IM Oncology Flashcards

1
Q

Breast Cancer

Presentation

A

breast cancer is found in asymptomatic women on screening ammography or by the palpation of a mass by the pt or a physician. when breast cncer presents as a plapable mass, it is hard to the touch. it may also be associated with retraction of the nipple bc ligaments int eh breast will withdraw and pull the nipple inward

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2
Q

Breast Cancer

diagnostic tests

A

FNA

core needle biopsy
open biopsy

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3
Q

Breast Cancer is usually

A

painless

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4
Q

Breast Cancer

FNA

A

usually the best initial biopsy. the false positive rates are less than 2%. however, bc fna is a small sample the disadvantages are a false negative rate of 10%

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5
Q

Breast Cancer

core needle biopsy

A

this is a larger sample of the breast. it is more deforming, but you can test for estrogen receptors (ER), progesterone, receptors (PR), and HER 2/neu. the difficulties inclued greater deformity with the procedure and the possibilitiy taht the needle will miss the lesion

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6
Q

Breast Cancer

open biopsy

A

the most accurate diagnostic test, allows for frozen section to be done while the pt is in the operating room followed by immediate resection of cancer followed by sentinel node biopsy

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7
Q

when can you not test for estrogen progestreon or her2/neu

A

on FNA

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8
Q

mammography

A

indicated to screen for breast cancer in the general population starting at age 50

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9
Q

why do a mammo on a person with a palpable mass

A

bc 5-10% of pts have bilateral disease, also to determine if there is multiple or just a single mass.

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10
Q

when is ultrasound the answer with breast lesion

A

clinically indeterminant mass lesions, it tells cysts versus solid lesions

if it is painful

if it varies in size with menstruation

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11
Q

when is PET scan the answer with breast lesion

A

to determine the content of abnormal lymph nodes that are not easily accessible to biopsy, cancer increases uptake on PET scan

like an abnormal hilar lymph node

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12
Q

how do you tell the content of an abnormal inaccessible lesion without biopsy

A

PET scan

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13
Q

When is BRCA testing the answer to breast lesion

A

BRCA is definitely associated with an increased risk of breast cancer, particularly within families

BRCA is associated with ovarian cancer and pancreatic cancer

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14
Q

what do you do if pt is BRCA positive

A

BRCA has not yet been shown to add mortality benefit to usual management. however, some pts opt for bilateral mastectomy

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15
Q

When is sentinel lymph node biopsy the answer to breast lesion

A

Sentinel node biopsy is done routinely in all pts at the time of lumpectomy or mastectomy

a negative sentinel lymph node eliminates the need for axillary lymph node dissection

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16
Q

When are estrogen and progesterone receptors tested in breast lesion

A

estrogen recptor and prgesterone rectpro testing is routine for all pts

hormone manipulation therapy is done if either test is positive

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17
Q

step 2 will not test on

A

who should get brca

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18
Q

Breast Cancer treatment

surgery

A

lumpectomy with radiation is equal in efficacy to modified radical mastecomty but much less deforming. the addition of radiation to lumpetomy is not a small issue. radiation at the site of the cancer is indispensible in preventing recurrences at the breast. lumpectomy is contraindicated if the cancer is multifocal or radiation is contraindicated

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19
Q

radical mastectomy is

A

always the wrong answer

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20
Q

Breast Cancer treatment

hormonal manipulation

A

all ER or Pr positive pts should receive tamoxifen, faloxifen, or one of the aromatase inhibitors (anastrazole, letrozole, exemestane). aromatase inhibitors seem to have a slight superiority in efficacy. if both are among the answer choices,

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21
Q

aromatase inihibitors are the answer to

A

the most likely to benefit the pt question

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22
Q

aromatase inhibitors are generally for

A

postmenopausal women

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23
Q

tamoxifen is better in

A

premenopausal women

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24
Q

tamoxifen ae

A

endometrial cancer and clots (it is a selective ER modifier)

