Term
| prophylaxis for instent restenosis after bare metal coronary artery stent |
|
Definition
| aspirin and plavix for 4 wks |
|
|
Term
| what is the complication of bare metal coronary artery stent within the first month of placement? |
|
Definition
|
|
Term
| what % of patients do instent restenosis after bare metal stent despite adequate prophylaxis, what is the cause and alternative Tx? |
|
Definition
| 25%, plavix resistance, switch to Prasugrel |
|
|
Term
| in restenosis, why is aspirin resistance a bigger problem than plavix resistance? |
|
Definition
| it is not helpful to raise doses of add another antiplatelet |
|
|
Term
| what is the erroneous mechanism in VTE vs. arterial thromboembolism? |
|
Definition
| coagulation factors vs. platelet activation |
|
|
Term
| a mutation in glycoprotein 1b platelet receptor would increase the risk for which disorder, venous or arterial thrombosis? |
|
Definition
| arterial thrombosis which is affected by platelet activation |
|
|
Term
| which patients with hemophilia receive primary prophylaxis? |
|
Definition
| severe cases with less than 1% normal factor |
|
|
Term
| in the Tx of bleeding d/t hemophilia what are the desired levels of normal factor? |
|
Definition
mild bleeds: 30-50%
major bleeds: 50% |
|
|
Term
| what is the adjunct Tx for Hemophilia A |
|
Definition
|
|
Term
| in mastocytosis what % of patients experience skin-limited disease and which experience systemic disease? |
|
Definition
|
|
Term
| what is the MC manifestation of skin mastocytosis and what are 2 other |
|
Definition
MC is cutaneous urticaria pigmentosa
other: diffuse cutaneous mastocytosis and mastocytoma |
|
|
Term
| 11 s/s in systemic mastocytosis |
|
Definition
| pruritus, dermatographia, rash, abd pain, flushing, HTN, syncope, diarrhea, arthralgia, fractures, eosinophilia |
|
|
Term
| 3 major associated diseases in systemic mastocytosis 40% |
|
Definition
| CML, myeloproliferative syndrome or MDS |
|
|
Term
| 6 signs that suggest poor Px in mastocytosis |
|
Definition
1. increases serum tryptase
2. BM involvement
3. Splenomegaly
4. cyopenia
5. skeletal involvement
6. malabsorption |
|
|
Term
| what is the MC mutation in matocytosis |
|
Definition
| C-kit (but gleevec not effective) |
|
|
Term
| what can be said about the epidemiology of the hypereosinophilic syndromes? |
|
Definition
|
|
Term
| what 3 things are imperative in the Dx of hypereosinophilic syndrome and chronic eosinophilic leukemia and establishing them is required as the first step before excluding other possible diseases |
|
Definition
1. eosinophilia>1500
2. increased marrow eosinophils
3. myeloblasts (<20%) in blood or marrow for at least 6 months |
|
|
Term
| what is the minimum time to make the Dx of hypereosinophilic syndrome or chronic eosinophilic leukemia? |
|
Definition
| 6 months (to establish myeloblasts in blood or marrow) |
|
|
Term
| what 4 steps does the Dx of hypereosinophilic syndrome and chronic eosinophilic syndrome consist of? |
|
Definition
1st step- establish imperative facts
2nd step- exclude possible causes of secondary eosinophilia
3rd step- exclude other clonal hypereosinophilic conditions
4th step- distinguish btwn the two |
|
|
Term
| 4 conditions of secondary eosinophilia to exclude as the 2nd step in the Dx of hypereosinophilic syndrome and chronic eosinophilic syndrome |
|
Definition
1. allergy
2. parasites
3. pulmonary disease (e.g., hypersensitivity pneumonitis, Loeffler's)
4. collagen vascular diseases |
|
|
Term
| 3rd step in the Dx of hypereosinophilic syndrome and chronic eosinophilic syndrome - what should practically be done? |
|
Definition
| to exclude other primary malignancies associated with eosinophilia or MPD perform immunoflueroscense and seek mutations in the peripheral blood and cytogenetics for translocations in the BM |
|
|
Term
| 4th step in the Dx of hypereosinophilic syndrome and chronic eosinophilic syndrome - how to distinguish btwn them |
|
Definition
check peripheral blood and marrow for blasts:
1. if PB<2% and BM<5% - hypereosinophilic syndrome
2. if PB>2% and BM>5% - chronic eosinophilic leukemia |
|
|
Term
| 3 of the MC organ systems to be affected in eosinophil-mediated tissue damage? |
|
Definition
|
|
Term
| after establishing the Dx of a disease associated with eosinophil-mediated tissue damage such as hypereosinophilic syndrome or chronic eosinophilic leukemia, what are the 3 steps in the workup? |
|
Definition
1. echocardiography
2. troponin
3. CXR |
|
|
Term
| which mutated receptor in hypereosinophilic syndrome or chronic eosinophilic leukemia indicates good resopnsiveness to Gleevec |
|
Definition
|
|
Term
| which mutated receptor in hypereosinophilic syndrome or chronic eosinophilic leukemia indicates poor resopnsiveness to chemotherapy? |
|
Definition
|
|
Term
| which patients with hypereosinophilic syndrome or chronic eosinophilic syndrome can be only observed? |
|
Definition
| asymptomatic patients with the absence of mutation in PDGF |
|
|
Term
| what is the 1st line of Tx for symptomatic hypereosinophilic syndrome and chronic eosinophilic leukemia, and what are 6 alternative Tx options |
|
Definition
1st line is steroids
Hydroxyurea
interferon
cladribine
cyclosporine
anti-IL5 antibody mepolizumab
Anti-CD52 antibody (alemtuzumab) |
|
|
Term
| what serum marker could indicate systemic vs. cutaneous mastocytosis? |
|
Definition
|
|
Term
| what is the MC myeloid neoplasm associated with mastocytosis? |
|
Definition
| myeloproliferative disorder |
|
|
Term
| what is the median survival of a patient with mastocytosis and an associated myeloid neoplasm? |
|
Definition
|
|
Term
| what is the median survival of patients with indolent mastocytosis |
|
Definition
|
|
Term
| what is the median survival of patients with aggresive mastocytosis w/o associated myeloid neoplasm |
|
Definition
|
|
Term
| 3 line Tx of mastocytosis |
|
Definition
1. Cladiribine
2. Hydroxyurea
3. Interferon alpha |
|
|
Term
| which of the Tx of mastocytosis achieves the longest response? |
|
Definition
|
|
Term
| what is the definition of mast cell leukemia? |
|
Definition
| over 10% of mast cells in peripheral blood (which occur when mast cells are over 50% in BM) |
|
|
Term
|
Definition
|
|
Term
| 8 entities on the DD of anterior mediastinal mass |
|
Definition
| thymoma, lymphoma, germ cell tumors, substernal thyroid tumors, lipoma, carcinoid, TB, sarcoidosis |
|
|
Term
|
Definition
respiratory symptoms
chest pain
weight loss/anorexia
night sweats |
|
|
Term
| what % are asymptomatic at presentation of thymoma |
|
Definition
|
|
Term
|
Definition
| Bx by mediastinoscopy or limited thoracotomy |
|
|
Term
| why not perform FNA for the Dx of thymoma |
|
Definition
| poor in differentiating thymoma from lymphoma |
|
|
Term
| how is the Px of thymoma determined |
|
Definition
|
|
Term
| most thymoma is diagnosed as invasive or non-invasive |
|
Definition
|
|
Term
| thymoma is associated with what 3 other conoditions MC |
|
Definition
| myasthenia gravis, pure red cell aplasia, hypogammaglobulinemia |
|
|
Term
| what Tx is effective in 30% of patients with thymoma and pure red cell aplasia |
|
Definition
|
|
Term
| in what thymoma associated condition is thymectomy not at all helpful? |
|
Definition
|
|
Term
| what % of ovarian cancer have BRCA |
|
Definition
|
|
Term
| what is the risk of developing ovarian cancer with BRCA1 |
|
Definition
|
|
Term
| what is the risk of developing ovarian cancer with BRCA2 |
|
Definition
|
|
Term
| what is the recommended action if BRCA is found, screening by CA125+US or oopherectomy? |
|
Definition
|
|
Term
| by how much does oopherectomy reduce the risk of breast cancer? |
|
Definition
|
|
Term
| what is the method of screening for Prostate Ca |
|
Definition
|
|
Term
| from what age do you screen for prostate ca |
|
Definition
| caucasians>50, african-american>45 |
|
|
Term
| what is the first step in screening for prostate ca? |
|
Definition
|
|
Term
| in screening for prostate ca, what is the next step if DRE is abnormal? |
|
Definition
|
|
Term
| in screening for prostate ca, if DRE was abnormal and Trus guided Bx was negative, what is the next step? |
|
Definition
|
|
Term
| in screening for prostate ca, if DRE was abnormal, Trus guided Bx was negative, and PSA>4, what is the next step? |
|
Definition
|
|
Term
| in screening for prostate ca, if DRE was normal, what is the next step? |
|
Definition
|
|
Term
| in screening for prostate ca, if DRE was normal and total PSA<4 and velocity<0.75, what is the next step? |
|
Definition
|
|
Term
| in screening for prostate ca, if DRE was normal and total PSA<4 and velocity>0.75, what is the next step? |
|
Definition
|
|
Term
| in screening for prostate ca, if DRE was normal, total PSA<4, velocity>0.75, and Trus guided Bx negative, what is the next step? |
|
Definition
|
|
Term
| in screening for prostate ca, if DRE was normal and total PSA 4-10, what is the next step? |
|
Definition
optional: 1. Trus guided Bx
2. % Free PSA |
|
|
Term
| in screening for prostate ca, if DRE was normal, total PSA 4-10 and Trus guided Bx was negative, what is the next step? |
|
Definition
|
|
Term
| in screening for prostate ca, if DRE was normal, total PSA 4-10 and %free PSA was low, what is the next step? |
|
Definition
|
|
Term
| in screening for prostate ca, if DRE was normal, total PSA 4-10, %free PSA was low, and Trus guided Bx was negative, what is the next step? |
|
Definition
|
|
Term
| in screening for prostate ca, if DRE was normal and total PSA>10, what is the next step? |
|
Definition
|
|
Term
| in screening for prostate ca, if DRE was normal, total PSA>10 and Trus guided Bx was negative, what is the next step? |
|
Definition
|
|
Term
| what is the benefit of screening for prostate ca in survival? |
|
Definition
| unclear. 1 in 6 diagnosed, 1-30 dies of the disease |
|
|
Term
| what is the effect on the risk of getting prostate ca if one family member is sick with the disease? |
|
Definition
|
|
Term
| what is the effect on the risk of getting prostate ca if 2 family members are sick with the disease? |
|
Definition
|
|
Term
| hereditary prostate ca is correlated with what disease dynamics? |
|
Definition
|
|
Term
| what % of prostate ca disease are hereditary |
|
Definition
|
|
Term
| which 2 genes are implicated in prostate ca? |
|
Definition
5 alpha reductase type 2 (SRD5A2)
cytochrome P450 c17 |
|
|
Term
| being african american is associated with increases in the incidence of what to things associated with prostate ca? and what is the reason |
|
Definition
larger tumors
prostatic intraepithelial neoplasia (PIN) - precancerous
higher levels of testosterone |
|
|
Term
| 4 protective dietary factors for prostate ca |
|
Definition
1. legumes (kitniyot) - 5areductase
2. cruciferous veggies (from the cabage family)
3. tomatoes - retinoids
4. statins - inhibit cholesterol biosynthesis |
|
|
Term
| which food increases the risk of prostate cancer |
|
Definition
|
|
Term
| which Tx is the only one considered protective against prostate ca |
|
Definition
| 5 alpha reductase inhibitors |
|
|
Term
| which 3 studied Tx are considered to have no effect on the risk of developing prostate ca |
|
Definition
|
|
Term
| what seemingly has no effect on the PSA, but actually does? |
|
Definition
| DRE can increase PSA X10 for 10 wks |
|
|
Term
| how long after prostatectomy will PSA be undetectable |
|
Definition
|
|
Term
| what % of patients with abnormal DRE and a PSA>4 have prostate ca |
|
Definition
|
|
Term
| what % of patients with normal DRE and a PSA of 2.5-4 have prostate ca |
|
Definition
|
|
Term
| which is the imaging technique of choice in prostate ca |
|
Definition
|
|
Term
| what % of people with prostate cancer a diagnosed with local disease (T1 or T2)? |
|
Definition
|
|
Term
| what % of patients with prostate cancer are diagnosed with regional disease (T3/T4 with no mets) |
|
Definition
|
|
Term
| what % of patients with prostate cancer are diagnosed with disseminated disease? |
|
Definition
|
|
Term
| what is the classic triad in RCC? and how many of the patients present with it? |
|
Definition
hematuria, flank pain and palpable mass
20% |
|
|
Term
| whats more common in RCC anemia or erythrocytosis? |
|
Definition
|
|
Term
| how do most cases of RCC present |
|
Definition
|
|
Term
| 2 conditions ~ with increased risk of RCC |
|
Definition
|
|
Term
| what is the Tx of RCC stage 1/2? and the 5 yr survival? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what % of TCC develops in the bladder, renal pelvis and ureters/urethra? |
|
Definition
|
|
Term
| 3 epidemiologic facts about TCC |
|
Definition
| M>F, whites>blacks, median age 65 |
|
|
Term
| what is the increase in risk of TCC with smoking? and how long does it persist after quitting? |
|
Definition
|
|
Term
| how many of the TCC cases are thought to be related to smoking? |
|
Definition
|
|
Term
|
Definition
smoking
phenacetin
aniline dye
schistosoma haematobium
radiation
cyclophosphamide |
|
|
Term
| in TCC, mutations in which 3 genes are associated with increased recurrence, metastasis and death? |
|
Definition
|
|
Term
| in TCC, mutations in which two components is associated with less invasive tumors? |
|
Definition
|
|
Term
| in TCC, which mutations in which 2 genes are associated with CIS and invasive disease? |
|
Definition
|
|
Term
| what is the MCC of gross hematuria from the bladder? 2nd MCC |
|
Definition
| benign cysts, 2nd-TCC of bladder |
|
|
Term
| what is the MC origin of microscopic hematuria? |
|
Definition
| prostate (much more than bladder) |
|
|
Term
| 3 needed steps in the workup of hematuria |
|
Definition
| urinary cytology, imaging of bladder by CT/intravenous pyelogram, cystoscopy |
|
|
Term
| what 5 steps should be taken in cystoscopy for suspected TCC of bladder? |
|
Definition
1. documentation of tumors
2. resection of all tumors
3. Bx from underlying muscle of each tumor resected
4. random Bx from healthy appearing areas
5. if no tumor visible in bladder but cytologies positive, catheterization and visualization of the ureters |
|
|
Term
| 2 uses of intravesical therapy in superficial TCC? |
|
Definition
1. prevent recurrence
2. eliminate disease that wasn't completely eliminated by resection |
|
|
Term
| in superficial TCC, what is the rate of recurrence of disease after resection? |
|
Definition
|
|
Term
| what % of superficial TCC after resection progress to advanced disease? |
|
Definition
|
|
Term
| 4 conditions where intravesical therapy is recommended in superficial TCC |
|
Definition
| recurrent disease, >40% involvement of the bladder surface by tumor, diffuse CIS, or T1 disease |
|
|
Term
| 4 possible drugs used in intravesical therapy for superficial TCC? |
|
Definition
| BCG, IFN, mitomycin-C, Gemcitabine |
|
|
Term
| 2 general side effects of intravesical therapy for the Tx of superficial TCC |
|
Definition
| dysuria and urinary frequency |
|
|
Term
| how do you monitor the recurrence of superficial TCC post-resection |
|
Definition
| a full (urethra to renal pelvises) endoscopic examination every 3 months for one year |
|
|
Term
| what happens when the Tx of superficial TCC is very "successful" in the bladder? |
|
Definition
| the disease tends to recur more frequently extravesicularly (ureters and urethra) |
|
|
Term
| 2 Tx options of persistent or new tumors of (post resection) superficial TCC |
|
Definition
1. repeat BCG or other intravesical therapy
2. cystectomy |
|
|
Term
| 4 CIs to neobladder after cystectomy in invasive TCC |
|
Definition
1. CIS in the urethra
2. inability to self catheterize
3. exophytic tumor
4. renal insufficiency |
|
|
Term
| 4 conditions to perform partial cystectomy in invasive TCC |
|
Definition
1. disease limited to thedome of the bladder
2. a margin of 2 cm
3. adequate remaining bladder capacity
4. no CIS in other areas |
|
|
Term
| 6 types of possible bladder malignancies |
|
Definition
1. TCC
2. SCC
3. adenocarcinoma
4. small cell
5. melanoma
6. lymphoma |
|
|
Term
| which symptoms in TCC are suggestive for in situ disease? |
|
Definition
|
|
Term
| the recurrence and Px in TCC is dependent on what 3 factors |
|
Definition
| pathologic stage, lymph node and metastasis |
|
|
Term
| what are the 3 factors that hinder complete remission in metastatic TCC |
|
Definition
1. karnofsky performance status < 80
2. nodal spread
3. visceral spread
the more factors the less remission |
|
|
Term
| which 3 organs does metastatic TCC involve? |
|
Definition
|
|
Term
| 3 standard chemotherpeutic regimens for the Tx of metastatic TCC |
|
Definition
1. M-VAC - MTX, vinblastine, adriamycin, cisplatin
2. Gemcitabine, paclitaxel, cisplatin
3. Gemcitabine, cisplatin |
|
|
Term
| in the Tx of metastatic TCC which side effects are typical of M-VAC and which of GC |
|
Definition
M-VAC: mucositis, fever, neutropenia
GC: anemia, thrombocytopenia |
|
|
Term
| which is a more efficient Tx of metastatic TCC, GC or GTC? |
|
Definition
| both are equally efficient |
|
|
Term
| in TCC what is the effect of adjuvant/neoadjuvant therapy? |
|
Definition
| improves 5 yr survival and median survival |
|
|
Term
| 2 risk factors for pelvic and ureter TCC |
|
Definition
1. balkan nephropathy - interstitial
2. chronic phenacetic use |
|
|
Term
| how is the Dx of pelvic/ureter TCC usually made? |
|
Definition
| during the workup of painless hematuria with intravenous pyelogram |
|
|
Term
| how is low grade TCC of the renal pelvis/ureter treated? |
|
Definition
| nephroureterectomy - including a part of the bladder |
|
|
Term
| what is the 5 year survival after Tx of low grade renal pelvis/ureter TCC |
|
Definition
|
|
Term
| what % of patients with VHL develop clear cell renal cell carcinoma? |
|
Definition
|
|
Term
| besides RCC, what other (6) neoplasms are associated with VHL? |
|
Definition
1. retinal hemangioma
2. hemangioblastoma of the spinal cord and cerebellum
3. pheochromocytoma
4. neuroendocrine tumors and cysts
5. epididymal cysts
6. broad ligament cysts |
|
|
Term
| 4 paraneoplastic conditions seen in RCC |
|
Definition
1. dysfibrinogenemia
2. hypercalcemia
3. erythrocytosis
4. non-metastatic hepatic dysfunction |
|
|
Term
| 4 steps in the workup of a patient suspected of RCC and a 5th optional step |
|
Definition
1. abdominal CT
2. CXR
3. urine analysis
4. urine cytology
5. if suspected involvement of IVC - MRI |
|
|
Term
| 5 malignancies that may involve the kidney |
|
Definition
1. RCC
2. TCC
3. lymphoma
4. wilm's tumor
5. sarcoma |
|
|
Term
| 4 stages of RCC according to the American joint committee on cancer |
|
Definition
1. <7 cm confined to kidney
2. >7 cm confined to kidney
3. invades perinephric tissue but confined to Gerotas fascia or invades IVC or regional lymph node involvement
4. invades Gerotas fascia or mets |
|
|
Term
| Tx of localized RCC stage 1-3 |
|
Definition
| radical nephrectomy which includes everything inside gerotas fascia: kidney, adrenal and lymph nodes and tumor invading IVC |
|
|
Term
| 2 situations where partial nephrectomy d/t RCC should be considered |
|
Definition
1. bilateral RCC
2. one kidney left |
|
|
Term
| what is the role of adjuvant Tx in partial nephrectomy d/t RCC? |
|
Definition
| none, doesn't change outcome |
|
|
Term
| 2 indications for nephrectomy in the RCC metastatic patients |
|
Definition
1. alleviate pain and hemorrhage
2. cytoreduction of disease before systemic Tx |
|
|
Term
| what is the role of chemotherapy in metastatic RCC? |
|
Definition
|
|
Term
| what are 2 components of cytokine therapy in metastatic RCC and what % of patients produce regression? |
|
Definition
|
|
Term
| 2 1st line Tx in metastatic RCC |
|
Definition
Sunitinib (Sutent)
Sorafenib(Nexavar) |
|
|
Term
| a common side effect for Sunitinib and sorafenib used in the Tx of metastatic RCC and 2 additional side effects of sorafinib |
|
Definition
diarrhea
rash, hand-foot syndrome |
|
|
Term
| 2 alternative Tx to metastatic RCC patients refractory to Sorafenib/Sunitinib |
|
Definition
| mammalian Target of Rapamycin inhibitors (mTOR inhibitors) Temsirolimus and Everolimus |
|
|
Term
| how do Sunitinib and Sorafenib work? |
|
Definition
| inhibit Receptor Tyrosine Kinase signalling in VEGF/PDGF receptors |
|
|
Term
| 5 poor prognostic factors in metastatic RCC |
|
Definition
1. no prior nephrectomy
2. Kornofsky performance status < 80
3. hypercalcemia
4. increased LDH
5. low Hb |
|
|
Term
| 5 yr survival of all stages combined in pancreatic ca? |
|
Definition
|
|
Term
| what % of patients with pancreatic ca present with inoperable or metastatic disease? |
|
Definition
|
|
Term
| MC risk factor for pancreatic ca and 5 other risk factors |
|
Definition
smoking
hereditary chronic illnesses, chronic pancreatitis, DM, familial multi-organ cancer syndromes, direct hereditabillity |
|
|
Term
| the MC oncogene in pancreatic ca and the MC tumor suppressor gene + 2 other TSGs + 5 other oncogenes |
|
Definition
Kras
p16
p53, SMAD4
Survivin, FAK, c-Src, IGF-1R, PALB2 |
|
|
Term
| which genetic abberation is associated with poorer survival after resection in pancreatic ca? |
|
Definition
| inactivation of the tumor suppressor gene SMAD4 |
|
|
Term
| what % of pancreatic ca is inherited? in what 3 mechanism is it inherited? and which is the MC? |
|
Definition
16%
1. predisposition to chronic disease predisposing to pancreatic ca
2. MC - directly inherited predisposition
3. multiple organ malignancy syndromes |
|
|
Term
| 6 familial multi-organ cancer syndromes consisting of pancreatic ca |
|
Definition
1. Li-Fraumeni
2. HNPCC
3. FAP
4. BRCA1/BRCA2
5. Peutz-Jegehrs
6. Familial atypical Multiple Mole Melanoma (FAMMM) |
|
|
Term
| which familial multi-organ cancer syndrome is associated with the highest lifetime risk of pancreatic ca? what is the genetic mutation? |
|
Definition
| Peutz-Jegehrs syndrome, STK11 |
|
|
Term
| 4 hereditary chronic illnesses associated with increased risk of pancreatic ca |
|
Definition
1. CF
2. hereditary pancreatitis
3. DM
4. ataxia telangiectasia |
|
|
Term
| 4 situation where there is a consensus for performing pancreatic ca screening, what is common to the 4 of them and the screening method |
|
Definition
4 situations that entail a tenfold risk of pancreatic ca:
1. hereditary pancreatitis
2. peutz jeghers
3. over 3 1st degree family members with pancreatic ca
4. FAMMM
Endoscopic Ultrasound |
|
|
Term
| what is the imaging modality of choice in pancreatic ca? |
|
Definition
| dual phase contrast enhanced spiral CT |
|
|
Term
| for what goal is MRI superior to CT? and where are those equal |
|
Definition
| assessing spread of disease (not tumor resectibility) |
|
|
Term
| in pancreatic ca, what is the advantage of EUS over the rest of the imaging modalities? |
|
Definition
| superior ability to provide local staging - lymph node involvement, vascular invasion, identify lesion smaller than 3 cm |
|
|
Term
| in pancreatic ca, when should FDG-PET be seriously considered? |
|
Definition
| prior to surgery or major chemoradiation Tx b/c of its superior ability to detect metastasis |
|
|
Term
| what is the method of choice for obtaining ductal brushings in pancreatic ca? |
|
Definition
|
|
Term
| when is tissue Bx indicated in pancreatic ca (2)? and what is the method of choice for obtaining it? |
|
Definition
1. doubt regarding the Dx of pancreatic ca.
