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General Internal Medicine

Medical Oncology   

Questions discussed in this category

How do you differentiate demoralization from depression during cancer treatment?
2 Answers available
How would you approach the staging and treatment of extranodal marginal zone lymphoma of left and right lacrimal gland?
1 Answer available
How do you manage patients desiring home hospice but with severe thrombocytopenia and/or anemia due to advanced malignancy?
Do you consider supportive transfusions, and if so, have you been successful with keeping patients on hospice while receiving transfusions? Do you us...
2 Answers available
What is the role of surveillance imaging after first line therapy in patients with aggressive lymphomas?
1 Answer available
What is the optimal management of pain and loss of function due to pathologic compression fractures?
Assume no epidural/cord compromise. Is kypho/vertebroplasty, radiation therapy, or conservative management (brace, antiresorptive therapy) the superio...
1 Answer available
How do you approach an otherwise healthy patient with an incidental 1 mm GIST involving the serosal surface in terms of staging workup, EGD, and surveillance?
1 Answer available
Should you consider thromboprophylaxis, even for low-dose lenalidomide maintenance, post-autologous transplantation?
1 Answer available
Which patients, if any, treated according to PROSPECT for an early stage rectal cancer, would you offer surveillance if they achieved cCR after neoadjuvant chemotherapy?
Some patients have declined surgery knowing they achieved cCR. Would you observe or recommend chemoRT?
1 Answer available
Is there any evidence for amyloid/amyloidosis causing a spurious/false PSA reading?
1 Answer available
Should GLP-1 agonists be held during chemotherapy?
3 Answers available
How do you manage anticoagulation in a patient with DVT from likely malignant mechanical obstruction?
Patient has bilateral common, internal, and external iliac and femoral DVT from obstruction by a large uterine mass that is likely malignant and is pl...
1 Answer available
What parameters would you use to monitor and interpret iron levels in a hemochromatosis patient where ferritin is unreliable due to underlying chronic inflammation?
How would your recommendation change if the patient has H63 homozygous mutation?
2 Answers available
Would you change treatment approach for rectal cancer with an associated intussusception?
1 Answer available
Is there a role for DOAC use for patients with unprovoked PE, that have had recent sleeve gastrectomy with duodenal bypass?
Or do you generally prefer warfarin/non-DOAC agents? Do you consider trialing DOACs and testing anti-Xa DOAC levels to assess for absorption?
1 Answer available
How do you approach severe anemia and thrombocytopenia in an elderly patient whose bone marrow biopsy shows hypercellular marrow with mild dysplasia in erythroid and megakaryocytic lineage but normal cytogenetics and a negative NGS panel?
Hgb is 8 and platelets 10. A very small PNH clone (0.08%) detected. No evidence of hemolysis. No response to steroids. All other anemia/thrombocytopen...
1 Answer available
How does one interpret an SPEP showing potentially obscured but non-quantifiable M-spike however an IFE showing monoclonal protein?
Can you elaborate on reasons for a non-quantifiable SPEP and how does one follow the paraprotein?
3 Answers available
How do you evaluate a patient with MGUS and peripheral neuropathy?
Can you explain when would you consider light chain amyloidosis work up with fat pad biopsy?
1 Answer available
How do you approach management for CCUS with severe cytopenias?
Bone marrow biopsy does not meet criteria for MDS and no other identifiable cause of the cytopenias.
1 Answer available
Do patients with central adrenal insufficiency on maintenance hydrocortisone therapy require doubling of their corticosteroid during chemotherapy cycles?
1 Answer available
Would you anticoagulate an SMV thrombosis caused by malignant obstruction in the setting of metastatic colorectal cancer?
For what duration and is there a preferred anticoagulation agent?
1 Answer available
Would you start anticoagulation in a patient with RCC and related (tumor) thrombus with extension to renal vein and further?
3 Answers available
What is the expected timeframe for the development of radiation myelitis and therapies that have helped with neurologic symptoms?
4 Answers available
What infections should we rule out in patients who develop diarrhea on immunotherapy?
Chemotherapy is associated with acquiring C diff colitis. Does immunotherapy share that same risk and necessitate ruling out infection prior to anti-d...
1 Answer available
Does your evaluation of a young person with spontaneous upper extremity DVT vary as compared to lower extremity DVT?
Do you do additional workup for venous obstruction or any other different testing/evaluation?
1 Answer available
Do you use direct oral anticoagulants to treat port-a-cath related VTE in patients with an active malignancy?
Do social or economic factors (i.e., relative cost of acquiring LMWH, the patient being injection averse) affect your decision to use DOACs? Do you s...
