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1. CE prep > Cancers > Flashcards

Cancers Flashcards

1
Q

Anal carcinoma
1. w/u
2. tx
3. surveillance

A
  1. w/u:
    -Bx, DRE with anoscopy, inguinal node exm, HIV test, pap
    - CT CAP, ?PET
  2. tx: 5FU/mitomycin + XRT
    - neoadj: mets
  3. surveillance:
    - h/p, DRE w/ anoscopy: q6m x 5y
    - CT CAP q1y x 5y
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2
Q

Breast cancer
1. w/u:
2. tx:
3. surveillance:

A
  1. w/u:
    - mammo, US, ?MRI
    - core needle biopsy
    -?genetic counseling, preggo test
    - Mets: CT CAP, bone scan, ?Brain MRI, ?PET
  2. tx: lumpectomy vs. BCT vs. MRM
    - neoadj: IBC, clinical nodes, T4, large mass but wants BCT
  3. surveillance:
    - h/p q6m x 5 years
    - mammo q1y x life
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3
Q

Colon cancer
1. w/u:
2. tx:
3. surveillance:

A
  1. w/u:
    - cbc, CEA
    - CT CAP
    - colonscopy
    - bx w/ MSI/MMR testing
  2. tx: colectomy
    - 5 cm margin; 12 nodes
    - neoadj: t4b
  3. surveillance:
    - h/p, CEA, CT CAP q6m x 5y
    - C’scope @ 1, 3, 5 years
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4
Q

Esophageal cancer
1. w/u:
2. tx:
3. surveillance:

A
  1. w/u:
    - nutrition, smoking, h. pylori, GERD
    - EGD w/ bx, EUS
    - CT CAP, PET
  2. tx:
    - HGD, TIS, T1a: endoscopic ablation
    - T1b: upfront esophagectomy
    - Neoadj: T2 or N
    - 5 cm margin; 15 nodes
  3. surveillance:
    - h/p, CT CAP, EGD q6m x 5y
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5
Q

Gastric cancer
1. w/u:
2. tx:
3. surveillance:

A
  1. w/u:
    - nutrition, smoking, h. pylori, GERD
    - EGD w/ bx, EUS
    - CT CAP, PET
  2. tx: D2 sub-total gastrectomy
    - proximal: D2 total gastrectomy
    - 5 cm margin; 15 nodes
  3. surveillance:
    - h/p, CT CAP, EGD q6m x 5y
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5
Q

GIST
1. w/u:
2. tx:
3. surveillance:

A
  1. w/u:
    - EGD/EUS w/ bx (FNA or core)
    - Bx: mitosis/hpf
    - Genotyping: KIT/TKI therapy
    - CT or MRI CAP
  2. tx: resection (histo negative margins)
    - no nodes
    - Imatinib (TK inhibitor) if > 5cm or >5 mitosis/50 hpf
  3. surveillance:
    - h/p, CT CAP q6m x 5y
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6
Q

HCC
1. w/u:
2. tx:
3. surveillance:

A
  1. w/u:
    - cirrhosis, hepatitis, etoh, fatty liver
    - hep panel, CMP, AFP
    - U/S
    - Liver protocol CT/MRI, CT CAP, CT liver volumetry
  2. tx:
    - hepatectomy: well compensated
    - transplant: milan criteria/cirrhotic
    - unresectable: TACE or ablation
  3. surveillance:
    - Liver protocol CT/MRI, AFP q6m x 5y
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7
Q

Cholangiocarcinoma
1. w/u:
2. tx:
3. surveillance:

A
  1. w/u:
    - cirrhosis, hepatitis, etoh, fatty liver
    - hep panel, CMP, AFP
    - U/S
    - Liver protocol CT/MRI, CT CAP
    - EGD w/ EUS/FNA
    - ERCP w/ brushings (or MRCP)
  2. tx: resect
    - unresectable: chemo or transplant
  3. surveillance:
    - Liver protocol CT/MRI, AFP q6m x 5y
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8
Q

Gallbladder cancer
1. w/u:
2. tx:
3. surveillance:

A
  1. w/u:
    - lap chole with t1b+
    - multiphase CT CAP
  2. tx:
    - resectable: resection 4b/5 w/ LADN (porta hepatis) +/- bile duct excision
    - unresectable: systemic therapy
  3. surveillance:
    - Yearly liver protocol CT/MRI x 5y
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9
Q

Melanoma
1. w/u:

