ONcology Flashcards
when mastectomy is required over BCT
1) tumor involving skin, chest wall
2) more than 1 quadrant
3) inflammatory breast cancer
4) contraindications for radiation exist
Screening required for AI’s
q2yr DEXA scans + bisphosphonate therapy if T score less than 2.5
indications for adjuvant chemo in breast cancer
1) triple negative
2) HER2 positive
3) high grade tumors
4) extensive lymphovascular invasion
5) positive lymph nodes
inflammatory breast cancer treatment
neoadjuvant chemo –> surgery –> XRT
Treatment of lytic bone mets
Bisphosphonates or denosumab or XRT
tamoxifen SE’s
endometrial cancer
VTE
Aromatase inhibitor SE’s
Arthralgia + bone pain + HLD + osteoporosis
denosumab SE’s
hypocalcemia, osteonecrosis of the jaw, especially in patients with dental disease
ideal site to biopsy
1) peripherally
2) site that will simultaneously diagnose and stage disease (peripheral lymph node, medistinal node)
limited stage small cell
one hemithorax, no effusion present
other paraneoplastic conditions associated with small cell
cortical cerebellar degeneration
limbic encephalitis
treatment of extensive stage small cell
chemotherapy (no radiation)
treatment of symptomatic brain mets in SCLC
whole-brain XRT
treatment of Stage 1 NSCLC
surgical resection, then cisplatin-based adjuvant chemo (only if solid tumor >4cm) and XRT if positive margins
treatment of Stage 3 NSCLC
Platinum-based chemo + XRT
treatment of Stage 4 NSCLC
1) chemo if good performance status
2) immunotherapy with anti-PD1 and anti-PDL1 checkpoint inhibitor if PDL1 expression is high
treatment of solitary brain mets in NSCLC
surgical excision and postop brain radiation
stage 1 NSCLC
3-5 cm + no LAD
stage 2 NSCLC
regional LAD, pleura or cehst wall invovlment, tumor near carina
stage 3 NSCLC
mediastinal involvment or contralateral mediastinal lymphadenopathy
stage 4 NSCLC
mets or effusion
treatment of EGFR positive NSCLC
erlotinib (or gefitinib, afatinib)
treatment of ALK or ROS1 positive NSCLC
crizotinib
localized gastric cancer treatment
neoadjuvant chemo, followed by surgery
metastatic gastric cancer treatment
platinum-based regimen
early stage MALT lymphoma treatment
PPI + abx
colorectal cancer staging
CT chest/abdomen/pelvis
Serum CEA
CRC staging
Stage 1 – confined to colon
Stage 2 – local invasion
Stage 3 – metastatic to regional lymph nodes
stage 4 – distant mets
treatment of stage II and III rectal cancer
neoadjuvant XRT and chemo, surgery, postop chemo
CRC follow-up
CEA q6months for 5 years
c-scope 1 yr following resection, 3 yrs after, then q5 years
CT abdomen/chest/pelvis q5 years
management of widely metastatic CRC
no chemo, hospice
anal cancer treatment
XRT + mitomycin plus 5-FU
agent for advanced/metastatic HCC
sorafenib
first-line for HCC
surgical resection or liver transplant
IF surgery not possible –> RFA or percutaneous ethanol injection.
IF cirrhotic and 3 tumors or 1 tumor <5cm –> transplant
IF advanced, multifocal HCC –> chemoembolization
Trousseau syndrome
- episodes of vessel inflammation due to blood clot (thrombophlebitis) which are recurrent or appearing in different locations over time (thrombophlebitis migrans or migratory thrombophlebitis). The location of the clot is tender and the clot can be felt as a nodule under the skin
- associated with pancreatic cancer
pancreatic cancer treatment
Resect if resectable.
IF unresectable –> XRT alone OR 5-FU plus radiation therapy OR single-agent chemo (usually gemcitabine)
Unresectable pancreatic cancer
SMA or celiac trunc involvment
Management of most NETs
observation until symptomatic (most are indolent)
sunitinib mechanism
anti-VEGF
everolimus mechanism
mTOR inhibitor
general treatment of endometrial cancer
Surgical resection of uterus, cervix, and adnexa.
IF higher risk –> XRT and/or chemo
next step after rising PSA
transrectal ultrasonography-guided prostate biopsy
gemcitabine SE’s
Flu-like symptoms(muscle pain, fever, headache, chills, fatigue) Fever (within 6-12 hours of first dose) Fatigue. nausea (mild)/Vomiting. Poor appetite. Skin rash. bone marrow suppression liver and kidney problems, nausea, fever, rash, shortness of breath, mouth sores diarrhea neuropathy hair loss.
what antimetabolite means…
chemical that inhibits the use of a metabolite, which is another chemical that is part of normal metabolism.[1] Such substances are often similar in structure to the metabolite that they interfere with, such as the antifolates that interfere with the use of folic acid; thus, competitive inhibition can occur, and the presence of antimetabolites can have toxic effects on cells, such as halting cell growth and cell division, so these compounds are used as chemotherapy for cancer.
For instance, MTX is an antimetabolite because it interferes with folic acid metabolism.
APR stands for
abdominoperineal resection – common treatment for rectal cancer when the cancer is located close to the anus, entire rectal cancer, adjacent normal rectum, rectal sphincter or anus, and surrounding lymph nodes are removed through an incision in the lower abdomen and the perineum (the skin around the anus).
definitive chemotherapy
no plan for surgery just chemo and possibly radiation.
when ANC usually reaches nadir after chemo
12-14 days after day 1
Neoadjuvant chemo options for locally advanced breast cancer
Anthracycline-, alkylator-, and taxane-based chemotherapy regimens
what are the taxanes
paclitaxel + docetaxal + cabazitaxel
general ANC threshold for starting or resuming chemotherapy
1000
hypopharynx defined as
inferior to epiglottis
Xeloda generic name
Capecitabine
