Term
| Most common cancer in men? Women? |
|
Definition
| Men is prostate, women is breast. |
|
|
Term
| What cancer has the highest mortality rate? |
|
Definition
|
|
Term
| What are some risk factors for breast cancer? |
|
Definition
| personal Hx of breast cancer, older than 60, menarche onset before 12, menopause after 55, age of first birth over 30, obesity, alcoholism and HRT. |
|
|
Term
| What % of breast cancer is familial? |
|
Definition
|
|
Term
| What are some genetic alterations that can predispose an individual to breast cancer? |
|
Definition
| BRCA-1, BRCA-2, overexpression of HER-2/neu (25%), and p53 mutations (40&). |
|
|
Term
| Which breast cancer gene mutation results in a breast cancer that recurs more often and is more aggressive? |
|
Definition
|
|
Term
| When should a women get a baseline mammogram? When should she get yearly mammograms? |
|
Definition
| Baseline at age 40 and then yearly at age 50 (Every other year between then). |
|
|
Term
| How is breast cancer diagnosed once a mass is seen on mammogram? |
|
Definition
|
|
Term
| Where are most breast cancers located? |
|
Definition
| In the "tail" of the breast - the superior lateral border |
|
|
Term
| How will DCIS (ductal carcinoma in situ) appear on mammogram? |
|
Definition
| As abnormal micro-calcifications |
|
|
Term
| What are some common PE findings with breast cancer? |
|
Definition
| mass/palpable thickening, bloody nipple discharge, skin changes (peau d'orange) and palpable lymph nodes. |
|
|
Term
| Is DCIS breast cancer typically invasive? |
|
Definition
| It is typically a non-invasive tumor of the breast ducts but it can progress to being invasive. |
|
|
Term
| What is Tamoxifen and how does it treat breast cancer? |
|
Definition
| It is an estrogen receptor blocker and can be used to treat breast cancer because it has been shown that breast cancers rely on estrogen for growth so it blocks the estrogen receptors on a known breast cancer to prevent growth. |
|
|
Term
| How is Herceptin used to treat breast cancer? |
|
Definition
| used with HER-2/neu breast cancer by inhibiting the gene. |
|
|
Term
| What class of drugs treat breast cancer by blocking the production of estrogen? |
|
Definition
|
|
Term
| What are the screening tests for prostate cancer? |
|
Definition
|
|
Term
| When is it recommended to start screening for prostate cancer? |
|
Definition
| age 50 with an average risk or age 45 in those with high risk (African American or those with a first degree relative) |
|
|
Term
| What level of PSA is diagnostic of prostate cancer? |
|
Definition
|
|
Term
| How else can prostate cancer be diagnosed besides PSA and DRE? |
|
Definition
| biopsy and transrectal ultrasound |
|
|
Term
| What are some treatment options for prostate cancer? |
|
Definition
| watchful waiting (mild only), androgen deprivation, prostatectomy, radiation therapy, brachytherapy or cryotherapy. |
|
|
Term
| Leading cause of cancer death in the US? |
|
Definition
|
|
Term
|
Definition
frequently asx
cough
hemoptysis
dyspnea
pleural or chest wall pain
lymphadenopathy
anorexia, wt loss
fatigue
anemia |
|
|
Term
| Briefly describe the staging system for lung cancer. |
|
Definition
| TNM - Tumor size, Node involvement and Metastasis |
|
|
Term
| What are PET scans good for with lung cancer? |
|
Definition
| They are more sensitive than CT for staging and they also check for distant METS. |
|
|
Term
| How is lung cancer treated? |
|
Definition
| surgical resection, chemotherapy (especially small cell) and radiation. |
|
|
Term
| What is the etiology of Mesothelioma? |
|
Definition
| 50% are from asbestos exposure, the other 50% are idiopathic. |
|
|
Term
| When will mesothelioma symptoms occur? |
|
Definition
| 30-35 years after exposure |
|
|
Term
| Does Mesothelioma metastasize? |
|
Definition
| It does not METS, but it does spread locally. |
|
|
Term
| How will Mesothelioma appear on CXR? |
|
Definition
| unilateral pleural effusion |
|
|
Term
| Treatment for Mesothelioma? Prognosis? |
|
Definition
| Treatment is surgery, chemo and radiation. The prognosis is poor, 9-12 months from time of diagnosis. |
