Background: Highest incidence: East Asia (Japan, Korea, China) Increased in Eastern Europe & South America Male predominance (~2:1) Major Risk Factors: Chronic H. pylori infection (strongest risk factor) Chronic atrophic gastritis / intestinal metaplasia Smoking High salt/smoked foods, low fruits/vegetables Pernicious anemia Partial gastrectomy (long-term) CDH1 mutation → hereditary diffuse gastric cancer Histologic types: Intestinal: Gland-forming Associated with: H. pylori,
Types: Papillary Thyroid Carcinoma Medullary Thyroid Carcinoma Follicular Thyroid Carcinoma Hurthle Cell Carcinoma Anaplastic Thyroid Carcinoma Suspicious features of thyroid nodules on US: Irregular margins Microcalcifications Taller than wide shape Rim calcifications with small extrusive soft tissue component Extrathyroidal extension Central vascularity Treatment: Treatment typically entails surgery (lobectomy vs. thyroidectomy) Indications for thyroidectomy : History of pr
Risk factors: History of cryptorchidism (undescended testis) Family history of testicular cancer Personal history of testicular cancer Initial work up: Testicular ultrasound Tumor markers: AFP, hCG, LDH Do not biopsy testis. Radical inguinal orchiectomy (through inguinal incision, not scrotum) Brain MRI recommended if: Neurologic symptoms Post-orchiectomy beta-hCG > 5000 Extensive lung metastases Non-pulmonary visceral metastases AFP >10000 (non-seminoma) Predominant chorioca
Background: Genetic Risks: Li-Fraumeni syndrome (p53) NF1 (malignant peripheral nerve sheath tumors) Familial Rb Gardeners/FAP (APC) Desmoid tumors Most are sporadic tumors Risk factors: Prior radiation is the #1 risk factor (esp within 10-30 years) HIV or HHV-8 (Kaposi Sarcoma) Chronic Lymphedema (Angiosarcoma) Most common types: Gastrointestinal stromal tumor (GIST) Characterized by c-KIT or PDGFRA mutations Liposarcoma Well-differentiated/Dedifferentiated liposarcoma MDM2
Background: Poor prognosis. Median OS ~ 12-14 month Limited-Stage SCLC: confined to the ipsilateral hemithorax, which can be safely encompassed within a radiation field Extensive-Stage SCLC: metastatic, beyond the ipsilateral hemithorax, including malignant pleural or pericardial effusion May present with SVC Syndrome IR consult - Ideally could still get tissue diagnosis before treating Rad Onc consult for Emergent treatment with concurrent chemoRT LS-SCLC Treatment Stage I-
Cutaneous Melanoma The BRAF V600 mutation is a frequent somatic/acquired driver mutation in cutaneous melanoma. Cyclin-dependent kinase inhibitor 2A (CDKN2A) is the most frequently mutated high-risk gene associated with familial cutaneous melanoma. Staging: Any N+ disease is Stage IIIA and up Memorize staging: Stage Thickness Ulceration T1a < 0.8 mm No T1b < 0.8 mm Yes T1b 0.8–1 mm with or without T2a 1–2 mm No T2b 1–2 mm Yes T3a 2–4 mm No T3b 2–4 mm Yes T4a > 4 mm No T4b > 4
Early detection: Individualized informed decision-making for prostate cancer screening (DRE and PSA) Discuss risks and benefits: Age 45–75 at average risk Age 40–75 at high risk (Black/African American, family history, germline mutations) Definitive diagnosis: Requires prostate biopsy, Gleason grading, and TNM staging. Clinical Pearls: Think of Prostate Cancer treatment on a "spectrum": Localized Disease → Biochemical recurrence (BCR) → Non-metastatic castrate resistant prost
Work up: EUS/ERCP for biopsy and stent placement Consult GI for ERCP if bilirubin high (prior to giving chemotherapy) CT Chest/Abdomen/Pelvis CA 19-9 (baseline) CA19-9 is a good marker but should not be used to determine need for treatment alone Elevated CA 19-9 prompts further evaluation/imaging Consider screening in patients with strong family history of pancreatic cancer and genes associated with pancreatic adenocarcinoma: ATM, BRCA1, BRCA2, CDKN2A, MLH1, MSH2, MSH6, EPCAM
Background: NSCLC (85%): Adenocarcinoma (60%), Squamous (30-35%), other Neuroendocrine (5%) SCLC (15%) Staging: Recommend to memorize TNM staging (questions will not always state what stage but may provide size, nodal involvement, etc) T2 starts at 3 cm and each T goes up by 2 cm → T2 (3 cm), T3 (5cm), T4 (7cm) N1 is hilar nodes, N2 is ipsilateral mediastinal nodes, N3 is contralateral OR supraclavicular nodes Stage I NSCLC Curative intent: Surgical resection (preferred) or r
Background: Types: Pleural mesothelioma (~85%) Peritoneal mesothelioma (~15%) Histology: Epithelioid Mesothelioma: Epithelioid-to-round cells Better prognosis Non-Epithelioid Mesothelioma: Sarcomatoid: Spindle cells with tapered nuclei Biphasic: Contains both epithelioid and sarcomatioid components in various proportions (each at least 10% of the tumor) Diagnosis: Immunohistochemical panels are essential for diagnosis, requires both criteria: 2 positive mesothelial markers:
