Oncology
7 high-yield topics. Open a topic to review its pearls.
Breast Cancer
Risk, screening, staging
Risk Factors
- Age, BRCA1/2, prior breast cancer, family history
- Menarche <12, menopause >55, nulliparity
- Hormone therapy, alcohol, obesity
Screening
- Mammography age 40-50 (individualized)
- Clinical breast exam + mammogram annually
- Self breast exam no longer a screening test
- BRCA testing with strong family history of breast AND ovarian cancer
- Implants: mammogram with multiple views
Staging
- TNM classification
- ER/PR status, HER2 status
Lymphoma
Hodgkin and non-Hodgkin
Hodgkin
- Reed-Sternberg cells
- Nodular sclerosis most common
- B symptoms: fever, night sweats, weight loss
- Treatment: ABVD chemotherapy
Non-Hodgkin
- Indolent: follicular, marginal zone
- Aggressive: DLBCL, Burkitt
- DLBCL: R-CHOP regimen
Paraneoplastic Syndromes
Metabolic and neurologic
Metabolic
- SIADH: small cell lung cancer → hyponatremia
- Hypercalcemia: PTHrP (squamous cell lung, renal, breast)
- Hypoglycemia: large cell lymphomas
Neurologic
- Lambert-Eaton: anti-VGCC (small cell lung)
- Cerebellar degeneration: anti-Yo, anti-Tr
- Limbic encephalitis: anti-Hu
Prostate Cancer
Screening and treatment
Key Points
- PSA age ≥50 annually, discuss limitations
- Not shown to reduce mortality — shared decision making
- DRE and PSA; if abnormal, ultrasound and biopsy
- Treatment depends on stage, grade (Gleason), and life expectancy
GI & GU Malignancies
Testicular, bladder, colon
Testicular
- Young men, painless mass
- Markers: AFP, beta-hCG, LDH
- Highly treatable even when metastatic
Bladder
- Painless hematuria, smoking, aniline dyes
- Cystoscopy for diagnosis
Colon
- See GI section for screening
- CEA for monitoring, not screening
Melanoma
ABCDE and staging
Key Points
- ABCDE: Asymmetry, Border, Color, Diameter >6mm, Evolving
- Breslow depth is key prognostic factor
- Excisional biopsy for diagnosis
- Sun avoidance best prevention
Anti-tumor Drug Side Effects
Key toxicities
Common Toxicities
- Doxorubicin/anthracyclines: cardiotoxicity
- Bleomycin: pulmonary fibrosis
- Cisplatin: nephrotoxicity, ototoxicity, neuropathy
- Vincristine: peripheral neuropathy
- Cyclophosphamide: hemorrhagic cystitis (give mesna)
- Methotrexate: mucositis, myelosuppression (give leucovorin)