1 Answer available
What is your approach to radiographically suspicious lung nodules for which initial biopsy was negative for malignancy?
4 Answers available
How do you prescribe a steroid taper for radiation and checkpoint inhibitor related pneumonitis?
I've seen a handful of fatal radiation pneumonitis associated with rapid steroid tapers by the non-treating physicians. How do you recommend prescribi...
2 Answers available
What is the management strategy for patients who develop AKI and nephrotic range proteinuria secondary to biopsy proven FSGS during immune checkpoint inhibitor therapy?
1 Answer available
In what situations would you treat a rectal mass as cancer despite negative biopsies?
For example, if mass is ulcerated and cannot be excised with polypectomy? Would you ever consider radiation and chemotherapy?
4 Answers available
In SIADH due to malignancy, do you prefer to use free water restriction or salt tablets?
Or other therapy - e.g., tolvaptan? Free water restriction may hinder QOL. Salt tablets may raise levels more quickly but have risks of edema and hype...
1 Answer available
Do you recommend a kidney biopsy for patients who develop acute kidney injury after starting sacituzumab?
1 Answer available
How would you manage a patient pre-operatively with a prolonged PTT that does not correct on mixing, with lupus anticoagulant testing that is abnormal by LA-PTT only?
Confirmatory tests with DRVVT, hexagonal phase assay, and PNP are all normal. No bleeding history
1 Answer available
What is the indication for phlebotomy in compound heterozygous hemochromatosis?
What is the ferritin target that you would aim for? What would be your approach for a ferritin >500? When do you order an MRI liver for iron quanti...
1 Answer available
Do you typically use NOACs or Lovenox in patients with stroke due to hypercoagulability from malignancy?
1 Answer available
Is there a role for nintedanib in the management of patients with radiation-induced pulmonary fibrosis?
1 Answer available
In patients with active IBD and rectal cancer, do you take any precautions before starting TNT?
Would you wait until bowel symptoms are controlled or ever pursue diversion before starting treatment?
2 Answers available
Is there a role for phlebotomy in secondary polycythemia?
Aside from addressing the underlying case, is there a role for phlebotomy in secondary polycythemia such as in COPD or post-renal transplant erythrocy...
1 Answer available
Is a bone marrow necessary in patient with splenomegaly and polycythemia vera?
1 Answer available
How do you discuss harms of MGUS screening with other medical providers?
For example, how do you address tendency to "over-order" these tests in patients with common aches/pains but no structural abnormalities on advanced i...
2 Answers available
What is your approach to working up diarrhea in an immunocompromised patient?
1 Answer available
How would you manage an elderly patient with mild pancytopenia who refuses bone marrow biopsy and whose flow cytometry is suggestive of CMML/MDS?
2 Answers available
How would you manage a young patient with HL who develops HF (EF < 30%) after 4 cycles of A+AVD who obtained a PET2 CR?
2 Answers available
For a patient who has T4 squamous cell esophageal carcinoma on imaging, and who has biopsy-confirmed disease in an involved local lymph node, are EUS or EGD still indicated to complete workup?
1 Answer available
What is your preferred formulation of parenteral iron?
There are various formulations of intravenous iron; each with varying costs, test dose requirement, elemental dose, and number or time of infusions ne...
1 Answer available
What is your approach for an RA patient with lung cancer who is starting immunotherapy?
1 Answer available
For a pedunculated rectal polyp found to be adenocarcinoma after endoscopic removal, with PNI as the only adverse feature, would you recommend additional treatment such as surgery or chemoradiation?
Consider some stalk invasion, but no deep submucosal extent and negative margins by 9 mm. 
1 Answer available
How would you approach a stage II colon cancer with negative ctDNA but markedly elevated CEA level post-colectomy?
5 Answers available
How do you approach immunosuppression in patients with a positive Interferon Gamma Release Assay and prior intravesicular BCG treatment for bladder cancer?
Assuming no symptoms of TB, should patients be treated for latent TB prior to starting TNF inhibitors or other immunosuppressive agents?
1 Answer available
How should one approach an incidentally found T-cell gene arrangement?
Work-up was performed for isolated anemia which resolved to >11 g/dl after the reversible cause was treated.
1 Answer available
How extensive of a workup do you do for systemic AL amyloidosis for a patient with a resected amyloidoma, localized AL amyloid deposition in their airway or lungs, who has no other symptoms?
Would you do a 24-hour urine and echocardiogram in all of these patients? Cardiac biomarkers, PT/PTT, or any other such blood tests?
3 Answers available
What is your strategy for managing immunosuppression in patients with a kidney transplant who develop metastatic cancer?
3 Answers available
How do you manage drug-drug interactions between oral anticoagulants and the ARSI agents such as apalutamide and enzalutamide?
