Oncology Course - Tumors and Cancers

Describe acute lymphoblastic leukemia, emphasizing 80% b-cell cases and t-cell variants with thymus enlargement. Note associations with down syndrome, ataxia telangiectasia, and neurofibromatosis type 1, and cd10, cd19, cd20 markers.

Explore how red blood cell shapes change in disease, from acanthocytes and teardrop cells to schistocytes and target cells, with basophilic stippling and sideroblasts.

Multiple myeloma arises from bone marrow plasma cells overproducing immunoglobulins IgG and IgA, causing anemia, lesions, hypercalcemia, renal failure, and rouleaux formation; diagnosed by electrophoresis and treated with chemotherapy.

Assess palpable breast masses by age: ultrasound under 30 and mammogram over 30. Simple cysts require no treatment unless symptomatic; complex or suspicious lesions need image-guided core biopsy.

Explore risk factors for breast and ovarian cancers, including alcohol use (one drink per week), oral contraceptives protect against ovarian cancer, hormonal therapy, early menarche, late menopause, and BRCA testing.

Identify breast mass types from infection-driven abscesses to cysts, fat necrosis, fibroadenoma, and lipoma. Highlight fibrocystic cyclic changes, intraductal papillary malignancy with bloody nipple discharge, and pill-related tenderness.

Identify the thyroid nodules spectrum from benign adenomas to carcinomas, noting papillary features like Orphan Annie nuclei and nuclear grooves, follicular and medullary invasion patterns, and anaplastic prognosis.

Order TSH and T4, use ultrasound to distinguish cold from hot nodules, and apply fine-needle aspiration for nodules over 1 cm or with malignant features; use radioiodine uptake for lesions.

Pheochromocytoma arises from neural crest-derived adrenal medulla chromaffin cells, causing hypertension from epinephrine/dopamine; diagnose via metanephrines and chromogranin or enolase; treat with alpha blockade, then beta blockade, and tumor removal.

Incise the skin, reflect the platysma, separate the strap muscles to expose the thyroid, locate the inferior thyroid artery near the gland, and protect the recurrent laryngeal nerve.

Explore bacterial genetics, including transposition between chromosome and plasmid, conjugation of F plasmids, transformation with naked DNA and antibiotic resistance, and phage-mediated transduction with lytic and lysogenic outcomes.

Explore key bacterial virulence factors, including protein A and M, immunoglobulin protease, injectisome, serpentine cord factor, sulfatides, and the K capsule, and their roles in preventing phagocytosis and forming granulomas.

Explore how hepatitis B and C drive liver cancer, Helicobacter pylori drives gastric cancer, Clonorchis flukes drive gallbladder cancer, and HTLV, EBV, HIV, herpes, HPV relate to cancers and warts.

Prevent HPV-related genital warts by vaccination, and address non-cancerous, highly contagious infections with treatments such as excision, cryotherapy, or topical agents, noting high recurrence and no cure.

Follow the hepatitis B infection curve from initial replication to antibody response, highlighting rising surface antigen and anti-core antibodies, the window period, and outcomes of becoming immune or chronically infected.

Explore hepatitis B therapy through a mnemonic guide to key antivirals—Interferon as a last resort due to side effects, and Lamivudine, Adefovir, Telbivudine, Tenofovir, and Entecavir.

Treat only acute Hepatitis C; genotype determines prognosis. Vaccinate after therapy and monitor RNA at 3 and 6 months to confirm eradication; regimens include Sofosbuvir plus partner, Ombitasvir–Paritaprevir–Dasabuvir, or Elbasvir–Grazoprevir.

Explore hepatitis viruses a through e, including transmission routes (a/e fecal-oral; others via blood), liver failure risk, incubation, and cancer risks.

Initiate folate inhibitors for pcp prophylaxis at cd4 count 100. Use itraconazole for histoplasmosis at 150 in endemic areas, and toxoplasmosis prophylaxis at 100 with antibodies, plus herpes zoster prophylaxis.

Assess resistance before starting HIV therapy, start a regimen with two RTIs and one integrase inhibitor, and switch to second-line options if viral load remains detectable after six months.

Explore herpesviruses from herpes simplex virus types 1 and 2 to varicella zoster virus, Epstein-Barr virus, cytomegalovirus, roseola infantum, and Kaposi sarcoma, detailing transmissions and hallmark symptoms.

Describe how HPV spreads by skin-to-skin contact, differentiate wart-causing from cancer-causing genotypes, and summarize vaccination and cervical cancer risk prevention.

Explore antigenic shift through reassortment and co-infection, and compare it with antigenic drift; identify the four virus groups—bunyavirus, orthomyxovirus, arenavirus, and reovirus—and describe phenotypic mixing, recombination, and complementation.

