Cancer Flashcards
Mammography Screening
Women 50 +
If woman finds a hard lump w/ plans for FNA, should she still get mammography?
YES - 5-10% will have bilateral
When do you use breast US?
Cystic v solid?
Usually if painful or varies in size w/ menstruation
What is the first-line treatment for breast cancer?
Lumpectomy + radiation
Prefer over radical mastectomy b/c less deforming
May supplement w/ tamoxifen, raloxifene or aromatase inhibitor (anastrozole, letrozole) if ER/PR+
Trastuzumab if HER2/neu +
Side effects of tamoxifen, raloxifene or aromatase inhibitors and trastuzumab
Tamoxifen - endometrial cancer and blood clots
Raloxifene - no endometrial risk (“relax”)
Aromatase Inhibitors - osteoporosis (inhibit estrogen bone effects)
Trastuzumab - cardiotoxic
Surgery v. Radiation for Prostate Cancer
Surgery = inc risk erectile dysfunction
Radiation = diarrhea
What do you do if multiple first-degree relatives have breast cancer?
PPX w/ tamoxifen or raloxifene
What do you do if patient requests PSA check?
DO IT
If palpable mass then biopsy
If no palpable mass then transrectal US
Lung Cancer Screening
Annual low dose CT once 55-80 yrs if smoking for 30+ years
Unless quit 15 yrs ago
How do you treat lung cancer that tests positive for programmed death biomarker (PD)?
Pembrolizumab or nivolumab
4 Anterior Mediastinal Masses
Thymoma
Teratoma
Thyroid cancer
Lymphoma (“terrible lymphoma”)
2 Posterior Mediastinal Masses
Neurofibromas
Esophageal cancer
What cancer is most often associated w/ asbestos?
LUNG (much more common than mesothelioma)
Cervical Cancer Screening
Pap smear 21 yrs q 3 yrs
Can move to q 5 yrs w/ HPV co-test once 30 yo
Until 65 yo
If low or high grade dysplasia –> colposcopy w/ biopsy
If ASCUS –> do HPV test –> HPV pos then colposcopy, HPV neg then repeat pap in 6 mo
Top 3 Drug Classes for Chemo Nausea
1- 5HT inhibitors - ondansetron (zofran) - check QT
2 - Glucocorticoids - dexamethasone
3- NK receptor Antagonist - aprepitant (if cannot use zofran or zofran does not work)