2. prior to neoadjuvant Tx
EUS |
|
|
Term
| why is EUS-FNA preferred over percutaneous FNA for tissue Bx in pancreatic ca? |
|
Definition
| less peritoneal dissemination |
|
|
Term
| in pancreatic ca, when is percutaneous FNA acceptable? |
|
Definition
| only in metastatic or inoperable disease |
|
|
Term
| 4 uses of CA19-9 in pancreatic ca |
|
Definition
1. presurgery prognostic factor
2. post surgery indicator of recurrence
3. postsurgery prognostic factor
4. biomarker of response to chemo in metastatic disease |
|
|
Term
|
Definition
1. limited to pancreas
2. beyond pancreas or regional lymph nodes (T3 or N1)
3. involves celiac axis or SMA (T4)
4. mets |
|
|
Term
| what % of patients with pancreatic ca have microscopic residual disease post surgery |
|
Definition
|
|
Term
| what is the median survival and 5 yr survival for patients who underwent R0 resection in pancreatic ca? |
|
Definition
|
|
Term
| what is the cutoff of tumor size in pancreatic ca that entails better prognosis? |
|
Definition
|
|
Term
| what type of surgery for pancreatic ca of the uncinate or head of the pancreas |
|
Definition
| pylorus-preserving pancreaticoduodenectomy (modified Whipple's procedure) |
|
|
Term
| what type of surgery for pancreatic ca of the body or tail of the pancreas |
|
Definition
| distal pancreatectomy, includes splenectomy. |
|
|
Term
| what is the adjuvant Tx for resection in pancreatic ca in europe vs. USA |
|
Definition
1. europe: 5FU or Gemcitabine
2. USA: 5FU based CRT following Gemcitabine |
|
|
Term
| what is the survival difference btwn 5FU and Gemcitabine |
|
Definition
|
|
Term
| which Tx given post complete resection delays recurrence? |
|
Definition
|
|
Term
| how is Gemcitabine superior to 5FU? |
|
Definition
| safety profile - less incidence of stomatitis and diarrhea |
|
|
Term
| what is the adjuvant Tx to Gemcitabine in patients with locally advanced non metastatic pancreatic ca who had reached steady disease after 3-6 months of Tx? |
|
Definition
|
|
Term
| what % of patients present with metastatic pancreatic ca? |
|
Definition
|
|
Term
| what is the standard Tx of metastatic pancreatic ca |
|
Definition
|
|
Term
| in metastatic pancreatic ca, what 2 combinations of Gemcitabine show improved survival compared with Gemcitabine alone? |
|
Definition
| 1. Gemcitabine + Erlotinib (TARCEVA - a reversible tyrosine kinase inhibitor, which acts on the epidermal growth factor receptor (EGFR) 2. Gemcitabine + Capcitabine (GEM-CAP) |
|
|
Term
| which Tx for metastatic pancreatic ca shows improved response rate compared with Gemcitabine monotherapy? |
|
Definition
|
|
Term
| which patients with metastatic pancreatic ca are eligible for chemotherapy and what regimen? |
|
Definition
only good performance status
FOLFIRINOX - 5FU/FA, Irinotecan, Oxaliplatin |
|
|
Term
| what is the incidence ratio of HCC in males vs. females? |
|
Definition
4:1 with cirrhosis
1:1 w/o cirrhosis |
|
|
Term
| what % of people with HCV develop cirrhosis? out of them, what % develop HCC? out of patients with HCV what % develop HCC annually? |
|
Definition
|
|
Term
| 2 areas in the world with the greatest incidence of HCC? |
|
Definition
| china, sub-saharan africa |
|
|
Term
| 5 common risk factors for HCC |
|
Definition
1. cirrhosis
2. HBV/HCV
3. Aflatoxin B1
4. NASH
5. ethanol |
|
|
Term
| 8 unusual risk factors for HCC (think substance overload conditions) |
|
Definition
1. alpha1 antitrypsin def
2. hereditary tyrosinemia
3. primary billiary cirrhosis
4. hemochromatosis
5. wilson's disease
6. citrullinemia
7. glycogen storage diseases
8. porphyria cutanea tarda |
|
|
Term
| what is the MC presentation of HCC (in USA)? |
|
Definition
|
|
Term
| what is the 2nd MC presentation of HCC? |
|
Definition
| routine lab work with LFTs |
|
|
Term
| what % of patients have no cirrhosis prior to Dx of HCC? |
|
Definition
|
|
Term
| what are 3 tumor characteristics of HCC |
|
Definition
1. 3 or more lesions
2. bilobar
3. portal vein invasion |
|
|
Term
| what is the MC sign of physical exam in HCC |
|
Definition
|
|
Term
| what is the cause of thrombocytopenia and leukopenia in HCC? |
|
Definition
|
|
Term
| 10 paraneoplastic signs in HCC |
|
Definition
1. hypercholesterolemia
2. hypercalcemia
3. hypoglycemia
4. increased thyroxin-binding globulin
5. increased sex hormone binding globulin
6. leukopenia
7. thrombocytopenia
8. dysfibrinogenemia
9. carcinoid syndrome
10. porphyria cutanea tarda |
|
|
Term
| 3 popular staging systems for HCC |
|
Definition
|
|
Term
| 4 parameters in the Okuda staging system for HCC? |
|
Definition
1. albumin (cutoff 3)
2. extent of tumor in liver (cutoff 50%)
3. ascites
4. bilirubin (cutoff 3) |
|
|
Term
| 5 parameters in the CLIP staging system for HCC? |
|
Definition
1. single or multiple tumors
2. extent of liver involved
3. AFP
4. Child-Pugh score
5. portal vein thrombosis |
|
|
Term
| 9 laboratory tests indicated in the workup of a patient with recent hepatic decompensation or palpable liver mass suspected of HCC |
|
Definition
| CBC (splenomegaly), LFTs, ammonia, CEA, AFP and DCP (PIVKA-2), Ca2+ and Mg2+ hepatitis B, C, and D serology (and quantitative HBV DNA or HCV RNA, if either is positive); neurotensin (specific for fibrolamellar HCC) |
|
|
Term
| what is PIVKA and except for HCC in what iatrogenic setting is it elevated? |
|
Definition
| protein induced by vitamin K absence (des gamma carboxy prothrombin) |
|
|
Term
| what is a good screening tool for HCC and what 2 classic vascular abnormalities does it pick up? |
|
Definition
| US, neovascularization and thrombosis |
|
|
Term
| what is the best imaging option to determine size, extent and portal vein invasion by HCC? |
|
Definition
| triphasic contrast CT of the abdomen, pelvis and chest |
|
|
Term
| what is the finding on CT in portal vein involvement d/t HCC |
|
Definition
| obstruction and expansion of the vessel |
|
|
Term
| what is the advantage of using MRI with the new contrast dye Ethiodiol for HCC |
|
Definition
| it stains the tumor cells, so that when Bx is performed you can be certain that you got tissue from the tumor itself |
|
|
Term
| which imaging technique is superior in HCC |
|
Definition
|
|
Term
| what is the preferred method to obtain tissue Dx in HCC and why? |
|
Definition
| core Bx (not FNA) b/c required tissue architecture to distinguish HCC from adenocarcinoma |
|
|
Term
| 4 causes of bleeding complication during Bx in HCC |
|
Definition
1. ascites
2. coagulation factor def
3. thrombocypenia
4. hypervascularity |
|
|
Term
| what is the significance of finding portal vein involvement on liver Bx in HCC? |
|
Definition
| CI for liver transplantation |
|
|
Term
| what is the benefit of screening for HCC in high risk populations? |
|
Definition
|
|
Term
| what is the consensual method of screening for HCC in high risk populations and who are these populations? |
|
Definition
6 monthly AFP and CT/US (or)
HBV carriers, HCV cirrhosis, family history of HCC |
|
|
Term
| what is the mortality risk for major hepatectomy in HCC |
|
Definition
|
|
Term
| what is a preoperative procedure for surgical excision in HCC and what is the rationale for it? |
|
Definition
| Preoperative portal vein occlusion to cause the tumor to shrink and the normal tissue to hypertrophy - safer surgery |
|
|
Term
| what are 5 preconditions to perform surgical excision in HCC? |
|
Definition
1. no cirrhosis or child's A cirrhosis
2. single tumor
3. no metastases
4. no ascites
5. no variceal bleeding |
|
|
Term
| what are preconditions to perform liver transplantation in HCC? |
|
Definition
1. any class of cirrhosis
2. single lesion smaller than 5 cm or maximum 3 lesions each smaller than 3 cm (Milan Criteria)
3. no gross vascular invasion |
|
|
Term
| 4 factors that are CI to surgery in HCC? |
|
Definition
1. gross vascular invasion
2. more than 3 lesions or a lesion over 6 cm
3. lymph node involvement
4. metastases |
|
|
Term
| in patients with HCC who are candidates for transplantation, how do you determine if for cadaver or live doner? |
|
Definition
| UNOS - United Network for Organ Sharing protocol |
|
|
Term
| what is a bridging Tx for patients waiting on the UNOS transplant list (2)? |
|
Definition
1. neoadjuvant
2. Radio Frequency Ablation (RFA) or Transarterial Chemoembolization (TACE) or 90Yttrium - beta emitter |
|
|
Term
| in HCC patients who are not candidates for any surgical intervention, who are the patients eligible for TACE or 90Yttrium (2)? |
|
Definition
1. child's A/B
2. no metastases |
|
|
Term
| what is the Tx of stage 1 or 2 HCC patients with either child B or C cirrhosis, variceal bleeding or ascites? |
|
Definition
|
|
Term
| what are the 4 excisional approaches in HCC? and how to decide btwn them? |
|
Definition
open surgery, laparoscopic, RFA, Percutaneous Ethanol Injection (PEI).
no head-to-head trials choose by surgeon's expertise |
|
|
Term
| what is the maximal size of HCC lesion adequate for RFA? |
|
Definition
|
|
Term
| 2 obligations in the use of RFA for HCC? |
|
Definition
1. size 3-4 cm maximum
2. proximity to portal triad - obstruction |
|
|
Term
| what is the maximal size of HCC lesion Tx with PEI? |
|
Definition
|
|
Term
| what is the 5 yr tumor-free survival for a patient with HCC and Milan criteria who had underwent liver transplantation? |
|
Definition
|
|
Term
| 2 unknown facts about bridging Tx for patients waiting on the list for liver transplantation d/t HCC |
|
Definition
1. if there is a survival benefit after transplantation
2. if recurrence rates should be calculated according to disease state post or pre bridging therapy |
|
|
Term
| what is an acceptable approach for downstaging HCC lesions for following trnasplantation which do not adhere to the Milan Criteria |
|
Definition
|
|
Term
| what is the TNM definition of stage 3 HCC |
|
Definition
|
|
Term
| what is the surgical approach to stage 3 HCC without Cirrhosis or child's A cirrhosis (2) |
|
Definition
1. a small percentage of patients will achieve long-term survival, justifying an attempt at resection when feasible
2. downstaging with TACE can allow for liver transplantation |
|
|
Term
| what is the role systemic chemotherapy in the Tx of HCC? |
|
Definition
| none - no agent has shown any survival benefit |
|
|
Term
| what are the only two chemotherpeutic options administered via TACE have shown a survival benefit in HCC |
|
Definition
| Cisplatin and Doxorubicin |
|
|
Term
| how is regional chemotherapy (TACE) administered in patients with stage 3 or 4 HCC? |
|
Definition
| alongside with arterial embolization |
|
|
Term
| what are 6 possible adverse effects of the embolization therapy part of TACE in HCC patients |
|
Definition
| transient fever, abdominal pain, anorexia (all in >60% of patients, increased ascites, elevation of transaminases, cholecystitis |
|
|
Term
| The hepatic toxicities associated with embolization for the Tx of HCC may be ameliorated by the use of what |
|
Definition
|
|
Term
| of the targeted new biological therapies for stage 3 and 4 HCC, which 2 regimens had shown a survival benefit? |
|
Definition
1. Sorafenib (Nexavar)
2. bevacizumab (Avastin) plus erlotinib |
|
|
Term
| what is the Tx for Multiple unilobar tumors or tumor with vascular invasion |
|
Definition
| TACE or sorafenib (Nexavar) |
|
|
Term
| what is the TX for Bilobar tumors, with no vascular invasion |
|
Definition
| TACE with OLTX for patients with tumor response |
|
|
Term
| what is the Tx for Extrahepatic HCC or elevated bilirubin |
|
Definition
| sorafenib (Nexavar) or bevacizumab (Avastin) plus erlotinib (combination agent trials are in progress) |
|
|
Term
| what is a typical test for fibrolamellar HCC |
|
Definition
|
|
Term
| differences in fibrolamellar HCC compared with adult type |
|
Definition
1. younger age (teenagers)
2. females more than males
3. Tx of choice is always surgical b/c poorer response to chemo
4. higher survival rates
5. no cirrhosis
6. less vascular invasion |
|
|
Term
| 4 characteristics of epitheloid hemangioendothelioma |
|
Definition
1. higher survival than adult type HCC
2. vascular origin as thus expresses factor 8
3. treated with liver transplantation
4. no cirrhosis |
|
|
Term
| what are 3 serologic markers used to follow up on the Tx of Cholangiocarcinoma |
|
Definition
|
|
Term
| what 3 stains are positive in cholangiocarcinoma and which is negative? |
|
Definition
| cytokeratins 7, 8, and 19 and negatively for cytokeratin 20 |
|
|
Term
| surgical Tx for hilar Cholangiocarcinoma - how many resectable, survival, procedure? |
|
Definition
| 30% resectable, typical survival 24 months, bile duct resection and lymphadenectomy |
|
|
Term
| 2 step Tx for distal Cholangiocarcinoma and survival? |
|
Definition
1. resection of the extrahepatic bile ducts with pancreaticoduodenectomy
2. postoperative adjuvant radiotherapy (no survival benefit) or photodynamic therapy (shows survival benefit)
survival 24 months |
|
|
Term
| neoadjuvant radiotherapy with sensitizing chemotherapy followed by liver transplantation is indicated by the UNOS for perihilar cholangiocarcinoma, given 2 preconditions |
|
Definition
1. lesion < 3 cm
2. no metastases |
|
|
Term
| what is the standard Tx for unresectable cholangiocarcinoma? |
|
Definition
|
|
Term
| what is the only adjuvant Tx for cholangiocarcinoma that had shown a survival benefit? |
|
Definition
|
|
Term
| what is the Px of Gallbladder carcinoma? |
|
Definition
| typical survival is 6 months in most cases, few cases are presented in stage 1 or 2 and entail higher much higher prognosis. prognosis is worse than HCC and CCC |
|
|
Term
| what is the Tx of unresectable gallbladder carcinoma? |
|
Definition
| chemo has no survival benefit |
|
|
Term
| what is the role of adjuvant radiation therapy in resectable gallbladder carcinoma? |
|
Definition
| none. no survival benefit |
|
|
Term
| 2 characteristics of the patients with gallstone carcinoma |
|
Definition
1. female
2. antecedent gallstone disease |
|
|
Term
| what is the MC clinical presentation of carcinoma of the ampulla of vater? |
|
Definition
|
|
Term
| what is the definition of carcinoma of the ampulla of vater? |
|
Definition
| a tumor situated anywhere on the CBD within 2 cm of the ampulla |
|
|
Term
| what is the MC histologic type of carcinoma of the ampulla of vater? |
|
Definition
|
|
Term
| what is the Tx of carcinoma of the ampulla of vater? what % of patients are resectable? what is the associated 5 yr survival? |
|
Definition
| pylorus-sparing pancreaticoduodenectomy, 80% resectable!, 25% if lymph node involvement and 50% if not |
|
|
Term
| what is the role of adjuvant chemo or radiotherapy? |
|
Definition
| none, no survival benefit |
|
|
Term
| which is the preferred method of adjuvant chemotherapy in colon cancer metastatic to the liver following metastasis resection? |
|
Definition
| systemic approach (vs. local infusion to the hepatic artery) |
|
|
Term
| what are the 3 benign types of tumor of the liver, which one is treated and why? |
|
Definition
1. hemangioma
2. focal nodular hyperplasia
3. adenoma - Tx with resection b/c of 30% risk of bleeding and slightly elevated risk of HCC |
|
|
Term
| 3 epidemiologic facts about esophageal carcinoma |
|
Definition
1. blacks > whites
2. can be familial
3. associated with lower socioeconomic status |
|
|
Term
| what % of esophageal cancer is adenocarcinoma vs. SCC in the western world today? |
|
Definition
|
|
Term
| 9 risk factors for esophageal SCC |
|
Definition
| hot tea, smoking, alcohol, nitrites, smoked opiates, lye (used for making soap), achalasia, fungal toxins in canned vegetables, radiation |
|
|
Term
| which 2 syndromes are associated with increased risk of esophageal SCC? |
|
Definition
1. plammer-vinison
2. tylosis palmaris et plantaris - congenital hyperkeratosis and pitting of the palms and soles |
|
|
Term
| which 3 nutritional deficiencies are associated with an increased risk of esophageal SCC? |
|
Definition
| zinc, selenium, and vitamin A |
|
|
Term
| 2 risk factors for esophageal adenocarcinoma except barret's (GERD) |
|
Definition
|
|
Term
| which medical condition is associated with and increased risk of esophageal SCC |
|
Definition
|
|
Term
| 6 sites of metastases in esophageal cancer |
|
Definition
| adjacent and supraclavicular lymph nodes, liver, lungs, pleura, and bone |
|
|
Term
| paraneoplastic phenomenon in esophageal SCC and its mechanism |
|
Definition
|
|
Term
| what are the methods used in the Dx and workup of esophageal cancer? |
|
Definition
| endoscopy (Bx, brush smears), abdominal and chest CT or EUS, PET-CT |
|
|
Term
| what is the use of EUS in the workup of esophageal cancer |
|
Definition
| assessment of mediastinum and para-aortic lymph nodes |
|
|
Term
| what is the role of PET-CT in the workup of esophageal cancer? |
|
Definition
| assessment of resectability - spread to mediastinal lymph nodes |
|
|
Term
| what is the 5 yr survival for patients with esophageal cancer |
|
Definition
|
|
Term
| what % of esophageal cancers are resectable at presentation |
|
Definition
|
|
Term
| what is the 5 yr survival for esophageal cancer undergoing resection? |
|
Definition
|
|
Term
| what is the perisurgical mortality rate in esophageal cancer? what are the causes |
|
Definition
| 5%, fistulas/respiratory complications and subphrenic abscesses |
|
|
Term
| what is the survival rate for primary radiation therapy for esophageal cancer as a substitute for surgical resection? what is the advantage and the downside? |
|
Definition
| same survival rates as for surgery (20% 5yr), spares the perioperative mortality, doesn't palliate as efficiently |
|
|
Term
| what is the Tx of choice for esophageal cancer for patients with a good performance status? |
|
Definition
| chemoradiation +/- resection depending on residual disease after chemoRx |
|
|
Term
| what is the most efficient chemo for the Tx of esophageal cancer |
|
Definition
| a combination of cisplatin and another drug |
|
|
Term
| 4 methods of palliation in esophageal cancer |
|
Definition
1. dilation endoscopy
2. laser
3. metal stent
4. surgical gastrostomy/jejunostomy |
|
|
Term
| which condition is associated with both esophageal adenocarcinoma and SCC? |
|
Definition
|
|
Term
| incidence of gastric adenocarcinoma is decreasing or increasing worldwide? |
|
Definition
|
|
Term
| risk factor for gastric adenocarcinoma |
|
Definition
|
|
Term
| how does migrating from a high incidence area of gastric adenocarcinoma to a low incidence area affect the risk of disease |
|
Definition
| in the adult in doesn't change the risk in its offsprings the risk is reduced, suggesting an early life environmental factor, possibly nutritional |
|
|
Term
| 4 histologic types of gastric cancer and their incidence |
|
Definition
85% - adenocarcinoma
15% - lymphoma, GIST, leimyosarcoma |
|
|
Term
| 5 characteristics of diffuse type gastric adenocarcinoma in comparison to intestinal type |
|
Definition
1. lintis plastica
2. decreased distensibility
3. involves any part of the stomach
4. poorer prognosis
5. younger patients |
|
|
Term
| why is lintis plastica formed in diffuse type gastric adenocarcinoma |
|
Definition
| loss of expression of E-cadherin, cell don't attach to each other to form a mass |
|
|
Term
| 3 characteristics of intestinal type gastric adenocarcinoma in comparison to intestinal type |
|
Definition
1. create ulcerative lesions
2. antrum and lesser curvature
3. prolonged precancerous H.Pylori |
|
|
Term
| what is the hypothesis for the etiology of gastric adenocarcinoma? exogenous and endogenous factors that contribute to it? |
|
Definition
lower socioeconomic class patients ingest decayed food containing bacteria able to turn nitrates in salty, smoked, food into nitrites which are carcinogenic.
