Egyptian Board Clinical Oncology cheat sheet

Cytotoxic classes by mechanism: alkylators (cyclophosphamide, ifosfamide, cisplatin) cross-link DNA; antimetabolites (methotrexate, 5-FU, gemcitabine, pemetrexed) block nucleotide synthesis; topoisomerase I inhibitors (irinotecan, topotecan) and II inhibitors (etoposide, doxorubicin); taxanes stabilize microtubules; vinca alkaloids depolymerize them.

Rescue and toxicity antidotes: leucovorin for high-dose methotrexate, mesna for ifosfamide/cyclophosphamide hemorrhagic cystitis, dexrazoxane for anthracycline extravasation/cardiotoxicity, amifostine for radiation xerostomia, rasburicase for tumor lysis hyperuricemia (contraindicated in G6PD deficiency).

Anthracyclines: cumulative doxorubicin cardiotoxicity risk rises above 400-450 mg/m2 (lower with mediastinal radiation, age >65, prior trastuzumab); monitor LVEF by echocardiography or MUGA at baseline and periodically.

Cisplatin requires aggressive hydration with mannitol or saline diuresis; nephrotoxicity, ototoxicity, peripheral neuropathy, severe emesis (give 5-HT3 antagonist + NK1 antagonist + dexamethasone + olanzapine). Carboplatin dosed by Calvert formula: total dose (mg) = target AUC x (GFR + 25).

Targeted agents and their class: trastuzumab/pertuzumab (HER2 monoclonal antibodies), lapatinib/tucatinib (HER2 TKIs), imatinib (BCR-ABL/KIT), osimertinib (EGFR T790M), crizotinib/alectinib (ALK), bevacizumab (VEGF-A), ramucirumab (VEGFR2), olaparib/niraparib (PARP inhibitors, synthetic lethality in BRCA1/2).

Immune checkpoint inhibitors: ipilimumab (anti-CTLA-4), nivolumab/pembrolizumab/atezolizumab/durvalumab (anti-PD-1/PD-L1). Immune-related adverse events include colitis, pneumonitis, hepatitis, thyroiditis, hypophysitis; grade 3-4 events require holding drug and high-dose corticosteroids (1-2 mg/kg prednisone equivalent).

Common toxicity profiles: bleomycin pulmonary fibrosis; busulfan veno-occlusive disease; vincristine dose-capped at 2 mg and neurotoxic (fatal if given intrathecally); 5-FU/capecitabine hand-foot syndrome and coronary vasospasm; oxaliplatin cold-induced neuropathy; methotrexate mucositis and hepatotoxicity.

Antiemetic prophylaxis by emetogenicity: highly emetogenic regimens need 5-HT3 antagonist + dexamethasone + NK1 receptor antagonist (aprepitant) + olanzapine; moderately emetogenic need 5-HT3 + dexamethasone ± NK1. Delayed emesis (24-120 h) after cisplatin is controlled mainly by dexamethasone and aprepitant.

Drug dosing adjustments: carboplatin by AUC and renal function; methotrexate requires renal function and third-space assessment; doxorubicin capped by cumulative dose; capecitabine reduced for CrCl <30; vincristine never dose-reduced for hepatic dysfunction without caution because neurotoxicity predominates.

Radiation units: 1 Gy = 1 J/kg = 100 cGy = 100 rad; 1 Sv = 100 rem. Absorbed dose measures energy deposited; equivalent dose weights for radiation type (alpha particles and neutrons have higher weighting than photons).

Fractionation biology (4 R's): repair of sublethal damage, redistribution through the cell cycle, repopulation, and reoxygenation. Standard fractionation is 1.8-2 Gy per fraction; hyperfractionation uses smaller doses more often; hypofractionation uses larger doses per fraction (e.g., 42.56 Gy in 16 fractions for whole breast).

Linear accelerator produces megavoltage photons (6-18 MV) or electrons; superficial lesions (skin, chest wall) use electrons or orthovoltage. Inverse square law: dose falls with the square of distance from the source.

Target volume definitions (ICRU): GTV is gross visible tumor, CTV adds microscopic spread, PTV adds setup/positioning margin, ITV accounts for internal organ motion. Organs at risk (OAR) constrain dose.

Techniques: 3D conformal radiotherapy, IMRT (intensity-modulated, improves OAR sparing), VMAT (volumetric arc), SBRT/SABR (high dose per fraction, typically 1-5 fractions for small tumors), IGRT (image guidance with CBCT or fiducials), proton therapy (Bragg peak, sharp distal falloff).

Tolerance doses: spinal cord max ~45-50 Gy (2 Gy/fraction); whole-lung V20 <30-35%; mean heart dose kept low in breast/lymphoma; parotid mean dose <26 Gy to reduce xerostomia; kidney bilateral tolerance ~20-23 Gy; liver mean dose <30-32 Gy.

Emergencies treated with urgent RT: spinal cord compression (single 8 Gy or 20 Gy in 5 fractions), superior vena cava syndrome, tumor bleeding, brain metastases (whole-brain 30 Gy in 10 fractions or 20 Gy in 5 fractions).

Radiotherapy indications by site: adjuvant breast after breast-conserving surgery, post-mastectomy chest wall with high-risk features, definitive chemoradiation in locally advanced NSCLC, limited-stage SCLC (45 Gy twice daily or 60-66 Gy once daily with concurrent cisplatin/etoposide), head and neck definitive 70 Gy with concurrent cisplatin.

Acute versus late effects: acute (during and weeks after) include mucositis, dermatitis, diarrhea, fatigue; late (months to years) include fibrosis, xerostomia, radiation pneumonitis, radiation myelopathy, second malignancies. Late effects depend on fraction size and total dose.

Molecular subtypes drive therapy: hormone receptor-positive/HER2-negative (endocrine therapy ± CDK4/6 inhibitor), HER2-positive (trastuzumab + pertuzumab + taxane), triple-negative (chemotherapy ± immunotherapy with pembrolizumab in PD-L1-positive disease).

Staging: T size, N nodal status, M distant. Sentinel lymph node biopsy is standard for clinically node-negative axilla; axillary dissection for positive nodes or after neoadjuvant therapy depending on protocol.

Adjuvant endocrine therapy: tamoxifen 5-10 years for premenopausal; aromatase inhibitors (anastrozole, letrozole, exemestane) for postmenopausal; ovarian suppression added for high-risk premenopausal women.

