Oncology and Palliative Care (0-5%) Complete Flashcards
Screening for Breast Cancer:
“Average risk” guidelines
Age-based recommendations:
__ - ___yrs – Recommend FOR screening ____________ q___-___ yrs
Age-based recommendations:
50-74 yrs – Recommend FOR screening mammogram q2-3 yrs
Screening for Breast Cancer
“High-risk” guidelines
• Screen from ages ___-___ yrs with ____________________
Self-study: Genetics: BRCA 1 & 2
Screening for Lung cancer
Need ALL three
- Age ___-___ years*
- _____ pack-year* smoking history
- Current smoker or quit within the past ____ years
Need ALL three
- Age 55-74 years*
- ≥ 30 pack-year* smoking history
- Current smoker or quit within the past 15 years
Screening for Colorectal Cancer
Average risk = General population (CTFPHC 2016)
o Age __-__ – Screen with _______ q ___ yrs OR ______ q___ yrs
o Recommend AGAINST using ________ as a screening test in average risk
Increased risk (CAG 2018)
o _____ First-degree relative with colon cancer OR advanced adenoma
o Age ___-___ yrs or ___ yrs before earliest age of relative’s diagnosis (whatever is youngest) - Screen with _______ q__-__ yrs
Average risk = General population (CTFPHC 2016)
o Age 50-74 – Screen with FIT or gFOBT q2 yrs OR Flex sigmoidoscopy q10 yrs
o Recommend AGAINST using colonoscopy as a screening test in average risk
Increased risk (CAG 2018)
o ≥ 1 First-degree relative with colon cancer OR advanced adenoma
o Age 40-50 yrs or 10 yrs before earliest age of relative’s diagnosis (whatever is youngest) - Screen with colonoscopy q5-10 yrs
Screening for Hepatocellular Carcinoma
Whom to screen?
Screening test – ______ q ________
o DO NOT screen Pts with _________, unless ___________
Whom to screen?
High-risk populations (either of…)
o All patients with cirrhosis, regardless of age/etiology
o Hep B carrier (sAg +) AND…
§ Asian males ≥40, Asian females ≥50
§ African or North American blacks ≥20 yrs
§ FHx of HCC in 1st-degree relative (start at
age 40)
§ CASL = All HIV co-infected patients (start at
age 40)
§ AASLD= All Hep D co-infected patients
Screening test – Ultrasound q6 months
o DO NOT screen Pts with Childs-Pugh C cirrhosis, unless awaiting liver transplant
Screening for Cervical Cancer (CTFPHC)
• Screening population
o Women ages ___- ___ –> Screen with ____________ q ______
• Screen with ____________ q ______
• STOP screening at age ____ AND _____ negative tests in the last ____ yrs
Screening for Cervical Cancer (CTFPHC)
• Screening population
o Women ages 25-69 – Screen with cervical cytology q3 years
• Screen with pap test cervical cytology q3 yrs
• STOP screening at age ≥70 AND ≥ 3 negative tests in the last 10 yrs
Esophageal cancer screening?
Esophageal (CTFPHC 2020) - Do NOT screen for cancer or dysplasia/ Barrett’s in chronic GERD without alarm symptoms
– Does not apply to patients with alarm symptoms (dysphagia, odynophagia, weight loss, anemia, bleed, loss of appetite)
– Does not apply to patients with previously diagnosed Barrett’s
Breast Cancer: Diagnostic Workup
Relevant Biology
• KNOW- Breast Cancer mainly grows on __________ or _________
Diagnosis
• Imaging __________
• Biopsy/Markers __________ + __________
Mastitis not responding to antibiotics -> Next step? ________________ to rule out ________
Once Confirmed Localized Breast Cancer -> Move to ____________
*If receiving COVID vaccine, attempt mammogram/ultrasound ______ or _______ to avoid ______________
Breast Cancer: Diagnostic Workup
Breast Cancer: Initial Localized Management
Bottom Line for early stage Breast CA: _____________ or ___________ + _____________
Breast Cancer: Staging
Staging Post Surgery- Do they need imaging?
and which imaging?
Breast Cancer: Adjuvant Therapy
Indications for adjuvant anti-estrogen therapy
• __________________
o Pre-menopausal – _______ x ______ years
o Post-menopausal – _______ x ______ years
Indications for adjuvant chemotherapy**
• ___________________
• ___________________
• ___________________
• ___________________
Breast Cancer: Metastatic Management
- Hormone receptor (ER/PR) +
___________ - HER-2 +
___________ - Triple Positive
_______________ - Triple Negative (ER/PER/HER-2 -)
___________
Breast Cancer: Metastatic Management
- Hormone receptor (ER/PR) +
o Endocrine therapy + CDK 4/6 inhibitor (e.g. Letrozole + Palbociclib) - HER-2 +
o Double HER-2 blockade (Trastuzumab + Pertuzumab) + chemotherapy (Taxane) - Triple Positive
o Double HER-2 blockade (Trastuzumab + Pertuzumab) + chemotherapy (Taxane) + Endocrine therapy - Triple Negative (ER/PER/HER-2 -)
o Immunotherapy (for PD-L1+ disease)
o Chemotherapy
Breast Cancer Treatment Side Effects
Side effects of Tamoxifen?
