Common Cancers in Midlife Women

Question 1

top estimated new ca cases

Answer 1

1) breast
2) lung & bronchus
3) colon & rectum
4) endometrium
5) melanoma (skin)

Question 2

top female ca deaths

Answer 2

1) lung & bronchus
2) breast
3) colon & rectum
4) pancreas
5) ovary

Question 3

Breast ca

Answer 3

-most common; improvement in survival may be bc of early detection & improved therapies
-surgical risk reduction strategies: BRCA 1 or 2 have a lifetime risk of up to 72%
-chemoprevention: tamoxifen, raloxifene, AIs if Gail Model risk is >1.7% over 5yrs
-survivorship care:
GSM - nonrandomized studies have failed to show an increased risk of breast ca recurrence in women w vaginal estrogens
VMS - gabapentin, sertraline, venlafaxine

Question 4

breast ca RFs

Question 5

Breast ca Tx

Answer 5

-lumpectomy w/wo radiation therapy
-ER/PR+, HER2- w <3nodes will benefit from oncotype reduction score
-triple negative disease: anthracycline + taxane
-large tumors: neoadjuvant chemo or endocrine therapy then surgery
-if HR+: premeno 10yr tamoxifen; postmeno 5yr of AI

Question 6

Endometrial ca

Answer 6

-4th most common
-sxs: 90% dx’d w uterine ca present with AUB
-screening: dada do not support screening for uterine ca in the absence of sxs
-HT use: after Tx, based on individual

Question 7

Endometrial ca RFs

Answer 7

-age >50yo
-genetics: hereditary nonpolyposis colorectal ca (Lynch II), fam hx
-hyperestrogenic states - PCOS, nulliparity, unopposed estrogen, anovulatory cycles
-hyperinsulinemia & variations of estrogen receptor gene
-obesity, inactivity, DM, etoh

Question 8

Endometrial ca Tx

Answer 8

-hyperplasia wo atypia: progestin (IUD or oral) or OCPs if perimeno
-hyperplasia w atypia: hysterectomy + BSO or high-dose progestin if conservative approach necessary
-Stage I-II: hysterectomy, BSO, staging, possible RT
-Stage III: surgery, adjuvant chemo
-Metastatic/Recurrent: chemo for palliation

Question 9

Cervical ca

Answer 9

-develops in the setting of persistent HPV infection
-sxs: frequently asymptomatic but maybe watery discharge, postcoital bleeding, vaginal spotting
-Tx: early stage disease may be eligible for fertility sparing resection; preferred curative approach for stage Ia-IIa - radical hysterectomy, possible RT; stage IIb or higher, chemo radiation
-HPV vax; children 11-12yo, young women up to age 45yo

Question 10

Cervical ca RFs

Answer 10

-smoking
-genetics: inherited gene polymorphisms that regulate immune response
-immunosuppression: HIV, organ transplant hx
-early age at first intercourse, multiple partners, STIs
-exposure to diethylstilbesterol in utero

Question 11

Cervical ca screening

Answer 11

-pap q3y starting age 21y, reflex HPV
-q5y if combined with HPV test for women aged 30-65y
-screening not indicated in women 65yo or older w adequate prior screening and not at high risk
-high-risk women should undergo Pap test w reflex screening q3y

Question 12

Epithelial Ovarian ca

Answer 12

-leading case of gyn cancer-related death
-sxs: nonspecific in early stage; bloating pelvic pain, urinary urgency
-screening: no satisfactory test; timely evaluation of sxs recommended
-prevention strategies from Society of GYN Onc: oral contraceptive use, tubal sterilization, BSO if BRCA+, genetic counseling, salpingectomy at elective surgeries
-tx: aggressive surgical staging; platinum/taxane-based chemo

Question 13

Epithelial Ovarian ca RFs

Answer 13

-hereditary: BRCA 1&2
-genetics: hereditary nonpolyposis colorectal ca; Li Fraumeni, Peutz-Jeghers
-increased ovarian activity - nulliparity, infertility
-aging >60yo
-endometriosis

Question 14

Epithelial Ovarian ca classification

Answer 14

-high-grade serous
-mucinous
-seromucinous and endometrioid
-clear cell
-Brenner tumor

Question 15

Lung ca

Answer 15

-leading cause of cancer-related death in women
- RFs: smoking, genetics, environmental factors & pollution, prior radiation
-screening: USPSTF recs annual low-dose CT screening in asymptomatic persons aged 55-80yo w 30pack/yr hx, current smokers, or quit w/in past 15yrs
-data for the use of HT in these patients are limited & w conflicting results
-antiestrogen agents may improve lung ca outcomes

Question 16

Non-small cell Lung ca

Answer 16

-traits: 85% adenocarcinoma , squamous cell, large cell
-tx: localized - surgery, possible chemo; unresectable - chemo/immunotherapy w RT

Question 17

Small cell Lung ca

Answer 17

-trait: 10-15%; rarely presents as solitary lesion
-tx: locally advanced - chemo, RT; metastatic - chemo

Question 18

Colorectal ca

Answer 18

-3rd leading cause of ca-related death in women
-screening: average risk women begin at age 45-50yo; halt after age 85yo
-tx: stage I - surgery; stage II & III - chemo radiation, surgery, post-op chemo; stage IV - combo chemo w cytotoxics

Question 19

Colorectal ca RFs

Answer 19

-nonmodifiable: ethnicity , age (increases after 50yo), fam hx, genetics (HNPCC-Lynch), IBS, prior hx of colon ca, prior polyps
-modifiable: type 2 DM, diet high in red and processed meats, physical inactivity, obesity, smoking, heavy etoh use

Question 20

Tests that detect adenomatous polyps & ca

Answer 20

-colonoscopy q10yr
-flexible sigmoidoscopy q5yr
-CT or virtual colonoscopy q5yr

Question 21

Tests that detect mainly colorectal ca

Answer 21

-guaiac-based FOBT q yr
=FIT q yr
=stool DNA q 3y (Cologuard)

Question 22

Skin ca

Answer 22

-most commonly dx’d ca
-RFs: fair skin, UV exposure (sunburns, tanning beds), age, fam or personal hx
-mitigation: use sunscreen that blocks UVA/UVB SPF >30, re-apply q 60-90 min; avoid sun between 10am-2pm
-screening: annual exams if fam or personal hx

Question 23

Skin ca types

Answer 23

-actinic keratosis -> can progress to SCC; tx w cryotherapy, 5-FU, imiquimod
-basal cell -> lifetime risk 28-33%; tx w excision
-squamous cell -> closely r/t sun exposure; tx w excision
-melanoma -> A,B,C,D,E criteria; tx w excision, staging, systemic therapy
-merkel cell -> aggressive, metastasis common; tx w box, staging, radiotherapy
-dermatofibrosarcoma protuberans -> rare, high rate of recurrence; tx w wife local excision