1 Answer available
What are the indications for anticoagulation in splenic infarctions?
What is the work up and what is the duration of anticoagulation if used?
2 Answers available
What is your approach to bridging anticoagulation in patients with history of recent HIT?
Do you always avoid heparin/enoxaparin or rechallenge if antibodies are negative?
1 Answer available
What is the ideal period to wait until curative surgery for patients with acute pulmonary embolism and solid malignancy?
Specifically, asymptomatic subsegmental PE diagnosed within a month from planned bilateral mastectomy for breast cancer. 
1 Answer available
For a patient with a lung tumor that is radiographically consistent with early-stage NSCLC but pathology with characteristics overlapping with upper GI origin, what additional diagnostic procedures would you consider before treating?
For example, there are no abnormalities on CT or PET in the upper GI and the pathology demonstrates strong CK7 staining and mucinous features with neg...
2 Answers available
How do you counsel cancer patients when they ask if they should avoid sugar?
9 Answers available
How do you manage patients with suspected cholangiocarcinoma that presents with biliary obstruction but has repeated negative brushings/biopsies?
Is liquid biopsy helpful? Would you treat if this shows somatic mutation?
2 Answers available
How do you manage incidentally identified pituitary lesions on brain imaging?
What workup do you typically recommend?
1 Answer available
How would you manage a patient with radiation pneumonitis who remains symptomatic on steroids?
2 Answers available
How would you manage a patient with new renal failure and mild anemia in the setting of a moderate M-Spike and low kappa/lambda ratio, but with negative PET and bone marrow with <10% plasma cells?
1 Answer available
How would you treat active rheumatoid arthritis in a patient in complete response on loralatinib for stage IV ALK positive NSCLC?
Patient already on methotrexate and plaquenil.   
1 Answer available
What are common indications for ordering NGS of peripheral blood?
Would a negative NGS eliminate the possibility of MDS? Is bone marrow biopsy indicated in a patient with pancytopenia with a negative NGS panel?
1 Answer available
Is it safe to treat checkpoint inhibitor-induced arthritis with methotrexate or biologics?
1 Answer available
Should patients with co-existing moderate-severe valvular disease (particularly AS and MS) and malignancy requiring radiation therapy undergo more frequent surveillance surface echocardiograms?
1 Answer available
Why do we use dexamethasone for CNS edema and prednisone for pneumonitis?
Is this an artifact of what agent prior clinical trials used or something to do with the mechanism of action (i.e., less mineralocorticoid effect of d...
1 Answer available
What is the recommended follow-up/surveillance schedule following organ preservation treatment approach for cT1-2N0 rectal cancer?
Taking into account follow up from NEO, OPERA and other organ preservation trials?
2 Answers available
When would you consider tapering glucocorticoids in a patient with ICI-associated myocarditis?
2 Answers available
Do the level of positive lupus anticoagulant titers correlate with the risk of VTE?
1 Answer available
How do you define an adequate EBUS when staging NSCLC?
Is there a minimum standard for which stations to sample? Does lymph node size affect your recommendations?
3 Answers available
What would be the main indications for opting for biosimilars over an original biologic, outside of insurance barriers?
Are there any instances where you would prefer a biosimilar rather than the reference product? 
2 Answers available
How do you manage hyponatremia in patients with renal cell carcinoma on cabozantinib and nivolumab?
2 Answers available
What would be your next step in workup for a patient with IgG Kappa Monoclonal protein detected on SPEP and free lambda light chains found in the urine, with chronic diarrhea for 3 years and concern for GI amyloidosis?
1 Answer available
Are there any concerns regarding side effects in changing from denosumab to zolendronic acid or vice versa?
1 Answer available
When do you perform a kidney biopsy in a patient with AKI that is thought to be related to an immune checkpoint inhibitor?
Do you wait to monitor response to empiric corticosteroids before pursuing a kidney biopsy?
2 Answers available
How do you approach the workup for a patient with persistently elevated inflammatory markers (CRP and ESR) whose history and exam do not point to a clear cause?
4 Answers available
What is your response to the question, "Is this terminal?"
How do you "have the talk" in a way that is straightforward without emotionally crushing the patient?
8 Answers available
What is the optimal frequency and duration of post-operative radiological surveillance following resection of a solitary fibrous tumor?
1 Answer available
Do you check for EGFR and other mutations in patients with squamous cell lung cancer, including in adjuvant setting before considering immunotherapy?
2 Answers available
Does recent COVID-19 infection result in elevated PSA?
1 Answer available
Do you recommend starting an antiplatelet for primary prophylaxis in post splenectomy thrombocytosis given there is some increased risk of venous thrombosis?
