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
fastest way to lower androgen /testosterone levels
orchiectomy (not first line though)
man w/ prostate ca. presents with signs of cord compression on MRI - managements?
- Steroids
- Flutamide - prevents androgen flare
GnRH agonists should NOT be started too soon - can worsen compression
a 60 year old woman presents with increasing abdominal girth at the same time as weight loss - dx?
likely ovarian ca.
Ca-125
NOT a screening test - marker of progression and response to therapy for ovarian ca.
Tx. ovarian ca.
surgical debulking + chemotherapy
- even in cases of extensive local metastatic disease`
diagnostic testing of suspected testicular ca.
inguinal orchiectomy of affected testicle
MC type of testicular ca.
germ cell tumors (seminoma and non-seminoma)
what types of testicular ca. secretes AFP
non-seminoma
what hormones/markers do you measure in testicular ca.
AFP
bHCG
LDH
staging of testicular ca.
CT abdo and pelvis
Tx. local disease testicular ca.
radiation
Tx. widespread testicular ca.
chemotherapy - can cure mets
cancer screening test that lowers mortality the most
mammogram
mortality benefit of mammogram is greatest above what age?
50
indications for influenza and pneumococcal vaccination
- pts with chronic lung, heart, liver, kidney and cancer
- HIV positive patients
- patients on steroids
- patients with diabetes
who benefits the most from influenza vaccine?
everyone > 50
pregnant women
healthcare workers
when do you give pneumococcal vaccine normally?
all patient > 65 yo
when is meningococcal vaccine given?
age 11
- earlier if pt has functional/anatomic asplenia OR terminal complement deficiency
who should receive the varicella-zoster vaccine?
everyone above age 60
most effective method of achieving smoking cessation
oral medication - bupropion, varenicline
osteoporosis screening
all women > 65 –> should receive bone densitometry
AAA screening
all men, > 65 who were every smokers
diabetes screening
only routine in those with HTN
HTN screening
all patients > 18 yo should have their BP checked at every visit
Hyperlipidemia screening
men > 35 and women > 45
