Step 2 Crush Onc

metastatic

table 9-1

table 9-3

Male incidence: Prostate, Lung, Colon
Female incidence: Breast, Lung, Colon
Male mort: Lung, Prostate, Colon
Female mort: Lung, Breast, Colon

non small cell: surg
small cell: chemo only, no surg if early mets

1. Horners from Pancoast tumor: unilateral ptosis, miosis, anhidrosis
2. Diaphragm paralysis: from phrenic nerve involvement
3. Hoarseness from recurrent laryngeal nerve involvement
4. SVC syndrome: edema, redness of neck, face, CNS sxs, compression of SVC
5. Cushings: from ACTH producing small cell carcinoma
6. SIADH from production by small cell carcinoma
7. HyperCal from bone mets of PTH production from small cell carcinoma
8. Eaton-Lambert Syndrome: myasthenia like syndrome from lung cancer that spares ocular muscles, become stronger with repetitive stim unlike myasthenia

compare to old CXRs. If same for 2 years than its not cancer. If no old films available and pt older than 35 or long smoking hx, get CT with PET scan if indeterminate. Get a biopsy.
If <35 most likely TB/infectious, hamartoma, or collagen vascular dz. Careful observation, f/u repeat chest CT

1/10

1. personal hx
2. family hx in first deg rel
3. age
4. early menarche, late menopause, late first preg, nulliparity
5. atypical hyperplasia of breast
6. radiation exposure before 30

fixation of mass to chest wall or overlying skin, satellite nodules, ulcers, lymphedema, peau d'orange, matted/fixed axillary nodes, inflammatory changes, any new brest mass in postmenopausal woman

think fibroadenoma, observe for few menstrual cycles before considering biopsy

invasive ductal car

aromatase inhibitors: Letrozole, Anastrozole, Tamoxifen

Trastuzumab against receptor

equally effective

to see if nodes are positive and to see if chemo is necessary

60%

black>white>Asian

local: surg
mets: hormonal tx: orchiectomy, GnRH agonist Leuprolide, AR antagonist Flutamide, Estrogen, DES
Chemo doesn't work, rads for local dz or pain from bony mets

UC more than Crohns

60-75 yrs

CEA

surgery, adjuvant chemo with 5FU and Levamisole or Leucovorin

resect if solitary. with mets elsewhere, prog is poor

smoker b/w 40 and 80: WL and jaundice, epigastric pain
Migratory thrombophlebitis (Trousseau's syndrome)
Palpable nontender gallbladder (Courvoisier's sign)

Whipple's, 5% 5 year survival

Whipple's triad 1. sxs of hypogly
2. low plasma glucose at the time of sxs
3. relief with normalization glucose
insulinomas mostly benign and can resect, look for C-peptide which will be high vs exogenous insulin taken

ZE synd: gastrinoma, acid hypersecretion, PUD, ulcers in weird places like all the way to distal duodenum/jejunum
More than half malignant

hypergly, migratory necrotizing skin erythema

serous cystadenocarcinoma: has psammoma bodies

reduces ov and endomet ca risk by 50%

virilization

causes feminization and prec pub

ovarian fibroma, ascites, R hydrothorax/effusion

stomach or GI ca with mets to the ovaries

<20 at first coitus/preg/marr
multiple partners
smoking
low SES
High parity (but protects against endomet ca)

clear cell ca of cervix/vag in daughters

pap smear, endocervical curettage, endomet biopsy, consider ultrasound

unopposed est stim: PCOS, estrogen secreting tumor, est replacement without prog
DM
Gallbladder dz'
HTN
late menopause
nulliparity
obesity

intermittent severe HTN, MS change, HA, diaphoresis
check 24h urine catecholamines

persistent painless hematuria
rubber/dye industry (aniline dye exposure)
first do cystoscopy

adults 2/3 are supratentorial
children 2/3 are infratentorial

seizures, neuro def, intracranial HTN, BV, papilledema, projectile nausea/vom, hydrocephalus and ataxia in children

adults: gliomas and meningiomas
children: cerebellar astrocytoma, medullo, then ependymoma

acoustic neuroma and hemangioblastoma
mets more likely then primary

Type 1: cafe au lait spots, neurofibromas, Lisch nodules (iris hamartomas), scoliosis, optic gliomas, pheo, increased tumor sus
Type 2: b/l acoustic neuromas, juvenile cataracts

hemangioblastomas of retina/cerebellum/medulla, b/l renal cell ca, increase in angiogenic HIF expression

small bowel or appendix

episodic cutaneous flushing, abd cramps, diarrhea, right sided heart valve damage, urine 5HIAA increased. lung carcinoids are rarely functional

WL, anemia, "my food is sticking", dysphagia, most commonly adeno in blacks obese with barrett's
squamous cell in smoker/drinker

CD1+ Birbeck granules (cytoplasmic inclusion bodies look like tennis rackets) in histiocytes

HIV pos, rash that doesn't respond to tx

WL, RUQpain, enlarged liver

angiosarcoma of liver

cholangiosarcoma

hemangioma, generally left alone

hepatic adenoma. stop OCPs. do a needle biopsy then surg

hepatoblastoma

Asians, assoc with EBV

Codman's triangle or Sunburst periosteal rxn. distal femur/tibia

bitemporal hemianopsia. most often functioning version is prolactinomas: galactorrhea, menstrual/sexual dysfunction.

leukocoria (red reflex is white), unilateral exophthalmos in a young child

rhabdosarcoma subtype in a girl with a bunch of grapes coming out of vagina

ABCD: asymmetry, borders irregular, color change or multiple colors, diameter
UV increases risk of basal, squam, and melanoma
most common is basal: never mets, pearly umbilicated telangiectasias
squam rarely mets
melanoma often mets

RF: japanese, age, smoking, smoked meat, H pylori
Krukenberg's tumor: stomach ca with b/l ovarian mets
Virchow's node: left supraclavicular node enlargement from visceral ca spread

most common solid malig in men <30
main RF: cryptorchidism
can diff hydrocele from ca by transillumination and u/s
most common is seminoma (radiosens)
test lymph drains paraaortic LNs at level of renal veins
scrotal lymph drains to inguinal nodes

cold nodule on nuc scan, hx of irradiation, "stony hard" nodule, increased calcitonin level (MENII)
tests: thyroid function tests, u/s, nuc scan, FNA for diag

expansile, lytic, well demarcated benign bone cyst in prox humerus in children and adolescents

nephroblastoma at age 2-4: flank mass and hematuria. embryonic glomerular structures. part of WAGR complex: Wilms tumor, Aniridia, GU malformations, Retardation mental-motor

tumor of adrenal medulla in children, can be anywhere along sympathetic chain, HVA in urine, N-myc oncogene
non-rhythmic conjugate eye mvments, myoclonus