HER2-positive early disease: trastuzumab plus pertuzumab with taxane, continued trastuzumab for 1 year; dual blockade improves pathologic complete response in neoadjuvant setting.

Neoadjuvant chemotherapy indications: locally advanced disease, inflammatory breast cancer, HER2-positive or triple-negative tumors to downstage and assess response; residual disease after neoadjuvant therapy may warrant capecitabine (TNBC) or T-DM1 (HER2-positive).

Metastatic disease: sequential endocrine therapy with CDK4/6 inhibitors (palbociclib, ribociclib, abemaciclib) for HR-positive/HER2-negative; alpelisib for PIK3CA-mutated tumors; olaparib/talazoparib for germline BRCA mutations; sacituzumab govitecan for triple-negative.

Bone health: aromatase inhibitors cause bone loss; monitor DXA and give calcium/vitamin D plus bisphosphonate or denosumab in high-risk patients; zoledronic acid or denosumab also reduces skeletal-related events in bone metastases.

Breast-conserving surgery plus radiotherapy gives survival equivalent to mastectomy for early-stage disease; contraindications to BCS include multicentric disease, prior chest radiation, and positive margins after re-excision.

NSCLC staging uses TNM 8th edition; stage I-II resectable, stage III often multimodality (chemoradiation ± surgery), stage IV systemic. Mediastinal staging with EBUS-TBNA or mediastinoscopy before resection.

Molecular testing in advanced non-squamous NSCLC: EGFR mutations (exon 19 deletion, L858R), ALK rearrangement, ROS1, BRAF V600E, KRAS G12C, MET exon 14 skipping, RET, NTRK, and PD-L1 expression. Osimertinib is first-line for EGFR-mutant disease; alectinib for ALK-positive.

Limited-stage SCLC: concurrent chemoradiation with cisplatin/etoposide, radiation 45 Gy twice daily or 60-66 Gy once daily, started early; prophylactic cranial irradiation for responders. Extensive-stage SCLC: platinum/etoposide + atezolizumab or durvalumab.

Malignant pleural mesothelioma: pemetrexed plus cisplatin with bevacizumab or nivolumab/ipilimumab for unresectable disease; pleural drainage and pleurodesis for symptomatic effusions.

Superior vena cava syndrome: facial/upper extremity edema, distended neck veins, often from lung cancer or lymphoma; urgent imaging, tissue diagnosis if possible, and radiotherapy or stent for severe cases.

Malignant pleural effusion management: thoracentesis for diagnosis, indwelling pleural catheter or pleurodesis (talc) for recurrent symptomatic effusion.

Thymoma and thymic carcinoma: surgical resection is cornerstone; adjuvant radiation for invasive or incompletely resected thymoma; platinum-based chemotherapy for advanced disease. Myasthenia gravis association with thymoma.

Pulmonary toxicity of thoracic therapy: radiation pneumonitis typically 1-6 months after completion, treated with corticosteroids; checkpoint inhibitor pneumonitis is a separate immune-related entity requiring drug hold and steroids.

Colorectal cancer: stage II high-risk (perforation, obstruction, T4, poor differentiation, <12 nodes) considered for adjuvant fluoropyrimidine ± oxaliplatin; stage III gets FOLFOX or CAPOX; metastatic disease tested for RAS, BRAF, MSI/dMMR, HER2.

Metastatic CRC first-line: FOLFOX or FOLFIRI plus bevacizumab or anti-EGFR antibody (cetuximab/panitumumab) only if RAS wild-type and left-sided primary. MSI-high/dMMR tumors respond to pembrolizumab or nivolumab.

Gastric and gastroesophageal junction cancer: perioperative FLOT (fluorouracil, leucovorin, oxaliplatin, docetaxel) for resectable disease; HER2-positive metastatic disease receives trastuzumab plus chemotherapy; PD-L1-positive tumors add nivolumab or pembrolizumab.

Esophageal cancer: neoadjuvant chemoradiation (CROSS regimen: carboplatin/paclitaxel with 41.4 Gy) for locally advanced disease; squamous cell carcinoma is more radiosensitive; immunotherapy now used in advanced disease.

Hepatocellular carcinoma: surveillance with ultrasound ± AFP every 6 months in cirrhosis; curative options are resection, transplantation (Milan criteria), and ablation; advanced disease treated with atezolizumab + bevacizumab, lenvatinib, sorafenib, or regorafenib.

Pancreatic adenocarcinoma: resectable disease gets adjuvant modified FOLFIRINOX or gemcitabine/capecitabine; borderline resectable receives neoadjuvant FOLFIRINOX; metastatic first-line FOLFIRINOX or gemcitabine/nab-paclitaxel.

Cholangiocarcinoma: gemcitabine/cisplatin plus durvalumab or pembrolizumab in advanced disease; FGFR2 fusions (pemigatinib) and IDH1 mutations (ivosidenib) are targetable; adjuvant capecitabine after resection.

Anal squamous cell carcinoma: definitive chemoradiation with mitomycin C and 5-FU (Nigro regimen); salvage abdominoperineal resection for persistent or recurrent disease.

Prostate cancer risk stratification uses PSA, Gleason score/Grade Group, and clinical T stage. Low-risk disease may be managed with active surveillance; intermediate/high-risk receive radiotherapy plus androgen deprivation therapy or radical prostatectomy.

Androgen deprivation therapy: GnRH agonists (leuprolide, goserelin) cause initial flare (prevent with antiandrogen), GnRH antagonists (degarelix, relugolix) do not flare. Abiraterone, enzalutamide, apalutamide, darolutamide are androgen receptor pathway inhibitors for castration-resistant and increasingly hormone-sensitive disease.

PSA kinetics: PSA recurrence after prostatectomy is typically >0.2 ng/mL; after radiotherapy, nadir + 2 ng/mL (Phoenix definition). PSA doubling time and Gleason score predict metastatic risk.

Renal cell carcinoma: clear cell histology most common; localized disease treated with partial or radical nephrectomy; metastatic disease uses VEGF TKIs (sunitinib, pazopanib, cabozantinib), immune checkpoint combinations (ipilimumab/nivolumab, pembrolizumab/axitinib), and mTOR inhibitors.

