Day 5- Prostate Cancer and Lung Cancer Flashcards
What is Prostate Cancer’s incidence and mortality rate?
What are Prostate Cancer risk factors?
Do you HAVE to do Digital rectal exam with PSA?
Most common cancer in men, 3rd most lethal.
Age(>65), Family history(African American), Living in US or Scandinavia(Asia has lowest and lowest family history),High diet in vegetables, tomatoes, soy.
YES!
When should you do PSA and is it specific to cancer?
Is Velocity more prognostic for PSA?
When should patients start screening for Prostate cancer?
Do it before exam, and NO!
Si, a happy maids.
Age of 50 for people with a 10 year life expectancy. High risk patients is at 40.
How do the 5 alpha reductase inhibitors help with chemoprevention?
Is Metastatic bone disease common in prostate cancer?
What does a high gleason grading score tell you?
They prevent the prostate from growing.
YES.
The higher the score the more aggressive the tumor.
Are surgical and medical castration equivalent?
What are your LHRH agonists?
What are the LHRH agonist side effects?
YES
Goserelin(3.6 mg every month), Leuprolide(7.5 mg every month) Triptorelin(3.75 mg every month), Historelin(50 mg per year).
Hot flashes, Tumor flare, Sexual Dysfunction, Gynecomastia, Osteoperosis, Injection site reaction.
How do you minimize tumor flare in LHRH agonists?
What is your GnRH agonist?
What are your anti androgens and do they require combination therapy?
Initiate by starting anti androgens prior to LHRH agonists.
Degarelix(240 mg first month than 80 mg every month after. Similar side effects to the LHRH agonists. Avoids tumor flare and has a fast drop in testosterone(7 days).
Flutamide, Bicalutamide, Nilutamide. All these drugs must be given in combination therapy.
What are the intermittent androgen therapy cut offs?
If patient is Locally advanced or high risk how do you treat them?
If patient is Metastatic how do you treat?
Hold when PSA <4, Start when PSA is 10-20.
RT + ADT every 2-3 years.
RT + ADT
When do you do a prostatectomy?
What chemotherapy agent do you use?
What things to know about Enzalutamide?
> 10 year life expectancy but intermediate or high risk.
Docetaxel.
Metastatic castration resistant indicated. Administered with or without food, take at same time each day.
Which drug is your calcium mimetic?
How does Sipuleucel-T work?
Do you have to give Abirateone with prednisone?
Radium-223.
Blood obtained, filled with antibodies, given back. Need ECOG of 0-1.
Si, a happy maids.
What 3 things do you need to stage a patient?
If patient is symptomatic do you always treat a patient?
What is lung cancer’s mortality and incidence rate?
Tumor characteristics, Gleason, PSA.
YESSSSS!!!
Most common cause of death, 2nd most common incidence.
What are your lung cancer risk factors?
What are the signs and symptoms lung cancer?
How do we diagnose lung cancer patients?
Smoking, environmental exposure, diet, pre existing lung disease(COPD), genetics.
Cough, hypercalcemia, SVC obstruction, vvenous thromboembolism, etc.
Visualization, tumor sampling(fine needle not preferred), sputum, thoracentesis, bronchoscopy, core needle biopsy.
What is the difference between small cell and non small cell cancers?
What 2 have been linked to smoking?
How do you stage small cell lung cancer?
Small cell is faster growing, 15% of all lung cancers, 70% present with metastasis, highly sensitive to chemotherapy and radiation.
Squamous cell and Small cell(S for smoking).
Limited or Extensive, Limited is 1/3 and is tumor located within single hemithroax or single radiation port.
How do you treat limited stage lung cancer?
What is PCI?
How do you treat extensive stage lung cancer?
Concurrent Chemoradiation. Either Etoposide-Cisplatin or Etoposide-Carboplatin.
Prophylactic Cranial irradiation–> offered to those with a good response to chemoradiation, CI’d in people with poor performance and impaired neurocognive function. If you do this your brain metastasis chance is SIGNIFICANTLY reduced and survival is improved.
Cisplatin/Carboplatin + Etoposide/Irinotecan. Chest radiation in patients with good response, Brain radiation –> if symptomaitc prior to chemo, if asymptomatic after, metasteses absent?–> PCI.
How do you manage combination chemo in extensive lung cancer?
How do you treat Stage 1 and 2 NSCLC?
How do you treat stage 3A and B NSCLC?
3 drugs is not better than 2!!!
Stage 1 is surgery, stage 2 is surgery and adjuvant chemo.
Surgery, Chemo, Radiation and sometimes neoadjuvant. Stage 3B is adjuvant chemo and RT.
How do you treat stage 4 NSCLC?
Is pemetrexed used in non-squamous histology and why?
When do you use carboplatin?
Molecular testing for targeted therapy.
YES, don’t use in squamous cell.
Only used in patients with co morbidities.
How do you treat stage 4 NSCLC if they are EGFR mutation positive?
How do you treat stage 4 NSCLC if they are EML4-ALK?
How do you treat stage 4 NSCLC if they are PD-L1 positive?
Erlotinib, Afatinib, Gefitinib, Osimertinib.
Crizotinib, Alectinib, Cereitinib.
Pembrolizumab.