|
|
Term
| What are the 3 most common types of colorectal cancer? |
|
Definition
| adenomas (polyps), adenocarcinomas and anal carcinoma. |
|
|
Term
| Are most colon polyps benign? |
|
Definition
|
|
Term
| Gold standard for colorectal cancer diagnosis? |
|
Definition
|
|
Term
| How might colon cancer look on barium radiography? |
|
Definition
|
|
Term
| What are the recommended screening tests and protocal for colorectal cancer? |
|
Definition
| annual FOBT (fecal occult blood test) and DRE at age 40 and a colonoscopy at age 50. |
|
|
Term
| How should you handle any patient that presents with rectal bleeding? |
|
Definition
| GI referral for colonoscopy |
|
|
Term
| What is the hallmark of FAP (Familial Adenomatous Polyposis)? |
|
Definition
| Hallmark is development of hundreds to thousands of adenomatous polyps in the large bowel at a relatively young age |
|
|
Term
| What is the treatment for FAP (Familial Adenomatous Polyposis)? |
|
Definition
| Proctocolectomy – surgical removal of the anus, rectum and colon. |
|
|
Term
| What are the limitations of flexible sigmoidoscopy? |
|
Definition
| It only reaches the splenic flexure so it missed a lot of cancers. |
|
|
Term
| What extracolonic manifestation occurs in over 90% of all FAP patients? |
|
Definition
| hypertrophy of the retina |
|
|
Term
| What conditions do FAP patients have an increased tendency for? |
|
Definition
| duodenal adenomas, osteomas of the skull, long bones and mandible, epidermoid cysts, fibromas, lipomas etc. |
|
|
Term
| What are the criteria for Hereditary Nonpolyposis Colorectal Cancer? |
|
Definition
| Autosomal dominant inherited disorder that meets the criteria: 3 or more relatives with colon Ca (one must be a first degree relative), Colorectal Ca involving at least 2 generations, 1 or more colorectal cancer cases < age 50 |
|
|
Term
| Where are the polyps with HNPCC usually located? |
|
Definition
|
|
Term
| When should you begin screening for colon cancer in someone that is high risk for HNPCC? |
|
Definition
| 10 years before the earlier onset of colon cancer in a family member. |
|
|
Term
| What is the typical age of onset for HNPCC? |
|
Definition
| Usually occurs at an earlier age (40s-50s) |
|
|
Term
| What is the most common cancer that causes pancreatic cancer? |
|
Definition
|
|
Term
| What are some risk factors for pancreatic cancer? |
|
Definition
| family history of pancreatic cancer, older age, Hemorrhagic necrotizing pancreatitis, Peutz-Jehgers syndrome (polyposis syndrome with hyperpigmented lips), smoking, chronic pancreatitis, alcohol, cholelithiasis, DM, high fat diet. |
|
|
Term
| S&S of pancreatic cancer? |
|
Definition
| dull midepigastric discomfort that may radiate to the back, weight loss, anorexia, vomiting, diarrhea, weakness, jaundice and Courvoisier's sign (palpable, distended non-tender GB from obstruction of the distal CBD by a tumor). |
|
|
Term
| What is Courvoisier's sign and what is it characteristic of? |
|
Definition
| Courvoisier’s sign – palpable, distended non-tender GB from obstruction of the distal CBD by a tumor. Characteristic of pancreatic cancer. |
|
|
Term
| How will pancreatic cancer affect ESR, alkaline phosphatase, bilirubin, transaminases and Ca19-9 tumor marker? |
|
Definition
| It will increase them all. |
|
|
Term
| What is the gold standard for diagnosing pancreatic cancer? How else can you diagnose it? |
|
Definition
| ERCP - endoscopic retrograde choleangiopancreatography. Can also diagnose by tranabdominal ultrasound for abdominal CT. |
|
|
Term
| What is the Whipple procedure? |
|
Definition
| It is the surgical resection of the head of the pancreas used to treat pancreatic cancer of the head of the pancreas. |
|
|
Term
| Leading cause of death from genital cancer for women? |
|
Definition
|
|
Term
| What are the S&S for ovarian cancer? |
|
Definition
S&S: lack energy
↑ abd girth/fullness/swelling
weight loss/ ↓ appetite/ feel full quickly
abd/ pelvic discomfort
dysuria or urinary frequency
dyspareunia
persistant indigestion/ gas/ N
constipation
low back pain
***Steadily worsening*** |
|
|
Term
