AOCNP cheat sheet

Hallmarks of cancer include sustained proliferative signaling, evasion of growth suppressors, resistance to apoptosis, replicative immortality, angiogenesis induction, tissue invasion and metastasis, and immune evasion.

Oncogenes are gain-of-function drivers that act dominantly (for example RAS, MYC, HER2); tumor suppressors such as TP53, RB1, and APC generally require loss of both alleles to remove growth restraint.

TNM staging classifies T by primary tumor size or invasion, N by regional lymph node involvement, and M by distant metastasis; the combined stage guides prognosis and treatment selection.

Grade describes tumor cell differentiation and is distinct from stage; well-differentiated low-grade tumors generally have a better prognosis than poorly differentiated high-grade tumors.

The cell cycle proceeds G1 to S DNA synthesis to G2 to M; G1/S and G2/M checkpoints verify DNA integrity, and loss of checkpoint control permits mutation accumulation.

Tumor markers such as AFP, CA-125, CEA, and PSA are not diagnostic alone; they are most useful for monitoring disease and in defined screening contexts.

Paraneoplastic syndromes include SIADH with small cell lung cancer, hypercalcemia with squamous cell lung cancer and myeloma, Cushing syndrome from ectopic ACTH, and Eaton-Lambert syndrome with small cell lung cancer.

Metastasis occurs through lymphatic or hematogenous spread, with lung, liver, bone, and brain as common distant sites; carcinogenesis is a multistep process of initiation, promotion, and progression.

Breast cancer screening uses mammography at intervals of 1 to 2 years for average-risk women in their 40s to 70s, with supplemental MRI reserved for appropriately defined high-risk groups.

Average-risk colorectal cancer screening begins at age 45 with colonoscopy every 10 years or annual FIT; hereditary syndromes and family history require earlier and more intensive screening.

Cervical cancer screening uses HPV testing every 5 years or co-testing every 5 years from ages 30 to 65; cytology alone every 3 years is an option for ages 21 to 29.

Annual low-dose CT lung cancer screening is recommended for adults aged 50 to 80 with at least a 20 pack-year history who currently smoke or quit within 15 years, after shared decision-making.

Prostate cancer screening with PSA is a shared decision for men aged 55 to 69; routine PSA screening is not recommended for men older than 70 or with limited life expectancy.

BRCA1/2 pathogenic variants are autosomal dominant and increase breast and ovarian cancer risk; Lynch syndrome from mismatch repair mutations increases colorectal and endometrial cancer risk.

Sensitivity equals true positives divided by all people with disease; specificity equals true negatives divided by all people without disease; positive predictive value also depends on disease prevalence.

Core needle biopsy is preferred when tumor histology, architecture, or receptor status is needed; fine-needle aspiration is useful for cytology but may not provide tissue architecture.

Surgery provides local control, debulking, or palliation; neoadjuvant therapy is given before surgery to shrink tumor and assess response, while adjuvant therapy follows surgery to eradicate micrometastases.

External beam radiation is commonly fractionated, SBRT delivers high doses in few fractions with precise targeting, and brachytherapy places a radioactive source near or inside the tumor.

Alkylating agents and platinum compounds are cell-cycle nonspecific; antimetabolites act mainly in S phase; taxanes and vinca alkaloids act in M phase.

Targeted therapies include tyrosine kinase inhibitors for EGFR or ALK, monoclonal antibodies such as trastuzumab for HER2 and rituximab for CD20, and angiogenesis inhibitors such as bevacizumab against VEGF.

Immune checkpoint inhibitors targeting PD-1, PD-L1, or CTLA-4 restore antitumor T-cell activity and can cause immune-related adverse events in skin, gut, lung, liver, and endocrine organs.

Hormone therapy includes tamoxifen as a selective estrogen receptor modulator, aromatase inhibitors in postmenopausal estrogen receptor-positive breast cancer, and androgen deprivation therapy in prostate cancer.

Autologous stem cell transplant uses the patient's own stem cells to rescue marrow after high-dose chemotherapy; allogeneic transplant uses donor cells and carries graft-versus-host disease risk.

Clinical trial phases are I for safety and dose finding, II for efficacy, III for comparison with standard therapy, and IV for post-marketing surveillance; RECIST categories are complete response, partial response, stable disease, and progressive disease.

The WHO analgesic ladder advances from non-opioids to weak opioids to strong opioids, with adjuvant agents for neuropathic or bone pain and reassessment after each change.

When converting opioids, calculate the equianalgesic dose, reduce for incomplete cross-tolerance, and reassess; oral morphine to intravenous morphine is approximately 3 to 1.

Highly emetogenic chemotherapy such as cisplatin requires a 5-HT3 antagonist, an NK1 receptor antagonist, and dexamethasone, often with olanzapine added.

Febrile neutropenia is fever of 38.3 C once or 38.0 C sustained with an absolute neutrophil count below 500 cells/microL; obtain cultures and give empiric broad-spectrum antibiotics promptly.

Primary G-CSF prophylaxis is considered when febrile neutropenia risk is approximately 20% or higher; colony-stimulating factors reduce duration and severity of neutropenia.

Tumor lysis syndrome causes hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia; management includes hydration, allopurinol or rasburicase, and electrolyte monitoring.

Hypercalcemia of malignancy is treated with intravenous fluids, a bisphosphonate or denosumab, and calcitonin for rapid lowering; renal function and electrolytes require monitoring.

Hospice is appropriate when prognosis is about 6 months or less and goals focus on comfort; palliative care can be provided concurrently with curative-intent treatment and advance directives guide future care.

A survivorship care plan includes a treatment summary, surveillance schedule, potential late effects, health promotion recommendations, and clear coordination between oncology and primary care.

Anthracycline cardiotoxicity is dose-dependent; baseline and periodic ejection fraction monitoring by echocardiography or MUGA is recommended, especially with additional cardiac risk factors.

Secondary malignancies can follow radiation or chemotherapy, particularly alkylating agents and topoisomerase inhibitors; long-term surveillance depends on prior exposures and age at treatment.

Fertility preservation should be discussed before gonadotoxic therapy; options include sperm banking, oocyte or embryo cryopreservation, and possibly ovarian suppression during treatment.

Distress should be screened at diagnosis and at intervals with a validated tool such as the NCCN Distress Thermometer; significant distress affects adherence and quality of life and warrants referral.

Lymphedema risk rises after axillary surgery or regional radiation; monitoring arm circumference, skin care education, gradual exercise, and early referral for compression or physical therapy are recommended.

Chemotherapy-induced peripheral neuropathy from taxanes, platinum agents, and vinca alkaloids requires assessment of sensation, gait, falls, and function, with treatment adjustment when symptoms are severe.

Surveillance after curative treatment follows site-specific guidelines and avoids unnecessary imaging; multidisciplinary coordination and timely handoff to primary care support long-term survivorship.