cancer pt 1

Question 1

cancer staging

Answer 1

T - tumor location, size, level of tumor invasion

N - absence or presence and extent of nodal involvement

M - presence or absence of systemic metastases (M1, M0)

Question 2

paraneoplastic syndrome

Answer 2

clinical syndrome involving non-metastatic systemic effects that accompany malignant disease (not directly caused by tumor mass)

may provide with clues about new cancer dx

ex. serotonin syndrome, SIADH, hypercalcemia, hypoglycemia

Question 3

induction chemotherapy

Answer 3

causes shrinkage or the disappearance of tumors

Question 4

neoadjuvant chemotherapy

Answer 4

administered before localized (surgical or radiation) treatment

Question 5

adjuvant chemotherapy

Answer 5

administered after surgical excision with the goal of eliminating micrometastases

Question 6

breast cancer hormone receptors

Answer 6

ER/PR + - take Tamoxifen/aromatase inhibitor to slow growth (5-10 years, menopause s/s, inc risk for uterine CA)

HER-2 amplified - more aggressive, tx w Herceptin (AE HF)

triple negative - young, <40, rapid mutations, poor outcomes

Question 7

breast cancer RF

Answer 7

age 60-70
white race
family hx
genetic mutations - BRCA1/2
hx of endometrial CA or other proliferative disorders
early menarche (<12), late menopause (>50)
nulliparous or late first pregnancy

Question 8

ductal vs lobular carcinoma

Answer 8

ductal in situ - cancer fully contained in milk duct

invasive ductal - cells break through ductal lumen and invade adipose tissue

(85-90% of cancers are ductal)

lobular carcinoma - arises from lobes/glands deeper within breast (can be in situ/invasive)

Question 9

paget’s carcinoma

Answer 9

less common form of breast cancer

burning/itching of nipple

most have underlying ductal breast cancer

Question 10

inflammatory carcinoma

Answer 10

rare form of breast cancer but most malignant

rapidly growing mass with erythema, edema, warmth

mistaken for cellulitis/mastitis

Question 11

who to test for BRCA1/2

Answer 11

dx <50
cancer in both breasts
concurrent ovarian & breast CA in fam
multiple breast CA in fam
two or more primary types of BRCA 1/2 CA in a fam member
cases of male breast CA
ashkenazi jewish

Question 12

breast cancer screening

Answer 12

mammography & CBE - q 2 years vs annually starting at 40
BSE - not recommended
MRI w mammography for high risk (dense breasts)

Question 13

breast cancer dx

Answer 13

mammogram first
then US, MRI if concerning lump ID
biopsy if mass found

hormone testing w biopsy

Question 14

breast cancer tx

Answer 14

stage I, II, III - curative intent
- surgical resection
- adjuvant radiation and chemo vs neuoadjuvant or both
- adjuvant endocrine therapy (tamoxifen vs aromatase inhibitor)
- HER 2 target treatments

stage IV - palliative intent
- radiation for pain relief
- palliative chemo
- endocrine therapy

Question 15

cervical cancer basics

Answer 15

HPV

highest malignancy cancer worldwide

most squamous cell/adenocarcinoma

Question 16

cervical cancer screening

Answer 16

Pap smear, HPV testing every 5 years beginning at age 30 (21 if high risk)

if positive, more frequent screening

Question 17

HPV vaccine

Answer 17

girls 11-13
boys - prevent other cancers (anal, HEENT)

Question 18

cervical cancer dx

Answer 18

cervical cytology
HPV testing
cervical biopsy

imaging not typically necessary

often diagnosed early!!!c

Question 19

cervical cancer mgmt

Answer 19

in situ/stage I - cervical colonization, ablation, hysterectomy if no childbearing potential

stage II/III - total hysterectomy, chemo/radiation

recurrent/metastatic - chemo with platinum agent