| What is ovarian cancer frequently misdiagnosed as? |
|
Definition
| IBS, stress or depression |
|
|
Term
| What is recommended as a prophylaxis for women having a high risk for ovarian cancer? |
|
Definition
| Prophylactic oophorectomy or salpingo- oophorectomy are being recommended for high risk women |
|
|
Term
| How is ovarian cancer diagnosed? |
|
Definition
| abdominal/pelvic ultrasound or CT and Ca 125 levels |
|
|
Term
| What are some measures that are protective against ovarian cancer? |
|
Definition
| child bearing, oral contraceptives (containing estrogen and progesterone) and breast feeding. |
|
|
Term
| What is the biomarker of colorectal cancer? What will its value be to indicate colorectal cancer? |
|
Definition
| CEA (carcinoembryonic antigen). Levels over 10.0ng/mL indicate cancer. |
|
|
Term
| What is the biomarker of Hepatocellular cancer? When may this biomarker also be produced? |
|
Definition
| AFP (alpha-fetoprotein). Will also be produced during pregnancy. |
|
|
Term
| What is the biomarker for varian cancer? |
|
Definition
|
|
Term
| What is the biomarker for prostate cancer? What value is abnormal? |
|
Definition
| PSA (prostate specific antigen). Levels over 4ng/mL are abnormal. |
|
|
Term
| What are monoclonal antibody biologic drugs? |
|
Definition
| Genetically engineered antibodies used to fight bacteria and viruses. |
|
|
Term
|
Definition
| a monoclonal antibody used in brain, lung, breast and colorectal cancer. |
|
|
Term
| What are the protein inhibitor biologic drugs (Rituxan and Herceptin) used to treat? |
|
Definition
| lymphoma and breast cancer |
|
|
Term
| What is the monoclonal antibody biologic drug (Tysabri) used to treat? |
|
Definition
|
|
Term
| What are some common side effects of biologic drugs? |
|
Definition
| infection, MI, lymphoma, CNS disorders and immune system disorders. |
|
|
Term
| What are the advantages of biologic drugs? |
|
Definition
| They provide a selectivity not achievable with conventional chemotherapy and can produce dramatic antitumor effects with less toxicity. |
|
|
Term
| What do the immune system altering biologics (Enbrel, Humira and Remicade) treat? |
|
Definition
| Rheumatoid arthritis and psoriasis. |
|
|
Term
| What do the biologic drugs (Epogen and Procrit) treat? |
|
Definition
|
|
Term
| What does the biologic drug (Neulasta) treat? |
|
Definition
|
|
Term
| What does the biologic drug (Novolog) treat? |
|
Definition
|
|
Term
| What are some common causes of splenomegaly? |
|
Definition
| lymphomas, leukemia, polycythemia vera, hemolytic anemia, CHF, portal HTN, mononucleosis and malaria |
|
|
Term
| What kind of cells are produced with leukemia? |
|
Definition
| Blast cells (abnormal/immature WBCs) |
|
|
Term
| What is the hallmark of leukemia? |
|
Definition
| pancytopenia with circulating blasts |
|
|
Term
|
Definition
| fever, malaise, bone pain, weight loss, night sweats, splenomegaly, recurrent infection, bleeding tendencies, petechaie and lymphadenopathy. |
|
|
Term
| What kind of leukemia should you think of when you see increased blasts on CBC? |
|
Definition
|
|
Term
| What is typical of acute leukemia's on the CBC? |
|
Definition
|
|
Term
| Do chronic leukemias have a high # of blasts? |
|
Definition
|
|
Term
| What does a typical CBC look like with chronic leukemias? |
|
Definition
| Very high WBC count and it can have anemia and thrombocytopenia. |
|
|
Term
| What are some distinguishing features of CML? How is it differentiated from a leukemoid like reaction? |
|
Definition
| Philadelphia chromosome and splenomegaly. Differentiated from leukemoid like reaction by the present of the Philadelphia chromosome in CML, CML will have a decreased LAP score and no BLASTS and LLR will have BLASTS and an increased LAP score. |
|
|
Term
| What is the most common adult leukemia in the US? |
|
Definition
|
|
Term
| What are some indicative characteristics of CLL on smear and PE? |
|
Definition
| Smudge cell on smear and lymphadenopathy on PE. |
|
|
Term
| What are common bacterial, viral and protozoan causes of benign lymphadenopathy? |
|
Definition
Bacterial - TB, cat scratch fever.
Viral - HIV, Mono.