Bladder cancer: non-muscle-invasive disease managed with transurethral resection plus intravesical BCG or mitomycin; muscle-invasive disease treated with neoadjuvant cisplatin-based chemotherapy followed by radical cystectomy or trimodality bladder preservation with chemoradiation.

Metastatic urothelial carcinoma: platinum-based chemotherapy first-line (cisplatin/gemcitabine); maintenance avelumab for responders; erdafitinib for FGFR-altered tumors; enfortumab vedotin and sacituzumab govitecan in later lines.

Testicular germ cell tumors: seminoma versus non-seminoma; orchiectomy followed by surveillance, chemotherapy (BEP: bleomycin, etoposide, cisplatin), or retroperitoneal lymph node dissection depending on stage. Tumor markers are AFP, beta-hCG, and LDH.

Germ cell tumor late effects: bleomycin pulmonary toxicity, cisplatin-related neuropathy and renal impairment, and secondary malignancies; fertility preservation should be addressed before treatment.

Ovarian cancer: most present at advanced stage with ascites and peritoneal carcinomatosis; primary treatment is cytoreductive surgery plus platinum/taxane chemotherapy. BRCA1/2 mutation testing guides PARP inhibitor maintenance (olaparib, niraparib).

Epithelial ovarian cancer subtypes: high-grade serous (most common, TP53 mutated, often BRCA-related), endometrioid, clear cell, mucinous. Germ cell tumors affect younger women and are treated with bleomycin/etoposide/cisplatin (BEP).

Cervical cancer: screening with HPV testing and cytology; early-stage disease treated with radical hysterectomy or radiotherapy; locally advanced disease (stage IB3-IVA) treated with concurrent cisplatin chemoradiation plus brachytherapy; pembrolizumab added for PD-L1-positive advanced disease.

Endometrial cancer: most common gynecologic malignancy; surgery is primary treatment; risk stratification by grade, histology, and myometrial invasion determines adjuvant radiotherapy or chemotherapy. Molecular classification includes POLE, MSI, p53, and NSMP groups.

Gestational trophoblastic disease: beta-hCG is the tumor marker; low-risk disease treated with single-agent methotrexate or actinomycin D; high-risk disease with EMA-CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine).

Vulvar cancer: squamous cell carcinoma, often HPV-related; surgical management with radical local excision and inguinofemoral lymph node assessment; radiotherapy for advanced or node-positive disease.

Gynecologic brachytherapy: intracavitary brachytherapy is essential in cervical cancer treatment, delivering high dose to the tumor while sparing bladder and rectum; dose is prescribed to point A in traditional systems.

Ovarian germ cell and sex cord-stromal tumors: germ cell tumors are chemosensitive with BEP; granulosa cell tumors are treated with surgery and platinum-based chemotherapy, with inhibin as a tumor marker.

Lymphoma classification: Hodgkin lymphoma (Reed-Sternberg cells, CD15/CD30 positive) versus non-Hodgkin lymphoma (B-cell and T-cell). Staging uses Lugano classification with PET-CT.

Hodgkin lymphoma: ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) is standard first-line; brentuximab vedotin and checkpoint inhibitors (nivolumab, pembrolizumab) for relapsed disease; BEACOPP escalated for high-risk advanced disease.

Diffuse large B-cell lymphoma: R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) is standard; CNS prophylaxis for high-risk sites; CAR-T cell therapy (axicabtagene, tisagenlecleucel) for relapsed/refractory disease.

Chronic lymphocytic leukemia: ibrutinib, acalabrutinib, venetoclax, and obinutuzumab are targeted options; FISH for del(17p) and TP53 status guides therapy; Richter transformation to aggressive lymphoma carries poor prognosis.

Multiple myeloma: CRAB criteria (calcium elevation, renal insufficiency, anemia, bone lesions); treatment uses proteasome inhibitors (bortezomib, carfilzomib), immunomodulators (lenalidomide, pomalidomide), anti-CD38 antibodies (daratumumab), and autologous stem cell transplantation for eligible patients.

Acute myeloid leukemia: induction with cytarabine plus anthracycline (7+3); cytogenetics and molecular markers (FLT3, NPM1, IDH1/2) guide targeted therapy (midostaurin, gilteritinib, ivosidenib, enasidenib); allogeneic transplant for high-risk disease.

Hematopoietic stem cell transplantation: autologous transplant uses the patient's own stem cells (myeloma, lymphoma); allogeneic transplant uses a donor and provides graft-versus-tumor effect. Graft-versus-host disease is a major complication of allogeneic transplant, treated with corticosteroids and immunosuppression.

Tumor lysis syndrome: hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia after rapid lysis of bulky chemosensitive tumors; prevention with hydration, allopurinol, or rasburicase; monitor electrolytes and renal function.

Head and neck squamous cell carcinoma risk factors: tobacco, alcohol, and HPV (oropharyngeal, especially HPV-16). HPV-positive oropharyngeal cancer has better prognosis and is staged separately in AJCC 8th edition.

Locally advanced head and neck cancer: definitive concurrent chemoradiation with cisplatin (100 mg/m2 every 3 weeks or weekly 40 mg/m2) or cetuximab with radiotherapy if cisplatin-ineligible; surgery followed by adjuvant radiation for high-risk features.

Head and neck radiation toxicity: mucositis, xerostomia (parotid sparing with IMRT), dysphagia, osteoradionecrosis of the mandible, hypothyroidism, and carotid stenosis; dental evaluation before radiation.

Glioblastoma: standard treatment is maximal safe resection followed by radiotherapy 60 Gy in 30 fractions with concurrent and adjuvant temozolomide (Stupp regimen); MGMT promoter methylation predicts temozolomide benefit; tumor-treating fields may be added.

Low-grade gliomas: IDH mutation and 1p/19q codeletion define oligodendroglioma; treatment includes surgery and radiotherapy ± chemotherapy depending on risk factors.

Brain metastases: whole-brain radiotherapy for multiple lesions; stereotactic radiosurgery for limited metastases; surgical resection for single accessible lesion with mass effect; targeted therapy for EGFR/ALK-driven NSCLC metastases.

Meningioma: usually benign and slow-growing; surgery for symptomatic or growing tumors; radiotherapy for subtotal resection or recurrence. Atypical and anaplastic meningiomas have higher recurrence risk.