If so, what platelet count threshold would you use? Would age impact your decision? Would you do a bone marrow to rule out primary MPD in adults if th...
1 Answer available
How would you manage an adult patient status post subtotal resection of spinal osteoblastoma?
The patient presented with spinal cord compression, had subtotal resection and instrumentation with metallic hardware. Main concern is that post op su...
1 Answer available
How do you balance aspiration risks with encouraging PO intake for HN cancer patients during and after chemoradiation?
Encouraging aggressive PO intake in patients with swallowing dysfunction may place them at risk for aspiration pneumonia, especially risky if undergoi...
1 Answer available
What is your approach for using anticoagulation/aspirin in patients with multiple myeloma?
2 Answers available
Are there any risk factors for IO induced rhabdomyolysis and how do you approach and manage it?
2 Answers available
For hypogammaglobulinemia as a complication of successful treatment, do you empirically start prophylaxis with either 400 mg/kg monthly for IVIG or 100 mg/kg weekly for subcutaneous immune globulin?
1 Answer available
Would you consider clearing a patient with essential thrombocytosis for a kidney donation?
1 Answer available
How would you work up a mildly neutropenic patient (ANC >800) with family history of neutropenia and personal history of occasional mouth sore?
What are indications to order gene mutation studies (e.g. ELANE) and how would it help the patient?
1 Answer available
For a rectal cancer with questionable T3 or questionable N+ by MRI, can short course radiation be given followed by surgery and the pathology still be interpreted to guide adjuvant chemotherapy?
I.E., can a patient with a questionable 5 mm node (MRI T2N1) which is negative on pathology after short course radiation be staged T2N0 and receive no...
3 Answers available
What is the appropriate management of arthralgias associated with bosutinib?
1 Answer available
Among asymptomatic patients with structurally normal TTE undergoing treatment with anthracyclines or alkylating agents that develop mildly elevated BNP and/or troponin levels, would you consider referring them for cardiac MRI to evaluate for subclinical cardiotoxicity?
1 Answer available
Do you initiate management of new onset diabetes in a patient on immunotherapy or refer immediately to endocrinology given the risk of rapid worsening?
1 Answer available
How would you treat a patient with rectal cancer with a solitary lung metastasis, who now has no evidence of disease after total neoadjuvant therapy followed by rectal surgery and resection of the solitary metastasis?
Would you give additional treatment after surgery?
1 Answer available
How do you follow up a patient with esophageal adenocarcinoma who is not a surgical candidate after finishing chemoradiation?
2 Answers available
How should you work up calvarium or other osseous lesions when found during the initial staging of a patient with a new diagnosis of NSCLC otherwise non-metastatic?
1 Answer available
How do you approach RA management in a patient who develops a new solid tumor while on therapy?
2 Answers available
How do you approach work-up for a patient suspected for monoclonal gammopathy of renal significance for whom renal biopsy is contraindicated?
E.g. a patient with monoclonal protein with mild light chain ratio elevation. Do we need to get a BM biopsy in all such patients?
2 Answers available
How do you manage refractory hyponatremia in patients on active therapy in small cell lung cancer?
1 Answer available
How would you work up and manage persistent lymphopenia in an asymptomatic patient?
ALC<200
1 Answer available
How would you manage an incidental catheter-related thrombosis in a functioning dialysis catheter?
- Dialysis catheter used for hemodialysis- RIJ thrombus in dialysis catheter was incidentally found- Patient asymptomatic with no prior history of VTE...
2 Answers available
Do you always initiate hypercoagulable work up in a patient with recurrent stroke?
If so, what would you consider ordering?
1 Answer available
How do you manage psoriatic arthritis in patients who are planning to start treatment with checkpoint inhibitors for underlying malignancy?
2 Answers available
At what platelet count would you feel comfortable dosing aspirin 81 mg for coronary artery disease in a patient with ITP?
Presuming strong indication for ASA - eg history of NSTEMI
1 Answer available
How would you approach protein S deficiency found on hypercoagulability work-up in a patient with a post-operative central retinal vein occlusion?
In the setting of no personal or family history and no other risk factors for thrombosis, is systemic anticoagulation warranted if local treatments (e...
4 Answers available
How do you approach the management of capmatinib induced edema?
1 Answer available
How do you manage insomnia in cancer patients that is refractory to traditional sleep aides?
In patients who continue to have insomnia despite diphenhydramine, benzos, and trazodone, are there other evidence based treatments that are helpful?
4 Answers available
Do you stop PPI when starting patients on immunotherapy?
1 Answer available
Do you consider EBUS TBNA in the diagnostic evaluation of patients with mediastinal lymphadenopathy with concern for lymphoma?