Protozoan - Toxoplasmosis. |
|
|
Term
| What are some general signs and symptoms of leukemia? |
|
Definition
| fever, bone pain, weight loss, night sweats, splenomegaly, recurrent infections, bleeding tendencies, petechaie and lymphadenopathy. |
|
|
Term
| What is the hallmark of leukemia? |
|
Definition
| Pancytopenia with circulating blasts. |
|
|
Term
| Briefly describe what happens with flow cytometry. |
|
Definition
| Cells are tagged by monoclonal antibodies for identification. |
|
|
Term
| How is leukemia definitively diagnosed? |
|
Definition
| Bone marrow biopsy or lymph node biopsy. |
|
|
Term
| What is the current treatment plan for leukemia? |
|
Definition
| Combo chemo and stem cell transplant, also use radiation. |
|
|
Term
| What are the 3 main myeloid neoplasms? |
|
Definition
| AML, CML and Polycythemia vera. |
|
|
Term
| What is the staging system for AML and ALL? |
|
Definition
|
|
Term
| What peripheral smear finding is indicative of AML? |
|
Definition
|
|
Term
| What is the diagnostic finding with CML? |
|
Definition
|
|
Term
| Which leukemia is characterized by a stable phase followed by a "blast crisis"? |
|
Definition
|
|
Term
| What are the 4 most common lymphoid neoplasms? |
|
Definition
| ALL, CLL, Hodgkins and Non-Hodgkins lymphoma. |
|
|
Term
| What cells are affected in lymphoid neoplasms? |
|
Definition
| B cells, T cells and NK cells. |
|
|
Term
| What is a lymphoid neoplasm called when it is present in the blood? Lymph tissue? |
|
Definition
| Blood = leukemia. Lymph = lymphoma. |
|
|
Term
| What is the most common childhood malignancy and 2nd leading cause of death in children? |
|
Definition
|
|
Term
| What is the diagnostic criteria for ALL? |
|
Definition
| At least 20% of bone marrow cells must be leukemic lymphoblasts. |
|
|
Term
| Which leukemia is a neoplastic transformation of a B cell and is the most common overall leukemia? |
|
Definition
|
|
Term
| What is the staging system for CLL? |
|
Definition
|
|
Term
| What is the hallmark of CLL on CBC? |
|
Definition
| isolated lymphocytosis with WBC levels over 20,000/uL. |
|
|
Term
| What condition is characterized by a malignant disorder of the plasma cells? |
|
Definition
|
|
Term
| What does MM look like on CBC? |
|
Definition
|
|
Term
|
Definition
| SPEP, Bence Jones protein in urine and a "honeycomb or punched-out" lesions seen on x-ray. Confirmed by bone marrow biopsy. |
|
|
Term
| What is MGUS (Monoclonal Gammomopathy of Undetermined Significance)? |
|
Definition
| It is a premalignant state of MM that is asymptomatic but 25% progress to malignant disease. |
|
|
Term
| What virus is found in 40-50% of Hodgkin's Lymphoma patients? |
|
Definition
|
|
Term
| What is the prognosis for Hodgkin's lymphoma? |
|
Definition
|
|
Term
| PE findings with Hodgkin's Lymphoma? |
|
Definition
| upper extremity painless lymphadenopathy, hepatosplenomegaly, fatigue, fever*, night sweats*, weight loss*, and pruritis*. (*symptoms lead to a worse prognosis) |
|
|
Term
| What is the staging system for Hodgkin's lymphoma? |
|
Definition
|
|
Term
| How is Hodgkin's Lymphoma diagnosed? What is the characteristic finding on a smear? |
|
Definition
| Bone marrow biopsy confirms diagnosis. Will see Reed-Sternberg cell. |
|
|
Term
| What disease is characterized by a malignant proliferation of B or T lymphocytes? |
|
Definition
|
|
Term
| How will NHL typically present on PE? |
|
Definition
| painless enlargement of lymph nodes and spleen. Less fever, weight loss, fatigue or night sweats than HL. |
|
|
Term
| What disease is characterized by a very aggressive tumor of immature B-cell origin? |
|
Definition
|
|
Term
| What is the characteristic appearance of Burkitt's lymphoma on a blood smear? |
|
Definition
| diffuse infiltrate of small noncleaved lymphocytes mixed with a large cells – “starry sky” appearance |
|
|
Term
| Where does the tumor typically present for Burkitt's lymphoma? What virus is it associated with? |
|
Definition
| Presents as a tumor that is localized to the jaw. It is strongly associated with EBV. |
|
|
