
-
Labs
(get CBC, Sed, BUN, liver)

and
-

Back 43

Images
-CT (chest, abdomen and pelvis
-PET scan



Bone Marrow biopys

Front 44

Hodkins Chemo Tx?
-
-
-
-

Back 44

ABVD

Adriamycin
Bleomycin
Vinblastin
Dacarbazine

Front 45

Workup of supsected Hodgkins patient?

Back 45

#1Bone Marrow biopsy
#2 Stage with PET and CT

Front 46

Mononclonal Define?

Back 46

Arising from one group of cells
(cells normal but just forget to die)

Front 47

Gammopathy?

Back 47

Abnormal proteins migrate to gamma region of electorphoresis

(**THis is the Antibody region ) Gamma**

Gamma spike = way to many Ig's

Front 48

Mutliple Myeloma
What is it?

Characterized by?
-
-
-
-
-

Back 48

A malignant plasma cell dyscrasia

Characterized by:
Monoclonal protein in serum, urine or both
Abnormalities of bone
Anemia
Hypercalcemia
Renal failure

Front 49

Whats the pathophys of multiple myeloma?

Back 49

Interluekin-6---->+ plasma cell proliferation

THese cells produce monoclonal Ig's or Fragments

Causes the Uncoupling of Osteoblastic and osteoclastic activity

Front 50

Most common Ig produced in Multiple Myeloma?

Protein produced?

70% have___in urine?

Back 50

IgG #1 (not M***)
IgA #2

Light Chains #3

M protien in 93%

Immune suppresion (other Ig's decreased)

Bence jones protein in pee pee

Front 51

M protein increased in things other than multiple myeloma?

-
-
-

Back 51

MGUS
-Lymphoma
-CLL

Front 52

M protien can cause?
-
-
-
-

Back 52

Imunnodeficiency
Hyperviscosity
Renal Fail
AMyloid Deposition

Front 53

Clinical Manafestations of Multiple Myeloma?

Back 53

Painful, osteolytic bone lesions

Frequent fractures

Seen on X-ray

Front 54

Hypercalcemia in 25% multiple myeloma patients can cause what symproms?

Back 54

Fagtigue
Somnolence
Constipation
Nausea

Front 55

Stage I of multiple myeloma, must have all good criteria. However in stage III all you need is one of the following or more.
A. Hb <
B.Serum IgG >
C.Serum IgA >
D.Serum Ca >
E. Urin Monoclonal protien exretion >
F. X-ray

Back 55

A. Hb < 8.5
B.Serum IgG > 7
C.Serum IgA >5
D.Serum Ca >12
E. Urin Monoclonal protien exretion >12
F. X-ray see lesions

Front 56

Multple myeloma
A vs B class

Back 56

A serum creatinine < 2

B class > 2

Front 57

IgM serum gammopathy is what?

what other sx do you see with it?

Back 57

Waldenstroms

Blurry vision
Retinal Hemorrage
Neurologic Signs
Anemia

(Sx usually due to increased viscosity)

Front 58

Tx of Waldenstroms

Back 58

Rituximab*
Alkylating agents
Fludarabine
Plasmapheresis (4-6W)

Front 59

MUGS what is it?

*** You must?

Back 59

Monoclonal Gammopathy of unknown significance

(basically presence of an asymptomatic monoclonal protien)

***BUT must still Distinguish from mutliple Myeloma***
get you some electrophoresis tests

M protein <3
Marrow <10% plasma cells

Front 60

What makes up the Amyloid deposits?

Back 60

Lamba Light chains

Front 61

Primary Amyloidosis
Presentation
-
-
--

Back 61

Cardiomyoptahy
Bleeding from factor Xa
Nephrotic SYndrome or proteinuria
Hepatomegaly

Front 62

Testicular Cancer chromosome?
(can give you a definitive dx however dont need it)

Back 62

Isochromosome 12
i(12P)

Front 63

Testicular Cancers
#1
#2 is a tie

Back 63

#1 Seminoma

#2
Emyronal cell
Teratoma

Front 64

Testicular Cancer Diagnosis
-
-Markers
-
-
-
-*
NO____biopsies

Back 64

Testicular Ultrasound

Markers
-LDH
-AFP
-B-HCG

orchiectomy, Inguinal Aproach

NO TRANSCROTAL BIOPSY (metastasis)

Front 65

Testis Tumor Markers
Increas in the following could Mean:

A. AFP?

B. B-HCG

Back 65

A. AFP=Embryonal and Yolk sac tumors

B. Choriocarcinomas


(seminomas often marker negative)*

Many pts have both markers elevated

Front 66

Testical Tumor Chemo RX?

MOA?

Toxicity?

Back 66

Cis-Platinum*** Major decrease in the deaths!

MOA: Cross-links DNA

Toxicity: Nephrotoxic and aucustic nerve damage

Front 67

First AID indications for Hydroxyurea and MOA?

Back 67

Melanoma, CML, Sickle Cell (increases HbF why for sickle)


MOA: Inhibits Ribonucleotide Reductatse** (decreases DNA synthesis = S phase only)

Front 68

Sarcoma Origin?

Typiical Presentation?

Back 68

Mesenchymal (mesoderm) origin

Pt. presents with a painless mass

Front 69

Genetic Instability Disorders that can predispose you to tumors like Sarcoma or other cancers?
-
-
-
-

Back 69

*Neurofibromatosis (common the rest are rare)

Li-Fraumeni
Gardeners syndrome
Retinoblastoma

Front 70

What is important for staging of Sarcomas?

