Medical Oncology
Astra Clinical Library
Hematology and oncology
Practical hematology and oncology guides for clinical decisions, with cited evidence, testing strategies, and actionable next steps.
59 guides
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Neurology, Neurosurgery, Neuro-oncology
Conus and Cauda Equina Tumors
Conus and cauda equina tumors require urgent localization when sphincter dysfunction or progressive deficits occur, contrast-enhanced MRI for compartment-based differential diagnosis, and early multidisciplinary planning to balance neural preservation, tissue diagnosis, resection extent, stability, and oncologic prognosis.Pulmonology and Medical Oncology
Lung Cancer
Lung cancer management depends on rapid histologic confirmation, accurate stage assignment, and—particularly in non-small cell lung cancer—tumor biomarker characterization before selecting surgery, radiation, systemic therapy, or symptom-directed care. Multidisciplinary coordination is central to preserving curative options and matching treatment intensity to patient goals.Medical Oncology
Small Cell Lung Cancer
Small cell lung cancer requires prompt distinction between limited- and extensive-stage disease, early multidisciplinary planning, and vigilance for rapid clinical decline. Current therapy remains stage-dependent chemoradiation or chemoimmunotherapy, but relapse is common and emerging therapies are reshaping later-line management.Gynecology and Gynecologic Oncology
Cervical Cancer
Cervical cancer care hinges on prevention through HPV-based screening, prompt risk-based evaluation of abnormal results, stage-appropriate local therapy, and biomarker-directed systemic treatment for persistent, recurrent, or metastatic disease.Hematology
Disseminated Intravascular Coagulation
Disseminated intravascular coagulation is an acquired, dynamic syndrome of systemic coagulation activation, consumptive factor depletion, and dysregulated fibrinolysis. Diagnose it from the clinical trigger plus serial global hemostasis testing; treatment priorities are rapid source control, organ support, and phenotype-directed hemostatic therapy.Hematology-Oncology
Acute Myeloid Leukemia
Acute myeloid leukemia requires rapid confirmation, cytogenetic and molecular risk assessment, treatment-intensity selection, and early transplant planning. Management is increasingly genotype-directed, but supportive care, response assessment, measurable residual disease interpretation, and clinical-trial access remain central to outcomes.Hematology-Oncology
Acute Promyelocytic Leukemia
Acute promyelocytic leukemia is a hematologic emergency in which immediate presumptive treatment and aggressive coagulopathy support should precede definitive molecular confirmation, because early hemorrhagic death is preventable. Subsequent therapy is risk-adapted to presenting leukocyte count and requires specialized monitoring.Urology and Medical Oncology
Prostate Cancer
Prostate cancer care requires risk-adapted use of PSA testing, MRI and biopsy, judicious selection of surveillance or definitive local therapy, and stage-specific systemic treatment anchored by androgen deprivation therapy.Hematology
Sickle Cell Anemia
Sickle cell anemia requires longitudinal, multidisciplinary care focused on preventing stroke and infection, modifying disease severity, safely managing acute complications, and evaluating curative cellular therapies for appropriately selected patients.Hematology
Sickle Cell Crisis
Sickle cell crisis requires rapid recognition of vaso-occlusive pain while actively excluding acute chest syndrome, infection, stroke, and other time-sensitive complications. Care is strongest when acute analgesia, complication-directed evaluation, and longitudinal disease-modifying or curative options are coordinated with a sickle cell specialist.Hematology and Oncology
Chronic Lymphocytic Leukemia
CLL requires confirmation of persistent clonal B-cell lymphocytosis, risk assessment before therapy, and treatment only for active disease. Modern care prioritizes BTK- and BCL2-directed strategies, while surveillance remains appropriate for most asymptomatic early-stage patients.Hematology-Oncology
Chronic Myelogenous Leukemia
Chronic myelogenous leukemia requires molecularly confirmed BCR::ABL1 disease classification, early and serial standardized molecular monitoring, individualized tyrosine kinase inhibitor selection, and prompt evaluation of inadequate response, intolerance, adherence, interactions, and kinase-domain mutations to prevent progression.Hematology-Oncology
Burkitt Lymphoma
Burkitt lymphoma requires urgent expert confirmation, staging that specifically interrogates marrow and cerebrospinal fluid, tumor-lysis planning, and prompt rituximab-containing multiagent therapy with central nervous system-directed treatment selected by disease risk and CNS involvement.Hematology-Oncology
