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Oncology General


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