Back 70

Grade** is estimate of agression

Based On mitotic activity and degre of differentiation

Front 71

Patterns of sarcoma spread
Local

Hematogenous

Back 71

Local extension and invasion Seldom crosses fascial planes
Seldom violates bone

Hematogenous metastases
Lung
Liver Bone

Front 72

Sarcoma Most common sites of presentation?

Back 72

Sites of presentation

Thigh, groin and buttock 46%
Torso 18%
Upper extremity 13%
Retroperitoneum 13%
Neck 9%

Front 73

Adverse Prognostic Factors of Sarcoma
-
-size>
-Age>
-location

Back 73

-HIGH GRADE
->5mm
->50yo
-NON extermity location

Front 74

Dx assesement of Sarcoma
-
-
-Biopsy
*Only by an experianced surgeon
-size of biopsy?
-**incision lines must not?

Back 74

MRI of mass
Plain films of mass


Biopsy
Small enough to remove incision line, large enough to get diagnosis (not FNA)

Surgical incision lines must not cross fascial plane or compartment

Front 75

Main Sarcoma Tx?

How to do it?

Back 75

Surgery is the cornerstone of cure

Complete excision demanded
Violation of fascial planes discouraged in diagnosis

Resection of isolated metastases is often considered (particularly lung)

Front 76

What is a GIST and whats the most common pres?

Whats it tx?

Back 76

Mesenchymal or stromal tumor arising from GI tract.


Abdominal Mass #1 at 40%
GI bleed 40%
Abd. pain.

Incidental mostly


Tx: Surgery****
Imatinib (gleevec) works well and has helped increase survior with surg.

Front 77

GIST tumor Marker

Back 77

CD117 antigen positive
(transmembrane tyrosine kinase receptor that is expressd from c-kit protooncogen*

Front 78

Monoclonal Antibody drug that targets CD20.

Whats its use? (FA)

Back 78

Rituximab

First Aid Says
Non-Hodgkins
RA (with methotrexate)

Front 79

Philadelphia Chromasome bcr-able tyrosine kinase inhibitor?

Whats it used in?

Back 79

Imatinib (Gleevec)

CML, GIST

Toxicity (fluid retention)

Front 80

Risk Factors For prostate Cancer?

Back 80

Age
Autopsy rates
50-60 years 20%
70-80 years 70%
Positive family history
Doubles with one family member 4x with two or more

African-American heritage
High serum testosterone levels
Higher rates of PIN

Front 81

PSA function?

Normal Levels
____-____=26% chanc of cancer
>___= 53% chance

Back 81

serine protease that is anticoagulatn for semen

N=0-4
4-10=26%

>10*=53%

Front 82

PSA Velocity

Back 82

Change in PSA within the normal range over time. A PSA doubling time is often used, and an absolute change of 0.5 in the normal range warrants a biopsy

Front 83

Prostate Cancer Dx workup
(after elevated psa)

Back 83

Biopsy of the prostate

performed as a transrectal ultrasound guided biopsy

Biopsies of the right and left lobe are taken

A minimum of six and usually twelve samples are obtained

Front 84

What is the Tx of prostate cancer?

Adverse outcomes
-
-

Back 84

If bad/young, and patient chooses

Surger(via robot)
or Radiation
both have positives and negatives

Adverse
-Both have Incontenance and impotence complications

Front 85

Treatment of Prostate Metastatic Cancer first line?

Back 85

Orciectomy is gold stand.***
LHRH agonists*

Hormone Depfivation
Androgen Deprivation(castration)


***NOT CURATIVE***

Front 86

Define Neutropenic Fever

Back 86

Fever over 101

Neutrophils <500
(ANC)

Front 87

Things to do to start workup Febrile Neutropenic Patient?

Back 87

Get cultuers

Chest-X-ray

Start Antibiotics Immediatly** and continue untill ANC>500

Front 88

Most common life-threating cancer emergency?

Back 88

Hypercalcemia of malignancy

Front 89

Pathophyso of hypercalcemia in Cancer?
-
-
-

Back 89

-PTH-related pro (80%) made by cancer cells that binds to PTH receptors.

-Osteolytic Metastasis (20%)

-Hyper vitamin D 1%

Front 90

Tx of hypercalcemia?
Day 1

Day 2

SIngle best tx***

Back 90

Day 1
-Saline hydration ( a lot and push hard and fast )
-STOP Thiazids, NSIADs, and Vit D or any other thing that cause hypercalc.

Day 2
Bisphosphenates
(zoledronate, Pamidroonate) stunt osteoclasts


****Tx cancer underlying

Front 91

SYmptoms of Superior Vena Cava Obstruction?

Back 91

Dyspnea
Face swell
Cough
Arm Swell (lift hands and veins dont collapse)


Venous distention, Face edema, plethora less

Front 92

2 MC causes of SVC obstruction?

Back 92

Lung and Lyphoma

Front 93

SVC obstruction dx?

Back 93

Biopsy Manditory

Front 94

Incidence of spinal cord compression?

Back 94

Lung, Breast, Prostate have a 3-7% (lots!)

Front 95

Sx of spinal cord compression?

In order of progression

Back 95

Pain (local, redicular, or both)
- dull, achy (not neuropathic)
-Classic Cancer pain-**Key is new!

Weakness--->numbness---Paralysis

Autonomics, rectal and bladder incontenance (bad!!)

Front 96

Suspect Spinal cord compression what test to get?

Back 96

Whole Neuroaxial MRI*****