factors that are associated with an increased risk of attaining such bacteria: low gastric acidity, H2 blockers, prior gastric surgery, pernicious anemia/atrophic gastritis |
|
|
Term
| which blood type is associated with higher risk of gastric adenocarcinoma |
|
Definition
|
|
Term
| which disease is associated with higher risk of gastric adenocarcinoma? |
|
Definition
| Ménétrier's disease - extreme hypertrophy of gastric rugal folds |
|
|
Term
| what kind of mutation is associated with a significant increased risk of gastric adenocarcinoma |
|
Definition
| germ line mutation in the E-cadherin gene CDH1 |
|
|
Term
| what genetic alterations have been associated with invasive disease in gastric adenocarcinoma |
|
Definition
| epigenetic changes - methylation |
|
|
Term
| what gene mutations are associated in the carcinogenesis of gastric adenocarcinoma (except for E-cadherin) |
|
Definition
| K-ras, p53, APC, DCC (deleted in colon cancer) |
|
|
Term
| which protein is associated with progression from dysplasia to gastric adenocarcinoma |
|
Definition
|
|
Term
| which protein can be found in the nucleus of tumor cells at the leading edge of invasion in gastric adenocarcinoma |
|
Definition
|
|
Term
| 4 unique sites of metastasis given names in gastric adenocarcinoma |
|
Definition
blumer's shelf - peritoneal cul-de-sac
sister mary joseph - periumbilical
kruckenberg - ovary
virchow's node - left supraclavicular |
|
|
Term
| what is the MC site of hematogenous spread in gastric adenocarcinoma? |
|
Definition
|
|
Term
| 4 Unusual clinical features associated with gastric adenocarcinomas |
|
Definition
| migratory thrombophlebitis, microangiopathic hemolytic anemia, diffuse seborrheic keratoses (so-called Leser-Trélat sign), and acanthosis nigricans. |
|
|
Term
| what is the first test in the workup of a patient suspected of gastric adenocarcinoma |
|
Definition
| double contrast radiography |
|
|
Term
| 4 factors that influence Px after resection in gastric adenocarcinoma |
|
Definition
| extent of wall invasion, regional lymph node involvement, vascular invasion, and abnormal DNA content (i.e., aneuploidy) |
|
|
Term
| what % of patient are eligible for complete resection including regional lymph nodes in gastric adenocarcinoma? |
|
Definition
|
|
Term
| which location is associated with a higher survival rate post resection, proximal or distal gastric adenocarcinoma |
|
Definition
|
|
Term
| what is the role of complete resection (includes regional lymph node resection)? |
|
Definition
| it is the only Tx that offers a chance for cure, but it is not associated with higher survival and is associated with more post-op morbidity |
|
|
Term
| what are the only 2 CI to resection of primary tumor in gastric adenocarcinoma and why? |
|
Definition
ascites or extensive hepatic or peritoneal metastases
decreasing tumor bulk is the best palliative Tx |
|
|
Term
| what is the role of radiation therapy in gastric adenocarcinoma and why? |
|
Definition
| palliation only. the tumor is radioresistant |
|
|
Term
| in which way is adjuvant chemotherapy administered in gastric adenocarcinoma? |
|
Definition
| perioperative - before and after surgery |
|
|
Term
| 2 chemo regimens given in advanced gastric adenocarcinoma |
|
Definition
1. cisplatin and epirubicin
2. taxel and 5FU or irinotecan |
|
|
Term
| what is the MC extranodal site for lymphoma? |
|
Definition
|
|
Term
| what is the MC histologic type of gastric lymphoma |
|
Definition
| non hodgkin's B cell lymphoma |
|
|
Term
| what is the 1st line Tx of gastric lymphoma and why? |
|
Definition
| Abx to eradicate H.Pylori b/c this leads to regression of disease in 75% of cases |
|
|
Term
| what is the underlying genetic abnormality in gastric lymphoma resistant to H.Pylori eradication? |
|
Definition
|
|
Term
| what is the Tx of localized high grade gastric lymphoma? |
|
Definition
| surgical plus adjuvant chemo leading to a 5 yr survival of 50% |
|
|
Term
| what is the Tx of gastric lymphoma with preoperative radiographic evidence of nodal involvement? |
|
Definition
| chemo - R-CHOP: rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone |
|
|
Term
| what is the role of adjuvant radiotherapy in gastric lymphoma? |
|
Definition
| none, b/c most recurrences are not at tumor bed but distant |
|
|
Term
| what is the MC of gastric sarcomas |
|
Definition
|
|
Term
| after diagnosing gastric sarcoma, what should be the first next step? |
|
Definition
| checking for c-kit mutation b/c 50% of patients with gastric GIST are responsive to Gleevec |
|
|
Term
| what is the 2nd line Tx for patients with gastric GIST that are unresponsive to Gleevec |
|
Definition
|
|
Term
| what is the role of chemo in the Tx of gastric GIST? |
|
Definition
| none, GIST are unresponsive to chemo |
|
|
Term
| what is the Tx of choice in gastric sarcoma (non c-kit)? |
|
Definition
|
|
Term
| what % of polyps become malignant? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| colon cancer develops more frequently in pedunculated or sessile polyps? |
|
Definition
|
|
Term
| what is the histology most associated with colon cancer in polyps? |
|
Definition
|
|
Term
| in colon, what is the size of an adenoma that holds the most substantial risk of being malignant? |
|
Definition
|
|
Term
| after finding a polyp why should the whole colon be checked? |
|
Definition
| synchronous lesions will appear in one third of the cases |
|
|
Term
| after finding and removing a polyp from the colon why should colonoscopy be repeated periodically |
|
Definition
| 50% chance of recurrence and a higher than standard risk of colorectal cancer |
|
|
Term
| what are 3 dietary factors that affect the risk of colorectal cancer? |
|
Definition
| animal fat, high caloric intake, high cholesterol levels |
|
|
Term
| what is the role of a high vegetable and fruit diet in preventing colorectal cancer |
|
Definition
| none, diet high in fiber has failed to show effect on the risk of colorectal cancer |
|
|
Term
| mortality from colorectal cancer is associated with mortality from what other disease |
|
Definition
|
|
Term
| what are 6 general risk factors for colorectal cancer |
|
Definition
| diet, hereditary syndromes, IBD, strep bovis, ureterosigmoidostomy, tobacco |
|
|
Term
| what % of colorectal patients have a family history of the disease |
|
Definition
|
|
Term
| what 6 lesions are associated with Gardner's syndrome? |
|
Definition
| Osteomas, fibromas, lipomas, epidermoid cysts, ampullary cancers, congenital hypertrophy of retinal pigment epithelium |
|
|
Term
| what 2 lesions are associated with HNPCC |
|
Definition
| Endometrial and ovarian tumors |
|
|
Term
| what 4 malignancies are associated with Peutz-Jegher's syndrome? |
|
Definition
| ovary, breast, pancreas, endometrium |
|
|
Term
| what is the first Tx once FAP has been diagnosed? |
|
Definition
|
|
Term
| 2 possible surveillance methods of the offsprings of patients with FAP? |
|
Definition
1. annual sigmoidoscopy from age 15-35
2. APC mutated gene in mononuclear cells in the peripheral blood |
|
|
Term
| what are the 3 amsterdam criteria for HNPCC |
|
Definition
1. 3 or more relatives with CRC where one of the patients is a 1st degree relative of the other two
2. the disease spans at least two generations
3. at least one patient is under 50 |
|
|
Term
| what is the MC site of tumor in HNPCC? |
|
Definition
|
|
Term
| what is the histology and prognosis of CRC in HNPCC compared with sporadic CRCs? |
|
Definition
| despite being poorly differentiated in histology it has better prognosis |
|
|
Term
| what is the recommended screening strategy in females afflicted with HNPCC? |
|
Definition
| biannual colonoscopy (every 2 years), intermittent pelvic US and endometrial Bx |
|
|
Term
| what are the 2 genes mutated in HNPCC and their role |
|
Definition
| hMLH1 and hMSH2 - DNA mismatch repair when damaged causeing microsatellite instability |
|
|
Term
| what is the rate at which the risk of CRC is increased in people with UC and at what point of time? |
|
Definition
| 10 yrs into the IBD the risk of CRC climbs to a rate increase of 1% every year |
|
|
Term
| what % of patients with IBD will develop CRC after age 25 |
|
Definition
|
|
Term
| who are the IBD patients more prone to suffer from CRC? |
|
Definition
|
|
Term
| what is the role of colonoscopic screening for CRC in patients with IBD? |
|
Definition
| controversial, it has not shown survival benefit |
|
|
Term
| what is the primary prophylactic Tx of choice for IBD patients experiencing frequent bouts of disease for over 15 yrs? |
|
Definition
|
|
Term
| 5 nutritional supplementations and drugs proven effective for primary and secondary prevention of CRC |
|
Definition
| aspirin, NSAIDs, estrogen replacement therapy, folic acid, oral calcium |
|
|
Term
| what are the 2 options the american cancer society recommendations provide for CRC screening |
|
Definition
1. annual occult fecal blood and sigmoidoscopy every 5 yrs as of age 50
2. colonoscopy every 10 yrs as of age 50 |
|
|
Term
| what % of CRCs are detected on occult fecal blood? |
|
Definition
|
|
Term
|
Definition
1. stage I (T1–T2,N0,M0) - doesn't pass after muscularis
2. stage II (T3,N0,M0) - passes all the way through muscularis
3. stage III (TX,N1,M0) - regional lymph involvement
4. stage IV (TX,NX,M1) - metastases |
|
|
Term
| why is the 5 yr survival rate a good predictor of cure in CRC |
|
Definition
| most recurrences occur within 4 yrs of resection |
|
|
Term
| what should be the minimum number of nodes examined when staging CRC and why? |
|
Definition
| 12. whether the number of lymph nodes involved is over 3 or under 4 impedes greatly on Px |
|
|
Term
| 10 predictors of poor Px after resection in CRC |
|
Definition
| regional lymph node involvement, number of lymph nodes involved, tumor penetration through the bowel wall, perforation, spread to adjacent organs, presurgery elevation in CEA, aneupleudy, certain mutations such as deletion of 18 chromosome (DCC), venous invasion, poorly differentiated histology |
|
|
Term
| In contrast to most other cancers, the prognosis in colorectal cancer is not influenced by? |
|
Definition
| the size of the primary lesion |
|
|
Term
| what is the MC organ for metastases in CRC |
|
Definition
|
|
Term
| which mutation detected is associated with a better outcome in CRC |
|
Definition
| APC - microsatellite instability |
|
|
Term
| 4 tests that should be preformed preoperatively in CRC? |
|
Definition
| LFTs, CEA, CXR, colonoscopy (if possible) |
|
|
Term
| why is it so important to perform colonoscopy preoperatively and when should it be done if it not possible to do it before resection |
|
Definition
| there is a likelihood of synchronous disease somewhere else in the colon. should be done several months post-operatively |
|
|
Term
| what is the follow up of patients with CRC who have undergone complete resection |
|
Definition
1. semi annual physical examination and annual LFTs or 3 monthly CEA only
2. CT or colonoscopy every 3 years |
|
|
Term
| why is it important to repeat colonoscopy after 3 years of disease |
|
Definition
| the chance of suffering a second bowel malignancy is 5% and adenoma - 15% |
|
|
Term
| 2 roles of chemoradiation in CRC |
|
Definition
1. adjuvant Tx to reduce recurrence rates
2. neoadjuvant Tx to reduce primary tumor size and allow resection |
|
|
Term
| what is the effect of radiation therapy in CRC on survival? |
|
Definition
|
|
Term
| adjuvant chemoradiation is indicated in what stages of CRC |
|
Definition
|
|
Term
| what are 2 optional 1st line Tx regimens in metastatic CRC? |
|
Definition
1. FOLFIRI +/- Cetuximab (Erbitux)
2. FOLFOX |
|
|
Term
| what are 2 optional 2nd line Tx regimens in metastatic CRC? |
|
Definition
1. alternate choice btwn FOLFIRI/FOLFOX
2. Cetuximab (Erbitux) or panitumumab (Vectibix) - EGFR inhibitors |
|
|
Term
| in what subset group of patients with CRC are EGFR inhibitors - Cetuximab (Erbitux) and panitumumab (Vectibix) - ineffective? |
|
Definition
| patients with a K-ras mutation |
|
|
Term
| what is the major side effect of EGFR inhibitors (Cetuximab (Erbitux) and panitumumab (Vectibix)) and what is this an indication for? |
|
Definition
| rash. indicating good therpeutic response |
|
|
Term
| what is the most effective adjuvant chemo Tx option for stage 3 CRC? |
|
Definition
| FOLFOX (FOLFIRI or Cetuximab do not show survival or recurrence benefit) |
|
|
Term
| what is the place for adjuvant chemotherapy in stage 2 CRC? |
|
Definition
| usually it is not beneficial except in the following 3 cases: perforated tumor, Ty lesions, lymphovascular invasion |
|
|
Term
| what is an adjuvant method to increase survival and decrease recurrence in rectal CRC stage 2/3? |
|
Definition
| neo/adjuvant 5FU+radiation therapy |
|
|
Term
| in what 3 situations should small bowel tumors be taken into account in the DD |
|
Definition
1. recurrent bouts of bowel obstruction w/o prior surgery or IBD
2. intussuception in the adult
3. evidence of bleeding with negative findings on endoscopy |
|
|
Term
| what is the diagnostic procedure of choice for suspected small bowel tumor |
|
Definition
| small bowel barium study with enteroclysis (NGT to constantly insert contrast) |
|
|
Term
| what is the role of clinical and radiological findings in determining whether a small bowel tumor is benign or malignant? |
|
Definition
|
|
Term
| 4 benign tumors of the small bowel |
|
Definition
| lipomas, angiomas, adenomas, leiomyomas |
|
|
Term
| MC malignant tumor of the small bowel |
|
Definition
|
|
Term
| 3 risk factors for small bowel malignancy |
|
Definition
| celiac, AIDS, chronic enteritis |
|
|
Term
| what is the MC site of adenocarcinoma in the small bowel? |
|
Definition
| distal duodenum-proximal jejunum |
|
|
Term
| Tx of small bowel adenocarcinoma |
|
Definition
|
|
Term
| Lymphoma in the small bowel may be primary or secondary. Dx is histologic in a clinical setting that is absent of the following |
|
Definition
| adenopathy, hepatosplenomegaly, no evidence on CXR, CT scan, or blood smear or on bone marrow Bx |
|
|
Term
| 4 step workup needed to confirm Dx of primary small bowel lymphoma |
|
Definition
1. Bx of bowel lesion
2. CXR
3. CT
4. BM Bx or blood smear |
|
|
Term
| what is the incidence of small bowel lymphoma amongst the malignancies of the small bowel? |
|
Definition
|
|
Term
| what are the histologic characteristics of primary lymphoma of the small bowel? |
|
Definition
| diffuse, large cell, T cell |
|
|
Term
| 3 sites of lymphoma in the small bowel by decreasing order of incidence and the reason for this |
|
Definition
| ileum, jejunum, duodenum - decreasing order of lymphatic component |
|
|
Term
| 3 risk factors for lymphoma of the small bowel (similar to the ones for small bowel malignancy) |
|
Definition
| celiac, chronic enteritis, immune deficiency from any reason |
|
|
Term
| what are the rates of cure in small bowel lymphoma? |
|
Definition
| 75% in resectable disease and 25% in unresectable disease |
|
|
Term
| what is immunoproliferative small intestinal disease (IPSID), Mediterranean lymphoma, or heavy chain alpha disease disease |
|
Definition
| diffuse lymphoma involving the entire bowel |
|
|
Term
| what cell type of lymphoma is IPSID? |
|
Definition
|
|
Term
| what are 2 unique findings in IPSID? |
|
Definition
1. clubbing
2. the presence in the blood and intestinal secretions of IgA with a shortened alpha heavy chain and devoid of light chains |
|
|
Term
|
Definition
|
|
Term
| where are carcinoid tumors found in the gut |
|
Definition
| remenants of the midgut - distal duodenum to ascending colon. MC site is distal ileum near ileocecal valve |
|
|
Term
| what is the incidence of anal carcinomas among large bowel malignancies? |
|
Definition
|
|
Term
| 2 histologic types of anal carcinoma according to their anatomical origin? |
|
Definition
1. basaloid or cuboidal - proximal to the pectinate line 40%
2. SCC distal to the pectinate line 60% |
|
|
Term
| what is the premalignant lesion of anal carcinoma? |
|
Definition
| condylomata acuminata caused by HPV |
|
|
Term
| what is the Tx of choice for patients with anal carcinoma |
|
Definition
|
|
Term
| what are the rates of disappearance of tumor smaller than 3 cm for chemoradiation in anal carcinoma |
|
Definition
|
|
Term
| what is the rate of recurrence for patients achieving complete remission after chemoradiation for anal carcinoma |
|
Definition
|
|
Term
| what are the rates of cure with chemoradiation for anal carcinoma |
|
Definition
|
|
Term
| what % of breast cancers can be associated to a germ-line mutation and what are 4 known such mutations? |
|
Definition
| 10%, BRCA1, BRCA2, Li-Fraumeni syndrome, PTEN |
|
|
Term
| what is the lifetime risk of a female with BRCA1 to develop breast cancer? |
|
Definition
|
|
Term
| what are the malignancies associated with male BRCA1 carrier |
|
Definition
|
|
Term
| in what % of sporadic breast cancer is the acquired mutation in p53 present? PTEN? |
|
Definition
|
|
Term
| the oncogene erbB2 (HER/2 neu) is present in what % of breast cancers? |
|
Definition
|
|
Term
| what is the risk of a female who went through menarch at the age of 16 to develop breast cancer in comparison to a female who went through menarch at the age of 12? |
|
Definition
|
|
Term
| menopause that occurs 10 yrs before the median age (52) reduces the risk of breast cancer by what % |
|
Definition
|
|
Term
| what is the breast cancer risk reduction for females that give birth before the age of 18 compared with nulliparus females? |
|
Definition
|
|
Term
| breast cancer risk factors |
|
Definition
| age at menarch, menopause, first full term pregnancy, increased height and weight, no breast feeding,increased caloric intake, moderate alcohol intake, OCP, exposure to radiation before the age of 30 |
|
|
Term
| why is increased caloric intake associated with and increased risk of breast cancer? |
|
Definition
| earlier menarch, later menopause, higher levels of estrogen post-menopause |
|
|
Term
| what is the role of folic acid in reduction of breast cancer risk? |
|
Definition
| it reduces the risk in alcohol drinkers only |
|
|
Term
| which medication is known to reduce the risk of breast cancer? |
|
Definition
|
|
Term
| what is the effect of OCP on the risk of breast cancer, endometrial cancer and ovarian cancer |
|
Definition
| it slightly elevates the risk of breast cancer and decreases the risk of both ovarian and endometrial cancer |
|
|
Term
| what is the effect of HRT on colorectal cancer? |
|
Definition
|
|
Term
| what is the overall effect of HRT on the risk of suffering and adverse event? |
|
Definition
|
|
Term
| when you find a dominant breast mass in a premenopausal female, what is the next step in the workup? |
|
Definition
|
|
Term
| when you find a mass breast mass in a post-menopausal female, what is the next step in workup? |
|
Definition
|
|
Term
| when you find a breast mass that is questionable in a pre-menopausal female, what is the next step in workup? |
|
Definition
| perform PE again during the follicular phase of the period? |
|
|
Term
| in the workup of a breast mass that turns out to be solid on aspiration, what is the next step in workup? |
|
Definition
|
|
Term
| in a solid breast mass suspicious of being malignant on mammogram, what is the next step in workup |
|
Definition
|
|
Term
| in the workup of a breast cyst, if the fluid aspirated is non-bloody, what is the next question you ask yourself? |
|
Definition
|
|
Term
| in the workup of a breast cyst, if the fluid aspirated is non-bloody and there's a residual mass, what is the next course of action? |
|
Definition
|
|
Term
| in the workup of a breast cyst, if the fluid aspirated is non-bloody and there's no residual mass, what is the next course of action? |
|
Definition
| check if fluid reaacumulates |
|
|
Term
| in the workup of a breast cyst, if the fluid aspirated is non-bloody and there's no residual mass but fluid reaccumulates, what is the next course of action? |
|
Definition
| reaspirate and check if fluid reaccumulates again |
|
|
Term
| in the workup of a breast cyst, if the fluid aspirated is non-bloody and there's no residual mass but fluid reaccumulates after 2 aspirations, what is the next course of action? |
|
Definition
|
|
Term
| what is the triple diagnosis technique in a breast lesion? if it's triple negative what is the false negative? |
|
Definition
|
|
Term
| what do you do with a nonpalpable mammographic lesion that has a low index of suspicion? |
|
Definition
| mammographic follow up in 3-6 months |
|
|
Term
| what is the workup of a breast mass in a pregnant female? |
|
Definition
| same as in the non-pregnant female |
|
|
Term
| what is the risk of breast cancer in females who have had a Bx of a breast mass that was benign in comparison to those who haven't? |
|
Definition
|
|
Term
| what is the risk of breast cancer in patients who have had a Bx of ductal/lobular hyperplasia or atypical hyperplasia in comparison to females who have not had a Bx at all? and what if these females had a 1st degree relative with breast cancer? |
|
Definition
|
|
Term
| what is the risk reduction of mortality in patients over the age of 50 who perform screening for breast cancer? |
|
Definition
|
|
Term
| which 3 populations are recommended to perform breast cancer screening with MRI before the age of 40? |
|
Definition
1. radiation to chest ages 10-30
2. BRCA1/2 carriers or unknown 1st degree relatives of breast cancer patients/carriers
3. Li Fraumeni, Bannayan, Cowden syndromes |
|
|
Term
| what is the recommend age to start screening for breast cancer with mammogram? |
|
Definition
|
|
Term
| in the staging of breast cancer, what is T0 |
|
Definition
|
|
Term
| in the staging of breast cancer, what is Tis |
|
Definition
|
|
Term
| in the staging of breast cancer, what is T1 |
|
Definition
|
|
Term
| in the staging of breast cancer, what is T1a |
|
Definition
|
|
Term
| in the staging of breast cancer, what is T1b |
|
Definition
|
|
Term
| in the staging of breast cancer, what is T1c |
|
Definition
|
|
Term
| in the staging of breast cancer, what is T2 |
|
Definition
|
|
Term
| in the staging of breast cancer, what is T3 |
|
Definition
|
|
Term
| in the staging of breast cancer, what is T4 |
|
Definition
| lesion expands to chest wall, inflammation, satellite lesions, ulcerations |
|
|
Term
| in the staging of breast cancer, what is PN0(i-) |
|
Definition
| No regional lymph node metastasis histologically, negative IHC |
|
|
Term
| in the staging of breast cancer, what is PN0(i+) |
|
Definition
| No regional lymph node metastasis histologically, positive IHC, no IHC cluster greater than 0.2 mm |
|
|
Term
in the staging of breast cancer, what is
PN0(mol-) |
|
Definition
| No regional lymph node metastasis histologically, negative molecular findings (RT-PCR) |
|
|
Term
in the staging of breast cancer, what is
PN0(mol+) |
|
Definition
| No regional lymph node metastasis histologically, positive molecular findings (RT-PCR) |
|
|
Term
in the staging of breast cancer, what is
PN1 |
|
Definition
| Metastasis in one to three axillary lymph nodes, or in internal mammary nodes with microscopic disease detected by sentinel lymph node dissection but not clinically apparent |
|
|
Term
in the staging of breast cancer, what is
PN1mi |
|
Definition
| Micrometastasis (>0.2 mm, none >2 mm) |
|
|
Term
in the staging of breast cancer, what is
PN1a |
|
Definition
| Metastasis in one to three axillary lymph nodes |
|
|
Term
in the staging of breast cancer, what is
PN1b |
|
Definition
| Metastasis in internal mammary nodes with microscopic disease detected by sentinel lymph node dissection but not clinically apparent |
|
|
Term
in the staging of breast cancer, what is
PN1c |
|
Definition
| Metastasis in one to three axillary lymph nodes and in internal mammary lymph nodes with microscopic disease detected by sentinel lymph node dissection but not clinically apparent.a (If associated with greater than three positive axillary lymph nodes, the internal mammary nodes are classified as pN3b to reflect increased tumor burden.) |
|
|
Term
in the staging of breast cancer, what is
PN2 |
|
Definition
| Metastasis in four to nine axillary lymph nodes, or in clinically apparent internal mammary lymph nodes in the absence of axillary lymph node metastasis |
|
|
Term
in the staging of breast cancer, what is
PN3 |
|
Definition
| Metastasis in 10 or more axillary lymph nodes, or in infraclavicular lymph nodes, or in clinically apparenta ipsilateral internal mammary lymph nodes in the presence of 1 or more positive axillary lymph nodes; or in more than 3 axillary lymph nodes with clinically negative microscopic metastasis in internal mammary lymph nodes; or in ipsilateral subcarinal lymph nodes |
|
|
Term
| in breast cancer what is stage 0 |
|
Definition
|
|
Term
| in breast cancer what is stage 1 |
|
Definition
|
|
Term
| in breast cancer what is stage 2a |
|
Definition
| T0N1M0 or T1N1M0 or T2N0M0 |
|
|
Term
| in breast cancer what is stage 2b |
|
Definition
|
|
Term
| in breast cancer what is stage 3a |
|
Definition
| T0N2M0 or T1N2M0 or T2N2M0 or T2N1,2M0 |
|
|
Term
| in breast cancer what is stage 3b |
|
Definition
|
|
Term
| 6 characteristics of Luminal A subtype according to gene expression breast cancer |
|
Definition
1. favorable prognosis
2. cytokeratin 8 and 18
3. resistant to chemotherapy
4. responsive to endocrine therapy
5. highest ER+ levels
6. low-grade |
|
|
Term
| what is the prognosis for Luminal B (according to gene expression) breast cancer in comparison to A? |
|
Definition
|
|
Term
| definition of normal-breast-like subtype of breast cancer and its Px |
|
Definition
| gene expression resembles that of normal breast tissue. Px is similar to Luminal B |
|
|
Term
| what is the gene expression subtype associated with BRCA related breast cancers |
|
Definition
| Basal/triple negative disease |
|
|
Term
| Basal subtype breast cancer are of what grade? |
|
Definition
|
|
Term
| which markers does Basal/triple negative breast cancer express? |
|
Definition
| cytokeratins 5/6 and 17, vimentin, p63, CD10, α-smooth muscle actin, (EGFR) |
|
|
Term
| 5 CI for lumpectomy in breast cancer |
|
Definition
| tumors >5 cm, involving the nipple, extensive intraductal disease involving multiple quadrants of the breast, history of collagen-vascular disease, no access to radiation therapy |
|
|
Term
| 3 indications for radiation therapy of the breast post mastectomy |
|
Definition
| T2 in size, positive margins, positive nodes |
|
|
Term
| 3 predictors of recurrence of breast cancer in the surgical bed? |
|
Definition
| lymph node, vascular involvement, extensive intraductal component |
|
|
Term
| what is the effect on survival rates for recurrence in the breast of patients who have undergone breast conserving surgery in comparison to those who underwent mastectomy |
|
Definition
| recurrence is associated with poorer survival |
|
|
Term
| what are the rates of recurrence in the surgical bed after successful breast conserving surgery? |
|
Definition
|
|
Term
| what is the prognostic significance of the hormone receptors in breast cancer? |
|
Definition
| patients who are negative in both ER and PR or in either one of them, are more likely to have recurrence of disease |
|
|
Term
| what is the most significant prognostic factor in breast cancer |
|
Definition
|
|
Term
| the decision to administer adjuvant chemotherapy is sometimes hard to determine. (for example: 1 cm tumor, negative lymph nodes, HER2+) what is a tool to decide? |
|
Definition
| Oncotype - 21 genes that classify the patient to either low, intermediate or high risk |
|
|
Term
| what are the prognostic factors in breast cancer? |
|
Definition
| stage, grade, molecular biology (HER2), microvascular proliferation, certain genes present in oncotype, collagenase, cathepsin D, plasminogen activator, plasminogen activator receptor, and the metastasis-suppressor gene nm23 |
|
|
Term
| what adjuvant Tx is given to females who are premenopausal and have positive lymph nodes (per Bx) |
|
Definition
| Multidrug chemotherapy + tamoxifen if ER-positive + trastuzumab in HER2/neu–positive tumors |
|
|
Term
| which 3 premenopausal female populations with breast cancer receive adjuvant chemotherapy? |
|
Definition
1. positive lymph nodes
2. T >2 cm,
3. T 1–2 cm with other poor prognostic variables |
|
|
Term
| what hormonal Tx is given to postmenopausal females? which post menopausal females receive hormonal Tx? |
|
Definition
| ER+, tamoxifen + aromatase inhibitors |
|
|
Term
| in what population of females is adjuvant chemotherapy for breast cancer controversial? |
|
Definition
| postmenopausal females with ER+ receptors |
|
|
Term
| when do breast cancer recurrence occur? |
|
Definition
| over 50% occur more than 5 yrs after initial Tx |
|
|
Term
| what is the workup for a patient suspected of breast cancer metastasis? |
|
Definition
| Bx - must be done to avoid mistakes with other conditions (TB, MM, sarcoidosis) |
|
|
Term
| 4 conditions unlikely to respond to hormonal Tx despite hormone positive breast cancer? |
|
Definition
| short disease-free intervals, rapidly progressive visceral disease, lymphangitic pulmonary disease, or intracranial disease |
|
|
Term
| which subset of patients with metastatic breast cancer should receive anti-hormonal therapy? |
|
Definition
|
|
Term
| what should be the initial anti hormonal therapy for metastatic breast cancer? |
|
Definition
|
|
Term
| which subset of patients with metastatic breast cancer has a higher respoonse rate to aromatase inhibitors than to tamoxifen? |
|
Definition
|
|
Term
| what are 3 anti hormonal therapies used solely in pre-menopausal females? |
|
Definition
| surgery, castration, LHRH agonists |
|
|
Term
| what is the place of surgical adrenalectomy in metastatic breast cancer hormonal Tx? |
|
Definition
| rarely employed 2nd line Tx |
|
|
Term
| what is Fulvestrant in the hormonal Tx of metastatic breast cancer? |
|
Definition
| an estrogen receptor blocker with no estrogen agonist effect at all, used as 3rd line Tx |
|
|
Term
| what is the MC used 4th line hormonal Tx in metastatic breast cancer? |
|
Definition
| high-dose progesterones - given after AIs, tamoxifen, fulvestrant |
|
|
Term
| what is an alternative 4th line hormonal Tx in metastatic breast cancer? |
|
Definition
| additive androgens/estrogens |
|
|
Term
| what are 3 surgical options targeted at anti-hormonal effects in metastatic breast cancer? |
|
Definition
| hypophysectomy, adrenalectomy, castration |
|
|
Term
| in what combinations should anti hormonal Tx for metastatic breast cancer be given? |
|
Definition
| no combination. only monotherapy and never alongside chemotherapy |
|
|
Term
| what is the standard adjuvant chemo combination given in breast cancer? |
|
Definition
| CMF - cyclophosphamide, MTX, Fluorouracil |
|
|
Term
| what is the 1st line chemotherapy for metastatic breast cancer? |
|
Definition
| a combination of drugs from 4 groups: alkylating agents, taxanes, antimetabolites, anthracyclines |
|
|
Term
| what is the 2nd line chemotherapy for metastatic breast cancer? |
|
Definition
| the approach is to use monotherapy: paclitaxel or anthracycline |
|
|
Term
| which drug can increase the response rate and duration achieved by paclitaxel for the 2nd line Tx of metastatic breast cancer? |
|
Definition
|
|
Term
| what is another line of chemotherapy after initial and monotherapy for metastatic breast cancer? |
|
Definition
| high dose chemo with autologous BMT |
|
|
Term
what is a common Tx approach for stage 3 - locally advanced disease - breast cancer?
stage 3 = N2-N3 with any T and M0 |
|
Definition
| neoadjuvant chemotherapy that include an Anthracycline. this allows inoperable disease to become operable or susceptible to radiation therapy |
|
|
Term
| what is the long term disease free survival in patients with locally advanced breast cancer treated with neoadjuvant chemo? |
|
Definition
|
|
Term
| in a female who had suffered breast cancer, what is the risk of developing cancer in the contralateral breast? |
|
Definition
|
|
Term
| 2 positive effects of long term use of tamoxifen for the prevention of breast cancer? |
|
Definition
| increased bone mineralization, reduction in cholesterol levels |
|
|
Term
| what is the risk of uterine cancer after 5 yrs of using tamoxifen as breast cancer prevention |
|
Definition
|
|
Term
| what is and adverse effect of tamoxifen for the prevention of breast cancer, besides endometrial cancer? |
|
Definition
| increased rate of cataracts |
|
|
Term
| 3 points of comparison btwn tamoxifen and Raloxifen in the prevention of breast cancer? |
|
Definition
1. same efficacy for invasive breast cancer but reduced efficacy for Raloxifene in the prevention of non-invasive disease
2. reduced thromboembolic events with Raloxifene
3. reduced rates of endometrial cancer with raloxifene |
|
|
Term
| what % of patients with untreated DCIS develop invasive breast cancer within 5 yrs? |
|
Definition
|
|
Term
| what is the 3 fold management of breast DCIS? |
|
Definition
| lumpectomy, radiation therapy, tamoxifen |
|
|
Term
| 5 prognostic features that indicate high risk of local recurrence in DCIS (and may aid in the decision of whether to pursuit full Tx) |
|
Definition
| age<40, extensive DCIS, histologic findings such as necrosis, comedo subtype with HER2, poor nuclear grading |
|
|
Term
| what is the role of sentinel lymph node dissection in DCIS breast cancer? |
|
Definition
| not needed unless there is the slightest evidence of invasion, even micrometastasis |
|
|
Term
| what % of patients with LCIS develop invasive carcinoma within 20 yrs |
|
Definition
| 30%, usually invasive ductal carcinoma |
|
|
Term
| what is the Tx of LCIS of the breast |
|
Definition
| local excision, SERMs for 5 yrs, annual mammogram follow up |
|
|
Term
| is locally advanced breast cancer more common in males or females? |
|
Definition
|
|
Term
| When male breast cancer is matched to female breast cancer by age and stage, what can be said about the prognosis |
|
Definition
|
|
Term
| how does gyncecomastia affect the risk of breast cancer in the male? |
|
Definition
|
|
Term
| what is the Tx of male breast cancer? |
|
Definition
| mastectomy and axillary node dissection= modified radical mastectomy |
|
|
Term
| which male patients with breast cancer should receive radiation therapy? |
|
Definition
| locally advanced disease or positive nodes |
|
|
Term
| what % of male patients with breast cancer are positive for estrogen receptors? |
|
Definition
|
|
Term
| what % of male metastatic breast cancer are responsive to hormonal therapy |
|
Definition
|
|
Term
| what are the guidelines for adjuvant systemic Tx for male breast cancer? |
|
Definition
|
|
Term
| what is the effect of early detection of breast cancer recurrence on the survival? |
|
Definition
|
|
Term
| what is the recommended follow up regime for breast cancer |
|
Definition
1. Hx and PE every 3-6 months for the 1st 3 yrs, then every 6-12 months for another 2 yrs and then every yr
2. monthly breast self examination
3. annual mammogram
4. annual pelvic examination |
|
|
Term
| what should be avoided in the follow up of breast cancer? |
|
Definition
| CBC, chemistries, markers, CXR, CT, bone scan, liver US |
|
|
Term
| what % of lung cancers occur in never smokers or former smoker (quit over a year ago)? |
|
Definition
|
|
Term
| what is the number of never smoker amongst lung cancer patients? |
|
Definition
| 1 in 5 females, 1 in 12 males |
|
|
Term
| what is the overall lifetime probability to develop lung cancer? |
|
Definition
| 8% in males and 6% in females |
|
|
Term
| what is the relative risk of lung cancer for people who currently smoke in comparison to those who never smoked? |
|
Definition
|
|
Term
| what is the relative risk of lung cancer for people who used to smoke in comparison to those who never smoked? |
|
Definition
|
|
Term
| what % of lung cancer are associated with smoking? |
|
Definition
|
|
Term
| what is the effect of increased duration of quitting to smoke on the risk of lung cancer? |
|
Definition
| the risk is reduced but is never equal to the non-smoker |
|
|
Term
| what is the % increase in risk of never smokers who have been married many years to smokers? |
|
Definition
|
|
Term
| risk factors other than smoking for lung cancer |
|
Definition
| asbestos, arsenic, bischloromethyl ether, hexavalent chromium, mustard gas, nickel, polycyclic aromatic hydrocarbons, low fruit and vegetable intake during adulthood, Prior lung diseases such as chronic bronchitis, emphysema, and tuberculosis, radiation, radon |
|
|
Term
| what is the effect of retenoids and carotenoids in smokers on the risk of lung cancer? |
|
Definition
| increased (though was expected to be protective) |
|
|
Term
| what is the reduction in risk of lung cancer with the cessation of smoking before middle age? |
|
Definition
|
|
Term
| what is the effect of smoking cessation on the already ill lung cancer patient? |
|
Definition
| elevated survival, decreased adverse effects from Tx and better quality of life |
|
|
Term
| what is the most effective drug for the cessation of smoking |
|
Definition
| verenicline - nicotinic acetylcholine partial agonist |
|
|
Term
| what are 1st line drugs for cessation of smoking |
|
Definition
| verenicline and bupropion |
|
|
Term
| what is a major adverse effect of both verenicline and bupropion for the cessation of smoking? |
|
Definition
|
|
Term
| what are 2nd line drugs for cessation of smoking |
|
Definition
| clonidine and nortryptiline |
|
|
Term
| what are 3 notable germ line mutations that increase the risk of lung cancer? |
|
Definition
polymorphism in P450 CYP1A1
Li Fraumeni syndrome (p53)
Retinoblastoma (RB) |
|
|
Term
| what is the increase in risk for 1st degree probands of patients with lung cancer? |
|
Definition
|
|
Term
| what are the 4 major epithelial subtypes of lung cancer? |
|
Definition
SCLC
NSCLC: adenocarcinoma, SCC, large cell |
|
|
Term
| adenocarcinoma is the MC histologic subtype of lung cancer in which 4 populations? |
|
Definition
| never-smokers, females, younger than 60, NSCLC |
|
|
Term
| where anatomically does SCLC usually occur in the lung |
|
Definition
|
|
Term
| what are 4 hormones produced by SCLC |
|
Definition
| ADH, ACTH, gastrin releasing peptide, ANP |
|
|
Term
| what is the typical anatomical location of SCC |
|
Definition
|
|
Term
| what is the typical anatomical location of adenocarcinoma |
|
Definition
|
|
Term
| what is the definition of bronchoalveolar carcinoma |
|
Definition
| it is a subtype of adenocarcinoma that is characterized by growth along side the alveoli w/o invading it. it may appear as a mass, multicentric or diffuse |
|
|
Term
| what is the typical anatomical location of large cell carcinoma of the lung? |
|
Definition
|
|
Term
| what histologically is typical of large cell carcinoma of the lung |
|
Definition
|
|
Term
| what % of NSCLC are curable by surgery? |
|
Definition
|
|
Term
| what are common immunohistochemical markers used in the Dx of SCC of lung |
|
Definition
| CK5,6, cytokeratin cocktail |
|
|
Term
| what are common immunohistochemical markers used in the Dx of adenocarcinoma of lung |
|
Definition
CK7
TTF-1
cytokeratin cocktail |
|
|
Term
| what are common immunohistochemical markers used in the Dx of large cell carcinoma |
|
Definition
|
|
Term
| what are common immunohistochemical markers used in the Dx of SCLC? |
|
Definition
cytokeratin cocktail
TTF-1
CD-56
chromogranin
synaptophysin |
|
|
Term
| what type of cell is the precursor of adenocarcinoma of the lung |
|
Definition
|
|
Term
| genes somatically altered in adenocarcinoma of lung - 3 oncogenes and 3 TSGs |
|
Definition
EGFR, KRAS, ALK
P53, p16/14, STK11 |
|
|
Term
| genes somatically altered in SCC of lung- 3 oncogenes and 2 TSGs |
|
Definition
EGFR, PIK3CA, IGF-1R
p53, p63 |
|
|
Term
| genes somatically altered in SCLC - 2 oncogenes and 3 TSGs |
|
Definition
|
|
Term
| where is an early somatic gene alteration detected in all lung cancer in histologicaly normal smokers lung? |
|
Definition
|
|
Term
| what 2 TSGs show somatic alterations in 90% of SCLC |
|
Definition
|
|
Term
| what is the role of screening for lung cancer with CXR or CT nowadays? |
|
Definition
| not recommended. although a large trial has shown early detection of many lung cancer, survival benefit is still not proven |
|
|
Term
| when nodule found on CT of lung and there is little if any doubt that its malignant, what should be the next step in mgmt? |
|
Definition
| surgery: video assisted thoracoscopy with visualization of mediastinal lymph nodes and frozen section and if malignant lobectomy |
|
|
Term
| when nodule found on CT of lung and there is doubt on whether its malignant or not, what should be the next step in mgmt? |
|
Definition
| risk should be assessed and lesion classified to either low risk - below 10% or moderate - 10-60% |
|
|
Term
| when nodule found on CT of lung and the risk of it being malignant is low, what should be the next step in mgmt? |
|
Definition
| serial CT follow-up at 3, 6, 12, 24 months |
|
|
Term
| when nodule found on CT of lung and the risk of it being malignant is moderate, what should be the next step in mgmt? |
|
Definition
if nodule>1 cm - PET-CT
if air-bronchus present - bronchoscopy
if nodule is peripheral - FNA
if available Contrast CT |
|
|
Term
| 2 characteristics of lung cancer in never-smokers |
|
Definition
| female, younger than average smoker/former |
|
|
Term
| what % of patients according to histologic subtypes are found post-mortum to have extra-thoracic metastatic disease? |
|
Definition
| SCLC - 95%, SCC-50%, adenocarcinoma-80% |
|
|
Term
| what is the MC life threatening metabolic disorder associated with malignancy? |
|
Definition
|
|
Term
| what are 2 paraneoplastic syndromes that may cause hyponatremia in SCLC? |
|
Definition
|
|
Term
| what is the mgmt of hyponatremia caused by SIADH in comparison to that by ANP |
|
Definition
SIADH - fluid restriction and if no improvement Demeclocycline.
ANP - if fluid restriction doesn't help within 3-4 days, measure ANP levels, if elevated treat with supplemental sodium |
|
|
Term
| what is the manifestation of ectopic secretion of ACTH in SCLC in comparison to that in Cushing's syndrome from a pituitary adenoma? |
|
Definition
SCLC - electrolyte disturbance (hypokalemia)
Cushing's - change in habitus |
|
|
Term
| what is the Tx of Cushing's caused by SCLC? |
|
Definition
Tx of the underlying disease or in extreme cases bilateral adrenalectomy.
the standard medication don't help - ketoconazole, Metyrapone |
|
|
Term
| what is a connective tissue symptom occuring in 30% with lung cancer, usually NSCLC? |
|
Definition
|
|
Term
| which neurologic symptoms occur exclusively with SCLC within lung cancer subtypes |
|
Definition
| Lambert Eaton, retinal blindness, encephalomyelitis |
|
|
Term
| which neurologic symptoms occur in all lung cancers? |
|
Definition
| peripheral neuropathies, subacute cerebellar degeneration, cortical degeneration, and polymyositis |
|
|
Term
| paraneoplastic encephalomyelitis in SCLC is associated with what antineuronal antibodies? |
|
Definition
| anti-Hu, anti-CRMP5, and ANNA-3 |
|
|
Term
| 2 paraneoplastic cardiovascular/hematologic symptoms in lung cancer |
|
Definition
| migratory venous thrombophlebitis (Trousseau's syndrome), nonbacterial thrombotic (marantic) endocarditis |
|
|
Term
| which one of the following bronchogenic methods of attaining tissue is the most sensitive for lung cancer Dx, bronchial brush, bronchial wash, bronchioloalveolar lavage, and transbronchial FNA? |
|
Definition
|
|
Term
| how does staging of lung cancer work? |
|
Definition
| 2 parts: anatomical staging and physiological staging (the capacity of the patient to undergo certain therapies) |
|
|
Term
| what is the cutoff of standardized uptake value suspicious for malignancy on PET-CT? |
|
Definition
|
|
Term
| what is the imaging method of choice in NSCLC? |
|
Definition
|
|
Term
| how is PET-CT superior to the rest of the imaging techniques in NSCLC? |
|
Definition
| demonstrating mediastinal lymph nodes and extrathoracic metastases |
|
|
Term
| 4 conditions where PET-CT may be false negative in NSCLC? |
|
Definition
| diabetes, lesions <8 mm, slow-growing tumors, concurrent infections such as tuberculosis |
|
|
Term
| what is the indication to use MRI in the staging of NSCLC |
|
Definition
| superior sulcus tumor to check for brachial plexus involvement |
|
|
Term
| what is the imaging of choice to detect brain metastasis in NSCLC? |
|
Definition
|
|
Term
| in NSCLC what are 11 CIs to curative resection? |
|
Definition
| extrathoracic metastases, SVC syndrome, vocal cord and phrenic nerve paralysis, malignant pleural effusion, cardiac tamponade, tumor within 2 cm of the carina (potentially curable with combined chemoradiotherapy), metastasis to the contralateral lung, metastases to supraclavicular lymph nodes, contralateral mediastinal node metastases (potentially curable with combined chemoradiotherapy) and involvement of the main pulmonary artery |
|
|
Term
| what is the recommended method of follow up for stage 3 NSCLC, concerning the fact that distant mets are highly likely and restaging may be nessecary? |
|
Definition
| beyond PET-CT, use regular brain CT/MRI |
|
|
Term
| what is the recommended staging regime for SCLC? |
|
Definition
1. CT of chest and abdomen (mets to the liver and adrenals likely)
2. brain MRI - 10% positive in asymptomatic patients
3. if indicated - bone scan |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| Tumor<3 cm diameter, surrounded by lung or visceral pleura, without invasion more proximal than lobar bronchus |
|
|
Term
|
Definition
Tumor >3 cm but 7 cm with any of the following:
Involves main bronchus, 2 cm distal to carina
Invades visceral pleura
Associated with atelectasis or obstructive pneumonitis extending to hilar region but not involving the entire lung |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
Tumor >7 cm or directly invades any of the following: chest wall (including superior sulcus tumors), phrenic nerve, mediastinal pleura, parietal pericardium
Tumor <2 cm distal to carina but without involvement of carina
Tumor with associated atelectasis or obstructive pneumonitis of entire lung
Separate tumor nodule(s) in same lobe |
|
|
Term
|
Definition
Tumor of any size that invades any of the following: mediastinum, heart or great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body, carina
Separate tumor nodule(s) in a different ipsilateral lobe |
|
|
Term
|
Definition
| ipsilateral peribronchial and/or hilar lymph node(s) and intrapulmonary node(s), |
|
|
Term
|
Definition
| ipsilateral mediastinal and/or subcarinal lymph node(s) |
|
|
Term
|
Definition
| contralateral mediastinal, hilar, ipsilateral or contralateral scalene or supraclavicular lymph node(s |
|
|
Term
|
Definition
Separate tumor nodules in a contralateral lobe
Tumor with pleural nodules or malignant pleural or pericardial effusion |
|
|
Term
|
Definition
|
|
Term
| in NSCLC what is stage IA |
|
Definition
|
|
Term
| in NSCLC what is stage IB |
|
Definition
|
|
Term
| in NSCLC what is stage IIA |
|
Definition
|
|
Term
| in NSCLC what is stage IIB |
|
Definition
|
|
Term
| in NSCLC what is stage IIIA |
|
Definition
| T1a-T3N2M0 or T3N1M0 or T4N0-1M0 |
|
|
Term
| in NSCLC what is stage IIIB |
|
Definition
|
|
Term
| in NSCLC what is stage IV |
|
Definition
|
|
Term
| what is the staging system for SCLC? |
|
Definition
limited disease=anything that can be encompassed in one radiation port
extensive disease=cannot be contained in one radiation port |
|
|
Term
| 3 conditions that are present outside of the hemithorax and still may be considered as limited disease in SCLC? |
|
Definition
| contralateral supraclavicular nodes, recurrent laryngeal nerve involvement, and SVC obstruction |
|
|
Term
| 3 conditions that are present outside of the hemithorax and cannot be encompassed in one radiation port, and therefore indicate extensive disease in SCLC? |
|
Definition
| Cardiac tamponade, malignant pleural effusion, and bilateral pulmonary parenchymal involvement |
|
|
Term
| how many patients are diagnosed with extensive disease at presentation in SCLC? |
|
Definition
|
|
Term
| which patients with NSCLC can tolerate a pneumonectomy? |
|
Definition
| FEV1>2 L or > 80% of predicted |
|
|
Term
| which patients with NSCLC can tolerate a lobectomy? |
|
Definition
|
|
Term
| in assessing the ability of a patient with lung cancer to undergo surgery, in patients with borderline lung function but a resectable tumor, what is the next step? |
|
Definition
| cardiopulmonary exercise testing. A Vo2max <15 mL/(kg·min) predicts for a higher risk of postoperative complications |
|
|
Term
| after assessing the ability of a patient with lung cancer to undergo surgery, what do you do with patients deemed unable to tolerate lobectomy or pneumonectomy from a pulmonary functional standpoint? |
|
Definition
| limited resections, such as wedge or anatomic segmental resection - more recurrences, lower survival |
|
|
Term
| what cardiopulmonary findings in the assessment of the ability of the patient with lung cancer to undergo surgery, are considered absolute CIs to surgery? |
|
Definition
| myocardial infarction within the past 3 months (associated with 20% reinfarction), uncontrolled arrhythmias, FEV1 < 1 L, PCO2>45, DLCO <40%, and severe pulmonary hypertension |
|
|
Term
| what cardiopulmonary finding in the assessment of the ability of the patient with lung cancer to undergo surgery, is considered a relative CI to surgery? |
|
Definition
| infarction in the past 6 months |
|
|
Term
| in lung cancer, what is Tx? |
|
Definition
| malignant cells are identified in a sputum or bronchial washing specimen but the chest imaging appears normal |
|
|
Term
| in lung cancer, what do you do with patients who have Tx stage tumor? |
|
Definition
| must localize the lesion - 90% will be identified by examination of the bronchial tree with a fiberoptic bronchoscope under general anesthesia and collection of a series of differential brushings and biopsies |
|
|
Term
| after a tumor was localized in Tx stage of lung cancer and resected, what is the next step? |
|
Definition
| close follow up b/c in 5% of cases (per year) there will be a 2nd primary in the lung |
|
|
Term
| in the evaluation of a solitary pulmonary nodule, when would be PET-CT be useful? |
|
Definition
|
|
Term
| what are the 5 variables taken into account in the risk stratification of patients with a newfound solitary pulmonary nodule? (values in brackets indicate intermediate risk) |
|
Definition
| diameter (1.5-2.2 cm), age (45-60), smoking cessation status(quit less than 7 yrs ago), smoking status (less than 20 cigarettes/day), nodule margins (low-smooth, int.-scalloped, high-radiata, spiculated) |
|
|
Term
| what are the only two radiographic criteria thought to predict the benign nature of a solitary pulmonary nodule? |
|
Definition
| lack of growth over a period >2 years and certain characteristic patterns of calcification: a dense center, multiple punctate foci, and "bull's-eye" (granuloma) and "popcorn ball" (hamartoma) |
|
|
Term
| what are signs suggesting a malignancy in the evaluation of a solitary pulmonary nodule? |
|
Definition
| large lesion, lack of or asymmetric calcification, chest symptoms, associated atelectasis, pneumonitis, or growth of the lesion revealed by comparison with an old x-ray or CT scan or a positive PET scan |
|
|
Term
| what is the 5 yr survival for stage 1 or 2 NSCLC patients undergoing surgery? |
|
Definition
stage 1 - 60-80%
stage 2 - 40-50% |
|
|
Term
| what is the 5 yr survival for stage 1 or 2 NSCLC patients undergoing surgery? |
|
Definition
stage 1 - 60-80%
stage 2 - 40-50% |
|
|
Term
| what is the recommendation on lymph node sampling/dissection in the process of NSCLC resection? |
|
Definition
| complete mediastinal node dissection and hilar node sampling - higher survival rates than just sampling |
|
|
Term
| what is the role of adjuvant radiotherapy for NSCLC stages 1 and 2? |
|
Definition
| none, radical radiotherapy may be used in patients who are refusing pulmonary resection or are not physically fit to undergo surgery |
|
|
Term
| what is the 5 yr survival associated with radical radiotherapy for NSCLC stage 1 or 2? |
|
Definition
|
|
Term
| apart from radical radiotherapy for the Tx of NSCLC, what are 2 other radiation therapy methods |
|
Definition
| cryoablation (T>3 cm) , stereotactic (T < 5 cm) |
|
|
Term
| what is the recommended follow up regimen for post resection NSCLC stages 1 and 2? |
|
Definition
| chest CT with contrast every 6 months for the first 2 years after surgery, followed by yearly CT scans of the chest without contrast thereafter |
|
|
Term
| what is the role of adjuvant chemotherapy for patients with NSCLC? |
|
Definition
| stages IB, II and III (N0 or N1 disease only) |
|
|
Term
| what is the recommended regimen of adjuvant chemo in NSCLC |
|
Definition
| a 2 drug combination containing cisplatin |
|
|
Term
| in what 3 condition should a patient indicated for adjuvant chemo Tx receive Carboplatin instead of Cisplatin? |
|
Definition
| reduced renal function, presence of neuropathy, or hearing impairment |
|
|
Term
| what is the Tx of N2 and N3 NSCLC? |
|
Definition
| chemoradiation (no surgery with an exception to N2 disease which shows greater survival performing lobectomy instead of pneumonectomy) |
|
|
Term
| what is the mgmt of patients with NSCLC evaluated clinically to have an N1 or N0 disease and found on surgery/pathology to have an N2 disease? how many patients are like that? |
|
Definition
if it is single-station and possible to resect all the mediastinal lymph nodes - continue as planned
if multinodular, bulky, extranodular or not possible to resect all mediastinal lymph nodes - abort surgery, give chemoradiation |
|
|
Term
| what stage NSCLC are recommended chemoradiation? |
|
Definition
| IIIB and IIIA bulky disease |
|
|
Term
| what is the definition of bulky disease in stage IIIA NSCLC? |
|
Definition
| lymph nodes >2 cm, which have extranodal involvement or multistation disease |
|
|
Term
| in chemoradiation (non surgical) Tx of NSCLC, which regimen entails higher rates of survival and side effects, sequential or concurrent |
|
Definition
| concurrent is associated with better survival, but more side effects: fatigue, esophagitis, and neutropenia |
|
|
Term
| what are the symptoms of pancoast tumor in NSCLC? |
|
Definition
| Horner's syndrome, shoulder and/or arm pain, and weakness and atrophy of the muscles of the hand |
|
|
Term
| what is the Tx of patients with N0/N1 disease and pancoast tumor |
|
Definition
|
|
Term
| what % of NSCLC patients present with advanced disease (stage IIIB with a pleural effusion or stage IV) at the time of diagnosis |
|
Definition
|
|
Term
| which NSCLC patients have a better Px, those that present with metastatic disease or those that recur with metastatic disease |
|
Definition
|
|
Term
| what is the Tx of advanced NSCLC and the prognosis? |
|
Definition
| supporative, 5 yr survival is 10% median survival 4-5 months |
