MTB - Oncology/ Preventive Medicine Flashcards
screening mammography
starts at age 50, ends at age 75
BRCA mutation is assoc. with
increased risk of familial breast ca. and ovarian ca.
BRCA mutation screening
NOT a routine screening test –> only for at-high risk patients
when do you use tamoxifen as preventative therapy?
if the patient has 2 or more first degree relatives with breast ca.; start therapy at age 40
adjuvant chemotherapy in breast ca.
if tumor > 2 cm (1 cm) or there is axillary LN involvement
more likely to be effective in menstruating women
s/e of tamoxifen
DVT
hot flashes
endometrial cancer
how are aromatase inhibitors different from tamoxifen?
no selective ER agonist activity
NO risk of DVT
do cause osteoporosis (antagonist in bone)
routine colonoscopy
age 50, every 10 years
CRC screening - one family member with CRC
colonoscopy age 40 or 10 years earlier than age of dx (whichever is earlier)
CRC screening - HNPCC (3 family members, two generations, one premature <50 yo)
colonoscopy at age 25, then every 1-2 years
CRC screening - FAP
screening sigmoidoscopy at age 12, then every 1-2 years
screening test for lung ca
none
52 yo smoker with 1.5 cm calcified nodule found on CXR; no symptoms. Next step?
Excisional biopsy on all lesions > 1 cm in smokers
Surgery is excluded in lung cancer if any of the following are present…(5)
bilateral lesions mets malignant pleural effusion involvement of aorta, vena cava, heart lesions w/in 1-2 cm of carina
follow-up for LSIL or HSIL found on pap smear
colposcopy and biopsy
follow-up for ASCUS found on pap smear
HPV testing
- if positive: colposcopy
- if negative: repeat pap in 6-12 months
which lowers mortality more? mammography or pap smear?
mammography
when do you start Pap Smears?
age 21 - regardless of onset of sexual activity
Every 3 years if normal results
when can you stop pap smears?
age 65
screening for prostate cancer
only if patient asks –> do PSA and DRE until age 75
do PSA and DRE testing lower mortality from prostate cancer?
no
most important prognostic factor in prostate ca.
Gleason score (measure of level of differentiation)
Tx. localized prostate ca.
surgery or external radiation or implanted radioactive pellets –> both are equal in efficacy
Tx. metastatic prostate ca.
androgen blockade w/ flutamide and leuprolide or goserelin