Diffuse Large B-Cell Lymphoma
Diffuse large B-cell lymphoma requires prompt tissue-confirmed classification, molecular risk assessment, stage-directed curative-intent therapy, and early referral for cellular therapy when relapse occurs within 12 months or disease is refractory.Hematology-Oncology
Follicular Lymphoma
Manage follicular lymphoma by confirming grade and excluding transformation, staging with FDG PET/CT, reserving therapy for clinically consequential disease, and tailoring relapse treatment to timing, prior exposure, refractoriness, fitness, and planned cellular or T-cell–engaging therapy.Hematology-Oncology
Hairy Cell Leukemia
Confirm classic HCL with integrated morphology, immunophenotyping, and BRAF V600E assessment; treat only clinically consequential disease, then select purine analog, BRAF-directed therapy, or relapse-directed treatment by infection status, fitness, and remission duration.Hematology-Oncology
Hodgkin Lymphoma
Confirm Hodgkin lymphoma on adequately sampled tissue, stage with FDG-PET/CT, and use disease extent, bulk, prognosis, and PET-adapted response to select curative-intent treatment while minimizing late toxicity.Hematology-Oncology
Mantle Cell Lymphoma
Confirm mantle cell lymphoma with tissue-based cyclin D1/CCND1 testing, distinguish its key diagnostic mimics, stage before treatment, and select induction intensity by fitness. Relapse management depends critically on prior BTK inhibitor exposure and eligibility for cellular therapy.Hematology-Oncology
Multiple Myeloma
Multiple myeloma management requires confirmation of a myeloma-defining event, urgent control of organ-threatening complications, risk-informed induction and transplant planning, and sequencing of cellular or T-cell–redirecting therapies at relapse.Hematology-Oncology
Non-Hodgkin Lymphoma
Non-Hodgkin lymphoma requires rapid conversion of a suspected lymphoid malignancy into a specific histologic diagnosis, stage, and tempo category. Management diverges sharply between aggressive entities requiring prompt systemic therapy and indolent entities in which symptom burden and disease distribution determine treatment timing.Transfusion Medicine
Transfusion-Related Acute Lung Injury
TRALI is acute, noncardiogenic pulmonary edema beginning during or within 6 hours of transfusion. Immediate transfusion cessation, respiratory support, exclusion of circulatory overload, and transfusion-service reporting are the critical decisions; diuresis is not indicated unless concurrent TACO is present.Hematology
Stem Cell Transplantation in Sickle Cell Disease
Allogeneic hematopoietic cell transplantation can cure sickle cell disease, but donor availability, conditioning toxicity, graft failure, and graft-versus-host disease determine whether its risks outweigh progressive disease. Donor selection and post-transplant lineage-specific chimerism are central management decisions.Endocrinology and Surgical Oncology
Thyroid Cancer
Management hinges on histology, anatomic extent, iodine avidity, and recurrence risk. Use ultrasound-directed staging and pathology to select lobectomy versus total thyroidectomy, reserve radioiodine for appropriate differentiated cancers, and avoid DTC algorithms in medullary disease.Medical Oncology
Esophageal Cancer
Esophageal cancer management hinges on histology, locoregional resectability, physiologic operability, and metastatic staging. Coordinate endoscopic diagnosis, staging, nutrition, and multidisciplinary selection of surgery-based, definitive chemoradiation, systemic, or symptom-directed treatment early.Medical Oncology
Gastric Cancer
Stage gastric adenocarcinoma with cross-sectional imaging and selective laparoscopy, then direct care by resectability and tumor biology. Perioperative FLOT is central for localized advanced disease; metastatic treatment depends on HER2, MSI/MMR, PD-L1, and CLDN18.2 results.Medical Oncology
Pancreatic Cancer
Manage pancreatic ductal adenocarcinoma by establishing histology when systemic therapy is planned, defining vascular anatomy and metastatic burden on pancreas-protocol imaging, and selecting surgery-first versus neoadjuvant treatment through multidisciplinary review of resectability and biologic risk.Urology and Medical Oncology
Bladder Cancer
Stage-directed bladder cancer management hinges on complete transurethral staging, separation of non-muscle-invasive from muscle-invasive disease, risk-adapted intravesical therapy, and timely cystectomy or chemoradiation when curative local treatment is indicated.Gynecologic Oncology
Endometrial Cancer
Endometrial cancer management hinges on diagnostic histology, extent of uterine and extrauterine disease, and molecular classification. Integrating MMR immunohistochemistry, POLE sequencing, and p53 testing refines hereditary-risk assessment, operative planning, prognosis, and systemic-treatment selection.Urology and Medical Oncology