  1. tx:
  2. surveillance:
A
  1. w/u:
    - skin exam
    - punch bx: breslow depth, ulceration, mitotic rate, LV invasion
    - lymphoscintigraphy (if planning SLNBx)
    -CT CAP/PET SLN+ or systemic disease suspected
    - BRAF testing
  2. tx: resection
    - SLNBx+: choose surveillance vs. CLND; all get pembrolizumab or BRAF inhibitor
    - Surveillance: U/S q4m x 2 years then q6m x 3 years
    - Cx+ node require CLND
  3. surveillance:
    - skin self exam, sunscreen education
    - h/p q1y x 5 years
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10
Q

PNET
1. w/u
2. tx
3. surveillance

A
  1. w/u:
    - Labs: gastrin, insulin/pro-insulin/c-peptide, glucagon, VIP, SS
    - Genetic counseling for MENs
    - Triphasic CT/MRI
    - SS PET
    - EUS/FNA
    - Selective intra arterial Ca
  2. tx: resection + LADN
    - enucleate insulinoma, small gastrinoma, small non-functional
  3. surveillance:
    - Yearly triphasic CT/MRI x 5y
    - Yearly markers x 5 years
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10
Q

Carcinoid
- w/u
- tx
- surveillance:

A
  1. w/u:
    - 24h urine/plasma 5-HIAA
    - Triphasic CT/MRI
    - SS PET if can’t locate
    - CT CAP if > 2cm
  2. tx:
    - < 2 cm: local excision (transanal, appendectomy, segmental)
    - > 2 cm: staging CT. radical resection
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11
Q

Adrenal mass
- w/u
- tx

A
  1. w/u: adrenal protocol CT
    - aldosterone: A/R > 20
    - pheo: 24h urine metanephrines
    - cortisol: dexa suppression test
    - androgen: urine androgens
  2. tx:
    - aldosteronoma: AVS ➡ unilateral, resect; bilateral, spironolactone
    - pheo: MIBG ➡ a block ➡ b block ➡ resect
    - cortisol: ACTH ➡ low, resect; high, high dose dexa suppresion (lung vs. brain)
    - ACC: open resection + mitotane
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12
Q

NSC Lung Cancer
- w/u
- tx

A
  1. w/u:
    - smoking cessation/advice
    - CT CAP
    - PET/CT
    - Tissue dx (for FDG+): intra-op frozen, CT-guided, or EBUS
    - EBUS for nodal disease
    - EBUS/EUS guided bx
  2. tx: Segmentectomy or lobectomy
    - n2 disease ➡ chemo
  3. surveillance:
    - h/p, CT chest q6m x 5y
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13
Q

Pancreatic cancer

A
  1. w/u:
    - ca19-9, LFTs
    - pancreatic CT/MRI
    - CT CAP +/- PET
    - EUS/FNA
    - ERCP w/ stent/brushings
    - ?staging laparoscopy
    - genetic testing
  2. tx: whipple
    - unresectable: chemotherapy
  3. surveillance:
    - h/p, CT CAP, Ca-19-9 q6m x 5y
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14
Q

Rectal cancer

A
  1. w/u:
    - CEA, MMR/MSI testing
    - DRE w/ anoscopy
    - C’scope w/ biopsy. Distance from AV
    - CT CAP
    - Pelvic MRI. Consider liver MRI
  2. tx: LAR/APR
    - 12 nodes; at least 1 cm distal margin
    - neoadj (chemo+XRT): t3 or n (stage 2)
  3. surveillance:
    - h/p, CEA, MRI rectum, CT CA q6m x 5y
    - c/scope at 1, 3, 5 years
15
Q

Thyroid mass

A
  1. w/u:
    - TSH, T3, T4
    - US FNA
    - Thryoid/neck US
    - ?Laryngoscopy
  2. tx:
    - total thryoid: > 4 cm, high risk features
    - consider levothyroxine to keep TSH low
    - consider RAI for high risk disease
  3. surveillance:
    - lobectomy: h/p, TSH, neck U/S q6m x 5y
    - thyroidectomy: h/p, TSH, Tg, neck U/S q6m x 5y
16
Q

Palpable thyroid nodule
- w/u
- tx

A
  1. w/u:
    - neck radiation, prior ca
    - TSH/T3/T4:
    - TSH low: Graves vs. toxic nodule vs. MNG ➡ thyroid scintigraphy
    - TSH high: Hashimoto’s, cancer ➡ U/S
  2. tx: thyroidectomy
    - total if > 4 cm or worrisome features

1. CE prep (3 decks)

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