Medulloblastoma: pediatric cerebellar tumor treated with surgery, craniospinal irradiation, and chemotherapy; molecular subgroups (WNT, SHH, group 3, group 4) influence prognosis.

Acute lymphoblastic leukemia is the most common childhood malignancy; treatment includes induction, consolidation, maintenance, and CNS prophylaxis with intrathecal chemotherapy. Risk stratification uses age, white blood cell count, cytogenetics, and minimal residual disease.

Wilms tumor: most common pediatric renal tumor; presents with abdominal mass; treatment is nephrectomy plus chemotherapy (vincristine, actinomycin D ± doxorubicin) and radiotherapy for advanced stages; associated with WT1 mutations and syndromes (WAGR, Beckwith-Wiedemann).

Neuroblastoma: arises from neural crest, often adrenal; MYCN amplification indicates high risk; treatment uses surgery, chemotherapy, radiation, and stem cell transplant with isotretinoin; urine catecholamines (VMA, HVA) are markers.

Retinoblastoma: intraocular tumor of childhood; hereditary form with RB1 germline mutation is bilateral; treatment options include enucleation, systemic or intra-arterial chemotherapy, and focal therapy; risk of second malignancies in germline carriers.

Pediatric sarcomas: rhabdomyosarcoma (surgery, chemotherapy, radiation) and osteosarcoma/Ewing sarcoma (neoadjuvant chemotherapy, surgery, radiation for Ewing). Ewing sarcoma is associated with EWSR1 gene rearrangement.

Late effects of childhood cancer therapy: anthracycline cardiotoxicity, radiation-induced growth impairment and second malignancies, cisplatin ototoxicity, and neurocognitive effects; long-term survivorship follow-up is essential.

Pediatric radiation principles: use of proton therapy and IMRT to spare growing tissues; craniospinal irradiation in medulloblastoma and leukemia prophylaxis; anesthesia and immobilization for young children.

Hodgkin lymphoma in adolescents: treated with risk-adapted chemotherapy (ABVD or pediatric regimens) and involved-site radiation to reduce late effects; fertility counseling before therapy.

Febrile neutropenia: fever ≥38.3°C once or ≥38.0°C sustained over 1 hour with ANC <500/µL; start empiric broad-spectrum beta-lactam antipseudomonal antibiotic within 60 minutes; add vancomycin for catheter infection, skin infection, or hemodynamic instability.

Spinal cord compression: back pain, weakness, sensory loss, bowel/bladder dysfunction; urgent MRI of the whole spine; dexamethasone 10-16 mg IV loading then 4 mg every 6 hours; surgical decompression or radiotherapy.

Superior vena cava syndrome: caused by tumor compression or thrombosis; elevate head, give oxygen, consider stent or urgent radiotherapy; tissue diagnosis before treatment if feasible.

Hypercalcemia of malignancy: symptoms include confusion, constipation, polyuria, and dehydration; treat with IV normal saline, calcitonin for rapid effect, and bisphosphonate (zoledronic acid) or denosumab for sustained control.

Tumor lysis syndrome: prevention with hydration and allopurinol for low risk; rasburicase for high risk or established hyperuricemia; monitor potassium, phosphate, calcium, and creatinine.

Pain management: WHO analgesic ladder with non-opioids, weak opioids, then strong opioids; morphine, oxycodone, fentanyl, and methadone; manage opioid side effects (constipation prophylaxis with laxatives, antiemetics for nausea).

Palliative care principles: symptom control, goals-of-care discussions, advance care planning, and psychosocial support; early palliative care improves quality of life and may improve survival in advanced cancer.

Malignant hypercalcemia and SIADH: SIADH causes euvolemic hyponatremia; treat with fluid restriction and demeclocycline or tolvaptan; hypercalcemia is most often from lung cancer, breast cancer, and myeloma.

Neutropenic sepsis and mucositis: use colony-stimulating factors (G-CSF) for primary prophylaxis when febrile neutropenia risk exceeds 20%; oral mucositis managed with oral hygiene, topical anesthetics, and palifermin in selected cases.

Breast cancer subtypes: luminal A (HR+/HER2-, low proliferation), luminal B (HR+, higher proliferation), HER2-enriched, and basal-like/triple-negative. Subtype guides systemic therapy selection.

Genetic risk: BRCA1/2 mutations confer high lifetime breast and ovarian cancer risk; BRCA1-associated tumors are often triple-negative; risk-reducing mastectomy and salpingo-oophorectomy are options; PARP inhibitors for BRCA-mutated disease.

Sentinel lymph node biopsy uses technetium-99m radiolabeled colloid and/or blue dye; positive sentinel nodes may be managed with axillary dissection or, in selected cases, axillary radiotherapy (ACOSOG Z0011 criteria).

Adjuvant chemotherapy for early breast cancer: anthracycline and taxane-based regimens (AC-T, TC) for high-risk disease; genomic assays (Oncotype DX, MammaPrint) guide chemotherapy decisions in HR-positive/HER2-negative disease.

HER2-positive metastatic breast cancer: trastuzumab + pertuzumab + taxane first-line; T-DM1 and trastuzumab deruxtecan in later lines; tucatinib with capecitabine and trastuzumab for brain metastases.

Male breast cancer: mostly HR-positive; treated with mastectomy and endocrine therapy (tamoxifen); BRCA2 mutations are associated.

Pregnancy-associated breast cancer: diagnosis is often delayed; treatment with surgery and chemotherapy is possible after the first trimester; radiotherapy and endocrine therapy are deferred to postpartum.

Breast cancer surveillance after treatment: clinical examination and annual mammography; no routine tumor markers or imaging for asymptomatic patients.

Lung cancer screening: annual low-dose CT for high-risk individuals (age 50-80, ≥20 pack-year history, current or former smoker within 15 years); reduces lung cancer mortality.

NSCLC stage I-II: surgical resection with lobectomy and mediastinal lymph node dissection; stereotactic body radiotherapy for medically inoperable early-stage disease.

NSCLC stage III: concurrent chemoradiation with platinum-based doublet; durvalumab consolidation for unresectable stage III disease after chemoradiation without progression.

NSCLC stage IV: systemic therapy based on molecular testing and PD-L1; pembrolizumab monotherapy for PD-L1 ≥50% without driver mutations; chemotherapy plus immunotherapy for lower PD-L1.

