When breast cancer is suspected, pursue it until it is diagnosed. Do NOT let a normal mammogram or ultrasound talk you out of further pursuing the diagnosis.   Always biopsy a breast lump (ultimately).  You might “follow” a breast lump in a pre-menopausal woman to check for hormonal variations in the lump.         [...]

G-CSF allows patients to: better tolerate chemotherapy and decreased febrile neutropenic infections The meta-analysis could not determine with statistical significance whether patients treated with G-CSF lived longer or remained cancer-free for longer than those in the control group. In the end, this may also impact the: length of hospital stay. The fact that G-CSF helps [...]

Types of Breast Nipple Discharge Discharge color Duct involvement Risk Evaluation Milky more than one galactorrhea due to medicines or anovulation confirm fat globules in the discharge, draw a serum TSH and prolactin for thyroid and hypothalamic disorders Clear, watery or yellowish one duct breast cancer or fibrocystic breast condition exam, mammogram, ductogram and cytology [...]

Acoustic neuromas are intracranial, extra-axial tumors that arise from the Schwann cell sheath investing either the vestibular or cochlear nerve.  Acoustic tumors, like other space-occupying lesions, produce symptoms by any of 4 recognizable mechanisms: (1) compression or distortion of the spinal fluid spaces, (2) displacement of the brain stem, (3) compression of vessels producing ischemia [...]

Features of Basal Cell Carcinoma and Lesions of Similar Appearance Lesion Location Surface Color Outline Other features Basal cell carcinoma Most common on face, but can occur anywhere Raised, pearly, firm Normal skin color Round at first, irregular later May ulcerate Superficial basal cell carcinoma Any location Roughened Skin-colored or pink Round or irregular Resembles [...]

Features of Squamous Cell Carcinoma and Lesions of Similar Appearance   Lesion Location Surface Color Outline Other features Squamous cell carcinoma Areas exposed to sunlight, radiation or arsenicals Rough, irregular, sometimes scaly, sometimes has visible vessels, sometimes warty or with fleshy masses Skin-colored at first, sometimes reddened later Vague New lesions may appear near old [...]

Hepatocellular carcinoma (HCC) is a primary malignancy of the liver. Hepatocellular carcinoma is now the third leading cause of cancer deaths worldwide, with over 500,000 people affected.  The incidence of hepatocellular carcinoma is highest in Asia and Africa, where the endemic high prevalence of hepatitis B and hepatitis C strongly predisposes to the development of [...]

Patients with porcelain gallbladder are usually asymptomatic, and the condition is usually found incidentally on plain abdominal radiographs, sonograms, or computed tomography (CT) images. Surgical treatment of porcelain gallbladder is based on results from studies performed in 1931 and 1962, which revealed an association between porcelain gallbladder and gallbladder carcinoma. Porcelain gallbladder is an uncommon [...]

5-Fluorouracil remains the backbone of chemotherapy regimens for colon cancer, both in the adjuvant and metastatic setting. In the past 10 years, it was established that combination regimens provide improved efficacy and prolonged progression-free survival in patients with metastatic colon cancer. In addition to 5-fluorouracil, oral fluoropyrimidines such as capecitabine (Xeloda) and tegafur are increasingly [...]

The American Society of Clinical Oncology (ACOG) has updated their practice guidelines regarding pharmacologic intervention for breast cancer risk reduction. Some of the highlights are are listed below: Tamoxifen use for 5 years reduces risk for at least 10 years in premenopausal women, particularly estrogen receptor (ER) – positive invasive tumors. Women 50 years or [...]

The BRCA1 and BRCA2 gene mutations, on chromosome 17 and 13, respectively, account for the majority of autosomal dominant inherited breast cancers. Both genes are believed to be tumor suppressor genes whose products are involved with maintaining DNA integrity and transcriptional regulation. Mutation rates may vary by ethnic and racial groups. For BRCA1 mutations, the [...]

Monoclonal proliferation of plasma cells of unknown cause Median age at diagnosis is 68 and is rare before 40. Bone pain is most common symptom (70%) (back and ribs). Bone lesions are typically osteolytic (activation of osteoclasts). Hypercalcemia is a common sign. Renal failure (due to light chain proteinuria, hypercalcemia, etc.) Anemia (due to myelophthisis) [...]

Most common leukemia. B cell origin. Usually asymptomatic lymphocytosis (median age 60 years) Lymphadenopathy and splenomegaly are also prominent features. Must exclude reactive lymphocytosis (usually normal T-cells). Initial observation is generally recommended (due to benign course). If needed, specific therapy includes Chlorambucil +/- prednisone. Fludarabine, pentostatin, and cladribine are also very active in CLL. Symptomatic [...]

Patients usually present with signs of marrow failure (anemia, thrombocytopenia, and neutropenia). CNS often affected (particularly as a site of relapse) Uric acid nephropathy – due to high cell turnover (and tumor cell lysis during therapy) Therapy includes induction, consolidation, CNS prophylaxis, and maintenance therapy. Anthracycline with vincristine and prednisone induce complete remission in 85% [...]

Most common of indolent lymphomas (50% of all non-Hodgkin’s) Patients usually present with painless peripheral adenopathy. Adenopathy frequently present for years Adenopathy has “waxed and waned”. Survival for stage III and IV is 7-9 years. Other indolent lymphomas are marginal zone lymphomas and mycosis fungoides.

Less than 30% of marrow blasts defines chronic (>30%=acute). The chronic myeloproliferative disease includes chronic myelogenous leukemia (CML), polycytemia vera, agnogenic myeloid metaplasia, and essential thrombocytopenia. Only CML has (90-95%) Philadelphia chromosome (translocation of part of the 22 chr. To 9 chr.- 22 chr.stays short). Disease may accelerate and undergo blast crisis (turns acute ML). [...]

Mostly male patients over 40 years of age Most common clinical presentation is pancytopenia and splenomegaly. Usually indolent course (median survival over 4 years) Tartarate-resistant acid phosphatase (TRAP) positive CD11c positive malignant B-cells Therapy with purine analogs (pentostatin, cladribine) highly effective regardless of the cell burden or previous therapy (durable complete remissions in 90% of [...]