Oncology

Cancer Statistics

Leading Cancer Cases

Rank Female Male
1 Breast Prostate
2 Lung Lung
3 Colorectal Colorectal
4 Melanoma Melanoma

Leading Cancer Deaths

Rank Female Male
1 Lung Lung
2 Colorectal Colorectal
3 Pancreas Pancreas
4 Breast Prostate

Cancer Screening

Cancer Population Age (years) Tests Interval (years)
Breast All 50 ~ 75 Mammography 2
Cervical All 20 ~ 65 Pap smear 3
  All 30 ~ 65 Pap smear
HPV testing		 5
Colon All 50 ~ 75 Fecal occult blood testing 1
      Sigmoidoscopy 5
      Colonoscopy 10
Lung Smoker 50 ~ 80 Low-dose CT 1

Earlier Cancer Screening

  • Breast: 10 years earlier than the first affected relative
  • Cervical: 3 years after first sexual activity
  • Colon: 10 years earlier than the first affected relative

Oncogenes

Gene Products Tumors
ABL1 Tyrosine kinase CML
BCL2 Anti-apoptotics Follicular lymphoma
BRAF Serine/Threonine kinase (STK) Melanoma
EGFR
[HER1]
[ERBB1]		 Tyrosine kinase Non-small cell lung cancer (NSCLC)
Colorectal cancer
NEU
[HER2]
[ERBB2]		 Tyrosine kinase Breast cancer
C-KIT Tyrosine kinase Gastrointestinal stromal tumor (GIST)
C-MYC Transcription factor Burkitt lymphoma
L-MYC Transcription factor Small cell lung cancer (SCLC)
N-MYC Transcription factor Neuroblastoma
KRAS GTPase Lung cancer
Colorectal cancer
Pancreatic cancer
RET Tyrosine kinase MEN 2A & 2B

Tumor Suppressor Genes

Gene Products Tumors
APC WNT inhibitors Familial adenomatous polyposis (FAP)
ATM DNA repair Ataxia telangiectasia
BRCA DNA repair Breast cancer
Ovarian cancer
ERCC DNA repair Xeroderma pigmentosum
FANC DNA repair Fanconi anemia
MEN1 Menin MEN 1
MLH1
MSH2		 DNA repair Lynch syndrome
NF1 RAS inhibitors Neurofibromatosis (NF) type 1
NF2 Cytoskeleton Neurofibromatosis (NF) type 2
P16 CDK inhibitors Melanoma
P53 Transcription factor for P21 Li-Fraumeni syndrome
PTEN PI3K inhibitors Breast cancer
Prostate cancer
Endometrial cancer
RB E2F inhibitors Retinoblastoma
Osteosarcoma
TSC1
TSC2		 Hamartin
Tuberlin		 Tuberous sclerosis
VHL HIF inhibitors Von Hippel-Lindau (VHL) disease
WT1
WT2		 - Wilms tumor

Tumor Markers

Marker Tumors
5-HIAA Carcinoid tumors
AFP Hepatocellular carcinoma
Germ cell tumors (GCT)
ALP Bone metastasis
Liver metastasis
Seminoma
CA 125 Ovarian cancer
CA 15-3
CA 27-29		 Breast cancer
CA 19-9 Pancreatic adenocarcinoma
CEA Colorectal cancer
Pancreatic adenocarcinoma
Calcitonin Medullary thyroid carcinoma
Chromogranin
Synaptophysin
NSE		 Neuroendocrine tumors (NET)
Desmin Myoma
Myosarcoma
GFAP Glioma
Glioblastoma
Schwannoma
hCG Hydatidiform moles
Germ cell tumors (GCT)
HVA
VMA		 Pheochromocytoma
Keratin Carcinoma
Neurofilament Neuroblastoma
PSA Prostate cancer
S-100 Neural crest tumors
Histiocytosis
TRAP Hairy cell leukemia
Vimentin Sarcoma

Paraneoplastic Syndromes

Syndrome Cancer
ACTH Small cell carcinoma
hCG Large cell carcinoma
Lambert-Eaton myasthenic syndrome Small cell carcinoma
Myasthenia gravis Thymoma
PTHrP Squamous cell carcinoma
Renal cell carcinoma
SIADH Small cell carcinoma
Acanthosis nigricans Visceral malignancy
Erythema nodosum Non-Hodgkins lymphoma
Migratory thrombophlebitis
Trousseau syndrome		 Pancreatic adenocarcinoma
Necrolytic migratory erythema Glucagonoma
Seborrheic keratosis
Leser-Trélat sign		 Visceral malignancy
Dermatomyositis Malignancy

Cancers Associated with Virus

Virus Cancers
HBV
HCV		 Liver cancer
HPV Cervical cancer
Oropharyngeal cancer
EBV Burkitt lymphoma
CNS lymphoma
Nasopharyngeal cancer
Lymphoproliferative disease
HHV8 Kaposi sarcoma
HTLV T-cell leukemia

