Study Guides:

Iron Metabolism: ~ 4000 mg of iron per person Mostly stored in the erythrocytes ( ~ 2700 mg) and liver ( ~ 1000 mg) Homeostasis is balance between absorption vs. loss Absorption is regulated Intestinal absorption can fluctuate in response to Iron status Erythropoietic demand Hypoxia  Inflammation Normally absorb 1-2 mg iron/day Loss is unregulated Physiologic exfoliation (hair, skin) Bleeding (physiologic, hemorrhage) Reproductive (iron needed to make a new human) Transferrin

Major components of hemostasis: Primary hemostasis (platelet plug) Defects lead to mucosal bleeding (petechiae, purpura, epistaxis)...

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

Background: B-cell lymphoid malignancy, characterized by Reed-Sternberg cells ( resemble owl’s eyes ) Most commonly affecting young adults Presenting with painless LAP and sometimes B symptoms Types: Classic Hodgkin Lymphoma: CD15+, CD30+ and CD20- Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL): CD15-, CD30- and CD20+ Deaville Scoring System: Used to interpret FDG-PET scans for response assessment in HL and aggressive NHLs: 1 = No uptake 2 = Uptake ≤ mediastinum 3 =

Types of transplant: Allogeneic HCT: Infusion of hematopoietic cells ( CD34⁺ ) from a HLA-compatible donor after cytotoxic conditioning to eradicate disease and enable engraftment. Used in order to deliver high doses of chemotherapy + “graft vs. tumor” (GVT) effect GVT affect: immune-mediated cytotoxic effect exerted by donor-derived immune cells against the recipient’s neoplastic cells following allo-HCT ~30-50% of allo-HCT develops with acute GVHD (aGVHD) Most commonly used

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

Erythropoiesis Stimulating Agent (ESA) Mechanism: Regulates RBC production Produced in liver in fetus, kidney is primary site in adults Regulated by the HIF transcription factors Functions by stabilizing CFU-e and promotes terminal differentiation of erythroid cells Ensure iron stores is adequate before using EPO Medications: Erythr o poietin / E poetin alfa (Epogen) Darbo poietin alfa Biosimilars Indications: Chronic Kidney Disease Start when Hb <10 Lowest dose necessary t

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

Background: 10-15% of all leukemias Male/Female: 1.5 Median age of 65 years old Ionizing radiation is the only known causative factor (usually within 6 to 8 years of exposure) No known genetic factors determine susceptibility to CML Pathophysiology: >95% of CML patients have Philadelphia chromosome (Ph) in the marrow. Contains BCR-ABL1 fusion gene (translocation between BCR on chromosome 22 and ABL1 on chromosome 9)  BCR-ABL1 oncoprotein has tyrosine kinase activity. BCR-ABL1

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

Background: 25% of all leukemias Morphologically mature but immunologically incompetent B lymphocytes Incidence increase with age Male/Female: 2 Predominantly found in caucasians, less common in African-Americans, Hispanics and Asians Positive family history: 2-8 fold increased risk Work-up: CBC: Clonal B-lymphocytes >5000 Anemia and thrombocytopenia are common PBS:  Small lymphocytes with round nuclei, clumped chromatin, scant cytoplasm Medium/large sized cells: less than 10

Below is a list of common chemotherapy regimens in alphabetical order: ABVD: Doxorubicin ( A driamycin), B leomycin, V inblastine, D acarbazine Hodgkin lymphoma AC: Doxorubicin ( A driamycin), C yclophosphamide Breast cancer AD: Doxorubicin ( A driamycin), D acarbazine Soft tissue sarcoma (esp leiomyosarcoma) AIM: Doxorubicin ( A driamycin), I fosfamide, M esna Soft tissue sarcoma BEP:   B leomycin + E toposide + Cis p latin Testicular cancer Ovarian malignant germ cell tumo

Bone marrow failure: Disrupted hematopoietic stem and progenitor homeostasis → Inadequate WBC, RBC, Plt Pancytopenia differential diagnosis: Autoimmune: HLH, TTP, Lupus, Evan’s syndrome Malignancy: Leukemia, lymphoma, metastatic tumors (myelophthistic), myelofibrosis Infectious Metabolic/Toxins: B12/folate deficiency, excess zinc, storage diseases, alcoholism Bone marrow failure (least common cause) Acquired Bone Marrow Failure: Rapid onset, no family history, usually associa

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

Introduction: NHL is categorized into two groups of B-cell lymphomas and T-Cell lymphomas: B-cell lymphomas (85–90%): High-grade B-cell lymphoma (HGBL): Diffuse large B-cell lymphoma (DLBCL) HGBL with MYC and BCL2/BCL6 rearrangements "Double-hit" lymphoma: MYC and BCL2 rearrangements "Triple-hit" lymphoma: MYC and BCL2 and BCL6 rearrangements Burkitt lymphoma (BL): Highly aggressive Derived from germinal center B cells Low-grade B-cell lymphomas (LGBL): Follicular lymphoma

Background: Risk factor: HPV (high risk) > HIV, smoking Mostl y SCC Work-up: DRE Anoscopy LN biopsy/FNA HIV test Chest/abd CT scan Staging: T1: ≤ 2cm T2: 2-5 cm T3: > 5cm T4: Any tumor size invaded to adjacent organs Perianal SCC Non-metastatic disease (M0): Local excision/surgery: Indications: T1 N0 well/moderately differentiated T2 N0 with no sphincter involvement ChemoRT: Indications: T1 N0 poorly differentiated T2-4 N0 Any T N+ ChemoRT can cure without requiring an abdomi

Anemia of chronic disease: Mediated by IL-6 Promotes hepcidin expression → decreased intestinal absorption and storage of ferritin in macrophages Transferrin downregulated Erythropoiesis becomes iron restricted (since iron not accessible)  May eventually lead to iron deficiency due to lack of GI absorption Hemolytic anemia (Separate section below) Iron deficiency anemia (Separate post " Iron Metabolism and Diseases ") Iron refractory iron deficiency anemia (IRIDA): Inherit

Anthracyclines: Myelosuppression (esp neutropenia ) Nausea, vomiting Total alopecia Mucositis Red-colored urine Cardiomyopathy (mostly with Doxorubicin, risk increases with cumulative dose) Secondary malignancies (AML, MDS) Topoisomerase I inhibitors: Irinotecan: Severe diarrhea , nausea, vomiting Neutropenia Top otecan: Myelosuppression Less GI toxicity Interstitial lung disease (rare but serious) Topoisomerase II inhibitors:  Doxorubicin: Discussed in Anthracyclines secti

Background: Second most common acute leukemia in adults 75% of cases are B-cell lineage, 25% are T-cell lineage Diagnosis requires ≥20% bone marrow lymphoblasts Work up: CBC with diff, CMP, LFT DIC panel TLS panel Hepatitis B/C and HIV serologies BMBx: Cytogenetics, Molecular analyses To identify if philadelphia chromosome/ philadelphia-like chromosome is present Philadelphia-like chromosome: Lacks the BCR-ABL1 gene Associated with poor prognosis Consider use of TKIs and earl