Intro to medical oncology wk8w11

Question 1

Breast Cancer Screening

Answer 1

• Breast Self Exam—optional
• Clinical Breast Exam- Every 3 years starting age 20, yearly after age 40
• Mammogram, yearly after age 40
• Women at high risk (>20% lifetime risk of breast cancer) should get yearly MRI and MMG (new 2007 ACS recommendation)

Question 2

Colon cancer screening

Answer 2

Beginning age 50:

• Yearly fecal occult blood + q5yr flex sig
• Double contrast barium enema q5 years
• Colonoscopy q10 years

If high risk (family history cancer, personal history polyps or inflammatory bowel disease) more frequent and may start at younger age

Question 3

Screening for cervical cancer

Answer 3

Pap smears start yearly 3 years after begin vaginal intercourse, no later than 21 yo.

Yearly screening regular pap or q2years with liquid based Pap

Age 30: if 3 normal Pap in a row, can screen q2-3 years or every 3 years if add HPV DNA test

If DES exposure before birth, HIV, immunosuppression continue annual screening

70 years old+, if 3 normal Paps in a row and no abnormal in last 10 years, can stop screening (except above risk groups)
New vaccine

Question 4

Prostate cancer screening

Answer 4

PSA blood test and digital rectal exam (DRE) yearly starting age 50

High risk men (African-American, strong family history) start screening age 40-45.

Discuss risks/benefits (limitations to testing), but should offer to patients

Question 5

Carcinogenic medical agents and disease caused

Answer 5

Estrogens Endometrial/Breast

Anabolic steroids Liver

Tamoxifen Endometrium

Melphalan Lymphoid tissue

Busulphan Bone marrow

Question 6

life style factors and associated cancers

Answer 6

Tobacco— lung, bladder, esophagus, mouth, larynx

Betel —-nut oral cavity

Alcohol —– esophagus, oral, pharynx, liver

UV Rad —– melanoma, other skin ca

Question 7

PET

Answer 7

Inject radiotracer Fluorine-18-DeoxyGlucose (FDG) (make radionuclide in a cyclotron near PET, b/c short ½-life).

Metabolically active tissues (cancer, infection) uptake glucose and show up on scan

Question 8

Imaging modalities for staging

Answer 8

PET
CT
MRI
Bone scan
Ultrasound
Plain X-rays

Question 9

Bone scan

Answer 9

Technetium-99m-MDP injected then scan with Gamma camera. Half radioactive material localized by bones.

More active bone turnover, the more it will be seen. Tumors, fractures, infections and arthritis positive. Not sensitive for lytic lesions.

Question 10

Cancer Staging

Answer 10

American Joint Committee on Cancer (AJCC) TNM

• T = Tumor size (T0, Tis, T1, T2, T3, T4)
• N = Regional Lymph node involvement (NO, 1, 2, 3)
• M = Metastases (MX, M0, M1)

TNM combined into stage: For example-
Stage 0: Tis N0 M0
Stage I: T1 N0 M0
Stage II: T0-2 N0-1 M0
StageIII: T0-3 N1-2 M0
StageIV: anyT anyN M1
Tumor types not typically staged by TNM
Pediatric; Leukemia/lymphoma; CNS tumors

Question 11

Clinical vs. pathologic staging

Answer 11

Clinical staging (by PE & imaging) guides presurgical (“neoadjuvant”) chemotherapy choices

Pathologic staging helps determine prognosis and guides whether patient should receive post-surgical (“adjuvant”) chemotherapy.

Question 12

Oncologic emergencies

Answer 12

Superior Vena Cava syndrome

Spinal cord compression (prostate, breast, lung)

Electrolyte disturbances (tumor lysis, low Na, high calcium, hyperuricemia, etc)

Cardiac tamponade (malignant effusion)

Venous thromboembolism

Febrile neutropenia

Question 13

HER 2 and breast cancer

Answer 13

• HER2 overexpressed in breat cancer
• Trastuzumab (herceptin)= targets Her2/neu protein on surface of breat cancer
• drug bound to emtansine (toxic), internalized and ph of lysosome causes toxin to be released and kill cell= T-DM1