Genetics: Consider VHL, Tuberous sclerosis, Birt-Hogg-Dube (spontaneous pneumothorax is a hallmark) Genetic testing in patients with: Multiple renal masses, bilateral or multifocal tumors, diagnosis age < 45, family history of RCC (more than one first/second degree relatives with RCC) Types: Clear cell RCC: 75% Non-Clear Cell RCC: 25% Papillary RCC is associated with MET mutation. Collecting Duct RCC Chromophobe RCC Associated with Birt-Hogg-Dube Medullary RCC Associated wit
Risk Factors: Cirrhosis of any cause (viral, alcoholic, metabolic, autoimmune, genetic etiologies) Cirrhosis present in over 80% of HCC cases Chronic HBV and HCV infection (with or without cirrhosis, especially with high viral load or active replication) Screening: At-risk populations requiring screening: Child-Pugh Class A or B cirrhosis of any etiology Child-Pugh Class C cirrhosis patients who are transplant candidates Hepatitis B carriers without cirrhosis Screening using
Risk factors: HPV infection (16, 18, 33, 35) Smoking Alcohol use (synergistic with smoking) Betelnut chewing Genetic factors such as Fanconi Anemia (avoid alkylating agents and radiation due to increased toxicity in these patients) Sites of tumor: Oral Cavity: mucosal lip, Buccal mucosa, anterior tongue, hard palate Oropharyngeal Cancer: upper throat, tonsil, base of tongue, soft palate, pharyngeal wall Hypopharyngeal Cancer (lower throat) Laryngeal Cancer Treatment: Principl
Background: Most common mesenchymal tumors of GI tract Risk assessment uses: Tumor size Mitotic rate Anatomic location Tumor rupture Significantly increases recurrence risk. Gastric GIST generally have better prognosis than non-gastric GIST. For example, a >10 cm gastric tumor with >5 mitoses/50 HPF has 34% metastasis risk, while the same parameters in small bowel GIST carry 71-90% risk. Work up: Histology + IHC: Confirm GIST with positive KIT and/or DOG1 immunostaining. Imag
Work up: CT CAP with IV and oral contrast EGD with biopsy Endoscopic Ultrasound (EUS) If no M1 unresectable disease Bronchoscopy for tumors at/above the carina to rule out fistula PET/CT scan Consider staging laparoscopy: To assess peritoneal metastases (mostly in signet ring histology) At least 15 LNs need to be removed during surgery Biomarker testing: MSI/MMR in all newly diagnosed patients PD-L1 in all newly diagnosed patients HER-2 if advanced/metastatic adenocarcinoma i
Increased risk of CRC: Personal history of adenoma, Sessile Serrated polyp (SSP)/ lesion (SSL), CRC, IBD, Cystic fibrosis, childhood cancers Positive family history of CRC Screening: Average risk adults: Age 45–75 years with a life expectancy of ≥10 years Screening between ages 76–85 should be individualized based on comorbidity status, life expectancy, and prior screening history. Colonoscopy Every 10 years Flexible sigmoidoscopy Every 5-10 years CT Colonoscopy Every 5 years
Screening (American Cancer Society): Average Risk: 40 - 44 years old: have the option to start screening with a mammogram every year. 45 - 54 years old: should get mammograms every year. 55 and older: Can switch to a mammogram every other year, or they can choose to continue yearly mammograms. Screening should continue as long as a woman is in good health and is expected to live at least 10 more years. High Risk: Definition: Women with lifetime risk of breast cancer of 20% or
Chondrosarcoma Background: Most common bone cancer in adults (40%) Most frequent sites of origin: Pelvis and proximal femur Characterized by malignant cartilage matrix production without osteoid Bony destruction + calcification Very chemoresistant Subtypes: Conventional (90%) Non-conventional (10%) Clear cell Dedifferentiated Mesenchymal Myxoid Juxtacortical Treatment: If resectable: Surgery If metastatic/not resectable: systemic therapy Ivosidenib (If IDH1 mutation) Pazopan
Types: Urothelial carcinoma/ Transitional cell (90%) Risk Factors: Occupational exposures (dye manufacturers, rubber aluminum factories), smoking SCC of the bladder (5%) Associated with chronic inflammation (schistosoma, chronic UTI, chronic foley use) Treatment: Surgery Adenocarcinoma of bladder (2%) Treatment: Cystectomy Small cell bladder cancer (1%) Treatment: Cisplatin + Etoposide (like regimen for SCLC) → RT or cystectomy Plasmacytoid: Associated with CDH1 gene mutatio
Here are some points that can make your Hematology/Oncology life easier- The earlier you learn them, the better. Lesson Number 1: Below is a list of anticancer agents for which the category and mechanism of action can be recognized by their names:
