oncology Flashcards
What cancer screening test lowers mortality the most?
mammography above age 50 (until age 75)
What is the next best step in management for an abnormal mammogram?
sentinel node biopsy (detect cancer and assess for estrogen & progesterone receptors)
What is the next best step in management for a sentinel node biopsy that shows cancer?
axillary lymph node dissection
What two types of cancer are associated with BRCA gene?
- familial breast cancer
2. risk of ovarian cancer
What is the best initial therapy for breast cancer?
lumpectomy with radiation treatment
When is tamoxifen indicated for primary prevention of breast cancer?
pt that has 2 or more first degree relatives with breast cancer
What is the next best step in management of a breast cancer pt with estrogen and/or progresterone positive receptors after lumpectomy and radiation therapy?
tamoxifen
What is the next best step in management of a breast cancer pt with positive axillary nodes after lumpectomy and radiation therapy?
adjuvant chemotherapy
What are the three major side effects of tamoxifen treatment?
- deep venous thrombosis
- hot flashes
- endometrial cancer
What is the major side effect of aromatase inhibitors like anastrozole?
osteoporosis
When is adjuvant chemotherapy indicated in the treatment of breast cancer? (2)
- cancer in axilla
- cancer larger than 1 cm
(best in menstruating patient bc cant use estrogen antagonists)
What medication is a monoclonal antibody to HER-2/NEU and can be used in metastatic breast cancer?
trastuzumab
What is the best treatment for colon cancer?
surgical resection of colon with chemotherapy (5-fluorouracil if high risk stage 2-3)
What are the recommended routine screening guidelines for colon cancer?
- colonoscopy starting at age 50, every 10 years
2. fecal occult blood starting at age 50, yearly
What is the recommended colon cancer screening guidelines for a pt with a single family member with colon cancer?
colonoscop starting at age 40 or 10 years earlier than age at which family member was diagnose; every 10 years
What is the recommended colon cancer screening guidelines for a pt with family history of HNPCC (three family members affected over two generations with one being at diagnosed at less than 50 y/os)?
colonoscopy starting at age 25; every 1-2 years
What is the recommended colon cancer screening guideline for pt with history of juvenile polyposis/ peutz-jeghers/ turcot’s syndrome/ gardner’s syndrome?
no additional screening
What is the next best step in the management of a pt with a solitary lung nodule incidentally found on Chest X-ray or CT?
biopsy (if age > 50, smoker, nodule > 1cm, not calcified)
What is the only indication for lung cancer screening and what diagnostic test is used?
all smokers with 30 pack years or more smoking history between ages 55-80; use chest CT
What are the contraindications to surgical resection of lung cancer? (6)
- bilateral disease
- metastases
- malignant pleural effusion
- involvement of aorta/ vena cava/ heart
- lesions within 1-2 cm of carina
- small cell carcinoma (b/c usually has 1 of the above)
What is the routine screening guideline for cervical cancer screening?
Pap smear starting at age 21 every 3 years until age 29; then can do Pap smear with HPV testing every 5 years until age 65
What is the next best step in management of a pt with low grade/ high grade dysplasia on a Pap smear?
colposcopy and biopsy
What is the next best step in management of a pt with atypical squamous cells of undetermined significance (ASCUS) on a Pap smear?
HPV testing
What is the next best step in management of pt with positive HPV testing after discovering ASCUS on Pap smear?
colposcopy
What is the next best step in management of pt with negative HPV testing after discovering ASCUS on Pap smear?
repeat Pap smear in 6-12 months
Who should receive HPV quadrivalent vaccine (Gardisil) to prevent cervical caner?
all women age 13-26
What is the next best step in management for a pt aged
perform PSA testing and digital rectal exam
do not routinely offer
What is the most important prognostic factor for prostate cancer?
Gleason score (measures level of differentiation)
What is the best treatment for localized prostate cancer?
surgical resection with external radiation/ implanted radioactive pellets
What is the best treatment for metastatic prostate cancer?
flutamide (androgen blockade) with leuprolide/ goserelin (GnRH agonists)
What is the next best step in management of a pt with cord compression secondary to metastatic prostate cancer after administering steroids?
flutamide (block temporary flare up in androgens that accompanies GnRH agonist) followed by GnRH agonist
A female pt > 50 years old presents with increasing abdominal girth and weight loss most likely suffers from ….
ovarian cancer
What test can be used as a marker for progression and response to therapy for ovarian cancer?
CA-125
What is the best treatment for ovarian cancer?
surgical debulking followed by chemotherapy
A male pt
testicular cancer
What is the best way diagnosis testicular cancer?
inguinal orchiectomy (measuring AFP, LDH, beta-HCG can detect which type of testicular cancer is present)
What diagnostic tool is used to stage testicular cancer?
CT scan of the abdomen and pelvis
What is the treatment for local testicular cancer?
radiation
What is the treatment for metastatic testicular cancer?
chemotherapy