EGFR-mutant NSCLC: osimertinib is first-line; resistance mechanisms include EGFR C797S and MET amplification; re-biopsy at progression is recommended.

ALK-positive NSCLC: alectinib, brigatinib, or lorlatinib; CNS penetration is important because of high rates of brain metastases.

Small cell lung cancer: strongly associated with smoking; paraneoplastic syndromes include SIADH, ectopic ACTH, and Lambert-Eaton syndrome; responds well initially but relapses frequently.

Mesothelioma: asbestos exposure, long latency; diagnosis by thoracoscopic biopsy; treatment with chemotherapy (pemetrexed/cisplatin) and immunotherapy; prognosis remains poor.

Colorectal cancer screening: colonoscopy every 10 years, or FIT annually, or CT colonography every 5 years, starting at age 45-50; earlier for family history or hereditary syndromes (Lynch syndrome, FAP).

Hereditary colorectal cancer: Lynch syndrome (mismatch repair gene mutations, MSI-high tumors) with high risk of colorectal and endometrial cancer; FAP with APC mutation and hundreds of polyps, requiring prophylactic colectomy.

Rectal cancer: neoadjuvant chemoradiation or short-course radiotherapy for locally advanced disease; total mesorectal excision is standard surgery; watch-and-wait for complete clinical response in selected patients.

Gastric cancer: risk factors include H. pylori, smoking, and pernicious anemia; treatment is perioperative chemotherapy or adjuvant chemoradiation; trastuzumab for HER2-positive disease.

Hepatocellular carcinoma surveillance: ultrasound every 6 months in cirrhotic patients; diagnosis can be made by imaging (arterial enhancement with washout) in cirrhotic livers without biopsy.

Pancreatic cancer: CA 19-9 is a marker but not diagnostic; most present with unresectable disease; palliative care and biliary stenting for obstructive jaundice are important.

Neuroendocrine tumors: well-differentiated tumors may be treated with somatostatin analogs (octreotide, lanreotide); peptide receptor radionuclide therapy (Lu-177 dotatate) for advanced disease; poorly differentiated tumors use platinum/etoposide.

Colorectal cancer surveillance after treatment: CEA every 3-6 months for 5 years, CT imaging annually for 3-5 years, and colonoscopy at 1 year then every 3-5 years.

Prostate cancer screening: PSA testing with shared decision-making; PSA >4 ng/mL warrants evaluation; digital rectal exam and biopsy; Gleason grading and Grade Groups 1-5.

Prostate cancer treatment: low-risk disease may be observed; intermediate/high-risk treated with radiotherapy plus ADT or surgery; docetaxel added to ADT for metastatic hormone-sensitive disease; cabazitaxel and radium-223 for castration-resistant disease with bone metastases.

Renal cell carcinoma risk factors: smoking, obesity, hypertension, and von Hippel-Lindau disease; VHL gene inactivation leads to VEGF overexpression; staging by TNM.

Bladder cancer risk factors: smoking, occupational exposure (aniline dyes, rubber industry), and schistosomiasis (squamous cell carcinoma). Painless hematuria is the classic presentation.

Urothelial carcinoma: cisplatin-based neoadjuvant chemotherapy for muscle-invasive disease; adjuvant nivolumab for high-risk resected disease; pembrolizumab for BCG-unresponsive non-muscle-invasive disease.

Testicular cancer: painless testicular mass; ultrasound and orchiectomy; serum tumor markers (AFP, beta-hCG, LDH); stage I seminoma may be managed with surveillance or single-agent carboplatin.

Penile cancer: squamous cell carcinoma; HPV and phimosis are risk factors; treatment depends on stage, with surgery for localized disease and chemotherapy for advanced disease.

Adrenal tumors: pheochromocytoma presents with paroxysmal hypertension, headache, and sweating; measure plasma metanephrines; alpha-blockade before surgery.

Ovarian cancer staging: surgical staging includes total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and lymph node sampling; optimal debulking leaves residual disease <1 cm.

Ovarian cancer chemotherapy: carboplatin plus paclitaxel every 3 weeks or weekly paclitaxel; neoadjuvant chemotherapy for unresectable disease; bevacizumab and PARP inhibitors for maintenance.

Cervical cancer staging: clinical staging historically, now imaging and surgical staging allowed; stage IB1 treated with surgery or radiotherapy; stage IB3-IVA with chemoradiation.

Endometrial cancer risk factors: obesity, diabetes, hypertension, unopposed estrogen, and Lynch syndrome; most present with postmenopausal bleeding; treated primarily with surgery.

Uterine sarcoma: aggressive tumors including leiomyosarcoma and endometrial stromal sarcoma; treatment is surgical resection; chemotherapy and radiotherapy have limited roles.

Ovarian cancer symptoms: bloating, pelvic pain, urinary urgency, and early satiety; often diagnosed at advanced stage; CA-125 is useful for monitoring but not screening.

Vaginal cancer: rare; most are squamous cell carcinoma; treatment with radiotherapy; clear cell adenocarcinoma associated with in-utero diethylstilbestrol exposure.

Fertility preservation in gynecologic cancer: conservative surgery for early-stage cervical, ovarian, and endometrial cancer may be possible; referral to reproductive specialists before treatment.

Anemia in cancer: evaluate iron studies, B12, folate, and hemolysis; treat with iron supplementation, erythropoiesis-stimulating agents in selected patients, and transfusion for symptomatic anemia.

Thrombocytopenia in cancer: causes include marrow infiltration, chemotherapy, immune thrombocytopenia, and disseminated intravascular coagulation; platelet transfusion for counts <10,000/µL or bleeding.

Chronic myeloid leukemia: BCR-ABL fusion (Philadelphia chromosome); treated with tyrosine kinase inhibitors (imatinib, dasatinib, nilotinib); monitor BCR-ABL transcript levels for response.

Acute lymphoblastic leukemia: Philadelphia chromosome-positive disease treated with TKIs plus chemotherapy; allogeneic transplant for high-risk disease; CNS prophylaxis with intrathecal chemotherapy.

Hairy cell leukemia: BRAF V600E mutation; treated with cladribine or pentostatin; rituximab for relapsed disease.

Myelodysplastic syndromes: cytopenias with dysplastic marrow; risk stratification by IPSS-R; treatment with hypomethylating agents (azacitidine, decitabine), lenalidomide for del(5q), and transplant for high-risk disease.

Graft-versus-host disease: acute GVHD affects skin, liver, and GI tract; prophylaxis with methotrexate and calcineurin inhibitors; treatment with corticosteroids and ruxolitinib for steroid-refractory disease.

Transplant complications: sinusoidal obstruction syndrome (veno-occlusive disease) after busulfan or high-dose chemotherapy; presents with jaundice, hepatomegaly, and weight gain; treated with defibrotide.

Head and neck cancer staging: TNM includes primary site, nodal involvement, and extranodal extension; HPV status changes oropharyngeal staging; imaging with CT/MRI and PET-CT for advanced disease.

Larynx cancer: early-stage disease treated with radiotherapy or conservation surgery; advanced disease often requires total laryngectomy; chemoradiation for organ preservation in selected cases.

Nasopharyngeal carcinoma: associated with Epstein-Barr virus; treated with concurrent chemoradiation; plasma EBV DNA is a marker for monitoring.

Salivary gland tumors: parotid tumors most common; surgery is primary treatment; radiotherapy for high-grade or positive margins; adenoid cystic carcinoma has perineural spread.

Thyroid cancer: papillary and follicular types treated with surgery and radioactive iodine; medullary carcinoma associated with RET mutations and treated with targeted inhibitors (vandetanib, selpercatinib); anaplastic carcinoma is aggressive.

CNS tumors: glioblastoma treatment with temozolomide and radiotherapy; bevacizumab for recurrent disease; IDH-mutant gliomas have better prognosis.

Brain metastases management: whole-brain radiotherapy, stereotactic radiosurgery, or surgery; systemic therapy for radiosensitive tumors; corticosteroids for edema.

Spinal cord tumors: extramedullary tumors (meningioma, schwannoma) treated with surgery; intramedullary tumors (ependymoma, astrocytoma) require surgical resection and possibly radiotherapy.

Childhood cancer incidence: leukemia most common, followed by brain tumors, lymphomas, and neuroblastoma; survival rates have improved significantly with multimodal therapy.

Pediatric acute myeloid leukemia: treated with intensive chemotherapy; allogeneic stem cell transplant for high-risk disease; cytogenetics guide risk stratification.

Brain tumors in children: medulloblastoma, pilocytic astrocytoma, and ependymoma are common; treatment includes surgery, radiation, and chemotherapy; late effects on cognition and growth are significant.

Hepatoblastoma: most common pediatric liver tumor; treated with surgical resection and chemotherapy (cisplatin, doxorubicin); AFP is a tumor marker; associated with Beckwith-Wiedemann syndrome and FAP.

Ewing sarcoma: bone and soft tissue tumor; EWSR1-FLI1 fusion; treated with neoadjuvant chemotherapy, surgery or radiation, and adjuvant chemotherapy.

Osteosarcoma: most common primary bone cancer in adolescents; treated with neoadjuvant chemotherapy (methotrexate, doxorubicin, cisplatin) and surgery; pulmonary metastases common.

Pediatric supportive care: prevention of infections with prophylaxis, growth factor support, and management of mucositis; psychosocial support for patients and families.

Survivorship care: monitor for late effects including cardiac dysfunction, pulmonary fibrosis, renal impairment, hearing loss, and secondary malignancies; transition to adult care.

Neutropenic fever: obtain blood cultures and start empiric antibiotics within 60 minutes; adjust based on cultures; add antifungal therapy for persistent fever after 4-7 days.

Malignant bowel obstruction: common in ovarian and colorectal cancer; manage with nil per os, nasogastric decompression, corticosteroids, and octreotide; surgery for selected cases.

Hypercalcemia of malignancy: most common in squamous cell lung cancer, breast cancer, and myeloma; treat with hydration, bisphosphonates, and calcitonin; monitor renal function.

Malignant pericardial effusion and tamponade: presents with dyspnea, hypotension, and distended neck veins; urgent pericardiocentesis; treat underlying malignancy.

Bone metastases: pain management with radiotherapy, bisphosphonates, or denosumab; pathologic fracture prevention with surgery or radiation; spinal cord compression requires urgent treatment.

Palliative care communication: discuss prognosis, goals of care, and advance directives; address psychosocial and spiritual needs; involve family in decision-making.

Opioid management: titrate to effect; manage breakthrough pain with short-acting opioids; rotate opioids for inadequate response or toxicity; prevent constipation with laxatives.

End-of-life care: focus on comfort; manage dyspnea with opioids and oxygen; manage agitation with benzodiazepines; provide family support and bereavement care.

Hormonal therapy: tamoxifen (selective estrogen receptor modulator) for breast cancer; aromatase inhibitors for postmenopausal breast cancer; abiraterone and enzalutamide for prostate cancer; fulvestrant as a selective estrogen receptor degrader.

Immunotherapy toxicities: immune-related adverse events can affect any organ system; most common are dermatitis, colitis, hepatitis, and thyroiditis; treatment with corticosteroids and hormone replacement as needed.

Targeted therapy resistance: acquired resistance through secondary mutations (e.g., EGFR T790M), bypass pathway activation, and histologic transformation; repeat biopsy at progression.

Chemotherapy administration: verify vesicant versus non-vesicant; use central venous access for vesicants; extravasation management depends on the drug (dexrazoxane for anthracyclines, dimethyl sulfoxide for mitomycin).

Dose modifications: adjust for renal and hepatic dysfunction; use ideal body weight for carboplatin dosing in obese patients; avoid live vaccines during immunosuppression.

Drug interactions: CYP3A4 inhibitors (ketoconazole, clarithromycin) increase levels of many targeted agents; CYP3A4 inducers (rifampin, phenytoin) decrease levels; warfarin interactions with fluoropyrimidines and azoles.

Clinical trial phases: phase I determines safety and maximum tolerated dose; phase II assesses efficacy; phase III compares with standard treatment; phase IV post-marketing surveillance.

Response criteria: RECIST 1.1 uses sum of longest diameters of target lesions; complete response, partial response, stable disease, and progressive disease; iRECIST for immunotherapy.

Radiation safety: ALARA principle (as low as reasonably achievable); time, distance, and shielding reduce exposure; radiation protection for staff and patients.

Brachytherapy: radioactive source placed inside or near the tumor; high-dose-rate (HDR) and low-dose-rate (LDR); used in cervical, prostate, and breast cancer; dose prescribed to a point or volume.

Stereotactic radiosurgery: high-dose single fraction for small brain lesions; stereotactic body radiotherapy for lung, liver, and spine tumors; requires precise immobilization and image guidance.

Radiation treatment planning: CT simulation, target delineation, dose calculation, and plan evaluation with dose-volume histograms (DVH); constraints for organs at risk.

Radiation-induced nausea and vomiting: prophylaxis with 5-HT3 antagonists; cranial irradiation has higher risk; dexamethasone added for moderate to high risk.

Radiation dermatitis: graded from erythema to ulceration; managed with gentle skin care, topical corticosteroids, and dressings; avoid irritants.

Radiation pneumonitis: occurs 1-6 months after thoracic radiation; presents with cough, dyspnea, and fever; treated with corticosteroids; risk increases with larger lung volumes irradiated.

Palliative radiotherapy: effective for bone pain, bleeding, and obstruction; single fraction or short courses (8 Gy x 1, 20 Gy in 5 fractions) are often sufficient.

Breast cancer risk factors: age, family history, BRCA mutations, early menarche, late menopause, nulliparity, hormone replacement therapy, obesity, and alcohol consumption.

Breast cancer screening: mammography every 1-2 years starting at age 40-50; MRI for high-risk women (BRCA mutation, family history); clinical breast exam.

Ductal carcinoma in situ: non-invasive breast cancer; treated with breast-conserving surgery plus radiotherapy or mastectomy; endocrine therapy for hormone receptor-positive disease.

Inflammatory breast cancer: presents with erythema, edema, peau d'orange, and rapid growth; treated with neoadjuvant chemotherapy, mastectomy, and radiotherapy; poor prognosis.

Breast cancer follow-up: history and physical every 3-6 months for 5 years, annual mammography, and bone health monitoring; no routine tumor markers.

Phyllodes tumor: fibroepithelial tumor; treated with wide local excision; malignant phyllodes may require mastectomy and radiotherapy.

Paget disease of the breast: presents with nipple eczema-like changes; associated with underlying carcinoma; treated with surgery and appropriate systemic therapy.

Breast cancer in older adults: treatment decisions based on life expectancy, comorbidities, and patient preferences; endocrine therapy often preferred for hormone receptor-positive disease.

Lung cancer histology: non-small cell (adenocarcinoma, squamous cell, large cell) and small cell; adenocarcinoma is most common and often peripheral; squamous cell is central and associated with smoking.

Lung cancer staging: TNM 8th edition; T size and invasion, N nodal stations, M distant metastases; staging with CT, PET-CT, and brain MRI for advanced disease.

Lung cancer treatment by stage: stage I-II surgery; stage III chemoradiation; stage IV systemic therapy; small cell limited stage chemoradiation and extensive stage chemotherapy plus immunotherapy.

Lung cancer paraneoplastic syndromes: SIADH (small cell), ectopic ACTH (small cell), hypercalcemia (squamous cell), Lambert-Eaton syndrome (small cell), and hypertrophic pulmonary osteoarthropathy (NSCLC).

Pleural effusion in lung cancer: cytology for diagnosis; management with thoracentesis, pleurodesis, or indwelling catheter; treat underlying malignancy.

Mediastinal tumors: thymoma, thymic carcinoma, lymphoma, germ cell tumors, and thyroid masses; imaging with CT and biopsy for diagnosis; treatment depends on histology.

Pulmonary nodules: evaluate with CT, PET-CT, and biopsy; size and growth rate determine risk; Fleischner Society guidelines for follow-up.

Lung cancer prevention: smoking cessation is the most effective measure; avoidance of occupational exposures (asbestos, radon) and air pollution.

Esophageal cancer: risk factors include smoking, alcohol, Barrett esophagus, and achalasia; squamous cell carcinoma and adenocarcinoma; treatment with surgery, chemoradiation, or palliative care.

Gastric cancer: H. pylori eradication reduces risk; treatment with perioperative chemotherapy or adjuvant chemoradiation; targeted therapy for HER2-positive disease.

Colorectal cancer: risk factors include age, family history, inflammatory bowel disease, and Lynch syndrome; screening with colonoscopy or FIT.

Hepatocellular carcinoma: risk factors include hepatitis B and C, alcohol, and aflatoxin; surveillance with ultrasound; treatment with resection, transplant, ablation, or systemic therapy.

Pancreatic cancer: risk factors include smoking, obesity, diabetes, and chronic pancreatitis; most present with advanced disease; palliative care is important.

Cholangiocarcinoma: risk factors include primary sclerosing cholangitis, liver flukes, and choledochal cysts; treatment with surgery, chemotherapy, and targeted therapy.

Gastrointestinal stromal tumors: KIT or PDGFRA mutations; treated with imatinib; surgery for localized disease; sunitinib and regorafenib for resistant disease.

Colorectal cancer molecular testing: RAS and BRAF mutations, MSI/dMMR status, and HER2 amplification guide targeted therapy; liquid biopsy for monitoring.

Prostate cancer: most common cancer in men; risk factors include age, family history, and African ancestry; screening with PSA and DRE; treatment based on risk group.

Kidney cancer: most common type is clear cell; treatment with surgery for localized disease; systemic therapy for metastatic disease; surveillance for small renal masses.

Bladder cancer: most common type is urothelial carcinoma; risk factors include smoking and occupational exposures; treatment based on stage and grade.

Testicular cancer: most common cancer in young men; risk factors include cryptorchidism and family history; treatment with orchiectomy and chemotherapy or radiotherapy.

Penile cancer: rare; risk factors include HPV, phimosis, and smoking; treatment with surgery, radiotherapy, or chemotherapy.

Adrenal cancer: rare; may be functional or non-functional; treatment with surgery and mitotane for adrenocortical carcinoma.

Urachal cancer: rare; arises from the urachus; treated with surgery; chemotherapy for advanced disease.

Genitourinary cancer survivorship: monitor for recurrence, treatment-related toxicities, and psychosocial effects; fertility preservation before treatment.

Ovarian cancer: risk factors include age, family history, BRCA mutations, nulliparity, and hormone replacement therapy; protective factors include oral contraceptives and parity.

Cervical cancer: risk factors include HPV infection, smoking, and immunosuppression; prevention with HPV vaccination and screening.

Endometrial cancer: risk factors include obesity, diabetes, hypertension, and unopposed estrogen; treatment with surgery and adjuvant therapy based on risk.

Gestational trophoblastic disease: risk factors include prior molar pregnancy and extremes of maternal age; treatment with chemotherapy for malignant disease.

Vulvar cancer: risk factors include HPV, smoking, and lichen sclerosus; treatment with surgery and radiotherapy.

Ovarian cancer: most common type is high-grade serous; treatment with cytoreductive surgery and platinum-based chemotherapy; PARP inhibitors for maintenance.

Gynecologic cancer screening: cervical cancer screening with HPV testing and cytology; ovarian cancer has no effective screening; endometrial cancer diagnosed by biopsy.

Gynecologic cancer survivorship: monitor for recurrence, manage treatment-related toxicities, and address sexual health and fertility concerns.

Leukemia: acute versus chronic; lymphoid versus myeloid; treatment with chemotherapy, targeted therapy, and stem cell transplant.

Lymphoma: Hodgkin versus non-Hodgkin; treatment with chemotherapy, immunotherapy, and radiation; stem cell transplant for relapsed disease.

Multiple myeloma: plasma cell malignancy; treatment with proteasome inhibitors, immunomodulators, and anti-CD38 antibodies; stem cell transplant for eligible patients.

Myelodysplastic syndromes: treatment with hypomethylating agents, lenalidomide, and stem cell transplant; supportive care with transfusions and growth factors.

Myeloproliferative neoplasms: polycythemia vera, essential thrombocythemia, and myelofibrosis; treatment with hydroxyurea, JAK inhibitors, and aspirin.

Hematopoietic stem cell transplantation: autologous versus allogeneic; complications include infections, GVHD, and veno-occlusive disease; long-term follow-up for late effects.

Tumor lysis syndrome: prevention with hydration and allopurinol; treatment with rasburicase; monitor electrolytes and renal function.

Hematologic emergencies: febrile neutropenia, hyperviscosity syndrome, and disseminated intravascular coagulation; urgent treatment required.

Head and neck cancer: risk factors include tobacco, alcohol, and HPV; treatment with surgery, radiotherapy, and chemotherapy; HPV-positive disease has better prognosis.

Laryngeal cancer: presents with hoarseness; treatment with radiotherapy or surgery; advanced disease may require laryngectomy.

Nasopharyngeal carcinoma: associated with EBV; treatment with chemoradiation; EBV DNA for monitoring.

Thyroid cancer: papillary, follicular, medullary, and anaplastic; treatment with surgery and radioactive iodine; targeted therapy for advanced disease.

Brain tumors: glioblastoma, astrocytoma, oligodendroglioma, and meningioma; treatment with surgery, radiotherapy, and chemotherapy; IDH and MGMT status guide therapy.

Brain metastases: treatment with whole-brain radiotherapy, stereotactic radiosurgery, or surgery; systemic therapy for radiosensitive tumors.

Spinal cord tumors: extramedullary and intramedullary; treatment with surgery and radiotherapy; prognosis depends on histology and extent of resection.

CNS tumor survivorship: monitor for recurrence, cognitive effects, and endocrine dysfunction; rehabilitation and supportive care.

Leukemia: most common childhood cancer; treatment with chemotherapy and stem cell transplant; long-term survival is high.

Brain tumors: most common solid tumor in children; treatment with surgery, radiotherapy, and chemotherapy; late effects on cognition and growth.

Neuroblastoma: arises from neural crest; treatment with surgery, chemotherapy, and stem cell transplant; MYCN amplification indicates high risk.

Wilms tumor: most common renal tumor in children; treatment with surgery and chemotherapy; associated with WT1 mutations.

Retinoblastoma: intraocular tumor; treatment with enucleation, chemotherapy, and focal therapy; genetic counseling for RB1 mutations.

Sarcomas: rhabdomyosarcoma and osteosarcoma; treatment with surgery, chemotherapy, and radiotherapy; multidisciplinary care.

Late effects: monitor for cardiac, pulmonary, renal, and endocrine toxicity; secondary malignancies; psychosocial support.

Survivorship: transition to adult care; education and vocational support; fertility counseling.

Febrile neutropenia: fever and low ANC; start antibiotics within 60 minutes; adjust based on cultures; add antifungal for persistent fever.

Spinal cord compression: urgent MRI and dexamethasone; surgical decompression or radiotherapy; preserve neurologic function.

Superior vena cava syndrome: caused by tumor compression; elevate head and give oxygen; stent or radiotherapy for severe cases.

Hypercalcemia: treat with hydration, bisphosphonates, and calcitonin; monitor renal function; treat underlying malignancy.

Tumor lysis syndrome: prevention with hydration and allopurinol; rasburicase for high risk; monitor electrolytes.

Pain management: WHO ladder; opioids for severe pain; manage side effects; palliative care involvement.

Palliative care: symptom control, goals-of-care discussions, and psychosocial support; early involvement improves quality of life.

End-of-life care: comfort-focused; manage dyspnea, agitation, and pain; support family and caregivers.

Cytotoxic chemotherapy: alkylating agents, antimetabolites, topoisomerase inhibitors, taxanes, and vinca alkaloids; each has specific toxicity profiles.

Targeted therapy: monoclonal antibodies, tyrosine kinase inhibitors, PARP inhibitors, and proteasome inhibitors; resistance mechanisms include secondary mutations and bypass pathways.

Immunotherapy: checkpoint inhibitors; immune-related adverse events; management with corticosteroids and immunosuppression.

Hormonal therapy: tamoxifen, aromatase inhibitors, abiraterone, enzalutamide; used in breast and prostate cancer.

Dose modifications: adjust for renal and hepatic dysfunction; use ideal body weight for carboplatin; avoid live vaccines.

Drug interactions: CYP3A4 inhibitors and inducers; warfarin interactions; monitor drug levels.

Clinical trials: phases I-IV; response criteria RECIST and iRECIST; informed consent and ethical considerations.

Supportive care: antiemetics, growth factors, and prophylaxis for infections; manage side effects to improve quality of life.