1 Answer available
What are best practices for engaging with multidisciplinary colleagues to ensure patients with earlier stage NSCLC are being appropriately considered for novel adjuvant therapies?
How are your teams effectively evaluating and counseling patients to ensure they are prepared for potential extended adjuvant treatment approaches? Is...
4 Answers available
Are there best practices or data regarding the use of open notes among oncology patients?
What is the impact among patients and providers? Has your documentation been adjusted now that patients can readily review?
2 Answers available
How do you approach heparin management in patients who have suprathetherapeutic Xa levels on minimal heparin?
1 Answer available
How would you approach a patient with imaging and labs suggestive of potentially resectable cholangiocarcinoma when several core biopsies reveal bridging fibrosis with no malignant cells?
1 Answer available
How would you qualify and treat a patient with neutropenia, anemia, and abnormal NK cell population with normal trilineage marrow maturation?
Peripheral blood flow shows prominent NK cell population but marrow aspiration/bx shows normocellular marrow with trilineage hematopoiesis. 
1 Answer available
Does 4G/5G polymorphism in the plasminogen activator inhibitor (PAI-1) gene increase the risk of thrombosis?
In the absence of a VTE would you consider prophylaxis after a surgical procedure? Often non-hematologists order this testing but we are consulted for...
1 Answer available
Do you recommend routine use of Evusheld for pre-exposure prophylaxis for patients on immunosuppression?
Does treatment with B-cell depletion and/or negative anti-spike antibody status despite COVID mRNA vaccination influence your decision?
1 Answer available
Is antiplatelet or anticoagulant therapy preferred for the secondary prophylaxis of cryptogenic stroke in a patient with underlying malignancy?
4 Answers available
For treatment of ITP, what would you add to dexamethasone to achieve the fastest recovery in a patient waiting for a procedure?
IVIG, TPO, or other agents?
1 Answer available
What infectious prophylaxis do you use for patients with newly diagnosed multiple myeloma?
How do you decide how long to continue?
1 Answer available
How would you approach evaluation and treatment of a patient on pembrolizumab therapy who presents with symmetric, proximal, upper extremity and lower extremity painful weakness without an elevated CK?
1 Answer available
How should one manage a patient with leukocytosis and borderline detectable BCR-ABL without other clinical features of CML such as basophilia or splenomegaly?
e.g. IS < 0.002% by qPCR
1 Answer available
How does one interpret persistently positive lambda light chains on serum immunofixation but without measurable serum monoclonal protein and a normal light chains and ratio?
Is a repeatedly abnormal serum immunofixation all it takes for MGUS?
2 Answers available
Are you comfortable using DOACs in obese patients with VTE?
1 Answer available
For rectal adenocarcinoma initially staged as T2N0 and treated with upfront surgical resection, but pathologically upstaged to pT3N0 without high risk features, how do you approach adjuvant therapy?
How do you counsel patients on the benefit of adjuvant therapy who thought surgical resection was curative?
1 Answer available
Do you approach the diagnosis and treatment of HIT patients differently in the outpatient setting or in a resource-limited community setting?
For example, for outpatients or resource-limited settings with a moderate probability 4-T score (but low clinical suspicion), would you ever consider ...
1 Answer available
What is your typical workup for a patient with a spontaneous renal infarct?
Please also discuss the type and duration of anticoagulation.
1 Answer available
What immunosuppressive agents would be available to patients with a history of melanoma?
Would you use immunosuppression in patients several years after curative treatment for melanoma?
1 Answer available
What is your preferred approach for patients with anti-phospholipid syndrome with recurrent thrombosis on coumadin and LMWH?
1 Answer available
How would you approach moderate neutropenia (ANC < 1000) in a solid organ transplant recipient?
Is there a particular sequence you would adjust contributing antirejection or antimicrobial medications? Is the use of G-CSF appropriate and at what c...
2 Answers available
How do you approach conversations regarding discontinuation of transfusions in patients with advanced hematologic malignancies who are otherwise appropriate for hospice?
Are there other supportive care interventions that would otherwise be covered by hospice?
1 Answer available
How would you manage VTE in a patient with bleeding disorder such as hemophilia?
Have you used anticoagulants other than coumadin? Or is that the only appropriate agent given monitoring is based on PT/INR?
1 Answer available
How would you manage a patient with acquired von Willebrand disease who requires DAPT for arterial disease?
1 Answer available
What hematologic conditions are contraindications for a COVID vaccine?
2 Answers available
How would you manage a patient with type 1 cryoglobulinemia secondary to MGUS?
What if the patient is no longer responding to steroids?
