Oncology Flashcards
best initial test breast cancer
biopsy
which type of biopsy is the best initial for breast cancer
FNA
FN rate of FNA for breast cancer
10%
core needle biopsy
LARGER SAMPLE, more deforming, ER/PR/HER2/Neu; possibility that needle will miss the lesion
most ACCURATE bx type for breast cancer
open biopsy– frozen section while in operating room; followed by immediate resection of cancer, followed by sentinel node bx
mammography screening– age start at
50yo
NB even if already getting FNA
do MAMMOGRAPHY – since 5-10% of patients = bilateral
MRI use for breast cancer
PRECISE USE NOT clear yet;
young woman with dense breasts
US breast cancer
indeterminant mass lessions
cystic vs. solid
if the lesion is PAINFUL
or VARIES in size/pain with MENSES
PET scan breast cancer
determine CONTENT of abnormal lymph nodes that are not easily accessible to biopsy
BRCA testing
a.w increased risk of breast cancer
other cancers a/w BRCA
PANCREATIC and OVARIAN cancer
BRCA positive… now what
WILL NOT BE ASKED–since NOT yet shown to add mortality benefit to usual mgmt;
(most go for bilateral mastectomy)
sentinel lymph node biopsy
done AT THE TIME of lumpectomy/mastectomy
negative sentinel node
ELIMINATES NEED FOR axially lymph node dissection
RADIATION for breast cancer
INDISPENSIBLE in preventing cancer RECURRENCES
premenopausal option of hormone manipulation breast cancer
tamoxifen
postmenopausal option of hormone manipulation breast cancer
aromatase inhibitors
letrozole
aromatase inhibitor
exemestane
aromatase inhibitor
side effect of aromatase inhibitors
OSTEOPOROSIS
RADICAL MASTECTOMY
ALWAYS the wrong answer
trastuzumab…
DECREASES risk of recurrent disease
INCREASES survival
adjuvant chemotherapy for breast cancer
- lesions > 1 cm
- positive axillary nodes are found
use tamoxifen when …
multiple FDR’s have breast cancer,
LOWERS RISK of breast cancer
lowering mortality
- mammography
- ER/PR testing, then tamoxifen/raloxifene
- aromatase inhibitors
- adjuvant CHEMO
- LUMPECTOMY and RADIATION
- modified radical mastectomy
- TRASTUZUMAB (anti-Her 2/neu)
- prophylaxis with tamoxifen/ raloxifene
best initial test for prostate cancer
BIOPSY
which is better for survival
prostatectomy MAY SLIGHTLY benefit more than radiation
complications of prostatectomy
erectile dysfunction
urinary incontinence
erectile dysfunction more likely post-prostatectomy OR radiation
post-prostatectomy
side effect of radiation
diarrhea
gleason grading
AGGRESSIVENESS or the
MALIGNANT POTENTIAL of prostate cancer
high glassine grade
GET IT OUT before it mets
helping to control size and progression of mets for prostate cancer
flutamide
GnRH agonists (leuprolide)
ketoconazole
orchiectomy
prostate US screening for prostate cancer
NOOOOOOO, always wrong
prostate US use…
localize lesions to biopsy if high PSA
lumpectomy for prostate cancer
NOOOOOOO, always wrong
PSA
NO clear mortality benefit
should NOT be routinely offered to patients
normal PSA doesn’t exclude possibility of prostate cancer
above age 75– DO NOT DO IT– EVEN IF ASKED
PSA and cancer
higher the PSA, GREATER RISK of cancer– corresponds to volume of cancer
patient is requesting a PSA to screen for cancer….
DO THE TEST
surgery for lung cancer
SIZE DOES NOT MATTER– depends on the surrounding lung (ie. BIG lesion with normal surrounding, vs. small lesion with abnormal surrounding)
CANNOT DO SX FOR LUNG CANCER
- bilateral disease or lymph nodes positive on opposite side
- malignant pleural effusion
- involvement: heart, carina, aorta, vena cava
screening for lung cancer
low dose chest CT:
- 30 pack years
- age 55-80
ovarian cancer screening…
NOOOOOO SCREENING
ovarian cancer tx
ONLY CANCER– where removing local metastatic disease will benefit the patient
cutting the scrotum for testicular cancer
NOOOOOOOOO DO NOT DO IT
needle biopsy of the testicle
NOOOOO WRONG– since seeding
after seminoma orchiectomy, for local disease
radiation
after seminoma orchiectomy, for widespread disease
chemo
seminomas are sensitive to
CHEMO and RADIATION
non-seminomas are sensitive to
CHEMO only
does Pap smear lower mortality as much as mammography or colonoscopy
NOOOOO it doesn’t
HPV vaccines
all women between 11-26yo
pap smears
starting at age 21, repeat every 3 years until 65yo
of women with fatal cervical cancer– what % have never had a pap smear
85%
ASCUS present
do HPV testing
–> colposcopy
ASCUS not associated with hpv
repeat pap smear at 6 months