|
|
Term
| patients with advanced NSCLC show a survival benefit with chemotherapy, how many cycles should they undergo |
|
Definition
|
|
Term
| what is the median survival in advanced NSCLC treated with chemo? |
|
Definition
|
|
Term
| in NSCLC what is the preferable regimen of chemotherapy according to tumor histology? |
|
Definition
SCC - cisplatin and pemetrexed
non-SCC - cisplatin and Gemcitabine |
|
|
Term
| what is the role of Bevacizumab(Avastin) in the Tx of NSCLC |
|
Definition
| advanced disease that is non-squamous (higher risk of bleeding) in conjunction with the specific regimen of Carboplatin/paclitaxel - in the USA and not in europe |
|
|
Term
| 3 Tx options for second-line therapy of NSCLC in the United States |
|
Definition
| docetaxel, pemetrexed, and erlotinib (Tarceva) |
|
|
Term
| what is the major side effect of docetaxel in comparison to the rest of the 2nd line chemo options in NSCLC? |
|
Definition
|
|
Term
| what side effect of erlotinib (Tarceva) occurs more commonly than the other 2 options for 2nd line chemo options in NSCLC? |
|
Definition
|
|
Term
| 4 Clinical features that have been shown to correlate with responsiveness to EGFR TKI treatment |
|
Definition
| female sex, never smoking status, adenocarcinoma histology, and Asian ethnicity |
|
|
Term
| which EGFR antibody showed improved survival in caucasians and not asians in advanced NSCLC in combination with Cisplatin/paclitaxel? |
|
Definition
|
|
Term
| in which malignancy does a KRAS mutation predict responsiveness to the EGFR inhibitor Cituximab? in which it doesn't |
|
Definition
| colon cancer. doesn't predict in NSCLC |
|
|
Term
| which Txs have been proven to show improved survival in a subset of asian patients with advanced NSCLC in comparison to the standard 1st line chemo of Carboplatin based doublet therapy? |
|
Definition
|
|
Term
| what is the only therapy approved by the U.S. FDA following platinum-based chemotherapy in patients with advanced NSCLC |
|
Definition
| pemetrexed (folate antimetabolite) |
|
|
Term
| what is the definition of maintanance Tx for advanced NSCLC |
|
Definition
| single agent therapy for patients who are done with their regimen of chemotherapy and are progression free either with complete or partial response |
|
|
Term
| which agent has been shown to improve survival as maintenance Tx in advanced NSCLC following platinum-based therapy? |
|
Definition
|
|
Term
| what are 2 first line options for SCLC-LD? |
|
Definition
1. platinum based + etoposide
2. Cyclophosphomide, Vincristine, doxorubicin |
|
|
Term
| what is the only 2nd line treatment approved for SCLC-LD? |
|
Definition
|
|
Term
| whats considered a platinum resistant disease in SCLC-LD? |
|
Definition
|
|
Term
| what is the 5 yr survival of SCLC-LD and ED? what are the median survivals? |
|
Definition
| 6-12%, 2%, 12-20 months, 7 to 11 months |
|
|
Term
| what are the response rates to chemotherapy in SCLC? |
|
Definition
|
|
Term
| what is the full Tx of SCLC? |
|
Definition
| chemoradiation with platinum based drug and etoposide |
|
|
Term
| what is an adjuvant therapy to patients with SCLC who have responded to initial Tx? and what effect that it have on survival? |
|
Definition
prophylactic cranial irradiation
5.4% survival benefit in LD with complete remission |
|
|
Term
| what % of patients with lung cancer an EGFR mutation who respond to treatment with an EGFR TKI inhibitor (gefitinib and erlotinib) develop resistance? |
|
Definition
|
|
Term
| what is the mechanism of resistance to EGFR TKI inhibitors in lung cancer? |
|
Definition
| developing a mutation in a different TKR |
|
|
Term
| in lung cancer, what is a TKR that mutates in the development of EGFR TKI inhibitors resistance in 20% of cases? |
|
Definition
|
|
Term
| 4 Clinical characteristics associated with EML4-ALK–positive lung cancer |
|
Definition
| younger age at diagnosis, minimal smoking history, male sex, and adenocarcinoma histology with signet-ring features |
|
|
Term
| which biomarker predicts sensitivity to platinum chemotherapy in lung cancer? |
|
Definition
| low levels of ERCC1 - excision repair cross-complementation group 1 |
|
|
Term
| in NSCLC, which biomarker predicts sensitivity to Gemcitabine therapy? |
|
Definition
| low RRM1 - Ribonucleotide reductase M1 |
|
|
Term
| pemetrexed (an agent commonly employed as second-line treatment in patients with nonsquamous NSCLC) resistance can be predicted by overexpression of what biomarker? |
|
Definition
|
|
Term
| why is pemetrexed more effective in adenocarcinoma vs. SCC/SCLC? |
|
Definition
| the latter have higher levels of Thymydilate synthase |
|
|
Term
| what % of lung tumors are benign |
|
Definition
|
|
Term
| what are the 2 types of benign lung tumors? |
|
Definition
| hamartomas and bronchial adenoma |
|
|
Term
| 4 characteristics of lung hamartomas? |
|
Definition
| M>F, median age 60, peripheral, popcorn pattern on CXR |
|
|
Term
| what 3 type of bronchial adenomas are there? |
|
Definition
| carcinoid 80%, adenocystic tumors, or mucoepidermoid tumors (2–3%). |
|
|
Term
| characteristics of bronchial adenoma |
|
Definition
| central (can cause pneumonia), mean age 45, can metastasize, high vascular (bleed with Bx), 5 yr survival 95%, Tx is surgical resection |
|
|
Term
| 2 of the most significant risk factors for head and neck cancer |
|
Definition
|
|
Term
| 8 risk factors for head and neck cancer |
|
Definition
| alcohol, tobacco, marijuana, occupational diseases (nickel refining, textile, woodworking), low consumption of fruits and vegetables, EBV, HPV, salted fish |
|
|
Term
| histopathologically, into what 2 classes would you divide nasopharyngeal carcinomas? which is more common? |
|
Definition
| differentiated SCC vs. nonkeratinizing and undifferentiated carcinoma (lymphoepithelioma) that contains infiltrating lymphocytes, is more common and is associated with EBV |
|
|
Term
| most parotid tumors are benign or malignant? |
|
Definition
|
|
Term
| in which malignancy are patients at a greater risk of dying from a second malignancy than a recurrence of the primary disease? |
|
Definition
|
|
Term
| a second primary in head and neck cancer would be caused from the same risk factors that led to the first one or from radiation therapy given for Tx of the first one? |
|
Definition
| same risk factors - carcinogens |
|
|
Term
| 4 clinical manifestations of carcinoma of the nasopharynx |
|
Definition
| serous otitis media due to obstruction of the eustachian tube, nasal obstruction, epistaxis, neuropathies of the cranial nerves |
|
|
Term
| 2 of the presenting symptoms of oral carcinoma? |
|
Definition
| pain and nonhealing ulcers |
|
|
Term
| in a primary of unknown origin found in cervicl lymph node and showing SCC histology, what is the likely origin? what is the workup? |
|
Definition
| head and neck. Bx of base of tongue, nasopharynx, tonsils, pyriform sinus |
|
|
Term
| what is the significance of leukoplakia or erythroplakia? |
|
Definition
| are premalignant and require Bx |
|
|
Term
| what is the workup of a patient who has been diagnosed with a head and neck cancer |
|
Definition
1. CT of head to asses extent of disease
2. if lymph node involvement - CXR, bone scan, PET to assess for metastases
3. thorough endoscopic examination with multiple Bxs |
|
|
Term
| what is considered localized disease in head and neck cancer? |
|
Definition
| T1 or T2, without lymph node involvement or metastases |
|
|
Term
| what are 2 Tx options for localized head and neck cancer? and which is adequate in what circumstances? |
|
Definition
radiation therapy - e.g. laryngeal cancer to preserve voice function
surgery - e.g. small lesions in the oral cavity to avoid the long-term complications of radiation, such as xerostomia and dental decay |
|
|
Term
| what is the 5 yr survival of limited head and neck cancer? |
|
Definition
|
|
Term
| what % of head and neck cancer present with metastases? |
|
Definition
|
|
Term
| what is locally or regionally advanced head and neck cancer? |
|
Definition
| disease with a large primary tumor and/or lymph node metastases |
|
|
Term
| what is the Tx of locally or regional advanced head and neck cancer? |
|
Definition
intermediate stage: surgery (if resectable) and post operative chemoradiation
otherwise: neoadjuvant chemoradiation and surgery |
|
|
Term
| what % of patients present with locally or regionally advanced head and neck cancer? |
|
Definition
|
|
Term
| what is the intent in the Tx of locally or regionally advanced head and neck cancer? |
|
Definition
|
|
Term
| in advanced head and neck cancers, what is the goal in induction chemotherapy and sequential radiotherapy instead of concurrent neoadjuvant chemoradiation? |
|
Definition
| it leads in some cases to complete clinical remission and therefore is organ sparing |
|
|
Term
| which head and neck cancers show increased survival when treated with a modality which includes cisplatin and radiation therapy? |
|
Definition
| HPV associated and nasopharyngeal carcinoma |
|
|
Term
| what is a major toxicity associated with concomitant chemoradiation for the treatment of advanced head and neck cancers? |
|
Definition
|
|
Term
| which monoclonal antibody is added to the chemoradiation regimen of advanced head and neck cancer Tx? |
|
Definition
|
|
Term
| what is the most common treatment modality of metastatic head and neck cancer? median survival? response rates? duration of response? |
|
Definition
| chemotherapy, 6-8 months, 30-50% response rate, 3 months duration of response |
|
|
Term
| in metastatic head and neck cancer what are some agents used in chemotherapy and in what way? |
|
Definition
| mono/double therapy: MTX, 5FU, paclitaxel, docetaxel, cisplatin |
|
|
Term
| which monoclonal antibody to EGFR may be added to chemotherapy of metastatic head and neck cancer? and what is its contribution to Tx? |
|
Definition
| Cetuximab, improves median survival |
|
|
Term
| what is a side effect of radiation therapy seen in 50% of patients? |
|
Definition
|
|
Term
| how much time after recovery is it plausible to present with salivary gland metastatses? |
|
Definition
|
|
Term
| risk factors for melanoma (2 mutations) |
|
Definition
| nevi, family history, uv exposure, light skin/eyes/hair, freckling, inability to tan, CDKN2A mutation, MC1R variants |
|
|
Term
| what is the lifetime risk of melanoma with giant nevus (>20cm)? |
|
Definition
|
|
Term
| what is the single greatest risk factor for melanoma? |
|
Definition
| personal history of melanoma |
|
|
Term
| what % of melanomas are familial? what are survival rates in comparison to sporadic melanoma? |
|
Definition
|
|
Term
| what is another malignancy seen among melanoma-prone families with CDKN2A mutations? |
|
Definition
|
|
Term
| what is the role of the CDKN2A gene in the healthy w/o melanoma? |
|
Definition
| encodes 2 proteins, p16 and ARF(p14), which inactivate a protein that itself inactivates p53 and Rb |
|
|
Term
| what are 5 types of melanoma? what is distinct to 3 of those types? |
|
Definition
lentigo maligna melanoma, superficial spreading melanoma, acral lentiginous - have a superficial (radial) growth phase that allows early detection and excision before vertical growth and invasion.
nodular melanoma, desmoplastic melanoma - only vertical (invasive) growth |
|
|
Term
| which of the melanoma types grow on your back? |
|
Definition
| superficial spreading melanoma |
|
|
Term
| which melanoma type grows on the soles of your feet? |
|
Definition
| acral lentiginous melanoma |
|
|
Term
| what is the most common type of melanoma observed in caucasian population? |
|
Definition
| superficial spreading melanoma |
|
|
Term
| which melanoma invaded neural tissue? |
|
Definition
|
|
Term
| what is the chararcteristic of melanomas in which a somatic in BRAF occurs? |
|
Definition
| they present in areas of intermittent and not chronic sun exposure |
|
|
Term
| 5 major somatic mutations (not germ line mutation) that occur in melanoma |
|
Definition
| N-RAS, B-RAF, PI3K, PTEN, AKT |
|
|
Term
| what nevus size suggests malignancy? |
|
Definition
| over 6 mm (pencil eraser) |
|
|
Term
| which way should Bx from a suspicious nevus be taken? |
|
Definition
| deepest part and most superficial part, shaving or cauterization are not acceptable |
|
|
Term
| what is the least of information that should be included in a Bx report |
|
Definition
| Breslow thickness (from deepest to most superficial), mitoses per square millimeter for lesions < 1mm, presence or absence of ulceration, and peripheral and deep margin status |
|
|
Term
| which test can be made to distinguish melanomas from benign nevi in cases with challenging histology? |
|
Definition
|
|
Term
| what is The best predictor of metastatic risk in melanoma? |
|
Definition
|
|
Term
| 5 important prognostic factors for melanoma (also incorporated in the staging system) |
|
Definition
| Breslow thickness, ulceration, nodal involvement, LDH, distant metastases |
|
|
Term
| what is a common infection caused by radical mastectomy, the loss of lymph node drainage? |
|
Definition
|
|
Term
| what is the prophylactic treatment of choice in a patient with malignancy who has undergone splenectomy? |
|
Definition
| amoxicillin/clavulonate to avert from overwhelming sepsis with H.Flu, N.meningitides, Strep.Pneumonia |
|
|
Term
| which 3 malignancies are associated with dysfunction of phagocytosis d/t lack of neutrophils? what organisms infect? |
|
Definition
hairy cell leukemia, ALL, AML
Staphylococci, streptococci, enteric organisms, fungi |
|
|
Term
| what 2 malignancies cause dysfunction of the humoral system? what are 2 manifestations |
|
Definition
CLL, MM
pneumonia, sinusitis - encapsulated organisms |
|
|
Term
| which 3 malignancies cause dysfunction of the cellular immune system? which organism infect? |
|
Definition
Hodgkin's disease, leukemia, T cell lymphoma
intracellular organisms - TB, listeria, fungi, HSV etc. |
|
|
Term
| in what 2 malignancies should patients receive Abx prophylaxis throughout chemotherapy for pneumocystis? |
|
Definition
|
|
Term
| patients with conditions/malignancies associated with t-cell dysfunction could have serious infections with the lack of.... |
|
Definition
| fever. hodgkin's, hairy cell, glucocorticoids |
|
|
Term
| patients with malignancies that cause neutropenia may have what unique manifestations of which common conditions? |
|
Definition
AML/ALL
pneumonia w/o sputum or CXR findings
cellulitis w/o purulence |
|
|
Term
| what are the immune def. typical of hodgkin's patients? |
|
Definition
| t cell dysfunction, splenctomized |
|
|
Term
| which viral vaccines are indicated for hodgkins patients and which are CIed? |
|
Definition
HPV, influenza
CI - MMR, VZV |
|
|
Term
| in which 3 conditions are MMR and VZV vaccinations CIed? |
|
Definition
| intensive chemotherapy, hodgkin's disease and HSCT (MMR can be given 24 months after procedure given there's no GVHD) |
|
|
Term
| which disease may be reactivated with the use of Rituximab (B-cell antibody)? |
|
Definition
|
|
Term
| which organism not so typical can cause which skin condition in neutropenic patients? |
|
Definition
| ecythema gangrenosum (central necrosis) in nonpressure areas caused by P.aeroginosa |
|
|
Term
| which 3 organisms are often associated with IV catheter infection in a patient with granulocytopenia/ |
|
Definition
| JK bacillus, Acinetobacter, non-aeroginosa pseudomonas |
|
|
Term
| 5 gram + cocci that may cause infection in the neutropenic patient/ |
|
Definition
Staphylococcus epidermidis Staphylococcus aureus
Viridans Streptococcus
Enterococcus faecalis
Streptococcus pneumoniae |
|
|
Term
| 8 gram - bacilli which may cause infection in the neutropenic patient? |
|
Definition
Escherichia coli
Klebsiella spp.
Pseudomonas aeruginosa
Non-aeruginosa Pseudomonas spp.a
Enterobacter spp.
Serratia spp.
Acinetobacter spp.a
Citrobacter spp. |
|
|
Term
| 2 gram + bacilli that may cause infection in the neutropenic patient? |
|
Definition
|
|
Term
| 2 Fungi that may cause infection in the neutropenic patient? |
|
Definition
Candida spp.
Aspergillus spp. |
|
|
Term
| what is sweet's syndrome? |
|
Definition
| febrile neutropenic dermatosis |
|
|
Term
| what is the dermatologic manifestation of sweet's syndrome? |
|
Definition
| red/bluish papules that coalesce to form sharp-bordered plaques |
|
|
Term
| what are the typical anatomical territories of the dermatologic manifestation of sweet's syndrome? |
|
Definition
|
|
Term
| what is the Tx for sweet's syndrome? |
|
Definition
| high dose glucocorticoids (60mg prednisone) followed by tapering for 2-3 wks |
|
|
Term
| what is a dermatologic diagnostic challenge in immunocompromised patients d/t malignancy who are both at increased risk of HSV, use multiple drugs, and may develop GVHD? |
|
Definition
| distinguishing btwn erythema multiforme (HSV) and SJS (drugs) and the rash typical to GVHD |
|
|
Term
what is an indication for immediate
IV tunneled-catheter removal in the in the patient undergoing chemotherapy? |
|
Definition
| red streak over the subcutaneous part of the line |
|
|
Term
| what is not an immediate indication for removal of a tunneled-IV catheter in the patient undergoing chemotherapy? |
|
Definition
| erythema over the exit port |
|
|
Term
| what is the Tx for IV catheter infection with blood cultures positive for coagulase negative staphylococci |
|
Definition
1. IV catheter optimal
2. Vancomycin (alternatives - Linezolid, quinupristin/dalfopristin, and daptomycin) |
|
|
Term
| which organisms causing IV catheter infections are notoriously hard to treat, and therefore should always prompt immediate removal of IV catheter? |
|
Definition
| Stenotrophomonas, Pseudomonas, Burkholderia, Fungal, Bacillus, Corynebacterium, Mycobacterium, Staph. Aureus |
|
|
Term
| IV catheter exit site erythema in the patient receiving chemo is usually caused by which organisms and how are they treated |
|
Definition
| coagulase negative staphylococci, vancomycin |
|
|
Term
| which bacteria is common in mouth ulceration d/t cytotoxic chemo? |
|
Definition
|
|
Term
| which drug is 1st line for the Tx of both localized (thrush) and systemic (esophagitis) infection with candida albicans? what is are 2 alternative options in case of resistance to this first drug? |
|
Definition
fluconazole
voriconazole, echinocandins (cell wall glucan inhibitors, caspofungin) |
|
|
Term
| Noma (cancrum oris), a disease where bacteria invade both hard and soft oral tissues, is common in what 4 conditions? which 2 bacteria are responsible? |
|
Definition
immunocompromised, debilitated, malnourished, low hygine
Bacteroides, Fusobacterium |
|
|
Term
| what is the likely diagnosis in a patient with hematologic malignancy who has recently recovered from neutropenia and has persistent fever unresponsive to antibiotics, abdominal pain and tenderness or nausea, and elevated serum levels of ALP? |
|
Definition
|
|
Term
| how is the diagnosis of hepatic candidiasis done? |
|
Definition
imaging(avoid Bx b/c risk of bleeding)
bull's eye lesion (granulomatous lesion) |
|
|
Term
| what is a possible diagnosis in a patient who is immunosuppressed with fever and right-lower-quadrant tenderness |
|
Definition
| Typhillitis (necrotizing colitis, neutropenic colitis, necrotizing enteropathy, ileocecal syndrome, and cecitis) |
|
|
Term
| in which conditions do you see Typhillitis? |
|
Definition
|
|
Term
| how is the diagnosis of typhillitis done? |
|
Definition
| finding of a thickened cecal wall on CT, MRI, or ultrasonography |
|
|
Term
| chemotherapy induced diarrhea can be caused by which organism? |
|
Definition
|
|
Term
| The presentation of meningitis in patients with which malignancies would be caused by which 2 organisms? |
|
Definition
lymphoma, CLL, chemotherapy for solid malignancies and BMT
cryptococcus and listeria |
|
|
Term
| A predisposition to encephalitis caused by intracellular organisms similar to those encountered in patients with AIDS is seen in cancer patients receiving what Tx? |
|
Definition
(1) high-dose cytotoxic chemotherapy (2) chemotherapy affecting T cell function (e.g., fludarabine), or (3) antibodies that eliminate T cells (e.g., anti-CD3, alemtuzumab, anti-CD52)
(4) cytokine activity (anti-tumor necrosis factor agents or interleukin 1 receptor antagonists) |
|
|
Term
| what are 3 possible organisms causing a brain mass in patients with cancer and prolonged neutropenia? |
|
Definition
| Aspergillus, Nocardia, or Cryptococcus |
|
|
Term
| what are 3 possible organisms causing a brain mass in patients with cancer and defects in cellular immunity? |
|
Definition
|
|
Term
| what are 6 possible organisms causing diffuse encephalitis in patients with cancer and defects in cellular immunity? |
|
Definition
| VZV, CMV, HSV, HHV-6, JC virus (PML), Listeria |
|
|
Term
| whats a possible organism causing diffuse encephalitis in patients with cancer and prolonged neutropenia? |
|
Definition
|
|
Term
| what is the imaging of choice for a suspected pulmonary infection in the neutropenic patient? |
|
Definition
|
|
Term
| if detecting a pulmonary lesion on high resolution CT in the immunocompromised patient what should be the next step in the workup? |
|
Definition
| check for platelet levels and elevate them to standard levels, so the next step you could perform and effective culture with the fluid you aspirate via endobronchial lavage |
|
|
Term
| in the immunocompromised patient with imaging proven pulmonary lesion, what organisms should you look for in the culture of the fluid aspirated? |
|
Definition
| Mycoplasma, Chlamydia, Legionella, Nocardia, PCP, fungi |
|
|
Term
| in the Differential Diagnosis of Chest Infiltrates in Immunocompromised Patients, what is the infectious cause of a localized infiltrate and what are 3 non infectious causes? |
|
Definition
bacteria (pneumonia)
local hemorrhage, embolism, tumor |
|
|
Term
| in the Differential Diagnosis of Chest Infiltrates in Immunocompromised Patients, what are 2 possible infectious causes of a lobular infiltrate and what is a possible noninfectious cause? |
|
Definition
fungi, nocardia
recurrent tumor |
|
|
Term
| in the Differential Diagnosis of Chest Infiltrates in Immunocompromised Patients, what are possible infectious causes of a diffuse infiltrate and what are possible noninfectious causes? |
|
Definition
Viruses (especially CMV), Chlamydia, Pneumocystis, Toxoplasma gondii, mycobacteria
Congestive heart failure, radiation pneumonitis, drug-induced lung injury, diffuse alveolar hemorrhage (described after BMT |
|
|
Term
| what is the "crescent sign" on chest x-ray of an immunocompromised patient? |
|
Definition
resolving aspergillus infection or invasive aspergillus infection
a necrotic part of the lesion in its center |
|
|
Term
| The appearance of a discolored area in the nasal passages or on the hard palate of an immunocompromised patient should prompt a search for what? |
|
Definition
|
|
Term
| If an immunocompromised patient has a diffuse interstitial pattern on chest x-ray, it may be reasonable, while considering invasive diagnostic procedures, to institute empirical treatment with what? |
|
Definition
| for Pneumocystis with TMP-SMX and for Chlamydia, Mycoplasma, and Legionella with a quinolone or an erythromycin derivative (e.g., azithromycin) |
|
|
Term
| what is the most common cause of chemotherapy-induced lung disease |
|
Definition
|
|
Term
| causes of chemotherapy-induced lung disease |
|
Definition
| bleomycin, alkylating agents (such as cyclophosphamide, chlorambucil, and melphalan), nitrosoureas [carmustine (BCNU), lomustine (CCNU), and methyl-CCNU], busulfan, procarbazine, methotrexate, and hydroxyurea |
