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Oncology Part 2 Cheat Sheet by

More Quick Notes - Diseases and Such

Tumor Lysis Syndrome

Definition
Simult­aneous death of many cancer cells produces release to blood of enormous quantities of products of their destru­ction.
When?
May partic­ularly occur during initial phase of treatment of pts. w/ large chemos­ens­itive tumors
Symptoms
Hyperp­hos­pha­temia
Hyperu­ricemia
Hyperk­alemia (life-­thr­eat­ening: cardiac arrhyt­mias)
Hypoca­lcemia secondary to formation of calcium phosphate: tetany, mental agitation, seizures
Acute renal failure
Diagnosis
Based on develo­pment of
-increased lvl. of serum uric acid (8mg%) , phosphate (4,5 mg%) , and potassium (6mg%)
-decreased levels of serum calcium (7mg%)
-increased serum creatinine (1,5 x upper normal limit)
-cardiac arrhyt­hmias or death, seizures
Manage­ment:
• Forced diuresis 3 L/m2 PWE + furosemide
• Allopu­rinol to fight hyperu­ricemia (protein degrad­ation).
• Novel agent: rasbur­icase

Hyperc­alcemia - Clinical Symptoms

Pts. w/ Ca. conc. b/w 10.5 & 12 mg/dl usually asympt­omatic
Clinical manife­sta­tions appear w/ higher lvls.
Renal
polyuria
nephro­lit­hiasis (chronic HC)
GI
anorexia
nausea
vomiting
consti­pation
pancre­atitis
Neuro-­psych
weakness
fatigue
confusion
stupor
coma
CV
shortened QT interval on ECG
bradya­rrh­ythmias
heart block
cardiac arrest
Ocular
band kerato­pathy (chronic HC)
 

Local Radiot­herapy

Telera­dio­therapy
tumor irradiated from a distant (usually ~ 1m) source
Brachy­therapy
irradi­ation source is placed @ direct vicinity of irradiated tissue
(aka. Curiet­herapy)

Brachy­therapy

Contact or intrac­avital irradi­ation
Instal­lation of radiation source into cavity or through a natural route
Inters­titial irradi­ation
Insertion of the radioa­ctive source inters­tit­ially
LDR (low-d­ose­-rate)
Currently, most freq. = Cesium 137
--> dose rate: 1 cGy/min
Intrac­avital: most freq. cervical ca.
Inters­titial: oral cavity ca. , pharyngeal ca. , prostate ca. , sarcoma
HDR (high-­dos­e-rate)
Currently, most freq. = Iridiuim 192
--> dose rate: 100 cGy/min
Intrac­avital: vaginal ca. , oesoph­ageal ca. , lung ca. , sarcoma
Inters­titial: prostate ca.

Telera­dio­therapy

Conven­tional
orthovolt (125-500 kV)
-can only be used for palliative tx. of superf­icially located metastases
--> practi­cally not used these days
Megavolt
teleco­bal­tot­herapy, photons & electrons from linear accele­rator, neutrons from either neutron generator or cyclotrone
--> energy: 4 - 20 MeV

Renal Ca. - Clinical Presen­tation

Typical Triad
hematuria
abd. pain
flank / abd. mass
(palpable tumor)
Less freq.
fever
weight loss
anemia
varicocele (abn. enlarg­ement of pampin­iform venous plexus)
PARANE­OPL­ASTIC SYNDROMES:
--> erythrocytosis
--> hyperc­alcemia
--> nonmet­astatic hepatic dysfunc. (Stauf­fer's synd.)
--> acquired dysfib­rin­oge­nemia
 

Pancreatic cancer

Notes
Freq. site = Head of pancreas
No screening test available
5-year survival < 5%
Median age of diag. = 72 y/o
Peak incidence - 65-84 y/o
Males > Females
Clinical Features
Pain
Obstructive Jaundice
Weight loss
Anorexia
Risk Factors
• Cigarette Smoking, Obesity, Non-he­red­itary Chronic Pancre­atitis
• Enviro­nmental Factors (diet, coffee), prev. partial gastre­ctomy / cholec­yst­ectomy & H. pylori
Physical Findings`
(+) Courvo­isier’s sign
• Palpable, nontender gallbl­adder
(+) Virchow’s Node
Advanced Disease
• Abdominal Mass, Hepato­megaly, Spleno­megaly, Ascitis
Diagnostic Procedures
Ultrasound
CT Scan
ERCP
Endoscopic US
MRCP
FDG-PET*
CA 19-9 (Serum Marker)
• 80-90% sensit­ivity & specif­icity
• Suggestive of diag. pancreatic ca.
• Prognostic impilc­ations – Very high levels w/ inoperable disease
• Serial evaluation useful for monitoring response to tx.
• Detecting recurrence in pts. w/ completely resected tumors
Treatment
Symptom management
Endoscopic biliary / duodenal stenting
Intestinal bypass surgery
Deoxyc­ytidine analogue Gemcit­abine
*Excluding occult distal metastasis

BI-RADS

0 (incom­plete)
Recommend add. imaging --> mammogram / targeted US
1 (negative)
Routine breast MR screening if cumulative lifetime risk ≥ 20%
2 (benign)
Routine breast MR screening if cumulative lifetime risk ≥ 20%
3 (prob. benign)
Short-­int­erval (6 mth) follow-up
4 (suspi­cious)
Tissue diagnosis
5 (highly suggestive of malign­ancy)
Tissue diagnosis
6 (known biopsy­-proven malign­ancy)
Surgical excision when clinically approp­riate
Breast Imaging Reporting and Database System score.
- Scoring syst. used by radiol­ogists describe mammogram results
- Most efficient tool to help detect breast cancer, esp. at its earliest stage

*Table taken from UCSF Department of Radiology & Biomed. Imaging
 

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