Introduction to Cancer Medicine Flashcards
52 year old woman notices a possible lump in the L breast, otherwise very well, and presents to LMO
What does the doctor need to do?
Full history: Hx of the lump, relevant FHx
Full examination and assessment of breast lump: hard vs soft, regular vs irregular, skin changes, nipple retraction
Imaging: U/S and mammography
Referral to breast surgeon: FNA and biopsy
What options are there for breast cancer treatment?
Local therapies: surgery, radiotherapy
Systemic therapies: chemotherapy, hormone therapy, immunotherapy, molecular therapy
Clinical trials
What local therapies are used to treat breast cancer?
Surgery
Radiotherapy
What systemic therapies are used to treat breast cancer?
Chemotherapy
Hormone therapy
Immunotherapy
Molecular therapy
What information is needed from the pathology report on a breast cancer?
Size
Grade
LN involvement
Molecular pathology (e.g. hormone receptors, HER-2)
Staging
What is the incidence of cancer in the 80+ population?
1:3
52 year old woman notices a possible lump in the L breast, otherwise very well, and presents to LMO
She elects to have a lumpectomy and sentinel node biopsy
Pathology: 24mm, grade 3, LN negative
What other information is needed from the pathology specimen itself?
What other information is needed?
Molecular pathology: oestrogen/progesterone receptor, HER-2, consider gene arrays
Need to stage (TNM)
In what cancers is adjuvant treatment commonly employed?
Breast
Colon
Lung
Sarcomas
What is the role of adjuvant treatment in cancer management? What are the limitations?
Reduces risk of local and systemic recurrence
Improves overall therapy
Limitations, finite therapy, must tolerate some toxicity, large numbers of patients treated for some individuals to benefit
52 year old woman previously diagnosed with and treated for breast cancer
5 years later, presents with 1/12 of mild R hypochondrial pain, 4 kg weight loss and mild fatigue
Next steps?
FHx and examination
Imaging (CT, consider need for PET)
Interpret this CT
52 year old woman with Hx of breast cancer has imaging which shows metastatic spread
What next?
Refer to medical oncologist
Biopsy of liver lesion
Systemic treatment: chemotherapy, hormone therapy, immunotherapy, molecular therapy, consider clinical trial if relevant
Give 2 examples of cancers which may be cured even where there is metastatic spread
Testicular cancer
Lymphoma
Give 3 examples of cancers in which chemotherapy may be curative for metastatic disease
What is the limitation of this treatment?
Germ cell cancers, NHL, leukaemias
Limitation: must tolerate significant toxicity (mortality is a risk)
What team members are involved in multi-disciplinary care of cancer patients?
LMO
Surgical oncologist
Radiation oncologist
Medical oncologist
Palliative care physician
Nurses
Allied health