|
|
Term
| what is The treatment of radiation pneumonitis? |
|
Definition
|
|
Term
| what might infect the thyroid in an immunocompromised patient? |
|
Definition
|
|
Term
| what might infect the adrenal in an immunocompromised patient? |
|
Definition
|
|
Term
| 2 viruses that may cause hemorrhagic cystitis in the immunocompromised patient |
|
Definition
|
|
Term
| patients undergoing intensive chemotherapy for any form of cancer will have defects in which components of the immune system? |
|
Definition
| granulocytes and lymphoctes dysfunction |
|
|
Term
| what is the length of Abx Tx in the neutropenic patient? |
|
Definition
| until at least 2 days where the neutrophil count stays above 500 |
|
|
Term
| if patients remain febrile after resolution of neutropenia the following 3 diagnoses should be seriously considered |
|
Definition
| (1) fungal infection, (2) bacterial abscesses or undrained foci of infection, and (3) drug fever |
|
|
Term
| what 4 things shouldn't be missed in the PE of a patient presenting with febrile neutropenia? |
|
Definition
| perianal area, skin lesions, mucous membranes, IV catheter sites |
|
|
Term
| in the workup of a febrile neutropenic patient, who has begun emperical Abx Tx, but the source of infection hasn't been found and the patient's fever persists, what is the next step in mgmt? |
|
Definition
|
|
Term
| what is the most important rule about choosing an Abx Tx for a neutropenic patient? |
|
Definition
| it should cover both gram + and - bacteria |
|
|
Term
| studies shows benefit for the use of prophylactic Abx in patients that are expected to undergo neutropenia, which agent? |
|
Definition
| ciprofloxacin or levofloxacin |
|
|
Term
| 5 fungal infections that are typical of neutropenic cancer patients |
|
Definition
| Candida, Aspergillus, Fusarium, Trichosporon, Bipolaris |
|
|
Term
| which fungal infection very common in immunocompromised patients of other causes, isn't seen in AML patients undergoing chemo? |
|
Definition
|
|
Term
| what is the Tx of choice for fungal infection in the neutropenic cancer patient? and which fungus does it not cover? |
|
Definition
|
|
Term
| why isn't Fluconazole adequate for the Tx of a neutropenic cancer patient with a fungal infection? |
|
Definition
| it doesn't cover aspergillus or non-albicans Candida species |
|
|
Term
| which antiviral drug is given for the prophylaxis of a viral infection (HSV, VZV, CMV, EBV) in the neutropenic cancer patient? |
|
Definition
|
|
Term
| which 3 antiviral drugs cover HHV-6 (sixth disease in kids) in the neutropenic cancer patient? |
|
Definition
| gancyclovir, valgancyclovir, foscarnet |
|
|
Term
| which 2 antiherpesviridae drugs are nucleic acid analogues? the rest work in what mechanism |
|
Definition
Famcyclovir (Pencyclovir), Cidofovir
Polymerase inhibitors - either specific for HSV (acyclovir) or broader |
|
|
Term
| which 3 antiherpesviridae drugs may cause bone marrow suppression? |
|
Definition
| Gancyclovir, Valgancyclovir, Cidofovir |
|
|
Term
| which antiherpesviridae drug may cause thrombotic microangiopathy? |
|
Definition
|
|
Term
| which antiherpesviridae drug may cause crystaluria (nephrolithiasis) at high doses? |
|
Definition
|
|
Term
| which 2 antiherpesviridae drugs may cause nephrotoxicity? |
|
Definition
|
|
Term
| which antiinfluenza A drug may be given prophylactically in the neutropenic cancer patient? |
|
Definition
|
|
Term
| how does Amantadine work? |
|
Definition
| it interferes with the uncoating of the Influenza A virus |
|
|
Term
| which 2 antiviral drugs are effective against influenza A and B and are Neuroaminidase inhibitors? |
|
Definition
| Oseltamivir (TamiFlu), Zanamivir |
|
|
Term
| which antiviral drugs are associated with side effects of fever, myalgias and bone marrow suppression? |
|
Definition
|
|
Term
| which antiviral drug is used against HCV and RSV viruses? what is a side effect of it? mechanism? |
|
Definition
| Ribavirin, anemia, purine analogue |
|
|
Term
| which prophylactic Tx is important in AML and ALL patients undergoing chemotherapy? |
|
Definition
|
|
Term
| what is the role of granulocyte transfusion in the neutropenic cancer patient? |
|
Definition
| as a Tx for patient who is unresponsive to Abx Tx (not to be used prophylactically) |
|
|
Term
| what is the recommended use of cytokine therapy in the neutropenic cancer patient (G-CSF, GM-CSF)? |
|
Definition
| in severe prolonged neutropenias only |
|
|
Term
| 4 possible side effects of cytokine Tx (G-CSF)? |
|
Definition
| fever, hypoxemia, pleural effusions or serositis |
|
|
Term
| what environmental factor is associated with in hospital infections with aspergillus? |
|
Definition
|
|
Term
| what is the source of most organisms that infect and invade the neutropenic cancer patient? |
|
Definition
| his own bowel and skin flora |
|
|
Term
| which 2 environmental health protection methods are used in hospitals but are not clinically proven to be effective in the neutropenic cancer patient? |
|
Definition
| laminar air flow, reverse isolation - visitors and staff wear gowns and gloves |
|
|
Term
| although not clinically proven, which foods should the neutropenic cancer patient avoid? |
|
Definition
| fresh vegetables (P.Aeroginosa), leftovers, deli foods, and unpasteurized dairy products |
|
|
Term
| what are the recommendations for intravenous immunoglobulin replacement therapy in the immunocompromised cancer patient? which conditions are associated with hypogammaglobulinemia? |
|
Definition
levels<400 for a prolonged period of time
CLL, MM, recipients of BMT |
|
|
Term
| all cancer patients receiving chemotherapy that includes glucocorticosteroids should be prophylactically treated with? |
|
Definition
|
|
Term
| Therapeutic radiation is delivered in three ways |
|
Definition
| (1) teletherapy, with beams of radiation generated at a distance and aimed at the tumor within the patient; (2) brachytherapy, with encapsulated sources of radiation implanted directly into or adjacent to tumor tissues; and (3) systemic therapy, with radionuclides targeted in some fashion to a site of tumor |
|
|
Term
| which cells are relatively resistant to radiation therapy? |
|
Definition
| hypoxemic cells and dividing cells |
|
|
Term
| which are the most widely used forms of radiation energy used in therapy? |
|
Definition
|
|
Term
| high voltage energy radiation results in what effect on the skin and why? |
|
Definition
| skin sparing effect d/t less scatter of radiation to adjacent tissues |
|
|
Term
| how does radiation therapy induce cancer cell death? |
|
Definition
| formation of free radical hydroxyl groups which create breaks in the DNA |
|
|
Term
| 5 diseases that are curative with radiation therapy? |
|
Definition
| breast cancer, Hodgkin's disease, head and neck cancer, prostate cancer, and gynecologic cancers |
|
|
Term
| which radionuclides are effective in controlling bone metastasis and reducing pain? |
|
Definition
| Strontium 89 and samarium 153 |
|
|
Term
| which Cancers can be possibly cured with "High-Dose" Chemotherapy With Stem Cell Support |
|
Definition
| Relapsed leukemias,Relapsed lymphomas - Hodgkin's and non-Hodgkin's, CML, MM |
|
|
Term
| 5 cancers that may be cured with the combination of chemo and radiotherapy |
|
Definition
| lung, cervix, anus, breast, head and neck |
|
|
Term
| 3 cancers that may be cured with adjuvant chemotherapy to surgery |
|
Definition
|
|
Term
| which 9 cancers are poorly responsive to chemotherapy in advanced stages? |
|
Definition
Pancreatic carcinoma
Biliary-tract neoplasms
Thyroid carcinoma
Carcinoma of the vulva
Non-small cell lung carcinoma
Prostate carcinoma
Melanoma
Hepatocellular carcinoma
Salivary gland cancer |
|
|
Term
| which two adverse phenomena are typical of Procarbazine, an alkylating agent? |
|
Definition
| cheese effect (acts as MAOi), disulfiram-like effect |
|
|
Term
| which 10 chemotherpeutic agents (belonging to 4 families) cause alopecia? |
|
Definition
1. alkylating agents: procarbazine, cyclophosphamide, chlorambucil
2. antitumor antibiotic - Actinomycin D, Doxorubincin, Daunorubicin
3. antitopoisomerase - etoposide, irinotecan, topotecan
4. antimitotic - paclitaxel |
|
|
Term
| which 13 chemotherapeutic agents (belonging to 3 families) cause CNS side effects? |
|
Definition
1. alkylating agents: Ifosfamide, Procarbazine, Altretamine, Oxaliplatin
2. antimetabolites: Deoxycoformycin (ADA inhibitor), hydroxyurea, Cytosine arabinoside, Azacytidine, Fludarabine, MTX, 5-FU
3. antimitotic agents: Vincristine |
|
|
Term
| which 7 chemotherapeutic (belonging to 4 families) agents cause neuropathy? |
|
Definition
1. alkylating agents: Ifosfamide, Cisplatin
2. anti-mitotic agents: paclitaxel (sensory), Docetaxel, Ixabepilone
3. proteosome inhibitors: Bortezomib (Velcade - relapsed MM/mantle cell lymphoma)
4. arsenic trioxide (2nd line in leukemia) |
|
|
Term
| which 8 chemotherapeutic agents (belonging to 2 families) cause renal toxicity |
|
Definition
1. alkylating agents: Carmustine, Cisplatin, Carboplatin
2. antimetabolites: Deoxycoformycin (ADA inhibitor), 2-Chlorodeoxyadenosine (hairy cell leukemia), Hydroxyurea, MTX, 5-FU |
|
|
Term
| which 2 chemotherapeutic agents cause hand-foot syndrome |
|
Definition
1. antimetabolites: Capcentabine (Xeloda)
2. Tyrosine-kinase inhibitors: Sorafenib (Nexavar) |
|
|
Term
| what increases the toxicity of 5-FU |
|
Definition
| leucovirin (same agent that rescues from MTX toxicity) |
|
|
Term
| which 11 chemotherapeutic agents (belonging to 5 families) cause stomatitis |
|
Definition
1. mTor inhibitors: Everolimus, Temsirolimus
2. antimitotic agents: Docetaxel
3. antimetabolites: Cytosine arabinoside, 5-FU, MTX, Hydroxyurea
4. antitumor Abx: Doxorubicin/Daunorubicin, Actinomycin D
5. antitopoisomerase - etoposide, topotecane |
|
|
Term
| what are 2 adverse effects of Imatinib (Gleevec)? |
|
Definition
| Nausea, periorbital edema |
|
|
Term
| which 3 chemotherapeutic drugs cause Raynaud's phenomenon |
|
Definition
1. antimitotic agents: Vinblastine
2. antitumor Abx: Bleomycin
3. alkylating agent: Cisplatin |
|
|
Term
| all Tyrosine kinase inhibitors cause Rash except for which 2? |
|
Definition
| Imatinib (Gleevec), Sunitinib (Sutent) |
|
|
Term
| which 10 chemotherapeutic agents (belonging to 5 families) cause cardiac toxicity |
|
Definition
1. alkylating agents: cyclophosphamide
2. antitumor Abx: Doxorubicin, Idarubicin, Epirubicin, Mitoxantrone
3. histone deacetylase inhibitors: romidepsin (lymphoma)
4. antimitotic agent: Vincristine, Paclitaxel, Estramustine
5. antimetabolites: 5-FU |
|
|
Term
| which 6 chemotherapeutic drugs (5 families) cause hypersensitivity reactions? |
|
Definition
1. antitumor Abx: Bleomycin
2. antitopoisomerase: Etoposide
3.antimetabolites: Asparaginase
4. antimitotic agents: Paclitaxel, Docetaxel
5. targeted toxins: Denileukin diftitox (leukemia/lymphoma - il2+diphtheria toxin) |
|
|
Term
| 3 chemotherapeutic agents which require liver metabolism activation |
|
Definition
| alkylating agents: Cyclophosphamide, Procarbazine, Altretamine |
|
|
Term
| which 5 chemotherapeutic drugs (belonging to 2 families) are eliminated via hepatic clearance |
|
Definition
1. antitopoisomerase: Etoposide
2. antimitotic agents: Vincristine, Vinblastine, Paclitaxel, Vinorelbine |
|
|
Term
| which chemotherapeutic agents cause cystitis, and which must be treated with Mesna? |
|
Definition
| Cyclophosphamide, Ifosphamide - must give mesna |
|
|
Term
| the cardiotoxicity of doxorubicin is increased when given together with what chemo drug? |
|
Definition
|
|
Term
| which chemotherapeutic drug oxidises Fe+2 to create a superoxide and hydroxyl radicals? |
|
Definition
|
|
Term
| which 9 chemotherapeutic agents (4 families) are vesicants? (cause fluid-filled skin blisters) |
|
Definition
1. antimitotic agents - vincristine, vinblastine, vinorelbine
2. antitumor Abx: Mitoxantrone, Idarubicin, Actinomycin D, Doxorubicin
3. alkylating agents: Mechlorethamine (nitrogen mustard)
4. antitopoisomerase: Etoposide |
|
|
Term
| which chemotherapeutic agents may cause Acute Leukemia? |
|
Definition
1. antitumor Abx: Mitoxantrone (APL)
2. antitopoisomerase: Etoposide |
|
|
Term
| which 3 drugs worsen renal failure (tubular) caused by MTX? |
|
Definition
| Salicylates, NSAIDs, Probenecid |
|
|
Term
| which antimetabolite chemotherapeutic agent should be administered with B12 and folate to decrease toxicity? |
|
Definition
|
|
Term
| which chemotherapeutic agents cause hyperglycemia |
|
Definition
| 1. antimetabolites: asparaginase |
|
|
Term
| what medication should be given prior to Tx with the chemotherapeutic agents of the Taxane family (Paclitaxel, Docetaxel)? |
|
Definition
| corticosteroids and H1/2 blockers d/t likelihood of hypersensitivity reaction |
|
|
Term
| in what circumstances is Oncotype-Dx used in breast cancer decision making? |
|
Definition
| ER+, node negative disease - to check if patient might benefit from hormonal and chemo therapy |
|
|
Term
| 6 indications for prophylaxis with G-CSF in the 1st chemotherapeutic cycle? |
|
Definition
1. probability of febrile neutropenia is 20%
2. preexisting neutropenia or active infection
3. Age >65 years treated for lymphoma with curative intent
4. poor performance status
5. Extensive prior chemotherapy
6. dose dense regimens |
|
|
Term
| indication for prophylactic G-CSF in subsequent chemotherapeutic cycles (not the first cycle) |
|
Definition
| febrile neutropenia in previous cycle |
|
|
Term
| 2 indications for the therapeutic use of G-CSF in febrile neutropenia (not used in afebrile neutropenia) |
|
Definition
1. BMT or HSCT
2. sepsis, pneumonia, fungal infection - no proven benefit |
|
|
Term
| what is the indication of platelet transfusion in the leukemic patient? |
|
Definition
| fever (stressor) + PLT<20,000 |
|
|
Term
| what is the indication of platelet transfusion in the patient with a solid tumor malignancy? |
|
Definition
|
|
Term
| what is the indication of platelet transfusion in the patient with a myeloproliferative state? |
|
Definition
| bleeding (regardless the level of platelets b/c whaplatelets are abnormal) |
|
|
Term
| what is the indication for the use Oprelvekin (il11)? what are the side effects? |
|
Definition
expected thrombocytopenic state
headache, fever, malaise, syncope, cardiac arrhythmias, and fluid retention. |
|
|
Term
| what is the indication for the use of EPO in patients undergoing chemotherapy? side effects? target level? |
|
Definition
therapy for >2 months on a "stable" regimen likely to require continuing transfusions
thromboembolic events, 9-10 |
|
|
Term
| what are 3 indications of blood transfusions in the patient receiving chemotherapy? |
|
Definition
1. Hb<8
2. Hb<9 in patient with severe cardiovascular disease
3. end organ failure |
|
|
Term
| what is the MC side effect of chemotherapy? |
|
Definition
|
|
Term
| which chemotherapeutic agents cause nausea in more than 90% of patients? |
|
Definition
| mechlorethamine, streptozotocin, DTIC (Dacarbazine - alkylating agent), cyclophosphamide at >1500 mg/m2, and cisplatin |
|
|
Term
| which chemotherapeutic agents cause nausea in 30-90% of cases? |
|
Definition
| carboplatin, cytosine arabinoside (>1 mg/m2), ifosfamide, conventional-dose cyclophosphamide, and anthracyclines |
|
|
Term
| 4 chemotherapeutic agents that cause nausea in 10-30% of cases? |
|
Definition
| fluorouracil, taxanes, etoposide, and bortezomib |
|
|
Term
| what is the prophylactic Tx of the anticipated nausea from high-risk chemotherapeutic agents? |
|
Definition
1. 5-HT3 antagonists: ondensatron etc.
2. NK1 receptor antagonists: Aprepitant
3. Dexamethasone |
|
|
Term
| what is the prophylactic Tx of the anticipated nausea from medium-risk chemotherapeutic agents (except cyclophosphamide and doxorubicin)? |
|
Definition
1. 5-HT3 antagonists: ondensatron
2. Dexamehtasone |
|
|
Term
| what is the prophylactic Tx of the anticipated nausea from low-risk chemotherapeutic agents? |
|
Definition
antidopaminergic - halidol, prochlorperazine, metoclopramide
benzodiazepines |
|
|
Term
| 2 chemotherpaeutic agents that cause severe diarrhea? |
|
Definition
1. antimetabolite: 5-FU
2. antitopoisomerase: irinotecan |
|
|
Term
| AKT1 is an oncogene expressed in what malignancy? |
|
Definition
|
|
Term
| AKT2 is an oncogene expressed in what malignancy? |
|
Definition
| ovarian, breast, pancreatic |
|
|
Term
| BRAF is an oncogene expressed in what malignancy? |
|
Definition
|
|
Term
| ERBB2 (HER2) is an oncogene expressed in what malignancy? |
|
Definition
| breast, ovary, neuroblastoma, gastric |
|
|
Term
| what is the MC mortality associated malignancy in males and females, and 2nd MC? |
|
Definition
|
|
Term
| what is the MC mortality associated malignancy in males age 20-39? 2nd MC? |
|
Definition
|
|
Term
| what is the MC mortality associated malignancy in females age 20-39? 2nd MC? |
|
Definition
|
|
Term
| what is the MC mortality associated malignancy in males age 40-59? 2nd MC? |
|
Definition
|
|
Term
| what is the MC mortality associated malignancy in females age 40-59? 2nd MC? |
|
Definition
|
|
Term
| 3 extragonadal sites from which germ cell tumors infrequently arise |
|
Definition
| mediastinum, retroperitoneum, pineal gland |
|
|
Term
| germ cell tumors occur most frequently in males of what age? |
|
Definition
|
|
Term
| which syndrome is associated with mediastinal germ cell tumor? |
|
Definition
|
|
Term
| what chromosome abnormality is associated with all germ cell tumors |
|
Definition
| duplication of the short arm of chromosome 12 |
|
|
Term
| what is a pathognomonic presentation of testicular cancer? |
|
Definition
| painless mass in the testicle |
|
|
Term
| what is the MC presentation of testicular cancer? |
|
Definition
| testicular swelling or discomfort |
|
|
Term
| what is the next step after identifying a testicular tumor in US? |
|
Definition
| radical inguinal orchiectomy |
|
|
Term
| staging for testicular malignancy is preformed after radical inguinal orchiectomy, what are the steps taken? |
|
Definition
1. serum levels of hCG, AFP, LDH
2. CXR
3. CT of chest and abdomen |
|
|
Term
| what is the staging of testicular malignancy? |
|
Definition
stage 1 - limited to the testis, epididymis, or spermatic cord
stage 2 - limited to retroperitoneal (regional) lymph nodes
stage 3 - outside the retroperitoneum, involving supradiaphragmatic nodal sites or viscera |
|
|
Term
| which 4 histologic subtypes does nonseminoma testicular cancer include |
|
Definition
| embryonal carcinoma, teratoma, choriocarcinoma, and endodermal sinus (yolk sac) tumor |
|
|
Term
| what does pure emryonal carcinoma (nonseminoma) secrete? |
|
Definition
|
|
Term
| in what stages does nonseminoma usually present |
|
Definition
| 33% stage 1, 33% stage 2 and 33% stage 3 |
|
|
Term
| in what stages does nonseminoma usually present |
|
Definition
| 70% stage 1, 20% stage 2 and 10% stage 3 |
|
|
Term
| which tumor marker is elevated in nonseminoma but not in seminoma? |
|
Definition
|
|
Term
| how should a patient diagnosed with seminoma but has elevated AFP be treated? |
|
Definition
|
|
Term
| what is the treatment of stage 1 nonseminoma after orchiectomy and declining AFP and hCG? |
|
Definition
if T1 and no evidence of vascular or lymphatic invasion - 2 options:
1. RPLND - retroperitoneal lymph node dissection
2. observation
otherwise, only RPLND |
|
|
Term
| what are 2 complications of retroperitoneal lymph node dissection? |
|
Definition
infertility
retrograde ejaculation |
|
|
Term
| what % of patients with non seminoma who had clinical stage 1 turned out to be pathological stage 2? |
|
Definition
|
|
Term
| what % of patients with non seminoma clinical stage 1, T2-T4, have pathological stage 2 disease and hence should undergo RPLND? |
|
Definition
|
|
Term
| what is the treatment of non seminoma stage 2 patients with limited, ipsilateral retroperitoneal adenopathy (nodes usually 3 cm in largest diameter) and normal levels of AFP and hCG? |
|
Definition
|
|
Term
| what is the Tx of patients with non seminoma stage 2, low volume retroperitoneal nodes and elevated levels of AFP and hCG? |
|
Definition
low volume retroperitoneal disease: tumor nodes< 2 cm in diameter and <6 nodes involved
surveillance - relapse less than 33% |
|
|
Term
| what is the Tx of patients with non seminoma stage 2, high volume retroperitoneal nodes and elevated levels of AFP and hCG? |
|
Definition
high volume retroperitoneal disease: >6 nodes involved, or any involved node >2 cm in largest diameter, or extranodal tumor extension
2 courses of adjuvant chemotherapy |
|
|
Term
| what is the regimen for stage 2 non seminoma adjuvant chemotherapy? |
|
Definition
| cisplatin + etoposide +/- bleomycin |
|
|
Term
|
Definition
| orchiectomy +/- radiation therapy to retroperitoneum |
|
|
Term
| what are the recurrence rates for stage 1 seminoma? |
|
Definition
| 15%, 30% of which recur after 2 yrs and 5% recur after 5 yrs |
|
|
Term
| 2 factors that have been associated with higher recurrence rates in stage 1 seminoma and are therefore recommended for retroperitoneal radiation? |
|
Definition
| rete testis involvement and size >4 cm |
|
|
Term
| what is the Tx for stage 2A (nodes<2cm) and 2B (nodes 2-5 cm non-bulky) seminoma |
|
Definition
| orchiectomy +radiation therapy to retroperitoneum |
|
|
Term
| what is the Tx for stage 2B and 2C (nodes>5cm, bulky) seminoma |
|
Definition
| orchiectomy + chemotherapy |
|
|
Term
| what are the relapse free survival rate for patients with stage 2 seminoma with retroperitoneal nodes<5 cm? |
|
Definition
|
|
Term
| what is the Tx for advanced germ cell tumors, stage 2C and stage 3 (either seminoma or non-seminoma) and the rates of complete remission? |
|
Definition
1. orchiectomy +chemotherapy alone - complete response (decreased AFP/hCG and no evidence of disease on imaging for > 1 month) - 60%
2. orchiectomy + chemo + surgery to remove residual disease |
|
|
Term
| in the risk stratification of advanced germ cell tumors for seminoma, what is considered good and intermediate risk? |
|
Definition
good - absence of nonpulmonary visceral metastases
intermediate - presence of nonpulmonary visceral metastases |
|
|
Term
| in the risk stratification of advanced germ cell tumors for non-seminoma, what defines a good risk? |
|
Definition
Gonadal or retroperitoneal primary site
Absent nonpulmonary visceral metastases
AFP <1000 ng/mL
Beta-hCG <5000 mIU/mL
LDH <1.5 x upper limit of normal (ULN) |
|
|
Term
| in the risk stratification of advanced germ cell tumors for non-seminoma, what defines an intermediate risk? |
|
Definition
Gonadal or retroperitoneal primary site
Absent nonpulmonary visceral metastases
AFP 1000–10,000 ng/mL
Beta-hCG 5000–50,000 mIU/mL
LDH 1.5–10 x ULN |
|
|
Term
| in the risk stratification of advanced germ cell tumors for non-seminoma, what defines a poor risk? |
|
Definition
Mediastinal primary site
Presence of nonpulmonary visceral metastases
AFP 10,000 ng/mL
Beta-hCG>50,000 mIU/mL
LDH > 10 x ULN |
|
|
Term
| which type uses markers in its risk stratification and staging, seminoma or non-seminoma? |
|
Definition
|
|
Term
| what % of patients with good, intermediate and poor risk stratification for germ cell tumors achieve durable complete responses? |
|
Definition
|
|
Term
| what is salvage chemotherapy (2nd and 3rd lines) in advanced germ cell tumor? |
|
Definition
2nd line: vinblastine, ifosfamide, and cisplatin
3rd line: high-dose carboplatin (1500 mg/m2) plus etoposide (1200 mg/m2), with or without cyclophosphamide, with peripheral blood stem cell support |
|
|
Term
| mediastinal nonseminoma is associated with what 3 conditions |
|
Definition
| AML, MDS, essential thrombocytosis |
|
|
Term
| nonseminoma can preform malignant transformation into which 2 diseases: |
|
Definition
| rhabdomysarcoma or adenocarcinoma |
|
|
Term
| risk factors for ovarian cancer |
|
Definition
| nulliparity, use of talc agents applied to the perineum, obesity, and probably hormone replacement therapy |
|
|
Term
| protective factors for ovarian cancer |
|
Definition
| oral contraceptives, multiparity, and breast-feeding |
|
|
Term
| what % of females with ovarian cancer present with stage 3c disease - tumors with bulky intraperitoneal disease? |
|
Definition
|
|
Term
| what are the stages of ovarian carcinoma? |
|
Definition
| stage I tumors confined to the ovary, stage II malignancies confined to the pelvis, and stage III confined to the peritoneal cavity |
|
|
Term
| what is the workup and Tx of a female with an ovarian lesion which turns out to be malignant primary? |
|
Definition
| first, make sure its malignant and primary by performing unilateral salpingo-oopherectomy. if primary cancer of the ovary - procede to hysterectomy, removal of the remaining tube and ovary, omentectomy, and pelvic node sampling along with some random biopsies of the peritoneal cavity |
|
|
Term
| what is the 2 step mgmt of bulky intrabdominal ovarian cancer |
|
Definition
1. maximal tumor cytoreduction is attempted even if it involves partial bowel resection and splenectomy b/c it is associated with better survival than visible disease
2. chemo - platine + texane |
|
|
Term
| what is the median survival of patients with and w/o gross residual disease? |
|
Definition
|
|
Term
| what % of patients with advanced stage ovarian cancer who underwent surgery + chemo, respond to therapy, go into complete remission relapse after complete remission? |
|
Definition
| 70%, 40-50%, 50% relapse from complete remission |
|
|
Term
| what are the chemotherapeutic agents used in relapse of ovarian cancer? |
|
Definition
| gemcitabine, topotecan, liposomal doxorubicin, and bevacizumab |
|
|
Term
| what % of ovarian cancer are HER2+? |
|
Definition
|
|
Term
| prognosis in ovarian cancer is influenced by what 2 parameters of disease? |
|
Definition
|
|
Term
| what are the risk factors for soft tissue sarcoma |
|
Definition
| radiation, immunosuppression, germ line mutations (p53 li fraumeni, Neufibromatosis, RB1) |
|
|
Term
| translocation invovled in 90% of sarcomas |
|
Definition
|
|
Term
| what is the substance secreted by some sarcomas? and its effects |
|
Definition
| IGF2 - growth, metastasis, hypoglycemia |
|
|
Term
| which sarcoma doesn't metastasize? |
|
Definition
| well-differentiated liposarcoma |
|
|
Term
| what is the rate of lymph node involvement in sarcoma? which 5 diseases are exeptional |
|
Definition
5%
synovial and epithelioid sarcomas, clear-cell sarcoma (melanoma of the soft parts), angiosarcoma, and rhabdomyosarcoma - 17% |
|
|
Term
| what is the MC site of metastasis in sarcoma? what are 3 exceptional diseases |
|
Definition
lungs
GIST - liver
myoxoid liposarcoma - adipose tissue
clear cell sarcoma - bones |
|
|
Term
| what is the imaging of choice for Dx in sarcoma |
|
Definition
depends on the location of tumor:
extremities or head and neck - x-ray
abdomen/chest/retroperitoneum - CT |
|
|
Term
|
Definition
G1/2,T1-2a,N0,M0
well differentiated-moderately differentiated, T1<5 cm, T2>5cm, a - superficial fascial involvement |
|
|
Term
|
Definition
G1/2,T2b,N0,M0, G3/4,T1-T2a,N0,M0
poorly differentiated, undifferentiated |
|
|
Term
|
Definition
G3/4,T2b,N0,M0
poorly differentiated, undifferentiated, b-deep fascial involvement |
|
|
Term
| what is the Tx of stage 1 soft tissue sarcoma? |
|
Definition
|
|
Term
| what is the Tx of stage 2 soft tissue sarcoma? |
|
Definition
| surgery + adjuvant radiation therapy |
|
|
Term
| what the Tx of stage 3 soft tissue sarcoma? |
|
Definition
| surgery + adjuvant chemo: doxorubicin + ifosfamide + growth factors in high risk (T2, high grade, local recurrence) |
|
|
Term
| what is the Tx of advanced (metastatic) soft tissue sarcoma? |
|
Definition
1. surgery
2. chemo - 1st line: doxorubicin + ifosphamide, 2nd line: Gemcitabine +/- Docetaxel
3. resection of metastases |
|
|
Term
| what % of patients with advanced soft tissue sarcoma achieve complete remission? out of those, what % achieve long term survival? |
|
Definition
|
|
Term
| which benign bone lesions can turn malignant? |
|
Definition
enchondromas, osteochondromas -> chondrosarcomas
fibrous dysplasia, bone infarcts, and Paget's disease --> osteosarcoma |
|
|
Term
| the stages of bone sarcomas? |
|
Definition
stage 1 - low grade
stage 2 - high grade
stage 3 - discontinous lesions in the primary site
stage 4 - lymph node/metastases |
|
|
Term
| what are the MC sites of osteosarcomas? |
|
Definition
| distal femur, proximal tibia, and proximal humerus |
|
|
Term
| what is the incidence of osteosarcomas amongst bone sarcomas? |
|
Definition
|
|
Term
| osteosarcoma has a predilection to which part of the bone? |
|
Definition
|
|
Term
| what is a radiographic sign of osteosarcoma? |
|
Definition
| codman's triangle - missing bone, raised periosteum, formation of new bone on the margin of the tumor |
|
|
Term
| what is the Tx of osteosarcoma? |
|
Definition
| Preoperative chemotherapy followed by limb-sparing surgery (which can be accomplished in >80% of patients) followed by postoperative chemotherapy |
|
|
Term
| which chemotherapeutic agents are used in osteosarcoma? |
|
Definition
| doxorubicin, ifosfamide, cisplatin, and high-dose methotrexate with leucovorin rescue |
|
|
Term
| what is the long term survival % in extremity osteosarcoma? |
|
Definition
|
|
Term
| what is the role for radiotherapy in osteosarcoma? |
|
Definition
|
|
Term
| chondrosarcomas have a predilection for which bones? |
|
Definition
| flat bones- shoulder/pelvic girdle |
|
|
Term
| what is the Tx of chodrosarcoma? |
|
Definition
| surgery, chemoresistant except 2 subtypes - dedifferentiated and mesenchymal chondrosarcoma |
|
|
Term
| Ewing's sarcoma has a predilection for which part of the bone |
|
Definition
|
|
Term
| what is the radiographic sign of Ewing's sarcoma and how does it correlate with its histology? |
|
Definition
| "onion-peel" periosteum which is d/t histologically monotoneous small blue cells resembling the appearance of other malignancies such as: small cell carcinoma, lymphoma, embryonal rhabdomyosarcoma |
|
|
Term
| what is a cell surface marker seen in Ewing sarcoma? derived from which gene? what does Ewing's sarcoma stain for? |
|
Definition
| p30/32, mic-2, periodic-acid-schiff (glycogen) |
|
|
Term
| Ewing sarcoma is a member of a family with 3 other sarcoma tumors, what is it called and what are the 3 tumors? |
|
Definition
| PNET - peripheral neuroepithelioma, Askin's tumor (chest wall), and esthesioneuroblastoma |
|
|
Term
| what is the classic translocation in Ewing sarcoma and other PNETs? |
|
Definition
|
|
Term
| what is the Tx of Ewing sarcoma/ |
|
Definition
usually start with chemo: Doxorubicin, cyclophosphamide or ifosfamide, etoposide, vincristine, and dactinomycin
local resection and radiation therapy |
|
|
Term
| what is the 5 yrs survival of ewing sarcoma that presents distally to the elbow or mid calf? |
|
Definition
|
|
Term
| what is the intent of Tx for 1st presentation metastatic ewing's sarcoma? |
|
Definition
|
|
Term
| which 8 malignancies metastasize to bone? |
|
Definition
| prostate, breast, lung, kidney, bladder, thyroid, lymphomas and sarcomas |
|
|
Term
| in descending order of frequency, the sites most often involved in bone metastasis |
|
Definition
| vertebrae, proximal femur, pelvis, ribs, sternum, proximal humerus, and skull |
|
|
Term
| what serum marker is elevated in osteoblastic metastases? |
|
Definition
|
|
Term
| how would you be able to distinguish btwn osteoporosis and metastases on imaging? |
|
Definition
| in metastases the cortical bone is destroyed |
|
|
Term
| in a carcinoma of unknown primary that is located in the midline and is poorly or undifferentiated what markers should be taken? |
|
Definition
| hCG and AFP for germ cell tumors |
|
|
Term
| what is the workup for every patient who presents with carcinoma of unknown primary? |
|
Definition
1. FNA/core Bx - in 60% of cases adenocarcinoma, 5% are SCC and 35% are poorly differentiated, hematoxylin & eosin stain, immunohistochemistry (CK7, CK20)
2. CXR, CT/MRI - abdomen, pelvis, chest |
|
|
Term
| what is the extra workup of a patient with a carcinoma of an unknown primary, which is SCC on pathology and presents as cervical lymphadenopathy? |
|
Definition
1. indirect and direct laryngoscopy, bronchoscopy, and upper endoscopy
2.PET: guide the biopsy; determine the extent of disease; facilitate the appropriate treatment, including planning radiation fields; and help with disease surveillance |
|
|
Term
| what is the major indication for PET in carcinoma of an unknown primary? what is a general minor one? |
|
Definition
cervical adenopathy
in managing a solitary tumor to help plan surgery and see if the field need to be widened |
|
|
Term
| what is the indication to preform endoscopy in the workup of a patient with carcinoma of and unknown primary? |
|
Definition
| symptoms/signs suggestive of a GI primary |
|
|
Term
| what are 2 options for CK7-, CK20+ in carcinoma of an unknown primary? |
|
Definition
|
|
Term
| what are 2 options for CK7+, CK20+ in carcinoma of an unknown primary? |
|
Definition
| Ovarian, Pancreatic/cholangiocarcinoma |
|
|
Term
| in a female with carcinoma of an unknown primary, adenocarcinoma on pathology, what are the 3 extra steps taken in the workup? |
|
Definition
mammogram/US
if negative MRI
if negative still, chemo+/-radiation |
|
|
Term
| what is the extra workup of a male with bone metastasis of an unknown primary, adenocarcinoma on pathology? |
|
Definition
PSA
if not elevated treat with chemo or radiotherapy |
|
|
Term
| what is the extra workup of a solitary site of metastasis of an unknown primary with adenocarcinoma pathology? |
|
Definition
| if resectable resect and treat with CRT if not resectable - CRT |
|
|
Term
| what is the extra workup for peritoneal metastasis of unknown primary with adenocarcinoma pathology? |
|
Definition
if primary peritoneal - treat for ovarian cancer
if not primary peritoneal - perform GI workup and treat with chemotherapy |
|
|
Term
| what is the treatment of disseminated carcinoma of an unknown primary, 2 or more sites with adenocarcinoma pathology? |
|
Definition
|
|
Term
| Gross cystic disease fibrous protein-15 is a immunohistochemical marker indicative of what primary? |
|
Definition
|
|
Term
| Thyroid transcription factor 1 (TTF1) is a immunohistochemical marker indicative of what primary? |
|
Definition
|
|
Term
| Chromogranin, synaptophysin, CD56 is a immunohistochemical marker indicative of what primary? |
|
Definition
| neuroendocrine tumors(e.g. SCLC) |
|
|
Term
| CDX-2 is a immunohistochemical marker indicative of what primary? |
|
Definition
|
|
Term
| Calretinin is a immunohistochemical marker indicative of what primary? |
|
Definition
|
|
Term
| Leukocyte common antigen is a immunohistochemical marker indicative of what primary? |
|
Definition
|
|
Term
| HMB-45, tyrosinase are immunohistochemical markers indicative of what primary? |
|
Definition
|
|
Term
| URO-III, thrombomodulin are immunohistochemical markers indicative of what primary? |
|
Definition
|
|
Term
| WT-1 is a immunohistochemical marker indicative of what primary? |
|
Definition
|
|
Term
| CD 10 immunohistochemical marker indicative of what primary? |
|
Definition
|
|
Term
| what is the median survival of patients with disseminated carcinoma of unknown primary? |
|
Definition
|
|
Term
| which 6 malignancies are associated with hypercalcemia d/t secretion of PTHrP? |
|
Definition
| SCC (head and neck, skin, lung), breast, GU, GI |
|
|
Term
| which malignancy causes hypercalcemia d/t 1,25 dihydroxyvitamin D secretion? |
|
Definition
|
|
Term
| which 2 malignancies cause hypercalcemia d/t PTH secretion |
|
Definition
|
|
Term
| which 2 malignancies cause hypercalcemia d/t PGE2 secretion? |
|
Definition
|
|
Term
| which 5 malignancies cause SIADH by secreting vasopressin? |
|
Definition
| Lung (squamous, small cell), GI, GU, ovary |
|
|
Term
| which 7 malignancies cause Cushing's syndrome by secretion of ACTH? |
|
Definition
| Lung (small cell, bronchial carcinoid, adenocarcinoma, squamous), thymus, pancreatic islet, medullary thyroid carcinoma |
|
|
Term
| which 4 malignancies cause cushing's syndrome by CRH secretion? |
|
Definition
| Pancreatic islet, carcinoid, lung, prostate |
|
|
Term
| which 6 malignancies cause hypoglycemia by secretion of insulin growth factor 2 (IGF2)? |
|
Definition
| sarcomas, adrenal, hepatic, GI, kidney, prostate |
|
|
Term
| which malignancy causes hypoglycemia by secretion of insulin? |
|
Definition
| small cell carcinoma of cervix |
|
|
Term
| which malignancies cause male feminization by bHCG secretion |
|
Definition
| hepatic, lung, pancreas, germ cell tumors |
|
|
Term
| which 4 malignancies cause diarrhea by secretion of calcitonine? |
|
Definition
| Lung, colon, breast, medullary thyroid carcinoma |
|
|
Term
| which 3 malignancies cause diarrhea by secretion of VIP? |
|
Definition
| Pancreas, pheochromocytoma, esophagus |
|
|
Term
| which malignancies cause oncogenic ostemalacia by secretion of FGF23? |
|
Definition
| Hemangiopericytomas, osteoblastomas, fibromas, sarcomas, giant cell tumors, prostate, lung |
|
|
Term
| which 2 malignancies cause acromegaly by secretion of GHRH? |
|
Definition
|
|
Term
| which 2 malignancies cause acromegaly by secretion of GH? |
|
Definition
|
|
Term
| which 3 malignancies cause hyperthyroidism by secretion of TSH? |
|
Definition
| Hydatidiform mole, embryonal tumors, struma ovarii |
|
|
Term
| which 4 malignancies cause hypertension by secretion of renin? |
|
Definition
| kidney, lung, pancreas, ovary |
|
|
Term
| when should dialysis be used in the Tx of humeral hypercalcemia of malignancy? |
|
Definition
| when bisphosphonates and saline have too slow an onset |
|
|
Term
| what is a distinct Tx for humeral hypercalcemia of malignancy in the case of MM, lymphoma or leukemia? |
|
Definition
|
|
Term
| what is the treatment of malignancy associated SIADH in the patient with severe hyponatremia Na<115? |
|
Definition
| hypertonic saline 3% + fusid |
|
|
Term
| 3 treatment options for malignancy associated SIADH? |
|
Definition
1. water restriction
2. Demeclocycline
3. Conivaptan - V2 antagonist |
|
|
Term
| what is the MC malignancy to cause ectopic ACTH secretion? |
|
Definition
|
|
Term
| 8 symptoms that are distinct to cushing syndrome cause by ectopic malignant secretion? |
|
Definition
| fluid retention, hypertension, hypokalemia, metabolic alkalosis, poor wound healing, glucose intolerance, steroid psychosis, opportunistic infections |
|
|
Term
| which malignancy causing ectopic ACTH secretion is distinct in the fact that it may experience negative feedback by dexamethasone or metyrapone? |
|
Definition
|
|
Term
| which opportunistic infections attach the patient with ectopic ACTH secretion related malignancy? |
|
Definition
|
|
Term
| what is the Tx of malignancy associated ACTH secretion? |
|
Definition
1. metyrapone, ketoconazole
2. if resection of primary not possible, sometimes adrenalectomy is favorable |
|
|
Term
| what is a characteristic of a tumor that secretes IGF2 and causes hypoglycemia? |
|
Definition
|
|
Term
| when does hypoglycemia occur in the IGF2 secreting tumor? |
|
Definition
| during fasting (night time) |
|
|
Term
| what are the signs of IGF2 induced hypoglycemia? |
|
Definition
low serum glucose and insulin
IGF2 need not be elevated in serum
IGF2 mRNA elevated |
|
|
Term
| what is the Tx of IGF2 induced hypoglycemia? |
|
Definition
treatment of underlying malignancy
iv glucose during sleep
glucagon and corticosteroids |
|
|
Term
| what are 3 malignancies that cause erythrocytosis by secretion of EPO? |
|
Definition
Renal cancers
Hepatocarcinoma
Cerebellar hemangioblastomas |
|
|
Term
| 5 malignancies that cause granulocytosis by secretion of G-CSF, GM-CSF or il6? |
|
Definition
| Lung cancer, Gastrointestinal cancer, Ovarian cancer, Genitourinary cancer, Hodgkin's disease |
|
|
Term
| 5 malignancies that cause thrombocytosis by secretion of il6? |
|
Definition
Lung cancer, Gastrointestinal cancer,
Breast cancer, Ovarian cancer, Lymphoma |
|
|
Term
| 3 malignancies which cause eosinophilia by secretion of il5? |
|
Definition
| Lymphoma Leukemia Lung cancer |
|
|
Term
| 7 malignancies which cause thrombophlebitis d/t to an unknown agent? |
|
Definition
Lung cancer Pancreatic cancer Gastrointestinal cancer Breast cancer
Genitourinary cancer
Ovarian cancer Prostate cancer Lymphoma |
|
|
Term
| what is the Tx of malignancy associated erythrocytosis? |
|
Definition
| resection of tumor. if tumor not resectable, phlebotomy is indicated |
|
|
Term
| what % of patients with a solid tumor have granulocytosis? |
|
Definition
|
|
Term
| what are the symptoms and Tx of malignancy associated granulocytosis? |
|
Definition
| asymptomatic, no need for Tx |
|
|
Term
| what are the symptoms of malignancy associated thrombocytosis? what is the Tx? |
|
Definition
| it is usually asymptomatic, not correlated to thrombosis of malignancy, hence no Tx needed. it is associated, however, with poorer prognosis |
|
|
Term
| what is a possible symptom of malignancy related eosinophilia? what is the Tx? |
|
Definition
| eosinophilia may lead to shortness of breath by infiltrating the lungs. this may be seen on CXR. palliative Tx: glucocorticoids |
|
|
Term
| what % of patients who develop DVT end up having cancer? |
|
Definition
|
|
Term
| what is the risk for DVT in a patient with cancer undergoing surgery requiring general anesthesia? |
|
Definition
|
|
Term
| what is the Tx for patients with cancer and proximal DVT and a relative contraindication to heparin anticoagulation (hemorrhagic brain metastases or pericardial effusion)? |
|
Definition
| placement of a filter in the inferior vena cava (Greenfield filter) |
|
|
Term
| what is an indication for placement of a filter in the inferior vena cava (Greenfield filter) in cancer patients? |
|
Definition
| proximal DVT and CIs to heparin anticoagulation (hemorrhagic brain metastasis or pericardial effusion) |
|
|
Term
| what are the 2 indications for anticoagulant prophylaxis in patients with cancer? |
|
Definition
breast cancer undergoing chemotherapy
indwelling catheters |
|
|
Term
| what are 2 neurologic paraneoplastic syndromes caused by the oncoprotein anti-Hu? and in what malignancy? |
|
Definition
| Encephalomyelitis, subacute sensory neuronopathy - SCLC |
|
|
Term
| what paraneoplastic neurologic disease is caused by the oncoprotein anti-Yo? in which 2 malignancies? |
|
Definition
| Cerebellar degeneration - Ovary, Breast |
|
|
Term
| what 2 paraneoplastic neurologic diseases are caused by the oncoprotein anti-Ri, in what 3 malignancies? |
|
Definition
| Cerebellar degeneration, opsoclonus - breast, gynecologic, SCLC |
|
|
Term
| what paraneoplastic neurologic disease is caused by the oncoprotein anti-Tr? in which malignancy? |
|
Definition
| Cerebellar degeneration - hodgkin's |
|
|
Term
| what 5 paraneoplastic neurologic diseases are caused by the oncoprotein Anti-CV2/CRMP5? in what 2 malignancies? |
|
Definition
Encephalomyelitis, chorea, optic neuritis, uveitis, peripheral neuropathy
SCLC, thymoma |
|
|
Term
| what 3 paraneoplastic neurologic diseases are caused by the oncoprotein Anti-Ma proteins? in what malignancy? |
|
Definition
Limbic, hypothalamic, brainstem encephalitis
testicular cancer |
|
|
Term
| what 2 paraneoplastic neurologic diseases are caused by the oncoprotein Anti-amphiphysin? in what 2 malignancies? |
|
Definition
Stiff-person syndrome, encephalomyelitis
Breast, SCLC |
|
|
Term
| what paraneoplastic neurologic disease is caused by the oncoproteins Recoverin and bipolar cell antibodies? in what 2 malignancies? |
|
Definition
| Cancer-associated retinopathy |
|
|
Term
| what 2 paraneoplastic neurologic diseases are caused by the oncoprotein Anti-GAD? in what malignancy? |
|
Definition
Stiff-person, cerebellar syndromes
thymoma |
|
|
Term
| what 11 neurologic paraneoplastic diseases are associated with SCLC? |
|
Definition
| Encephalomyelitis, subacute sensory neuronopathy, Cerebellar degeneration, opsoclonus, Encephalomyelitis, chorea, optic neuritis, uveitis, peripheral neuropathy, Cancer-associated retinopathy, Stiff-person syndrome |
|
|
Term
| what 4 neurologic paraneoplastic diseases are associated with breast cancer? |
|
Definition
| Stiff-person syndrome, encephalomyelitis, Cerebellar degeneration, opsoclonus |
|
|
Term
| what % of patients with paraneoplatic neuronal disease of the CNS and PNS are found to have antibodies against neuronal or neuromascular proteins that may be diagnostic of the paraneoplastic phenomenom? |
|
Definition
|
|
Term
| what is the role of MRI and CSF studies in the diagnosis of paraneoplastic neuronal disease? |
|
Definition
| MRI and CSF are none specific except in the case of limbic encephalitis where you might see abnormalities in the mesial temporal lobes seen also only in non paraneoplastic limbic encephalitis and HHV6 infection. MRI and CSF are used to R/O spread of the cancer to the brain (metastasis) |
|
|
Term
| what is the general unproven treatment for most neurologic paraneoplastic diseases? |
|
Definition
| IVIG, corticosteroids, plasmapheresis |
|
|
Term
| Paraneoplastic Opsoclonus-Myoclonus Syndrome is usually associated with what 3 malignancies? |
|
Definition
| breast, lung and neuroblastoma in children |
|
|
Term
| what triggers the paraneoplastic stiff-person's syndrome? in what conditions do the symptoms disappear? |
|
Definition
sensory or emotional trigger
symptoms disappear during sleep or general anesthesia |
|
|
Term
| what is the Tx of stiff person's syndrome? |
|
Definition
1. Tx of the underlying tumor
2. glucocorticoids
3. gaba'ergic agents: diazepam, baclofen, sodium valproate, tiagabine, vigabatrin |
|
|
Term
| what is the treatment of Waldenström's Macroglobulinemia associated paraneoplastic peripheral neuropathies? |
|
Definition
| plasma exchange, IVIg, chlorambucil, cyclophosphamide, fludarabine, or rituximab |
|
|
Term
| which disease may involve the thymus in sjogren's syndrome? |
|
Definition
|
|
Term
| which 5 diseases may involve the thymus? |
|
Definition
| castleman's, germ cell tumors, carcinoid, MALT lymphoma, thymoma |
|
|
Term
| what is the MCC of anterior mediastinal mass in adults? |
|
Definition
|
|
Term
| what autoimmune systemic diseases are associated with thymoma? |
|
Definition
| myasthenia gravis, pure red cell aplasia, hypogammaglobulinemia (Good's syndrome), and less so UC, SLE, sjogrens, polymyositis etc. |
|
|
Term
| what % of thymoma patients suffer a concurrent systemic disease? |
|
Definition
|
|
Term
| MRI has a defined role in the staging of posterior mediastinal tumors, what about anterior mediastinum? |
|
Definition
|
|
Term
| what are the means of attaining staging in thymoma? |
|
Definition
| surgical mostly with the help of CT and somatostatin labeled imaging for local invasion |
|
|
Term
| what is the main principle in the staging of thymoma? |
|
Definition
|
|
Term
| what % of thymomas are noninvasive? |
|
Definition
|
|
Term
| how can prognosis, which is measured by the degree of invasiveness of the thymic tumor, be anticipated? |
|
Definition