1 Answer available
How do you evaluate a suspicious, but negative pleural effusion when working up NSCLC and SCLC?
Are two negative pleurocentesis' adequate to conclude that the patient does not have metastatic disease? Do you routinely recommend VATS and pleural b...
1 Answer available
How would you manage early-stage low rectal cancer in a patient unable or unwilling to undergo surgery?
3 Answers available
In which patients with oncologic or hematologic disorders are you recommending a 3rd dose of mRNA COVID vaccine?
2 Answers available
Do you recommend anticoagulation for a splenic infarct in patients with myelofibrosis and splenomegaly?
1 Answer available
What is your perioperative approach to holding and restarting hydroxyurea in patients with essential thrombocythemia?
1 Answer available
What is the best way to approach elevated liver enzymes in patients treated with combination TKI and immunotherapy?
Are there any clinical features that can inform etiology/which medication to hold?
1 Answer available
Can you use other iron formulations if a patient develops Stevens-Johnson Syndrome with ferumoxytol?
1 Answer available
What is your approach to immunotherapy-related pancreatitis?
How do you manage the initial event, including length of steroid taper and the role of pancreatic enzyme monitoring? What is your experience of subse...
1 Answer available
How do you approach evaluation of pulmonary vein thrombosis?
Is there any difference between anticoagulants in this clinical context (e.g. anti-Xa inhibitors vs warfarin vs LMWH)?
1 Answer available
How would you approach chronic isolated severe non-cyclic neutropenia with negative bone marrow and rheumatologic work-up?
Is there a role for empiric antibiotics if there is history of opportunistic infection?
1 Answer available
How do you manage oxaliplatin-induced acute peripheral nerve hyperexcitability?
Patients can develop sensory and motor symptoms such as paresthesias, jaw/facial pain and stiffness, cramping and twitching, ptosis and vision changes...
2 Answers available
What is your approach following R1 resection in a patient who has received total neoadjuvant therapy for rectal cancer?
1 Answer available
Which patients with rectal cancer who have not received neoadjuvant treatment do you offer adjuvant radiation to?
Is there a subset of patients you would avoid neoadjuvant CRT and operate first?
3 Answers available
How do you interpret and utilize PSA values in patients on dialysis?
How does dialysis affect PSA lab values?
1 Answer available
Do you routinely start anticoagulation for a patient with newly diagnosed hepatocellular carcinoma presenting with a portal venous thrombosis?
3 Answers available
How do you approach patients with a history of lymphoma in remission who are in need of immunosuppressive (e.g. TNF blockers, 6MP) or other therapies (e.g. JAK inhibitors) for autoimmune disease that have been linked with the development of lymphoma?
1 Answer available
How do you workup erythrocytosis with a normal or elevated serum erythropoietin?
2 Answers available
What are the current official guidelines regarding COVID-19 vaccination for patients with cancer or for hematologic conditions?
2 Answers available
Why are autoantibodies not often detected on monoclonal gammopathy assays (SPEP/IFE, quantitiative immunoglobulins)?
For example, in cold agglutinin disease or AIHA, antibodies can be detected via DAT, but are often not observed on assays for monoclonal gammopathies.
1 Answer available
How would you time COVID-19 vaccination with someone on R-CHOP chemotherapy?
1 Answer available
Is there an equivalent test for serum viscosity in sickle cell disease?
1 Answer available
How do you counsel patients who are candidates for a clinical trial regarding their options?
Specifically, are there strategies you use to 1) empower patients to participate in decision-making and 2) reassure patients who may be skeptical?
2 Answers available
How do you perform geriatric assessment for cancer patients?
Do you use specific tools or take into account certain factors when considering treatment options for older adults?
1 Answer available
How would you approach diagnosis of residual ovarian tissue in a patient with ER positive breast cancer, history of BSO, and a rising estradiol level on tamoxifen?
1 Answer available
For which rituximab infusion reaction symptoms do you consider it safe to re-challenge in the office with adjusted rates and pre-medications?
1 Answer available
How do you handle hypogammaglobulinemia detected in patients prior to maintenance rituximab infusion?
2 Answers available
Do hemoglobin S levels always correlate with SCD phenotype?
What is the lowest level you have seen with uncomplicated or complicated crises?
4 Answers available
How do you approach diagnosing a patient with Iron Refractory Iron Deficiency Anemia (IRIDA)?
Do you go straight to TMPRSS2 genetic testing or what other lab testing (e.g. hepcidin) could be helpful?
1 Answer available
How would you approach a fit older (>70 years) with grade I-II, bulky, follicular lymphoma causing ureteral obstruction and renal failure?
