Background: Risk factors: Obesity Chronic anovulation/ prolonged unopposed estrogen exposure PCOS/chronic anovulation Estrogen-only menopausal hormone therapy Estrogen-producing tumors Obesity Nulliparity/ infertility Early menarche/ late menopause → greater lifetime estrogen exposure Increasing age/ postmenopausal status Tamoxifen Endometrial hyperplasia Combined OCP, progestin exposure and multiparity decrease risk of endometrial cancer High association with Lynch syndrome

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

Background: Most common solid malignancy in males aged 15-40 years Risk factors: History of cryptorchidism (undescended testis) Family history of testicular cancer Personal history of testicular cancer Types: Germ cell tumors (90-95%): Seminoma: Usually present with localized disease, indolent growth, less likely to be metastatic beyond RP nodes Non seminoma: Embryonal Carcinoma Choriocarcinoma Yolk Sac Tumor (endodermal sinus tumor) Teratoma Non- Germ cell tumors (5-10%) Sex

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: SCLC is a poorly differentiated neuroendocrine carcinoma. Small blue cells, scant cytoplasm, high N:C ratio, granular chromatin Types: Limited-Stage SCLC (LS-SCLC): Stages I–III confined to the ipsilateral hemithorax that can be safely encompassed within a radiation field Some stage III tumors are considered extensive-stage when the disease burden is too extensive to be safely encompassed in a tolerable radiation field. Extensive-Stage SCLC (ES-SCLC): Stage IV di

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

Background: Rectal cancer is a subtype of colorectal cancer, but clinically behaves differently from colon cancer (its pelvic location creates unique challenges related to local recurrence, resection margins, sphincter preservation, and radiation planning) Accounts for ~40% of all colorectal cancers Most rectal cancers are adenocarcinoma Key risk factors overlap with colorectal cancer: Age, prior adenomas/CRC, family history, Lynch syndrome/FAP, IBD, obesity, smoking, alcohol

*** A list of abbreviations is provided at the end of this note. Background: Most commonly diagnosed non-cutaneous malignancy in men Second leading cause of cancer death among men in the US Key risk factors: Age: mostly in men >50 (median age at diagnosis ~66) Family history: first-degree relative increases the risk 2-3 times Race: significantly higher incidence in African American, earlier onset and 2× mortality No biological differences in tumor genomics Germline mutations:

Background: Types: Pancreatic ductal adenocarcinoma (PDAC): 85–95% KRAS mutations are found in ~90% of PDAC Neuroendocrine tumors, Acinar cell carcinomas, Cystic neoplasms: 1-5% Rare Variants: Adenosquamous carcinoma, colloid carcinoma, etc: <1% 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 trea

Background: NSCLC (85%): Adenocarcinoma (~60%) Squamous (~25%) Large cell carcinoma and other less common histologies (~15%) SCLC (15%) Staging: Recommend to memorize TNM staging (questions will not always state what stage but may provide size, nodal involvement, etc) T: High-yield size cutoffs: T2 begins at 3 cm Each T goes up by 2 cm: T2 (3 cm) → T3 (5cm) → T4 (7cm) N1: Ipsilateral peribronchial Ipsilateral hilar Intrapulmonary LN N2: Ipsilateral mediastinal Subcarinal LN N

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

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,

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: Types: ~90% of head & neck cancers are squamous cell carcinoma (HNSCC). ~10% are salivary gland tumors, lymphomas, sarcomas, mucosal melanomas Risk factors: HPV infection (16, 18, 33, 35) HPV 16 is by far the dominant subtype (>80% of HPV-positive HNSCC) HPV 18 is the second most common but plays a much smaller role than in cervical cancer (~2.5% of all HNSCC) Smoking Alcohol use (synergistic with smoking) EBV esp in nasopharyngeal carcinoma Betel nut chewing Gene

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

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: