ONCOLOGY

1. CHEMOTHERAPY:
 BEST WORKS ON RAPIDLY DIVIDING CELLS
 MOSTLLY GIVEN IV
 MUST BE GIVEN IN A FREE FLOWING (FAST BLOOD FLOW) VEIN
 CENTRAL VENOUS THROUGH CATHETAR MOSTLY
 IF GIVEN PERIPHERALLY ,MONITOR CAREFULLY
 DRANGEROURS TO THE DR GIVING THE CHEMO….USE GLOVES
 ONDANSETRON( 5 HT3 ANTAGON) ANTIEMESIS
 NEUTROPENIA CAN BE REDUCED BY USING----G-CSF
 ACCELERATED CHEMO REGIMES ARE BETTER

 
2. SURGERY:
 3 MAIN REASON
 1 BX---CORE BX, IMAGE GUIDED BX, EXCISION BX
 EXCISION
 PALLIATION (QUIKEST WAY OF PALLIATION) TOILET SX
 
 
3. RADIOTHERAPY
 EXCELLENT FOR LYMPHOMAS
 TELETHERAPY(LINEAR RADIO BEAM ) MOST COMMON
 BRACHI( HIGH DOSE FROM NEAR BY)
 IV UPTAKE( THYROIDE IODIN AND STRONTIUM FOR BONE METS)
 
 CHEMO SUPPLIED:
 1 AND 2
3.MOST COMMON TREATMENT
 

4) CHEMOPREVENTION----CHEMOP PPX
  
 
 
 
METASTASIS
 MOST COMMON CAUSE OF DEATH IN CANCER PT
 BRAIN GETS MOST METS FROM LUNGS--(HEADACHE) 40-50%---TX
HIGH DOSE STEROIDS
 LUNG METS
 LIVER METS
 BONE METS---PAIN, PATHOLOGICA FX AND SPINAL CORD
COMPRESSION---BONE SCAN AND XRAY(MORE CORRECT)
TX..BISPHOSPHONATES
 MALIGNANT PLERAL EFF---PLEURAL TAP RBCS, LDH (LIGHTS
CRITERIA)
 
EMERGENCY COMPLICATIONS
 CORD COMPRESSION---MRI-DEXAMRTHASON-ANALGESICS-
NERUOSX
 SUPERIOR VCO---DYSPNEA AND FACIAL SWELLING AND
DISTEDNED VEINS---LUNG CA
 HYPERCALCEMIA---MOST COMMON METABOLIC PROBLEM IN
CA---Sr. CA++ AND ALBUMIN---HYDRATE AND
CALCITONIN+BISPHOS
 NEUTROPENIC FEVR---38*C <1.0x 10^9 /L
 
 
CUTANEOUS MANIFESTATION OF CANCERS:
 PRURITIS
 ACANTHOSIS NIGRACANS
 VITILIGO
 PEMPHIGUS
 DERMATITIS HERPETIFORMIS
  
 
SERUM TUMOR MARKERS
 CALCITONIN---MEDULLARY THYROID CA
 CA-125-OVARIAN
 CA-19.9-PANCREATIC
 BETA 2 MICRO-MEYELOMA
 CEA-COLORECTAL CA
 
 
 
ENVIRONMENT
 DYE ------BLADDER CA
 SCISTOSOMIASIS HEMATOBIUM----BLADDER CA
 UV LIGHT----BCC
 EBV---BURKITTS
 PETROLEUM BENZENE-----AML
 VINYL CHROLIRDE----LIVER
 AFLATOXIN ASPERGILLUS----LIVER
 Common Hereditary cancer syndromes
Syndrome Gene Associated neoplasms Pathogenesis
MSH2, MLH1,
 Colorectal cancer
MSH6, PMS2
Lynch syndrome  Endometrial cancer
(mismatch repair
 Ovarian cancer
mutation)
 Colorectal cancer
Familial adenomatous
APC  Desmoids and osteomes
polyposis
 Brain tumors
Autosomal dominant.
 Hemangioblastomas Caused by inactivating
Von Hippel-Lindau VHL  Clear cell renal carcinoma mutation in corresponding
 Phechromocytoma supressor gene.
Deletion of remaining
 Sarcomas normal allele (second hit)
 Breast cancer leads to heterozygosity and
Li-Fraumeni Syndrome p53  Brain tumors malignant transformation
 Adrenocortical carcinoma
 Leukemia

 Parathyroid adenomas
Multiple endocrine
MEN1  Pituitary adenomas
neoplasia type 1
 Pancreatic adenomas

Autosomal dominant.
Activating (gain of function)
 Medullary thyroid cancer
point mutation in
Multiple endocrine RET (Neural growth  Pheochromocytoma
proto-oncogen.
neoplasia type 2 factor receptor)  Parathyroid hyperplasia
Continuous stimulation of
(MEN2A)
cell division predisposes
tumor growth

GF / Suppressor Type Mutation Cancer

PDGFB Platelet-derived Growth factor B Overexpression Astrocytoma

EEBB2 (HER2 neu) Epidermal growth factor receptor Amplification Subset of breast carcinomas
KIT Stem cell growth factor receptor Point mutation Gastrointestinal stromal tumor
RAS gene GTP-binding protein Point mutation Carcinomas, melanoma and
lymphoma
ABL Tyrosine kinase t(9:22) with BCR CML and some types of ALL
Overexpression
c-MYC Transcription factor t(8:14) involving IgH Burkitt lymphoma
N-MYC Amplification Neuroblastoma
L-MYC Amplification Lung carcinoma (Small cell)
CCND1 Cyclin t(11:14) involving IgH Mantle B-cell lymphoma
CDK4 Cyclin-dependent kinase Amplification Melanoma
BCL2 Regulator of Apoptosis t(14:18) involving IgH Follicular lymphoma
Overexpression

DISEASE TRASLOCATION MARKERS CHARACTERISTIC CELLS

ALL – Philadelphia 9:22 TdT
B-cell lineage CD19 and CD10
Lymphoblastic Lymphoma CD1, CD2, CD5 and CD7

B-CLL CD19 and CD20, CD5

SLL CD5 Small B lymph
T-CLL Smudge cells (Parachute)
Hairy cell leukemia TRAP positive Hairlike lymph
Follicular lymphoma 14:18 + bcl2 B cell
Burkitt Lymphoma 8:14 + c-myc Starry Sky (macrophages)
Mantle cell lymphoma 11:14 + bcl1 CD19, CD20, CD5
Multiple Myeloma Rouleaux formation (coins)
Lymphoplasmacytic Lymphoma Waldenstrom M spike (IgM) Russell and Dutcher bodies
ATTL 4-leaf clover cells
Sezary Syndrome Cerebriform Sezary cells
Hodgkin Lymphoma CD15 (Leu-M1) CD30 (Ki- Reed Sternberg
1)
Lymphocite Predominant NEGATIVE CD15, CD30 Popcorn Cells
Lymphocite Depleted Reed Sternberg
Nodular sclerosis Lacunar cell
AML – M3 15:17 MPO, Sudan-black Auer Rods
Myelodisplastic Syndrome Pelger-Huet cells (aviator)
Myeloproliferative Syndrome
CML 9:22+ c-abl P210 Decreased LAP
Polycythemia vera Increased LAP
Myelofibrosis with myeloid Dry tap Teardrop RBCs
Langherhans cell histiocytosis CD1 Birbeck granules