Oncology
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| Philadelphia chromosome | CML
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| Painless LAD (us. Neck or axilla), LAD in orderly fashion; “B” signs + pruritis; splenomegaly; LN pain after drinking alcohol | Hodgkins lymphoma
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| Fatigue, PM sweats, weight loss, painless LAD or neck mass: suggestive of: | Lymphoma
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| Painless LAD, Scattered; “B” signs = | Non-Hodgkins lymphoma
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| Most common leukemia | CLL
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| Acute leukemia: 80-90% children | ALL (usu dx at 3-7 yo)
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| Acute leukemia: Primarily adults | AML (median onset 60 yo)
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| most common Hodgkin Lymphoma | Nodular sclerosing (other: lymphocyte predominant, mixed cellularity, lymphocyte depletion)
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| B symptoms include: | Fever, night sweats, weight loss, fatigue
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| virus found in 40-50% of cases of Hodgkin Lymphoma | EBV
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| Rai system used to: | stage/prognosis of chronic leukemia/ CLL (WBC, HSM, anemia) (stage 0 prog > stage 4)
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| acute leukemia S/S | epistaxis, gingival bleed, menorrhagia; GN infxn/low WBC: pna & cellulitis; pain sternum/tib/femur; LA & HSM in ALL > AML
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| chronic leukemia pathophys: | CLL: clonal malig of B cells; CML: myeloproliferative dz
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| CML 3 phases | chronic, accelerated, acute (blast crisis: >30% blasts)
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| Richter syndrome = | 5% of CLL: isolated node => aggressive large-cell lymphoma
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| Ann Arbor system used to stage: | Hodgkin dz; degree of LN/ extralymphatic involvement
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| 90% NHL arise from: | B lymphs
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| MDS: risk factors include exposure to: | Benzene, radiation, chemotx agents (esp alkylating agents & anthracyclines)
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| Important to differentiate btw multiple myeloma and: | MGUS (monoclonal gammopathy of unknown significance)
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| Disorder in which bone marrow is replaced with scar tissue, leading to anemia | Myelofibrosis
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| Dz occurs when blood cells do not develop into mature cells, but rather stay in an immature stage within the BM | MDS
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| Etiology of multiple myeloma; assoc with: | Etiology unknown; assoc w/pesticides, paper production, leather tanning, exposure to radiation from nukes
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| Replacement of normal bone marrow by plasma cells leads to bone marrow failure = | Multiple myeloma
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| Malignancy of B lymphocytes | Waldenstrom’s Macroglobulinemia: overproduction of monoclonal macroglobulin (IgM antibody)
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| Hyperviscosity syndrome (N/V, visual disturbances, mucosal/ GI bleed); cold hypersensitivity, peripheral neuropathy, HSM, engorged retinal veins = | Waldenstrom
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| CML S/S | Fever (w/o infxn); bone pain; LUQ pain (enlarged spleen); night sweats; bleeding & bruising; petechiae; fatigue ; weakness
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| ALL prognosis | 80% of children will be cured with chemo; 20-40% of adults will be cured
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| AML Etiology | Poss: exposure to toxins (benzenes, radiation, chemotherapy)
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| Leukemias treated w/tumor lysis ppx | AML & CLL & NHL
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| Non-Hodgkin Dz types | Follicular; Burkitt; Diffuse lg B-cell; Marginal zone; Cutaneous T-cell; Anaplastic large cell
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| Oncologic emergencies | Febrile neutropenia; SVC syndrome; tumor lysis syndrome; hypercalcemia; cord compression (myelomas)
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| Can affect T or B lymphocytes | ALL
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| Bulky lymphadenopathy seen in: | CLL; NHL
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| Next-door dz | HL
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| Drenching night sweats | CLL, Hodgkins
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| Skin infxn/shingles: seen in: | CLL
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| Leukemias w/meningitis | AML/ALL
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| Immunoproliferative diseases | Waldenström; Multiple Myeloma; MGUS
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| Engorged retinal veins: seen in: | P vera; waldenstrom
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| Lytic lesions in the back or skull | Multiple myeloma
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| acute leukemia prognosis | >50% kids w/ALL cured w/CT (induction + consolidation); >70% AML adults <60 yo complete remission (40% cure)
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| CML tx | Gleevec (ST1571 = imatinib); allo BMT may be curative (>80% <40 yo)
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| CLL tx | CT, xrt for bulky adenopathy, tumor lysis Ppx (allopurinol), BMT; palliative, once dz is advanced
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| Hodgkin dz tx | xrt = initial for low risk stage; combo CT (ABVD) cures >50%
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| NHL tx | xrt for single LN; rituximab +/- CT (R-ICE/CHOP); tumor lysis ppx; allo BMT poss for aggressive dz
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| multiple myeloma tx | CT (lenalidomide, dex, doxorubicin); poss local xrt, auto BMT; bisphosphonates
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| Thalidomide may be part of tx for: | Myelofibrosis, MDS, multiple myeloma
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| Waldenstrom mgmt | If asx follow expectantly; Plasmapheresis for hyperviscosity; CT, poss BMT; median survival 3-5 yrs
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| Role of surgery in NHL | Diagnostic
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| Only curative tx for MDS | Allogeneic BMT
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| Most common mets from osteosarcoma are: | pulmonary
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| Osteosarcoma histologic subtypes (3) | Osteoblastic (most common). Chondroblastic. Fibroblastic
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| Osteosarcoma pathology | Malignant spindle cell => osteoid deposited btw trabeculae => destroys compact bone & replaces it w/abnormal callus & osteoid. Periosteal rxn: tumor lifts off periosteum
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| Osteosarcoma dx studies | X-ray. Radionuclide bone scan. CT to assess bony destruction. CT chest to r/o bony mets
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| Most common primary benign bone tumor | Osteochondroma (3:1 M:F). Mostly distal femur, proximal humerus, tibia, femur
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