Med Onc Flashcards
3 Criteria that must be met for low dose CT annually x 3 years for lung ca screening?
Criteria (need all 3)
- Age 55-74 years
- ≥ 30 pack-year smoking history
- Current smoker or quit within the past 15 years
High risk population for breast cancer screening?
High risk population (> 25% lifetime risk)
o Known hereditary gene mutation (BRCA 1/2, TP53, PTEN, CDH1, PALB 1/2*) o 1st degree relative has a known hereditary gene mutation
o Personal or FHx of breast/ovarian cancer
o Radiation to the chest when < 30 yrs old, at least 8 yrs ago
Age cut-offs for mammography recommendations?
o 40-49 yrs – Recommend AGAINST screening
o 50-74 yrs – Recommend FOR screening mammogram q2-3 yrs
o ≥ 75 yrs – No evidence of benefits/harms to make formal recommendation
Recommended colorectal screening for age 50-74?
Screen with FIT or gFOBT q2 yrs
OR
Flex sigmoidoscopy q10 yrs
Recommenced CRC screening for patient with ≥ 1 First-degree relative with colon cancer OR advanced adenoma (aka increased risk)
Age 50 yrs or 10 yrs before earliest age of relative’s diagnosis:
o Screen with Colonoscopy q5 yrs if family member < 60 at age diagnosis
o Screen with Colonoscopy q10 yrs if family member ≥ 60 at age diagnosis
Recommendations for CRC screening for HNPCC/Lynch syndrome? (hereditary nonpolyposis CRC)
Age 20 or 10 yrs prior to earliest age of relative’s diagnosis – Colonoscopy q1-2 yrs
Recommendations for CRC screening for FAP?
Send for genetic counselling. Start at age 10-12. Screen with sigmoidoscopy annually
Recommendations for CRC screening for IBD, pancolitis and L-sided?
o Hx of Pan-colitis – Colonoscopy q1-3 yrs. Start 8 yrs after diagnosis
o Hx of Left-sided colitis – Colonoscopy q1-3 yrs. Start 12-15 yrs after diagnosis
These high risk populations warrant q6mo US for HCC screening.
o Cirrhosis o Hep B carrier (sAg +) AND... • § Asian males ≥40, Asian females ≥50 § African or North American blacks ≥20 § FHx of HCC in 1st degree relative (starting screening at age 40) § All HIV co-infected patients (starting screening at age 40) § All Cirrhotics (irrespective of age)
Who should be screened q3years with pap + cytology?
Women ages 25-69 – Screen with cervical cytology q3 years
§ Includes HPV-vaccinated women & women who have sex with women
What imaging should be sent for Breast Cancer work-up?
- Bilateral breast mammogram & ultrasound
* Axillary ultrasound
Indications for adjuvant chemo for breast cancer?
- Stage II/III for ER/PR+ breast cancer
- Stage II/III for HER2+ tumor (chemo + Trastuzumab (Herceptin®))
- Stage I-III for “Triple negative” (ER-, PR-, HER2-) breast cancer
Lifetime risk of breast cancer with BRCA 1 and BRCA 2
BRCA 1 = ↑ Lifetime risk of Breast ca (70%) and Ovarian ca (45%)
• BRCA 2 = ↑ Lifetime risk of Breast CA (70%), Ovarian Ca (20%), Prostate Ca,Pancreatic Ca, Gastric Ca
Imaging as part of work-up for Lung Ca?
• ALL patients – CT C/A/P, CT/MRI brain, Bone scan
• If no obvious metastatic disease
o PET scan – look for occult metastases
o Mediastinum nodal staging (mediastinoscopy or EBUS
Work-up (Pre-op) for CRC?
C-scope to terminal ileum, CT c/ap, CEA
CRC staging
Stage I -invades into muscle wall
Stage II -Invades through muscle wall
Stage III -Lymph node involvement
Stage IV -Distant metastases
Side effects of androgen deprivation therapy (ADT) for prostate Ca?
Osteoporosis
Decreased libido
Gynecomastia
Side effects of Docetaxel for prostate Ca?
Peripheral neuropathy
N/V
Hair loss
2 classes of check point inhibitors used as immunotherapy in solid organ malignancy
o PD-1 inhibitors (pembrolizumab, nivolumab)
o CTLA-4 inhibitors (ipilimumab)
Types of cancers with osteoblastic bone mets
Prostate, HL, SCLC, carcinoid
Types of cancers with osteolytic bone mets
MM, NHL, NSCLC, RCC, melanoma, thyroid
Types of cancers with mixed bone mets
Breast, GI, Squamous cell carcinomas (NSCLC, H&N, Cervical ca)
Types of radio resistant cancers
RCC, melanoma, osteosarcoma
Right supraclavicular node is suspicious for which Ca?
Lung