Bulky adenopathy compressed bilateral ureters, CrCl < 30, post stent placement, but renal function has plateaued
2 Answers available
How do you manage hand-foot syndrome associated with capecitabine (and other conventional chemotherapy agents)?
Do you prescribe creams (e.g., urea) to prevent HFS, or is their use generally more reactive? 
1 Answer available
How do you manage VTE in the setting of persistent severe thrombocytopenia?
Is there a preferred strategy of transfusional support versus reduced-dose anticoagulation during the duration of thrombocytopenia?
3 Answers available
Is there any role for direct oral anticoagulants in the treatment of antiphospholipid syndrome?
What if this was "triple-negative" antiphospholipid syndrome?
2 Answers available
Would you avoid the use of a TNF inhibitors in patients with a remote history of melanoma, including those with ocular melanoma?
1 Answer available
In patients with inflammatory bowel disease with low rectal cancer with planned proctocolectomy, would you consider creation of a pouch?
1 Answer available
Should new patients requiring chemotherapy be tested for COVID-19 prior to starting treatment?
1 Answer available
What surveillance do you recommend for a patient with locally advanced rectal adenocarcinoma who had a complete clinical response to total neoadjuvant therapy and declines to undergo surgery?
MRI? Endoscopy? Physical exam?
1 Answer available
How do you approach the decision of whether and when to initiate therapy in patients who remain COVID-19 positive >2 weeks after infection but are asymptomatic from the virus?
E.g. a patient with progression of their primary cancer but still is testing COVID19+ over a month after infection?
5 Answers available
How do you talk to patients about clinical trials?
I care deeply about clinical trials but have always struggled on how to approach this topic. I would really appreciate tips from those of you who have...
5 Answers available
Should we be utilizing prophylactic G-CSF in our patients with intermediate risk of febrile neutropenia due to the COVID-19 pandemic?
Are you placing more weight on patient risk factors such as age >65 or co-morbidities?
2 Answers available
Do you routinely prescribe anticoagulation for patients on active chemotherapy?
1 Answer available
Would you consider giving ESA for anemia secondary to chronic kidney disease in a patient with follicular lymphoma in remission and on rituximab maintenance?
1 Answer available
What are best practices for taking care of lung cancer patients during the COVID-19 pandemic?
4 Answers available
Due to the thrombotic nature of COVID-19, should we be discontinuing tamoxifen temporarily in patients with an active infection?
1 Answer available
How has COVID-19 altered your recommendations for invasive mediastinal staging for NSCLC?
Should staging and treatment decisions be made based on imaging alone?
2 Answers available
What are the current official guidelines regarding managing patients during COVID-19?
3 Answers available
Is your approach to managing immune related adverse events altered at all in light of COVID-19?
2 Answers available
How do you manage neurocognitive decline associated with chemotherapy (i.e. chemo brain)?
Is there specific workup you perform? Are there preventive measures? Once established, are there non-pharmacological and pharmacological treatments yo...
3 Answers available
Would you clear a patient who completed treatment for breast DCIS to donate her kidney to her husband?
Germline genetic testing negative
1 Answer available
How do you approach a patient with IgM monoclonal gammopathy associated with severe neuropathy of unclear etiology?
2 Answers available
How would you approach a patient with a recent MI s/p DES who is being considered for neoadjuvant chemotherapy for TNBC?
2D Echo - Normal Ejection Fraction 
1 Answer available
How do you explain progression free survival to patients?
5 Answers available
When do you recommend patients get vaccinations with respect to their chemotherapy course?
1 Answer available
How long do you continue surveillance imaging for NSCLC after definitive treatment?
NCCN recommends annual CT surveillance indefinitely after year 5, but I’m curious how many physicians continue and for how long?
3 Answers available
Should breast cancer patients with never-treated latent TB and for whom chemotherapy is indicated be treated for latent TB during chemotherapy?
2 Answers available
In what situations do you obtain both a pelvic MRI and EUS for rectal cancer staging and treatment planning?
For instance, in borderline cases for neoadjuvant therapy (e.g. T2N1 disease), should both be obtained to increase accuracy?
1 Answer available
What is your routine workup and treatment approach to patients with NSCLC NOS discovered in mediastinal nodes but without obvious primary lung lesions or metastatic disease?
1 Answer available
What is the preferred clinical management of hyperglycemia related to alpelisib?
1 Answer available
For small peripherally located NSCLC, when do consider referral for mediastinal evaluation prior to curative surgery vs proceeding to resection with mediastinal eval at time of surgery?
2 Answers available
How would you approach a biopsy proven NSCLC patient with mediastinum negative disease and contralateral suspicious spiculated PET avid nodule without pathologic diagnosis?
No other site of metastatic disease. It is unclear if this situation should be managed as two separate primaries or metastatic disease.
