Oncology

Question 1

Best initial diagnostic test for breast cancer

Answer 1

Biopsy

FNA = best initial biopsy

Core needle biopsy allows for ER, PR, and HER 2/neu testing

Open biopsy = most accurate

Question 2

A woman is scheduled to undergo a FNA biopsy after finding a hard, nontender breast mass on self-exam. Why is a mammography still indicated in addition to the FNA?

Answer 2

5-10% of patients have bilateral disease

Question 3

When is ultrasound the answer for breast cancer?

Answer 3

If the lesion is painful or varies in size/pain with menstruation

It tells cystic vs solid lesions

Question 4

When is PET scan the answer for breast cancer?

Answer 4

When abnormal lymph nodes are not easy accessible for biopsy

It can exclude metastasis and the need for additional chemo

Question 5

BRCA is associated with what types of cancer

Answer 5

Breast, Ovarian, Pancreatic

Question 6

Significance of a negative sentinel node

Answer 6

Eliminates the need for axillary lymph node dissection

Question 7

Lumpectomy with radiation

vs

Modified radical mastectomy

Answer 7

Equal in efficacy

Lumpectomy is contraindicated if the cancer is multifocal or radiation is contraindicated

Note: radical mastectomy (not modified) is always the wrong answer

Question 8

All ER or PR positive patients should receive

Answer 8

Tamoxifen, raloxifene, or an aromatase inhibitor (anastrazole, letrozole, exemestane)

Question 9

Side effects of tamoxifen

Answer 9

Endometrial cancer

Clots

Question 10

Side effects of aromatase inhibitors

Answer 10

Osteoporosis

Question 11

True/False

Aromatase inhibitors have a slight superiority in efficacy compared to SERMs

Answer 11

True

They are the answer to the “most likely to benefit the patient” question

Question 12

When is Trastuzumab the answer?

Answer 12

In patients with HER 2/neu positive breast cancer

trastuzumab = anti-HER 2/neu antibody

This will decrease the risk of recurrent disease

Cardiac function should be assessed with echo at baseline and at regular intervals (d/t cardiotoxicity)

Question 13

When is adjuvant chemo the answer for breast cancer?

Answer 13

When lesions are larger than 1 cm

or

Positive axillary lymph nodes are found

Question 14

Best test for prostate cancer

Answer 14

Best initial test = biopsy

Question 15

Prostatectomy vs radiation for prostate cancer

Answer 15

Prostatectomy may have a slight benefit; however it is associated with ED and urinary incontinence

Radiation leads to diarrhea

Question 16

A high Gleason grade suggests…

Answer 16

a greater benefit of surgical removal of the prostate (get it out before it metastasizes)

Question 17

How is hormonal manipulation in prostate cancer different than in breast cancer

Answer 17

Unlike in breast cancer (i.e., tamoxifen), hormonal agents used for prostate cancer (flutamide, GNRH agonists, ketoconazole, and orchiectomy) do NOT prevent recurrences

They do control the size and progression of metastases

Question 18

Elevated PSA, no palpable mass, transrectal ultrasound shows nothing

What is the next step?

Answer 18

Multiple blind biopsies

Question 19

When is surgery not possible for lung cancer

Answer 19

Bilateral disease or lymph nodes involved on opposite side

Malignant pleural effusion

Heart, carina, aorta, or vena cava is involved

95% of small cell cancer

Question 20

Screening for lung cancer

Answer 20

Annually with low-dose chest CT in those with:

30 pack-year history of smoking

Age 55-80

Question 21

Testicular cancer with elevated alpha fetoprotein

Answer 21

Nonseminomatous cancer

Unlike seminomatous cancer, this cannot be treated with radiation (only chemo)

Question 22

Cervical cancer screening

Answer 22

Pap smear at age 21, every 3 years until age 65 (or hysterectomy)

Pap and HPV testing increase the interval to 5 years after age 30

Question 23

ASCUS with positive HPV

Answer 23

Perform colposcopy

Question 24

True/False

Pap smears lower mortality as much as mammography or colonoscopy

Answer 24

False