Testicular Cancer
Testicular germ cell tumors require prompt inguinal orchiectomy, serum-marker staging, and risk-adapted postorchiectomy management. Surveillance avoids overtreatment in many stage I patients, while cisplatin-based therapy cures most metastatic disease but requires durable toxicity-focused survivorship care.Gynecologic Oncology
Vulvar Cancer
Manage vulvar cancer through biopsy-confirmed histology, clinically directed groin assessment, imaging for suspected nodal or advanced disease, and individualized primary excision with inguinofemoral staging. Sentinel-node techniques can reduce long-term morbidity in appropriately selected early-stage disease.Medical Oncology
Carcinoid Syndrome
Carcinoid syndrome requires biochemical confirmation, staging of the underlying well-differentiated neuroendocrine tumor, prompt control of hormone-mediated symptoms, and structured surveillance for carcinoid heart disease. Refractory diarrhea should trigger assessment of tumor burden, somatostatin analog delivery, and serotonin-directed or tumor-directed therapy.Hematology and Oncology
Febrile Neutropenia
Febrile neutropenia is an oncologic emergency requiring immediate empiric antibacterial therapy, focused source evaluation, and disposition based on physiologic stability, anticipated neutropenia, and validated complication-risk assessment.Hematology
Immune Thrombocytopenia
Diagnose ITP only after confirming true isolated thrombocytopenia and excluding urgent thrombotic, marrow, infectious, drug-related, and pregnancy-specific causes. Management is driven by bleeding, platelet trajectory, treatment requirements, comorbidity, and durability goals rather than platelet count alone.Hematology
Myelodysplastic Syndrome
Evaluate persistent unexplained cytopenias with marrow morphology, conventional cytogenetics, and molecular testing; then use IPSS-R or IPSS-M risk, transfusion burden, erythropoietin level, and transplant fitness to select supportive, anemia-directed, disease-modifying, or curative therapy.Hematology
Neutropenia
Use absolute neutrophil count, trajectory, accompanying cytopenias, infection burden, and exposure history to distinguish transient acquired neutropenia from chronic immune, congenital, marrow, or treatment-related disease and to determine when marrow evaluation, G-CSF, or urgent infection management is warranted.Hematology
Thrombocytopenia
A platelet count below 150 × 10^9/L requires rapid confirmation, bleeding and thrombosis triage, and pattern-based evaluation for pseudothrombocytopenia, consumption, microangiopathy, drug-mediated disease, immune destruction, or impaired production.Hematology
Von Willebrand Disease
Diagnose von Willebrand disease by linking a clinically meaningful bleeding phenotype to repeatable VWF abnormalities, then select desmopressin, tranexamic acid, or VWF replacement according to subtype, procedural risk, and measured treatment response.Hematology
Acute Chest Syndrome
Acute chest syndrome requires immediate imaging, oxygenation assessment, empiric treatment for pulmonary infection, lung-expansion measures, and early transfusion escalation when hypoxemia or radiographic disease progresses.Hematology and emergency medicine
Hyperviscosity Syndrome
Treat symptomatic hyperviscosity as an oncologic emergency: recognize retinal, mucosal bleeding, neurologic, and cardiopulmonary injury; obtain viscosity and cause-directed studies without delaying plasma exchange; then suppress the responsible paraprotein-producing or leukemic process.Hematology
Antiphospholipid Syndrome
Antiphospholipid syndrome requires a thrombotic or pregnancy morbidity phenotype plus persistent antiphospholipid antibodies. Management hinges on event type, antibody-risk profile, pregnancy status, and selection of warfarin rather than direct oral anticoagulation for arterial or triple-positive disease.Hematology
Glucose-6-Phosphate Dehydrogenase Deficiency
G6PD deficiency is an X-linked red-cell enzymopathy in which oxidative infection, drugs, or fava beans can precipitate hemolysis; clinical care hinges on confirming enzyme deficiency, recognizing assay limitations, stopping exposures, treating the trigger, and preventing high-risk drug administration.Hematology
Vitamin B12 Deficiency
Confirm clinically meaningful cobalamin deficiency, treat neurologic or severe hematologic presentations urgently, and define whether dietary insufficiency, autoimmune gastritis, or intestinal malabsorption requires lifelong replacement and surveillance.Pediatric Hematology, Immunology, and Transplantation
Wiskott-Aldrich Syndrome
Suspect Wiskott-Aldrich syndrome in boys with persistent microthrombocytopenia, eczema, infections, autoimmunity, or lymphoid malignancy; confirm the WAS variant and expedite curative therapy planning, because hematopoietic transplantation outcomes decline with older age and severe pretransplant infection.Hematology