Understand how colorectal cancer is common and presents with bowel changes, blood in stool, abdominal pain, and weight loss, progressing from stage zero to four starting as polyps.

Explore glucagonoma, a tumor that raises glucagon and other stress hormones, and presents with necrolytic migratory erythema, glossitis, cheilitis, weight loss, diabetes, deep vein thrombosis, and depression.

Identify liver failure signs, including jaundice, itchiness, spider angiomas, edema, varices, ascites, and progression to cirrhosis, including hepatorenal syndrome, hepatic encephalopathy, and pregnancy, alcoholic, or non-alcoholic hepatitis.

Explore adult CNS tumors including glioblastoma multiforme with butterfly glioma and oligodendroglioma with calcifications, chicken wire capillaries, and fried egg cells.

Identify cauda equina syndrome from compression below L2 by recognizing saddle anesthesia and the triad of sensory loss, reflex loss, and bladder dysfunction; initiate urgent steroids and surgical decompression.

Identify childhood brain tumors including pilocytic astrocytoma of the cerebellum, craniopharyngioma with calcifications, ependymoma of the fourth ventricle, medulloblastoma with drop metastasis, and pinealoma with Parinaud's syndrome and beta HCG.

Differentiate central vertigo from peripheral vertigo by noting brain stem or cerebellar tumors causing skew deviation, versus inner ear or cranial nerve eight causes with delayed horizontal nystagmus.

Explore vertigo diseases including hydrops endolymph, vestibular schwannoma, benign paroxysmal positional vertigo, endolymph fistula, labyrinthitis, vestibular neuritis, and multiple sclerosis, with audiometry and MRI to differentiate.

Explore the diaphysis, metaphysis, and epiphyses and their cancers: osteoid osteoma in the shaft, Ewing sarcoma, osteosarcoma in metaphysis, and giant cell tumors in epiphyses; treatments include resection and chemo.

Paget disease is localized remodeling with osteoclast-driven resorption followed by abnormal osteoblast-driven woven bone, producing mixed woven and lamellar bone and risks like chalk stick fractures and high-output heart failure.

Compare current chest x-ray with prior images to distinguish fibrous tissue from cancer, guiding follow-up or CT. If CT is inconclusive, biopsy—bronchoscopic for central lesions, percutaneous for peripheral.

Differentiate central and peripheral lung cancers: central squamous cell carcinoma in smokers with keratin pearls and parathyroid hormone–related peptide–driven hypercalcemia, and peripheral adenocarcinoma and large cell carcinoma with paraneoplastic hormones.

Explore actinic keratosis, a sun-exposed pre-malignant lesion with dysplasia that raises squamous cell carcinoma risk, and learn treatments from avoidance, topical therapies, cryotherapy, surgical excision, scraping, and photodynamic therapy.

Understand angiosarcoma as a malignant vascular cancer that often presents late and requires surgery, radiation, and chemotherapy, with risk factors including prior radiation and lymphedema, and metastasis worsens prognosis.

Identify bacillary angiomatosis caused by Bartonella in immunocompromised patients, presenting as pedunculated, red vascular lesions on skin and organs; treat with antibiotics and screen for immunosuppressive diseases.

Basal cell carcinoma is the most common skin cancer from sun exposure, typically on the face with an ulcerated center and rolled borders; Mohs surgery ensures complete removal with margins.

Cherry hemangiomas are common 2–4 mm vascular lesions that may appear singly or in groups; diagnosis is clinical, and removal by electrodesiccation, liquid nitrogen, or laser therapy may recur.

The glomus tumor is a painful lesion under the nail bed, arising from glomus bodies that regulate temperature, usually benign, diagnosed clinically and confirmed by biopsy, with surgery curative.

Kaposi's sarcoma is malignant endothelial cancer linked to HIV or HHV-8, presenting as reddish lesions from lips to skin, GI tract, or lungs; lymphocyte infiltrates differentiate it from bacillary angiomatosis.

Keratoacanthoma sits at the edge between benign and cancerous lesions, with rapid keratin-filled cell growth. It forms a horn, may regress spontaneously, and can transform into squamous cell carcinoma.

Explore pyogenic granuloma, a blood-rich polypoid lesion that often arises after trauma or during pregnancy and can bleed, with surgical excision or laser therapy as the gold standard.

Identify melanoma as a sun-exposed skin cancer. Apply the abcde criteria—asymmetry, borders, color, diameter, evolution—for assessment, with full-thickness biopsy and excision; for metastasis, use immune therapies.

Squamous cell carcinoma is the second most common skin cancer, linked to sun exposure, trauma, burns, and arson exposure, presenting as a scaly ulcer on sun-exposed areas, with keratin pearls.

Grow rapidly in newborns and infants, strawberry hemangiomas are benign capillary lesions that spontaneously regress over years and may involve any organ and require no treatment.