Common Bone Metastases

  • Breast cancer
  • Prostate cancer
  • Lung cancer
  • Kidney cancer
  • Thyroid cancer

Workup of Suspected Bone Metastases

Imaging Indications
Bone scan Prostate cancer
Small cell lung cancer
Hodgkin lymphoma
PET Breast cancer
Multiple myeloma
Non-small cell lung cancer
Non-Hodgkin lymphoma

Embryonal Tumors

  • Neuroblastoma
  • Medulloblastoma
  • Pineoblastoma
  • Retinoblastoma
  • Nephroblastoma

Presentation of Neurofibromatosis Type 1

  • Bone dysplasia
  • Cafe-au-lait spots
  • Lisch nodules
  • Neurofibroma
  • Optic glioma
  • Pheochromocytoma

Presentation of Neurofibromatosis Type 2

  • Vestibular schwannoma :: bilateral
  • Cataract
  • Meningioma
  • Ependymoma

Presentation of Tuberous Sclerosis {HAMARTOMAS}

  • Hamartoma
  • Angiofibroma
  • Mitral regurgitation
  • Ash-leaf spot
  • Rhabdomyoma :: heart
  • Tubers :: cortex
  • Autosomal dominant
  • Mental retardation
  • Angiomyolipoma :: kidney
  • Seizure
  • Shagreen patch

Presentation of Sturge-Weber Syndrome {STURGE-L}

  • Sporadic
  • Stain :: nevus flammeus
  • Tram-track calcification
  • Unilateral
  • Retardation
  • GNAQ gene
  • Glaucoma
  • Epilepsy
  • Episcleral hemangioma
  • Leptomeningeal angiomatosis

Presentation of von Hippel-Lindau (VHL) Disease {HARP}

  • Hemangioblastoma
  • Angiomatosis
  • Renal cell carcinoma (RCC)
  • Pheochromocytoma

Li-Fraumeni [SBLA] Syndrome {SBLA}

  • Sarcoma
  • Breast cancer
  • Leukemia
  • Adrenal tumor

Syndromes Associated with Wilms Tumor

WAGR Syndrome {WAGR}

  • Wilms tumor [Nephroblastoma]
  • Aniridia
  • Genitourinary anomaly
  • Retardation

Beckwith-Wiedemann Syndrome

  • Macrosomia
  • Macroglossia
  • Hemihyperplasia
  • Organomegaly
  • Abdominal wall defects
  • Wilms tumor [Nephroblastoma]
  • Embryonal tumors

Syndromes Associated with Colorectal Cancer

Gardner Syndrome

  • Familial adenomatous polyposis (FAP)
  • Osteomas
  • Soft tissue tumors
  • Congenital hypertrophy of retinal pigment epithelium (RPE)
  • Impacted / Supernumerary teeth

Turcot Syndrome

  • Colorectal cancer
    • Familial adenomatous polyposis (FAP)
    • Hereditary nonpolyposis colorectal cancer (HNPCC)
  • CNS tumors
    • Medulloblastoma
    • Glioma

Lynch Syndrome

  • Hereditary nonpolyposis colorectal cancer (HNPCC)
  • Endometrial cancer

Target Therapy

Mechanism Medication Indications
BRAF inhibitors Vemurafenib Melanoma
C-KIT inhibitors Imatinib Gastrointestinal stromal tumor (GIST)
EGFR inhibitors Cetuximab Colorectal cancer
  Gefitinib
Erlotinib		 Non-small cell lung cancer (NSCLC)
HER2 inhibitors Trastuzumab Breast cancer
VEGF inhibitors Bevacizumab Solid tumors
VEGFR inhibitors Sunitinib
Sorafenib		 Cancer
  Regorafenib Colorectal cancer (CRC)

Immunotherapy

Mechanism Medication
TLR7 activators Imiquimod
CTLA-4 inhibitors Ipilimumab
PD-1 inhibitors Nivolumab
Pembrolizumab
PD-L1 inhibitors Atezolizumab
Avelumab
Durvalumab

Side Effects of Chemotherapy

Side Effect Drugs
Immunosuppression -
Marrow toxicity -
Nephrotoxicity Platinums
Ototoxicity Platinums
Neurotoxicity Nitrosoureas
Platinums
Vincas
Taxanes
Cardiotoxicity Anthracyclines
Trastuzumab
Pulmonary fibrosis Bleomycin
Busulfan
Hemorrhagic cystitis Cyclophosphamide

Cancers Treated with Radiotherapy Only

Mnemonic Cancer
O Oral
N Nasopharyngeal
L Laryngeal
Y Lymphoma
Cure Cervical
Possible Prostate