Oncology Flashcards
Hypercalcemia occurs most commonly in which type of lung cancer?
Hypercalcemia in lung cancer is most associated with squamous cell cancer.
How do you initially manage acute hypercalcemia?
Acute hypercalcemia is initially treated with IV fluids with normal saline followed by bisphosphonates.
What are the most common causes of SVC syndrome? What is the treatment?
SVC syndrome is most commonly caused by lung cancer, lymphoma, and medastinal germ cell tumors.
Name the cancers that commonly metastasize to bone?
The most common cancers that metastasize to bone are lung, breast, prostate, and kidney. Also consider multiple myeloma and NHL.
What is the urgent treatment when you suspect spinal cord compression due to bone metastases?
The initial treatment of malignant spinal cord compression is dexamethasone. This may be followed by radiation, surgery, or chemotherapy.
Which treatment option is available to patients with 3 or fewer small brain mets?
Patients with 3 or fewer brain mets less than 3cm should be considered for stereotactic radiosurgery.
Which malignancies are associated with pericardial metastases?
The most common malignancies associated with pericardial metastases are lung cancer, breast cancer, and non-Hodgkin lymphoma.
Rasburicase is used in the management of what condition?
Rasburicase is used in the management of tumor lysis syndrome. It oxidizes uric acid to the more soluble allantoin.
List the factors associated with an increased risk for breast cancer.
Risk factors for breast cancer include female sex and age. There is also increased risk with early menarche, late menopause, late 1st pregnancy or mulliparity, and mantle field radiation.
Which cancers are associated with BRCA mutations?
The cancers associated with BRCA mutations are breast cancer and ovarian cancer.
Definitely recommend mammography, either yearly or every 2 years, as a screening tool for women at which ages?
Mammography is definitely recommended, either yearly or every 2 years, in patients age 50-69 years old.
When should you consider MRI screening for breast cancer?
MRI is considered for breast cancer screening in patients with lifetime risk of breast cancer of 20-25%.
Clinical mastitis in a woman who is not breastfeeding should make you consider what diagnosis?
A woman who is not breastfeeding who presents with clinical mastitis could have inflammatory breast cancer.
What is the sequence of actions used in the workup of a suspicious breast mass? Explain in detail.
A suspicious breast mass should be evaluated with mammogram and ultrasound. Unless there is a clearly benign mass, a biopsy should then be undertaken.
What are the indications for breast-conserving therapy for treatment of DCIS?
Most woman with DCIS are candidates for breast conserving therapy as long as as long as a good surgical margin can be achieved and the resection would be cosmetically acceptable.
What is the most important prognostic indicator for localized invasive breast cancer? How important is the size of the tumor?
The most important prognostic factor for localized invasive breast cancer is the presence or absence of lymph node metastases. The second most important factor is size of tumor. If tumor is <1 cm with no lymph node metastases, the 5 year relapse rates is around 10%. If >2 cm, the 5 year relapse rate is 20%. If any axillary nodes are positive, the relapse rate rises to 50-80%.
What is the significance of HER2/neu oncogene overexpression?
HER2/neu oncogene overexpression is associated with increased likelihood of distant metastases and a more aggressive cancer.
What is the significance of positive estrogen and progesterone receptors?
Positive estrogen and progesterone receptors are favorable prognostic factors because they predict response to hormonal therapy.
What factors influence the type of adjuvant therapy selected for a breast cancer patient?
The type of adjuvant therapy selected for breast cancer is based on the following factors: size of tumor and nodal status, hormonal status, and gene expression.
Which drugs, when given concomitantly, decrease the efficacy of tamoxifen?
CYP2D6 inhibitors, particularly SSRIs, can decrease the efficacy of tamoxifen.
What are the significant risks of tamoxifen therapy?
The most significant risks of tamoxifen therapy are thromboembolic disease and slight increased risk of endometrial cancer.
What is the role of aromatase inhibitors in the treatment of breast cancer?
Aromatase inhibitors markedly suppress estrogen levels by inhibiting the enzymes responsible for synthesizing estrogens from androgen substrates. They are used only in post-menopausal women since they do not block ovarian estrogen production.
What is the role of tamoxifen in the prevention of breast cancer? For which women is it considered?
Tamoxifen prophylaxis is indicated for a duration of 5 years in patient at high risk for invasive breast cancer (defined as 1.67% 5-year risk).
What are the established risk factors for cervical cancer?
The major risk factor for cervical cancer is HPV infection. Other risk factors reflect the risk of exposure to HPV including early onset of coitus, number of sexual partners, smoking, and history of other sexually transmitted diseases.
