The Quizzes about Oncology – Part 2 (20 test)

Age, history of smoking, and polycythemia in a patient with hematuria strongly suggests a renal cell carcinoma. The elevated hemoglobin represents increased erythropoietin production and is not related to prognosis. Involvement along the renal vein and metastases to the lungis also characteristic of renal cell carcinoma. Elevated liver enzymes and weight loss can represent nonmetastatic effects of malignancy and can reverse with resection. Almost half of patients will have a palpable abdominal mass on presentation. The CT of the thorax is a useful test because three-quarters of those with metastatic disease will have lung metastases

Breast-conserving surgery is now recommended for small tumors. Radiation therapy will decrease local recurrence rates. For tumors <1 cm, adjuvant therapy is indicated only if axillary nodes are positive. Therefore, in this case, an axillary dissection will provide important therapeutic information. However, this is an area of rapidly changing knowledge and practice.

Patients with adenocarcinoma of unknown origin are typically elderly and have metastatic tumors at many sites. Generally, the prognosis is poor, but some subsets, in which effective treatment is available, can be identified by clinical criteria with only moderate investigations. These include peritoneal carcinomatosis in women (responds to treatment for ovarian cancer), predominant skeletal metastases in men (can reflect prostatic cancer), and women with axillary lymphadenopathy (can reflect breast cancer). In the latter scenario, studies for estrogen and progesterone receptors are very useful in guiding therapy.

When men and women of all ages are considered, cardiovascular diseases are the most common cause of death. However, among women age 35–74 years, cancer is the leading cause of death. Lung cancer is the number one cause of death from cancer, when both men and women are considered. Men generally have higher incidence rates for cancer: breast, gallbladder, and thyroid cancers are the exceptions. It is felt that 75–80% of all cancers in the United States are due to environmental factors. The environmental contribution is estimated by comparing age-adjusted U.S. rates of specific cancers to the rates for the country with the lowest risk.

Barrett’s esophagus, characterized by a columnar cell-lined esophageal mucosa, is a major risk factor for adenocarcinoma of the esophagus. Although acid reflux may be a predisposing factor, there is no evidence that either medical or surgical antireflux measures alter the outcome. It is found in about 20% of patients undergoing endoscopy for esophagitis, and up to 50% may develop a malignancy.

Worldwide, the presence of liver flukes (e.g., Clonorchis sinensis) is the most likely predisposing factor for cholangiocarcinoma. Part of this increased risk is caused by the development of hepatolithiasis. The highest rate of cholangiocarcinoma is found in Southeast Asia. It is thought that liver flukes and a diet high in nitrosamine are the prime reasons for this. In North America, primary sclerosing cholangitis and chronic ulcerative colitis are the most common predisposing factors. Cholelithiasis, alcohol, smoking, and chronic hepatitis B are not known to be risk factors.

The size of the tumor is a prognostic factor, as is knowing menopausal status, endocrine receptor status, and lymph node involvement. These four factors are used to decide who will benefit from adjuvant chemotherapy, radiotherapy, or tamoxifen treatment.

Observation alone is adequate for this lesion. The “ABCD” rules are helpful in distinguishing benign skin lesions from malignant melanoma. (A) asymmetry, benign lesions are symmetric; (B) border irregular, most nevi have clear-cut borders; (C) color variation, benign lesions have uniform color; (D) diameter, >6 mm is more likely to be malignant. In addition, recent rapid change in size is also helpful in distinguish benign from malignant lesions. Thickness of the tumor is the most important prognostic factor in the majority of cases, and ulceration indicates a more aggressive cancer with a poorer prognosis. Although cumulative sun exposure is a major factor in melanoma (e.g., more frequent near the equator), it cannot explain such things as the more common occurrence of some types in relatively young people. It is possible that brief, intense exposure tosunlight may contribute to, or initiate, carcinogenic events.

Prognosis of patients with non-Hodgkin’s lymphoma is best assessed with the International Prognostic Index. It is an index with five clinical risk factors that helps to predict the 5-year survival. Poor prognostic factors are age >60 years, high serum LDH level, poor performance status (either Eastern Cooperative Oncology Group [ECOG] >2, or Karnofsky <70), Ann Arbor stage III or IV, or >1 extranodal involvement.

IgG spikes >3.5 g/dL or IgA >2 g/dL strongly suggest myeloma rather than monoclonal gammopathies of undetermined significance (MGUS). MGUS is suggested when the spike is <3.5 g/dL, the marrow has fewer than 10% plasma cells, and the Bence Jones proteinuria is <1.0 g/day. Depressed hemoglobin levels, elevated calcium levels, progressive bone lesions, and impaired renal function suggest more advanced stages of multiple myeloma.

Native Americans of both sexes have low cancer rates, but cancer rates (for women) for stomach, biliary tract, cervix, and kidney are surprisingly high.

Whites have high rates for melanoma, lymphoma, leukemia, and lip cancer.

Whites have high rates for breast, corpus uteri, testis, bladder, brain, colon, and rectum cancer.

Although Hispanic Americans have relatively low cancer rates (66% of that for White Americans and 54% of that for Black Americans), they do have high rates for cancer of the cervix.

Chinese Americans have a rate of nasopharyngeal cancer 23 times greater than White Americans and liver cancer rates 7 times greater than White Americans.

Japanese Americans have a threefold increase in stomach cancer rate compared to White Americans, but this is lower than rates in Japan.

The excess risk of cancers of the stomach, esophagus, lung, and cervix among Black Americans is diminished when socioeconomic variations are factored in.

Alcoholic beverages combine with tobacco smoking to increase cancer of the mouth and, by causing cirrhosis, can lead to liver cancer

Asbestos exposure causes more deaths from lung cancer (two-fold increase) than from mesothelioma (hundredfold increase) because the latter tumor is so rare.

Sun exposure severe enough to cause sunburn is associated with increased risk of melanoma, whereas other skin cancers are more related to cumulative exposure.