Oncology Flashcards
How is Breast CA usually found
ASx women on screening mamography
Palpation of mass by pt or doctor
Features of Breast CA mass
Palpable
Hard
Possible retraction of nipple
Painless
Best initial test for breast CA
Bx
Best method to Bx breast CA
FNA
What is the upside of doing core needle bx for breast CA
Can test for ER, PR, Her2/neu
Most accurate dx test for breast CA
Open Bx
When is mammography indicated
Screen for breast CA in gen pop starting at 50
Why do mammography in pt who is already undergoing FNA for a mass
5-10% have b/l disease
When to do U/S in breast CA
Clinically indeterminant mass
- Painful
- Varies in size and pain during menses
When to do a PET in breast CA
Determine content of abnormal LNs not accessble to bx
What is BRCA associated w/
Increased risk of breast CA in families
Ovarian CA
Does BRCA testing aid in mortality reduction
No
Who gets sentinel node bx
All pts at time of lumpectomy or mastectomy
Why do sentinal node Bx
Neg eliminates need for axillary dissection
Who gets ER, PR testing
All pts
When is hormone manipulation therapy done in breast CA
When ER or PR is positive
What is the role of localized radiation in breast CA
Prevent recurrence
What do all ER or PR positive pts receive
Tamoxifen, raloxifene or an aromatase inhibitor
Which hormonal manipulation drug is most likely to benefit a breast CA pt
Aromatase inhibitors
Tamoxifen AE
Endometrial CA
Clots
Aromatase inhibitor AE
Osteoporosis
When is trastuzumab (herceptin) given
Her2/neu positive
Reduces risk of recurrent disease
When is adjuvant therapy given
Lesions >1cm
Positive axillary LNs
When is tamoxifen given as PPx
Multiple 1st degree relatives have breast CA
What lowers mortality from breast CA
Mammography ER/PR testing then tamoxifen/raloxifene Aromatase inhibitors Adjuvant chemo Lumpectomy and radiation Modified radical mastectomy Trastuzumab PPx w/ tamoxifen/raloxifene
Presentation of prostate CA
Obstructive sx
Palpable lesion
Best initial test and most accurate test for prostate CA
Bx
MC complications of prostatectomy
ED
Urinary incontinence
What is gleason grading
Measure of aggressiveness or malignant potential
What does a high gleason grade suggest
Greater benefit of surgical removal
What is NOT beneficial in prostate CA
Screening
Lumpectomy
Chemo
Hormonal manipulation
Why is PSA controversial
No clear mortality benefit
Not routinely offered
NL does not exclude
>75 never done
If pt is
Do it
Elevated PSA and palpable mass, next step
Bx
Elevated PSA and no palpable mass, next step
Transrectal U/S
Elevated PSA,no palpable mass, Transrectal U/S shows mass, next step
Bx
Elevated PSA,no palpable mass, Transrectal U/S doesn’t show mass, next step
Multiple blind bx
When is surgery not possible in lung CA
B/L
Malignant pleural effusion
Heart, carina, aorta, vena cava involvement
Small cell
Is there a screening test for ovarian CA
No
Presentation of ovarian CA
Woman > 50
Increasing abdominal girth but still losing weight
Best initial test for ovarian CA
U/S or CT
Most accurate test for ovarian CA
Bx
Rx ovarian CA
Remove large amounts of locally metastatic disease
Chemo
What does testicular CA look like on PE
Painless lump
Doesn’t transilluminate
Who is at increased risk of testicular CA
Hx of cryptorchidism
Dx testing in testicular CA
Remove whole testical w/ inguinal orchiectomy
What secretes alpha fetoprotein
Nonseminomatous CAs
All testicular CAs have elevated
HCG
How is staging done in testicular CA
CT abd, pelvis, chest
Rx testicular CA
Orchiectomy
Radiation for local disease
Chemo for widespread disease
Management of cervical CA
Hysterectomy
Who gets HPV vax
All women 11-26
Who gets PAP
Women at age 21 then every 3yrs until 65
Low grade or high grade dysplasia on PAP, next step
Colposcopy for bx
ASCUS on PAP, next step
HPV testing
ASCUS on PAP, HPV+, next step
Colposcopy
ASCUS on PAP, HPV-, next step
Repeat PAP in 6 months
