Oncology

Question 1

warning signs of cancer

Answer 1

CAUTION - change in bowel/bladder habits, a sore that doesn’t heal, unusual bleeding/discharge, thickening/lump, indigestion or dysphagia, obvious change in wart/mole, Nagging cough or hoarseness

Question 2

Screening Recommendations

Answer 2

Breast: age 45-54 annual mammogram, age 55+ mammogram Q1-2 yrs
Cervical: age 21-29 pap Q3yrs, age 30-65 pap + HPV Q5yrs
Colon: age 50+ colonoscopy Q10yrs, sigmoidoscopy Q5yrs
Prostate: age 50+ PSA test and digital rectal exam

Question 3

skin cancer warning signs

Answer 3

ABCs - asymmetry, border is irregular/notched, color is not the same all over, diameter larger than eraser, evolving/changing size/shape/color

Question 4

nadir

Answer 4

lowest point WBCs, PLTs reach 7-14 days after chemo, improves over 3-4 weeks

Question 5

neutropenia

Answer 5

ANC <1,000

Question 6

colony stimulating factors

Answer 6

reduce mortality from infections, given if high risk of febrile neutropenia
filgrastim (Neupogen)
pegylated G-CSF (pegfilgrastim)
GM-CSF (eukine)
s/e: fever, bone pain, myalgia, rash
give 24-72 hrs after chemo

Question 7

febrile neutropenia

Answer 7

single temp >101 (38.3), or oral temp >100.4 for >1 hrs
ANC <500 or expected to be <500 in 48 hrs
low risk, no comorbidities: cipro + augmentin
high risk, comorbidities: IV cefepime, ceftaz, meropenem, zosyn

Question 8

anemia

Answer 8

normal Hgb: F 12-16, M 13.5-18
normal Hct: 36-50%
tx: RBC infusion or ESA (erythrocyte stimulating agent)
ESAs decrease survival and increase tumor progression - do not use if on chemo or trying to cure cancer
initiate when Hgb <10
will not work if low iron, give w/ iron supplement

Question 9

thrombocytopenia

Answer 9

PLTs <150k

PLT transfusion if <10k

Question 10

CINV

Answer 10

risks: female, age <50, dehydration, hx motion sickness, hx N/V
give 30 min before chemo, give take home meds
acute: w/in 24hrs of chemo, give 5HT3 antagonist (ondansetron)
delayed: 1-7 days after chemo: give NK1 antagonist (aprepitant), palonosetron, corticosteroids
anticipatory: preventive, give benzos

Question 11

CINV treatment by risk

Answer 11

high emetic risk: 3 drugs (NK1 + 5HT3 + dexamethasone)
mod emetic risk: 2-3 drugs (5HT3 + dexamethasone +/1 NK1)
low emetic risk: 1 drug (any drug except NK1)

Question 12

5HT3 antagonists for CINV

Answer 12

ondansetron (Zofran), granisetron (Kytril), dolasetron (Anzemet), palonosetron (Aloxi), Akynzeo

Question 13

NK1 antagonists for CINV

Answer 13

aprepitant PO (Emend), fosaprepitant IV (Emend), Akynzeo

Question 14

steroids for CINV

Answer 14

dexamethasone (Decadron)

Question 15

dopamine agonists for CINV

Answer 15

prochlorperazine (compazine, compro), promethazine (Phenergan, Promethegon), metoclopramide (Reglan)

Question 16

canabinoids for CINV

Answer 16

dronabinol (Marinol), nabilone (Cesamet)

Question 17

Breast Cancer

Answer 17

ER/PR+ = hormone therapy
tamoxifen x5-15yrs or until menopause, then aromatase inhibitor x5yrs
SERMS (tamoxifen, fulvestrant, raloxifene) for pre- and post-menopausal women
Aromatase inhibitors (anastrozole, letrozole, exemestane) only for post-menopause

Question 18

Prostate Cancer

Answer 18

1st line chemical castration: GnRH agonist/antagonist
leuprolide, goserelin - s/e: tumor flare
degarelix - s/e: osteoporosis
others: bicalutamide, enzalutamide, abiraterone

Question 19

NSCLC

Answer 19

afatinib, erlotinib, gefitinib, crizotinib, ceritinib, alectinib