VTE Anticoagulation Duration
Select anticoagulation duration after venous thromboembolism by classifying the provoking context, estimating recurrence and bleeding risk, and reassessing persistent risks. Most transiently provoked events require 3 months; unprovoked, recurrent, and active cancer-associated VTE commonly warrant extended therapy.Hematology Oncology
Cancer-Associated Thrombosis
Select anticoagulation for cancer-associated venous thromboembolism by balancing recurrence risk, bleeding-prone tumor location, renal function, platelet count, drug interactions, oral absorption, and the feasibility of sustained treatment for at least 6 months.Hematology
Thrombocytopenia Initial Workup
Confirm that thrombocytopenia is real, identify bleeding or thrombosis requiring immediate action, then use the smear, clinical setting, medication exposure, and accompanying cytopenias to separate peripheral destruction from impaired production and urgent consumptive syndromes.Hematology
DIC Laboratory Interpretation
Interpret suspected disseminated intravascular coagulation by integrating a triggering disorder with serial platelet count, PT, fibrinogen, and fibrin-related markers; use a validated score to identify overt disease while actively excluding mimics that require fundamentally different treatment.Hematology-Oncology and Infectious Diseases
Neutropenic Fever Antibiotics
Select empiric therapy immediately after cultures by separating unstable or prolonged profound neutropenia from clinically stable low-risk presentations, then individualize coverage for resistant Gram-negative colonization, suspected focus, and indications for anti-MRSA or antifungal escalation.Hematology-Oncology
Tumor Lysis Syndrome
Risk-stratify before cytoreductive therapy by malignancy biology, disease burden, baseline uric acid, renal function, and treatment potency; use hydration, urate lowering, and intensive biochemical surveillance to prevent arrhythmia, acute kidney injury, and dialysis-requiring metabolic collapse.Hematology
Sickle Cell Acute Chest Syndrome
Treat suspected acute chest syndrome as a potentially progressive pulmonary emergency: admit, establish oxygenation and respiratory trajectory, obtain chest imaging and transfusion readiness, begin analgesia, cautious hydration, lung expansion therapy, and antibiotics, then escalate promptly for refractory hypoxemia or multilobar deterioration.Hematology
Heparin-Induced Thrombocytopenia
Use the 4Ts score before ordering HIT tests. For intermediate or high probability, stop all heparin, begin nonheparin anticoagulation, obtain an IgG-specific PF4/heparin immunoassay, and use a functional platelet-activation assay to resolve positive or discordant results.Hematology
Iron Deficiency Anemia Thresholds
Diagnose iron deficiency anemia by integrating hemoglobin with ferritin and transferrin saturation, then adjust interpretation for inflammation, CKD, and discordant indices. A ferritin threshold of 45 ng/mL improves diagnostic sensitivity in anemic patients undergoing gastrointestinal evaluation.Hematology
Thrombotic Thrombocytopenic Purpura
Suspected immune thrombotic thrombocytopenic purpura requires immediate recognition of thrombotic microangiopathy, pre-treatment ADAMTS13 sampling, empiric plasma exchange when pretest probability is high, and rapid distinction from complement-mediated HUS and secondary thrombotic microangiopathies.Hematology
Anticoagulation
Select anticoagulant therapy by indication and the clinical setting that changes net benefit: bleeding urgency, valve status, antiphospholipid syndrome, hepatic function, cancer, and treatment duration. Use drug-specific assays and antidotes only when results will change immediate management.Dermatology and oncology
Kaposi Sarcoma
Confirm suspected Kaposi sarcoma with lesional histology and HHV-8 LANA-1 immunohistochemistry, then define HIV status, immunosuppression, and visceral burden to select antiretroviral therapy, immunosuppression reduction, local control, or systemic therapy.Emergency Medicine, Hematology, Medical Toxicology
Methemoglobinemia
Confirm suspected methemoglobinemia with blood-gas co-oximetry when cyanosis or low pulse oximetry is disproportionate to cardiopulmonary findings, immediately remove oxidant exposure, and use symptom-, concentration-, and oxygen-delivery risk–based antidotal treatment while avoiding methylene blue in G6PD deficiency.Gastroenterology and Medical Oncology
Cholangiocarcinoma
Manage cholangiocarcinoma by defining intrahepatic, perihilar, or distal anatomy; obtaining high-quality staging before biliary intervention when feasible; securing diagnosis without compromising curative options; determining resectability in a multidisciplinary setting; relieving clinically consequential obstruction; and profiling unresectable or metastatic disease for biomarker-directed therapy.Medical Oncology