2 Answers available
What are your recommendation for vaccines in patients while on immunotherapy?
Do you recommend or withhold influenza and pneumonia vaccines while on treatment with checkpoint inhibitors?
1 Answer available
How do you approach incidentally diagnosed mantle cell lymphoma found on a routine screening colonoscopy?
1 Answer available
How do you manage a patient with multiple similar appearing ground glass opacities (~8-9) on Chest CT where one has been surgically removed and confirmed to be adenocarcinoma in situ?
There is no evidence of disease outside the lung on PET, and the patient is completely asymptomatic with negative EGFR, ALK, ROS1, and BRAF and a PD-L...
1 Answer available
What is your preferred treatment to ameliorate bone pain from G-CSF?
1 Answer available
Is there anything you use for patients with anticipatory nausea who has failed Ativan and Zyprexa?
1 Answer available
How are you making the diagnosis of chronic lymphocytic leukemia transforming to prolymphocytic leukemia?
Technically, you can have up to 55% of larger cells circulating and still be called CLL.
1 Answer available
How do you decide which lab to use for multi-gene hereditary testing?
Is there a difference among all the commercial genetic testing labs? Is there anything beyond CLIA- and CAP-certification that we should look for...
1 Answer available
How do you handle the situation where a curative-intent patient unexpectedly passes away while under treatment?
Obviously the details matter a lot, but are there guiding tenets one should follow beyond expressing condolences to the family?
1 Answer available
Among the many assays/tests available for "liquid biopsies" in metastatic NSCLC, are there any situations where you would want to use one specific assay over the others?
1 Answer available
How do you approach rising gastrin and chromogranin levels without radiographic evidence of disease in patients with gastrinoma that has been fully resected?
Specifically, rising levels noted while on somatostatin analogue. 
1 Answer available
What is your approach to a low grade appendiceal mucinous neoplasm found incidentally at appendectomy?
1 Answer available
How do you present the trade off between a small chance of a sustained response for a new drug at the expense of potential worsening quality of life?
1 Answer available
Does it matter whether one uses MSI PCR testing versus IHC for MMR deficiency testing inorder to determine eligibility for immunotherapy?
1 Answer available
How do you approach the workup of subcentimeter contralateral nodules in cases of locally advanced NSCLC?
When there is biopsy proven mediastinal disease, do you offer definitive chemoradiation and monitor, or do you try to prove the presence/absence ...
1 Answer available
Would you ever omit adjuvant therapy for rectal cancer in patients who underwent primary resection (TME), without any neoadjuvant therapy?
What about T3N0 disease?  Would you use a recurrence score to help inform decisions?
0 Answers available
How do you treat hiccups in cancer patients?
Does your management differ if the hiccups are felt to be related to chemotherapy as opposed to the disease itself?
1 Answer available
When TPN is a barrier to enrollment in hospice for an eligible cancer patient with an irreversible malignant bowel obstruction, how do you approach the conversation about discontinuation of TPN?
The immediate response by patients in this situation seems almost universally to be, "But I'll starve to death!" Referencing literature about lack of ...
2 Answers available
In a patient with a history of treated stage II seminoma with rising bHCG while on surveillance, do you routinely recheck the bHCG with a different assay?
When are you concerned for a false positive? FDA guidelines include a suggestion to try another assay in case heterophile antibodies are causing a fal...
1 Answer available
How would you approach the management of a patient with oligometastatic NSCLC characterized by a LUL mass and a solitary adrenal metastasis, assuming a good performance status?
1 Answer available
How do you approach disease monitoring in patients with localized rectal cancer who have received treatment with chemoradiation?
Is MRI being considered the primary mode of imaging in multidisciplinary tumor boards, especially in light of the results of the MERCURY trial (JCO 20...
1 Answer available
When do you perform HER2 testing in patients with colorectal cancer?
1 Answer available
What is the best way to discuss an early palliative care referral with a patient?
We have a great palliative care clinic and I like to refer many patients with metastatic disease, even if I feel that they will live a year or two lon...
1 Answer available
Should early referral to palliative care be standard of care for all patients with metastatic cancer?
I know that some would argue that healthy patients with an excellent performance status may not need an early palliative care referral, but wouldn't i...
3 Answers available
How do you manage dabrafenib fever?
Decrease the dose? Treatment break? Steroids?
1 Answer available


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Glucagon-Like Peptide 1 Receptor Agonists and 13 Obesity-Associated Cancers in Patients With Type 2 Diabetes.
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Venous thromboembolism risk with contemporary lenalidomide-based regimens despite thromboprophylaxis in multiple myeloma: A systematic review and meta-analysis.

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