Oncology Flashcards
breast cancer screening with mammography begins at what age?
50
breast cancer screening with mammography is not routinely indicated at what age?
75
if a mammogram shows an abnormality, next step?
biopsy
what is the “sentinel node” in a sentinel node biopsy?
the FIRST node where the tracer goes
if sentinel node is FREE of cancer, then?
axillary node dissection is NOT necessary
if sentinel node HAS cancer, then?
axillary lymph node dissection
should BRCA genetic testing routinely be done?
NO
BRCA is associated with?
increased risk of familial breast cancer and ovarian cancer
best INITIAL treatment for breast cancer
lumpectomy WITH radiation
when should primary preventive treatment of breast cancer be given, at what age, and what should be given?
- multiple first-degree relatives with breast cancer
- age 40
- tamoxifen
treatment for estrogen receptor + or progesterone receptor + breast cancer
tamoxifen, or raloxifene
adverse effects of tamoxifen (3)
- DVT
- hot flashes
- endometrial cancer
MOA of aromatase inhibitors (anastrozole, letrozole, exemestane)
pure estrogen antagonists
adverse effect of aromatase inhibitors (anastrozole, letrozole, exemestane)
osteoporosis
when should adjuvant chemotherapy be given in breast cancer?
- cancer in axilla
- cancer larger than 1cm
- patient is still menstruating
trastuzumab MOA
monoclonal Ab against HER-2/NEU
when do you use trastuzumab?
metastatic breast cancer
colon cancer treatment
surgical resection and 5-FU
colon cancer screening: routine
- colonoscopy starting at age 50
- every 10 years
colon cancer screening: single family member with colon cancer
- colonoscopy at age 40 or 10 years EARLIER than age at which family member was diagnosed
- every 10 years
colon cancer screening: HNPCC (3 family members, 2 generations, or one premature (less than 50 yoa))
- colonoscopy at age 25
- every 1-2 years
colon cancer screening: FAP
- sigmoidoscopy at age 12
- every 1-2 years
colon cancer screening: juvenile polyposis, Peutz-Jeghers, Turcot syndrome, Gardner syndrome
- no additional screening
- same as routine screening guidelines: start at age 50, every 10 years
which patients should be screened for lung cancer?
- more than 30 pack-years smoking history
- between ages 55-75
- chest CT scan at age 55
when and what is the treatment for lung cancer?
- if disease is LOCALIZED ENOUGH
- surgery
when is surgery not an option for lung cancer? (5 scenarios)
- B/L disease
- metastases
- malignant pleural effusion
- involvement of aorta, vena cava, or heart
- lesions w/i 1-2cm of carina
is small-cell lung cancer resectable, and why?
NO, bc 1 of these features is present in more than 95% of cases
- B/L disease
- metastases
- malignant pleural effusion
- involvement of aorta, vena cava, or heart
- lesions w/i 1-2cm of carina
is size alone a reason lung cancer is not resectable?
no, as long as it’s peripheral, and without metastases
when do you start cervical cancer screening?
- age 21
- repeat every 3 years until age 29
- then do Pap WITH HPV every 5 years
abnormal Pap smear with low-grade or high-grade dysplasia; next step in management
COLPoscopy and biopsy
if Pap smear shows atypical squamous cells of undetermined significance (ASCUS); next step in management
test for HPV
if patient is HPV POSITIVE; next step in management
COLPoscopy, or repeat Pap in 6-12 months
when do you stop screening for cervical cancer?
greater than 65 yoa
should screening be performed for prostate cancer?
NO, not recommended
besides SPREAD OF DISEASE, most important PROGNOSTIC factor for prostate cancer
Gleason score
higher score, more aggressive cancer
LOCALIZED prostate cancer treatment
SURGERY, AND either external radiation, or implanted radioactive pellets
METASTATIC prostate cancer treatment
ANDROGEN blockade (flutamide), AND GnRH agonist (leuprolide, or goserelin)
- woman greater than 50 yoa
- increasing abdominal girth
- weight loss
ovarian cancer
marker of progression and response to therapy in ovarian cancer
CA-125 (carcinoma Ag)
treatment for ovarian cancer
surgical debulking, then chemotherapy
- man under 35 yoa
- painLESS scrotal lump
testicular cancer
diagnostic test for suspected testicular cancer
inguinal orchiectomy
do NOT do a needle biopsy
95% of all testicular cancers are
GERM CELL TUMORS (seminoma and nonseminoma)
AFP is secreted ONLY by this type of testicular cancer
NONSEMINOMA
what should be measured in testicular cancer?
- AFP
- LDH
- B-HCG
how do you stage testicular cancer?
CT scan of abd/pelvis
treatment for testicular cancer after orchiectomy: LOCAL disease
radiation
treatment for testicular cancer after orchiectomy: WIDESPREAD disease
chemotherapy