| it correlates with the histology type: thymomas are good, thymic carcinoma are bad |
|
|
Term
| what is the unique Tx step for stage 3 and 4 - invasion of neighboring organs, dissemination to pleura/pericard? |
|
Definition
|
|
Term
| which thymoma associated autoimmune systemic disease doesn't benefit from thymectomy at all? |
|
Definition
|
|
Term
| what is a long term complication on the eyes associated with the use of Radiation? |
|
Definition
|
|
Term
| 3 long term complications of the heart associated with the use of Radiation? |
|
Definition
| Pericarditis, myocarditis, coronary artery disease |
|
|
Term
| 4 long term complications of the heart associated with the use of chemotherapy? |
|
Definition
| dysrhythmias, cardiomyopathic congestive heart failure (CHF), pericardial disease, and peripheral vascular disease |
|
|
Term
| what are 5 cofactors in promoting anthracycline-associated CHF |
|
Definition
| Advanced age, other concomitant cardiac disease, hypertension, diabetes, and thoracic radiation therapy |
|
|
Term
| what is the 2nd most cardiotoxic chemotherapeutic agent after anthracyclines? |
|
Definition
|
|
Term
| how is cardiotoxicity d/t chemotherapy monitored? |
|
Definition
1. MUGA - multigated acquisition scan (checks ejection fraction via nuclear-bound RBCs)
2. US |
|
|
Term
| how does cardiotoxicity caused by Trastuzumab differ from that by anthracyclines? |
|
Definition
| reversible, not dose-dependent, no permanent effect on myofibrils |
|
|
Term
| which test monitors for Bleomycin pulmonary toxicity and recovery from toxicity? |
|
Definition
| Diffusion capacity of the lungs for carbon dioxide (DLCO) |
|
|
Term
| what are 5 additive risk factors to bleomycin induced pulmonary pneumonitis? |
|
Definition
| age, prior lung disease, concomitant use of other chemotherapy, lung irradiation and high FiO2 |
|
|
Term
| what are risk factors for radiation pneumonitis? |
|
Definition
| advanced age, poor performance status, preexisting compromised pulmonary function, radiation volume, and dose |
|
|
Term
| what is The dose "threshold" for radiation pneumonitis? |
|
Definition
|
|
Term
| what is the Tx of radiation/chemotherapy induced pneumonitis? |
|
Definition
|
|
Term
| which is the only chemotherapeutic agent causing pneumonitis that does not respond to steroid Tx? |
|
Definition
|
|
Term
| Neurocognitive dysfunction, "chemo brain", in children with ALL is d/t which chemotherapeutic agents |
|
Definition
| intrathecal MTX + Cytarabine and radiation therapy to the cranium |
|
|
Term
| what is the pathophysiology of early onset brain radiation toxicity vs. late onset? |
|
Definition
reversible demyelination
focal necrosis |
|
|
Term
| what is a symptom of spinal cord radiation toxicity? |
|
Definition
| Lhermitte's sign - electrical shocks up the spine |
|
|
Term
| what is a Tx to prevent cholestasis in the setting of high-dose chemotherapy before bone marrow transplant? |
|
Definition
Ursodiol - reduces cholesterol absorption and is used to dissolve (cholesterol) gallstones
only FDA approved Tx for primary billiary cirrhosis |
|
|
Term
| which 4 organs are at the highest risk to develop secondary cancer d/t radiation? |
|
Definition
| thyroid, breast, sarcomas, CNS cancers |
|
|
Term
| what 2 malignancies are mainly associated with chemotherapeutic treatment? |
|
Definition
|
|
Term
| what are the chromosomal characteristics of acute leukemia secondary to alkylating agents? |
|
Definition
| deletions in chromosomes 5 or 7 |
|
|
Term
| what are the chromosomal characteristics of acute leukemia secondary to antitopoisomerase agents? |
|
Definition
|
|
Term
| which malignancy is associated with treatment causing secondary bladder cancer? |
|
Definition
|
|
Term
| how do you distinguish iron deficiency anemia from the thallasemias |
|
Definition
| thallasemias: normal or increased serum iron and transferin saturation, low RDW |
|
|
Term
| how do you distinguish myelodysplastic syndromes from iron deficiency anemia - both cause microcytic hypochromic anemia |
|
Definition
| myelodysplastic syndromes - high serum iron |
|
|
Term
| what is the association btwn endocrine function and anemia |
|
Definition
thyroid, cortisol, testosterone deficiency can cause anemia
it is important to remember when correcting cortisol levels d/t addison's disease to also make sure thyroid function is normal otherwise anemia may drastically worsen |
|
|
Term
| 2 indications for iron transfusions |
|
Definition
serious underlying cardiovascular or pulmonary disease - 11 g/dl
otherwise - 8 g/dl |
|
|
Term
| 3 general elements in The management of acute painful sickle cell crisis |
|
Definition
1. vigorous hydration,
2. thorough evaluation for underlying causes (such as infection), and
3. aggressive analgesia |
|
|
Term
| 2 indications for treatment with hydroxyurea in sickle cell anemia |
|
Definition
| in patients experiencing repeated episodes of acute chest syndrome or with more than three crises per year requiring hospitalization |
|
|
Term
| indications for BMT in children with sickle cell anemia |
|
Definition
| presence of repeated crises early in life, a high neutrophil count, or the development of hand-foot syndrome |
|
|
Term
| prophylactic treatment of stroke in children with sickle cell anemia |
|
Definition
|
|
Term
| skeletal abnormalities seen in the thallasemias |
|
Definition
| "chipmunk" facies due to maxillary marrow hyperplasia and frontal bossing. Thinning and pathologic fracture of long bones and vertebrae |
|
|
Term
| when is splenectomy required in thallassemia |
|
Definition
| if the annual transfusion requirement (volume of RBCs per kilogram of body weight per year) increases by >50% |
|
|
Term
| how is the diagnosis of thallasemia made |
|
Definition
| severe anemia accompanied by the characteristic signs of massive ineffective erythropoiesis: hepatosplenomegaly, profound microcytosis, a characteristic blood smear (tear drop cells), and elevated levels of HbF, HbA2 |
|
|
Term
| Children with severe homocystinuria (blood levels 100 mol/L) due to deficiency of one of three enzymes, methionine synthase, MTHFR, or cystathionine synthase (Fig. 105-1), have vascular disease, e.g., ischemic heart disease, cerebrovascular disease, or pulmonary embolus as teenagers or in young adulthood |
|
Definition
|
|
Term
| prophylactic folic acid in pregnancy lowers the risk of what malignancy in childhood |
|
Definition
|
|
Term
| 5 GI conditions associated with decreased absorptions of B12 |
|
Definition
Simple atrophic gastritis (food cobalamin malabsorption)
Zollinger–Ellison syndrome
Gastric bypass surgery
Use of proton pump inhibitors
Celiac disease |
|
|
Term
| 7 substances that are associated with reduced absorption of Vit B12 |
|
Definition
colchicine,
neomycin, (aminoglycoside)
slow-release potassium chloride,
anticonvulsant drugs,
metformin,
cytotoxic drugs
Alcohol |
|
|
Term
| first line therapy of AIHA? second line? 3rd? |
|
Definition
1st: GCS
2nd: Rituximab or splenectomy
3rd: Azathioprine, cyclophosphamide, cyclosporine, and IVIG |
|
|
Term
| Paroxysmal Cold Hemoglobinuria (PCH)? |
|
Definition
| rare form of AIHA; children;viral infection;Donath-Landsteiner antibody;binds at low temps and lysis RBCs back at body temp |
|
|
Term
| what is the mechanism of hemolytic anemia caused by septicemia |
|
Definition
| Exotoxins produced by Clostridium perfringens |
|
|
Term
| 7 conditions causing intravascular hemolytic anemia |
|
Definition
Mismatched blood transfusion
Paroxysmal nocturnal hemoglobinuria (PNH)
Paroxysmal cold hemoglobinuria (PCH)
Septicemia
Microangiopathic
March hemoglobinuria
Favism |
|
|
Term
| what is the clinical triad of PNH (not always present) |
|
Definition
| hemolysis, pancytopenia and venous thrombosis |
|
|
Term
| PNH is associated with what other hematologic condition |
|
Definition
|
|
Term
| what is the gold standard for the Dx of PNH |
|
Definition
| flow cytometry showing a population of RBCs or granulocytes that are CD59-, CD55- |
|
|
Term
| 2 main treatments for PNH |
|
Definition
recurrent transfustions
eculizumab, antibody directed against the complement component C5 |
|
|
Term
| 2 synthetic oxygen carriers which are studied to be used as universal replacements to all blood supplements |
|
Definition
hemoglobin-based oxygen carriers
fluorocarbon synthetic chemicals |
|
|
Term
| 5 infections known to cause pancytopenia |
|
Definition
Brucellosis
Tuberculosis
Leishmaniasis
Q fever
Legionnaires' disease |
|
|
Term
| 4 viruses that can cause aplastic anemia |
|
Definition
Epstein-Barr virus (infectious mononucleosis)
Hepatitis (non-A, non-B, non-C hepatitis)
Parvovirus B19 (transient aplastic crisis, PRCA)
HIV-1 (AIDS) |
|
|
Term
| what is the most common early symptom of aplastic anemia |
|
Definition
|
|
Term
| what does the biopsy in aplastic anemia show |
|
Definition
|
|
Term
| when is isolated thrombocytopenia an indication for bone marrow biopsy |
|
Definition
| patients older than 60 b/c of the risk for myelodysplasia |
|
|
Term
| what is the initial step in the workup of thrombocytopenia? |
|
Definition
| check for abnormalities of RBCs and WBC on CBC |
|
|
Term
| what is the next step in the workup of thrombocytopenia, after it has been established that CBC is otherwise normal? |
|
Definition
|
|
Term
| what does fragmented RBCs on blood smear in a patient with isolated thrombocytopenia mean? |
|
Definition
| microangiopathic hemolytic anemias (TTP, DIC) |
|
|
Term
| what is the next step in the workup of thrombocytopenia in a patient with other abnormalities on CBC |
|
Definition
|
|
Term
| 9 drugs that cause isolated thrombocytopenia most frequently |
|
Definition
heparin
Furosemid
Gold, used to treat arthritis
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Penicillin
Quinidine
Quinine
Ranitidine
Sulfonamides |
|
|
Term
| heparin induced thrombocytopenia is a thrombogenic state! |
|
Definition
|
|
Term
| which is more prevalent in HIT, Clexane or UFH |
|
Definition
|
|
Term
| what is the average exposure to heparin in HIT |
|
Definition
|
|
Term
| what is an important step in the management of HIT |
|
Definition
| preform lower extremity duplex Dopplers for DVT |
|
|
Term
| how is the diagnosis of ITP made? |
|
Definition
| exclusion of other causes of isolated thrombocytopenia: HIV infection and hepatitis C (and other infections if indicated); serologic testing for SLE, serum protein electrophoresis, and immunoglobulin levels to potentially detect hypogammaglobulinemia; selective testing for IgA deficiency or monoclonal gammopathies and, if anemia is present, direct antiglobulin testing (Coombs test) to rule out combined autoimmune hemolytic anemia with ITP (Evans syndrome) |
|
|
Term
| when is bone marrow examination indicated in the diagnosis workup of ITP? |
|
Definition
|
|
Term
| which patients with ITP are not indicated for treatment |
|
Definition
| asymptomatic with platelets > 30,000 |
|
|
Term
| what is the treatment of ITP without significant bleeding symptoms, severe thrombocytopenia (<5000/L), or signs of impending bleeding (such as retinal hemorrhage or large oral mucosal hemorrhages)? what is the treatment if those exist? |
|
Definition
outpatient, monotherapy with: GCS, IVIG, anti-Rh(D) in Rh-positive patients only b/c you want to create hemolysis
inpatient: GCS + one of the other options |
|
|
Term
| what is the role of splenectomy in the treatment of patients with ITP |
|
Definition
| relapse after glucocorticoids are tapered |
|
|
Term
| 2 novel treatments of ITP |
|
Definition
| romiplostim and eltrombopag |
|
|
Term
| what is the mainstay of treatment of TTP |
|
Definition
|
|
Term
| what is the treatment of von Willebrand Disease? |
|
Definition
| DDAVP (vasopressin) and e-aminocaproic acid or tranexamic acid |
|
|
Term
| what is an alternative treatment to factor replenishment in Hemophilia A |
|
Definition
|
|
Term
| what is the test to check for factor inhibitors (antibodies) in hemophilia |
|
Definition
| bethesda - add plasma to patients serum and see if coagulation occurs or not |
|
|
Term
| what is the indication for treatment in FXI def. |
|
Definition
| patients with severe disease required to undergo a surgical procedure |
|
|
Term
| which substances are known to cause DIC |
|
Definition
Fibrinolytic agents
Aprotinin
Warfarin (especially in neonates with protein C deficiency)
Prothrombin complex concentrates
Recreational drugs (amphetamines) |
|
|
Term
| what is the treatment of DIC |
|
Definition
| FFP - 1 unit of FFP increases most coagulation factors by 3% in an adult without DIC |
|
|
Term
| what is the typical presentation of autoimmune hemolytic anemia |
|
Definition
| The onset of AIHA is very often abrupt and can be dramatic. The hemoglobin level can drop, within days, to as low as 4 g/dL; the massive red cell removal will produce jaundice; and sometimes the spleen is enlarged |
|
|
Term
| what is the presentation of CML? |
|
Definition
| leukocytosis, <5% blasts in peripheral blood, elevated platelets count |
|
|
Term
| what is the medical treatment of aplastic anemia in case HSCT is not an option |
|
Definition
| antithymocyte Ab + cyclosporine |
|
|
Term
| what is the treatment of coumadin overdose? |
|
Definition
asymptomatic INR 3.5-4.5: stop coumadin
asymptomatic INR >4.5 : stop coumadin + give vitamin K
bleeding - FFP |
|
|
Term
| 2 malignancies associated with PTHrP |
|
Definition
|
|
Term
| cyclophosphamide - side effects |
|
Definition
| cystitis + pulmonary fibrosis |
|
|
Term
| MC malignancy post renal transplantation |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what type of kidney injury does cisplatin cause |
|
Definition
|
|
Term
| what type of kidney injury does cisplatin cause |
|
Definition
|
|
Term
| what type of kidney injury does cisplatin cause |
|
Definition
|
|
Term
| what type of kidney injury does cisplatin cause |
|
Definition
|
|
Term
|
Definition
| חולים שאינם מסוגלים לסבול ברזל אוראלית, יש להם חסר חמור, או שהם נדרשים למתן ברזל על בסיס מתמשך |
|
|
Term
| in the physical examination of MM, what distinguishes it from the rest of the plasma cell disorders? |
|
Definition
| no hepatosplenomegaly nor lymphadenopathy |
|
|
Term
| what is the MCC of renal failure in MM |
|
Definition
|
|
Term
|
Definition
|
|
Term
| MGUS occurs in 10% of population over 75 |
|
Definition
|
|
Term
| causes of cold agglutination hemolytic anemia |
|
Definition
| lymphoma, CLL, mycoplasma, HIV, mononucleosis |
|
|
Term
| causes of warm agglutination hemolytic anemia |
|
Definition
| CLL, ovarian teratoma, connective tissue disease–eg, SLE, progressive systemic sclerosis, rheumatoid arthritis, ulcerative colitis |
|
|
Term
|
Definition
| oval nuclei, abundant cytoplasm, distinctive membrane projections, pancytopenia, splenomegaly, tartrate-resistant acid phosphatase, dry tap, monocytopenia - TB, splenectomy, CDA treatment |
|
|
Term
| pancytopenia 6 years after breast cancer |
|
Definition
|
|
Term
| how to distinguish PV from Relative erythrocytosis |
|
Definition
|
|
Term
| rbc count - Iron def vs. thallasemia |
|
Definition
|
|
Term
| what is the most common transfusion reaction |
|
Definition
| febrile non hemolytic transfusion reaction |
|
|
Term
| what is the mechanism of febrile non hemolytic transfusion |
|
Definition
| Antibodies directed against donor leukocyte and HLA antigens |
|
|
Term
| fever + skin lesions resembling erythema multiforme in neutropenic cancer patients = sweet's syndrome. treatment? |
|
Definition
|
|
Term
| necrotic skin lesions in immunosuppressed cancer patients may be caused by unusual pathogens such as E.Coli, pseudomonas or candida |
|
Definition
|
|
Term
| what is the role of smoking and alcohol in the risk of pancreatic cancer |
|
Definition
| smoking is a risk factor, alcohol isn't |
|
|
Term
|
Definition
|
|
Term
| what can be seen on blood smear of MDS |
|
Definition
few if any blasts
macrocytosis, no granules in platelets and neutrophils |
|
|
Term
| what can be seen in the BM of MDS |
|
Definition
| normal or hypercellular (20% - hypocellular), little megakaryocytes |
|
|
Term
|
Definition
| intravascular hemolysis, pancytopenia, venous thrombosis |
|
|
Term
treatment of factor 11 def.
how does it manifest itself?> |
|
Definition
only before surgery
menorrhea, epistaxis |
|
|
Term
|
Definition
| excess iron - HSM, liver and kidney damage |
|
|
Term
| what is the treatment of sideroblastic anemia |
|
Definition
| Vit B6, blood transfusion, BM transplant. do not give EPO |
|
|
Term
| abnormalities that cause venous thromboembolism (vs. arterial) |
|
Definition
| protein C,S def., factor V leiden, hyperprothrombin, anti-thrombin 3 def. |
|
|
Term
| abnormality that causes arterial thromboembolism |
|
Definition
|
|
Term
|
Definition
| venous, high dose heparin, lifetime anti-coag after 1 event of PE/DVT, OCP CIed, prophylactic anticoagulation in pregnancy and before surgery |
|
|
Term
|
Definition
| CML, myelofibrosis, hairy cell leukemia, acute leukemia, hodgkin's lymphoma, iron def/pernicious/hemosiderin anemia, metastasis to BM |
|
|
Term
| thrombocytopenia in alcoholics |
|
Definition
| injury to BM + folate def |
|
|
Term
|
Definition
|
|
Term
| drugs that cause thrombocytopenia |
|
Definition
| thiazide, phenytoin, chemo, vancomycin, sulfa, linezolid, ACEi |
|
|
Term
| CML doesn't cause hemolytic anemia |
|
Definition
|
|
Term
| anti thrombin 3 def is a life-long indication for anticoagulation |
|
Definition
|
|
Term
| when is MM associated with increased ALP |
|
Definition
| only in bone fractures (not just lytic bone lesions) |
|
|
Term
|
Definition
| lifelong coumadin, clexane during whole pregnancy, no need for aspirin, test family members, avoid oral contraceptives |
|
|
Term
|
Definition
| right shift - O2 delivered more deliberately to tissues: acidosis and temperature elevation |
|
|
Term
|
Definition
|
|
Term
| 3 indications to treat in CLL (Fludarabine) |
|
Definition
1. Hb<10
2. PLT<100,000
3. >3 areas + [symptoms or lymphadenopathy] |
|
|
Term
| indications for surgery in stage 3A NSCLC |
|
Definition
| מעורבות בלוטות לימפה איפסילטרליות פריברונכיאליות ו/או הילריות נודולות בתוך הריאות שהגיעות בהתפשטות ישירה מהגידול הראשוני |
|
|
Term
| duration of anticoagulation in DVT |
|
Definition
unprovoked - lifelong
PE, post-surgical, proximal leg - 6 months
distal leg - 3 months |
|
|
Term
|
Definition
• מחלות של הפרעות בפיברינוגן, בעיקר AD שמתאפיינות בדימום ולעיתים טרומבוזיס.
• מתגלה לפעמים עקב הפלות חוזרות, בעיות בריפוי פצע, דימום, טרומבוזיס.
• לרוב אסימפטומטי
• במעבדה עליה בPT , עליה TT ופיברינוגן נורמלי.
• יכול להופיע גם במחלות כבד עקב הפרעה בפולמריזציה של פיברין |
|
|
Term
|
Definition
• B12 לשריר כל 3-7 שבועות במשך 6 פעמים למילוי מאגרים
• לאחר מכן כל 3 חודשים, למרות שנהוג כל חודש |
|
|
Term
| פוליציטמיה ורה - היפראוריצמיה וביופסיית מח עצם |
|
Definition
• היפראוריצמיה , גאוט ואבני חומצה אורית
• מח עצם – לא מספק מידע אבחנתי כי יכול להיות נורמלי או כזה שלא ניתן להבדיל מIMF או ET. לכן, אלא אם כן יש לבסס אבחנה של מילופיברוזיס או לשלול מחלות אחרות, אין צורך לבצע. |
|
|
Term
| הסיכון לממאירות שנייה לאחר טיפול בהודגקין |
|
Definition
o ב10 שנים ראשונות יש סיכוי מוגבר ללוקמיות חריפות- עקב כימותרפיה , יותר בMOPP והקרינה
o לאחר 10 שנים סיכוי מוגבר לקרצינומות קשור יותר לחשיפה לקרינה.כולל סרטן שד וריאה בשדה קרינה ולכן יש צורך בסקירה והפסקת עישון |
|
|
Term
|
Definition
| o דימומים נפוצים יותר ב APL או ב Monocytic AML אלו גם נוטים לפלוש יותר לרקמות כמו חניכיים, עור וכד' (איפה שמונוציטים אוהבים ללכת) |
|
|
Term
| שינויים ציטוגנטיים טובים ב-AML |
|
Definition
| t15:17(APL), t8:21, inv16 |
|
|
Term
| שינויים ציטוגנטיים גרועים ב- AML |
|
Definition
|
|
Term
| ת"ל של Cytarabine – פגיעה צרבלרית |
|
Definition
|
|
Term
|
Definition
o חולה B-cell CLL עם מעורבות של מח העצם ולימפוציטוזיס בלבד ללא הפרעות נוספות- מעקב בלבד. השרדות- 10 שנים.
o ב-intermediate stage (לימפאדנופתיה ו/או הפטופלנומגליה) עם ספירה תקינה ואסימפטומטי- בתחילה מעקב וכעבור מספר שנים- טיפול. השרדות- 7 שנים.
o כשל מח עצם- טיפול! השרדות ללא טיפול- 1.5 שנים. |
|
|
Term
| השלב המואץ של CML מוגדר על ידי.... |
|
Definition
| אנמיה שלא ניתן להסביר על ידי טיפול או דימום, ציטוגנטיקה קלונאלית ו10-20 אחוז בלסטים בדם או במח עצם או 20 אחוז בזופילים בדם או מח עצם או טסיות מתחת ל100000 |
|
|
Term
| הטיפול בסימפטומים ההמורגיים של DIC |
|
Definition
| FFP אם PT מעל 1.5, רמות נמוכות של פיברינוגן או היפרפיברונלוזיה מהירה יכול לדרוש קריו (עשיר בפקטור 8, פיבירונוגן VWF), טסיות |
|
|
Term
| טיפול בסימפטומים של קרישתיות יתר ב-DIC |
|
Definition
| הפרין יכול להנתן במינון נמוך בחולים עם מחלה קלה על רקע APL או גידול סולידי או טרומבוזיס ברור. כמו כן בפורפורה פולמינס, כריתת המנגיומה והוצאת עובר מת. אך במחלה אקוטית הפרין יחמיר דימום. חסר בפרוטין C –ניתן להשלים ולתת אותו מבחוץ אם זו הסיבה לפרופורה פולמיננס. |
|
|
Term
| הסימפטום הכי נפוץ באנמיה אפלסטית |
|
Definition
|
|
Term
| אנמיה אפלסטית קשה נקבעת ע"י שניים מהבאים: |
|
Definition
| נויטרופניה של 500 ומטה, טסיות מתחת ל20000, רטיקולוציטים מתחת לאחוז |
|
|
Term
| איך לטפל בחולה שמקבל קומדין וצריך לעבור בדיקה פולשנית |
|
Definition
• יש להפסיק את הטיפול בקומדין 5 ימים טרם הטיפול החודרני כדי שINR יחזור לנורמלי
• למי שבסיכון גבוה לטרומבוזיס ניתן לקבל קלקסן, כאשר הINR נופל מתחת ל2
• המינון האחרון של קלקסן ינתן 12-24 שעות טרם הפעולה
• לאחר הפעולה ניתן לשוב לטפל בקומדין |
|
|
Term
| מה יהפוך בטא תלסמיה מיגור לקלה יותר קלינית |
|
Definition
נשאות ל-a-Thalassemia במקביל- חומרת ביתא תלסמיה מייג'ור נובעת מעודף שרשראות אלפא. לכן נשאות לאלפא תלסמיה תקל על חומרת המחלה כי יש פחות חוסר איזון
-Globin gene chains can substitute for chains, generating more
hemoglobin and reducing the burden of -globin inclusions ייצור פרסיסטנטי של שרשאות גמא-גלובין.
מוטציה הגורמת לפגיעה קלה יותר בייצור שרשראות בתא-גלובין |
|
|
Term
| אנמיה המוליטית בשל ספרוציטוזיס |
|
Definition
|
|
Term
| תאי דם אדומים חרמשיים במשטח וטחול מוגדל=אנמיה חרמשית + טלסמיה. אם הטחול אינו מוגדל=אנמיה חרמשית טהורה |
|
Definition
|
|
Term
| in which malignancies is Cetuximab used (EGFR antibody)? |
|
Definition
CRC - advanced and mets
Head and neck - advanced and mets
NSCLC - advanced |
|
|
Term
| in which malignancies is erlotinib (Tarceva) used? |
|
Definition
metastatic pancreas - with gemcitabine
HCC- stage 3 and 4 with avastin
NSCLC - 2nd line advanced disease, maintenance |
|
|
Term
| in which malignancies is etoposide used |
|
Definition
| nonseminomas stage 2, ewing sarcoma, SCLC - with platinum |
|
|
Term
| in which malignancies is paclitaxel used? |
|
Definition
2nd line met breast cancer - monotherapy/avastin
TCC - metastatic with gemcitabine and cisplatin
NSCLC - advanced, with cituximab/avastin/cisplatin
head and neck - metastatic |
|
|
Term
|
Definition
RCC - metastatic 1st line
stage 3 and 4 HCC - Multiple unilobar tumors or tumor with vascular invasion, Extrahepatic HCC or elevated bilirubin |
|
|
Term
|
Definition
metastatic breast cancer
HCC - extrahepatic disease, with erlotinib
NSCLC - advanced disease that is non-squamous with caboplatin and paclitaxel
relapse of ovarian cancer |
|
|
Term
|
Definition
Weakness, night sweats, weight loss, painful lymphadenopathy, or fever
Symptomatic anemia and/or thrombocytopenia
Autoimmune hemolytic anemia and/or thrombocytopenia poorly responsive to corticosteroid therapy
Progressive disease, as demonstrated by increasing lymphocytosis with a lymphocyte doubling time less than six months, and/or rapidly enlarging lymph nodes, spleen, and liver. In contrast, transient localized lymphadenopathy, occurring in response to localized infections, is not necessarily an indication for treatment.
Repeated episodes of infection. Hypogammaglobulinemia without repeated episodes of infection is not a clear indication for therapy |
|
|