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25
Aromatase inhibitors ae
osteoporosis
26
Aromatase inhibitors moa
inhibit estrogen effect everywhere, even the good effects like on bone density
27
Trastuzumab
all breat cancers should be tested for Her 2/neu. this is an abnormal estrogen receptor those who are positive should receive anti-Her 2/neu antibodies (trastuzumab) decreases the risk of recurrent disease and increase survival
28
adjuvant chemotherapy in breast cancer
not prohylactic bc pt already has the disease it is not treatmen tsinc eth termi implies there are no clearly identified mets adjuvent meant an additional therapy to clean up presumed microscopic cancer cells too small in amount to be detected
29
When is adjuvant chemotherapy in breast cancer the answer
lesions are larger than 1 cm positive axillary lymph nodes are found
30
when to use tamoxifen in prophylaxis
when multiple first degree relatives have breast cancer, it lowers the risk of breast cancer
31
what lowers mortality with breast cancer
mammography ER/Pr testing, then tamoxifen/raloxifen aromatase inhibitors adjuvant chemo lumpectomy and radiation modified radical mastectomy trastuzumab (anti-Her 2/neu) prophylaxis with tamoxifen (or raloxifene)
32
we do not know whaat to do when what is positive
BRCA
33
Prostate Cancer presentation
obstructive symptoms on voiding similar to benign prostatic hypertrophy or a palpable lesion on exam.
34
Prostate Cancer best initial test and accurate test
biopsy and biopsy
35
most prostate cancers are
asymptomatic
36
Prostate Cancer treatment
prostatectomy may have a slight benefit over radiation in terms of survival
37
most common complications of prostatectomy
ed urinary incontinence
38
Localized Prostate Cancer treatment
it is not known whether prostatectomy, external beam radiation, implantable radioactive pellets, or watchful waiting is uperior in localized prostate cancer
39
what prostate treatment gives ED
surgery>radiation
40
Prostate Cancer Gleason Grading
a measure of the aggressiveness or malignant potential of prostate cancer a high gleason grade suggests a greater benefit of surgical removal of prostate get it out before it metastasized if the gleason grade is high
41
hormonal manipulation in Prostate Cancer
flutamide, GNRH agonists, ketoconazole, and orchiectomy help control the size and progression of mets once they have occurred. they do not prevent recurrences like tamoxifen, they shrink lesions that are already there
42
wrong answers in Prostate Cancer
no screening imaging study (us is not a screening test it is used to localize lesions to biopsy when psa is high lumpectomy chemo is used only if hormonal therapy doesnt work no hormonal manipulation prevents recurrences
43
PSA
there is no clear mortality benefit no to be routinely offered to pts normal psa does not exclude cancer never do above 75
44
psa corresponds to
th volume of cancer the higher the psa the greater the risk of cancer
45
how many men above age 80 have prostate cancer on autopsy
50%
46
what to do if pt asks for psa
do the test
47
elevated psa palpable mass next step
biopsy the mass
48
elevated psa no palpable mass next step
transrectal us mass seen (then do a biopsy) mass not seen (multiple blind biopsies)
49
screen for lung cancer annually with low dose chest CT in those with:
30 pack year smoking hx and age 55-80
50
Lung cancer who should be treated with surgery
the size of the lesion is not the most important factore in whether or not the lesion if resectable. if the lesion is large, but is surrounded by normal lung and there is enough remaining lung function post resection, then surgery is still possible.
51
Lung cancer when is surgery not possible
bilateral disease or lymph nodes involved on opposite side malignant pleural effusion heart, carina, aorta, or vena cava is involved
52
Small cell cancer is considered
unresectable bc it is metastatic or spread outside of one lung in 95% of cases
53
Ovarian Cancer screening test
there is none
54
Ovarian Cancer look for
a woman above the age of 50 with increasing abdominal girth but who is still losing weight BRCA is associated with ovarian cancer
55
Ovarian Cancer initial test
us or Ct
56
Ovarian Cancer most acccurate diagnostic test
biopsy
57
Ovarian Cancer ca125
not for screening, only used in the follow-up of treatment
58
Ovarian Cancer treatment
the only cancer in which removing large amounts of locally metastatic dz will benefit the pt. remove all visible tumor and pelvic organs and give chemo
59
Testicular Cancer presentation
painless lump in the scrotum that does not transilluminate incraesed with hx of cryptorchidism
60
Testicular Cancer Diagnostic testing orchiectomy
use inguinal orchiectomy, do not cut the scrotum bc it can spread the disease
61
Testicular Cancer Diagnostic testing needle biopsy
always the wrong answer
62
Testicular Cancer Diagnostic testing markers
alpha fetoprotein is secreted by nonseminomatous cancers HCG is up in all of them
63
Testicular Cancer Diagnostic testing staging
performed with abdominal, pelvis, and chest CT it mestatasizes throught he lymphatic channels in the retroperitoneum and muves up into the chest
64
Testicular Cancer treatment
after orchiectomy, radiation is used for local disease and chemo is used for widespread dz (seminomas)
65
Testicular Cancer chemo
one of the only cancers where chemo can cure mets even in the brain
66
seminoma
sensitive to chemo and radiation
67
non-seminoma
sensitive to chemo
68
in cervical cancer pap smear does not lower mortality as much as
mammo or colonoscopy
69
managment of advanced cervical cancer
hysterectomy
70
Pervention of Cervical cancer
HPV vaccine is givent o all women between ages 11 and 26 pap smear is performed starting at age 21. Repeat test every 3 years until the age of 65. of women with fatal cervical cancer 85% have never had a pap smear, if testing HPV can increase to every 5 years
71
Detection of Cervical cancer low-grade and high grade syplasia on pap smear is followed up with a
colposcopy for a biopsy
72
Detection of Cervical cancer atypical squamos cells of undetermined significance (ASCUS)
can be a sign or early, perinvasive cancer or an infection, or may simply be a false positive
73
Detection of Cervical cancer if ASCUS is present
perfomr HPV testing, if HPV is found, colposcopy is performed
74
Detection of Cervical cancer if hpv is not associated with ASCUS,
repeat the pap smear at 6 months