Side effects of Aromatase inhibitor?
Side effect: Irreversible cardiomyopathy?
Side effect: Reversible cardiomyopathy?
Breast Cancer: Antiresorptive therapy
Which ones to use?
Role in adjuvant?
Role in Metastatic?
Survival benefit?
Breast Cancer: Surveillance
• ____________________________
• Recommend AGAINST ____________________________
Lifestyle modifications after breast cancer (CMAJ 2017)
__________ = reduced breast cancer mortality
Breast Cancer: Surveillance
• Annual mammogram, history, physical & breast exam
• Recommend AGAINST surveillance blood work, bone scan, CT scans
• Lifestyle modifications after breast cancer (CMAJ 2017)
o Exercise (150 mins/wk = reduced breast cancer mortality)
Lung Cancer: Biology
Which type of lung cancer smokers?
___________ cancer: Rapidly growing
PREOP do an _______ if suspicious of
carcinoid syndrome
Lung Cancer: Workup
Diagnostic Imaging + Staging: _________________________________________________
Biopsy/Markers:
Adenocarcinoma: _______, ______
_______ tells us about response to immunotherapy
Non-Small Cell Lung Cancer: Management
Stage I/II (early stage)
• Fit for surgery: ___________
• Unfit: _____________________
• General rule for who gets adjuvant Chemo: _____________________________
Stage III (locally advanced)
• Resectable: ____________
• Unresectable**: _____________
Stage IV (metastatic):
_____________________
__________________________ = Mortality benefit
Small Cell Lung Cancer: Workup & Management
Staging
• Limited – ______________
• Extensive – ______________
Treatment (______________is generally NOT a part of SCLC treatment unless ______________)
• Limited Stage- ______________ intent
o ______________ ± ______________ (Moving away from it)
• Extensive Stage- ______________ intent
o ______________ + ______________
(__________) now approved in Ontario)
Lung Cancer: Paraneoplastic Syndromes
Which ones are in SCLC?
Which ones are in NSCLC - Adenocarcinoma?
Which ones are in NSCLC - Squamous?
Colorectal Cancer: Workup
Imaging/Staging:
- ___________________
- ___________________
Stages of Colonic Adenocarcinoma*
• Stage 3 – ____________________
• Stage 4 – ____________________
Tumour and molecular markers
- ___________________
Colorectal Cancer: Management
Adjuvant therapy: Which stage?
Stage IV (metastatic)
• Oligometastatic (isolated liver or lung lesions, undefined number of mets)
o _______ + _________ (_______-intent)
Colorectal Cancer: Surveillance
• Stage 1
o __________, _________ months post resection
• Stage 2-3
o __________, _________ months post resection
o Years 1-3: Q _______: ________, ________, ________, ________
o Year 4-5: Q ________: ________, ________, ________, ________
• ___________ – Only for rising CEA alone without evidence of disease on CTs
Gastroesophageal Cancer
Risk factor: ALCOHOL in which cancer?
Prostate Cancer: Workup
• Biology
o Prostate Cancer feeds on ___________
(Hence backbone treatment is ____________ )
• Diagnosis
o _________________
o _________________
• Tumour Markers
o _________________
• Staging
o _________________
Prostate Cancer: Management
Castrate Sensitive- Responds to lowering Androgen:
1. Early/ Localized
______________________
______________________
______________________
2. Metastatic
______________________
______________________
Prostate Cancer: Treatment side effects
Androgen Deprivation Therapy?
Docetaxel (chemo)?
Non-steroidal antiandrogen?
- Abiraterone (+ Prednisone)
- Enzalutamide
ALL patients on ADT should be on __________, ____________ and ____________
Testicular Cancer
Imaging: ___________, ___________
Diagnosis: Made by ___________, (NEVER ___________ due to risk of ___________)
Tumour markers: ___________, ___________, ___________
Management
• Localized – ___________
• Metastatic – ___________
Typical chemo regimen: ___________
__________ (chemo) can cause Pulmonary fibrosis
Chemotherapy Toxicities
Other Systemic Therapy Toxicities
Immunotherapy Toxicity Management?
• “Mild” symptoms:?
• “Moderate-severe” symptoms?
Malignant Bowel Obstruction (MBO)
Febrile Neutropenia
Definition?
Etiology
• Nadir of neutropenia occurs _____ days after chemo
Treatment?
Outpatient antibiotics regimen for Febrile Neutropenia in adults
Hypercalcemia of Malignancy
Etiology?
Pathology?
Management?
Spinal Cord Compression
Management?
Opioid Rotation
Methylnaltrexone is used in opiate-induced constipation.
Black box warning?
GI perforation
Lynch syndrome (HNPCC)
Most common cancer?
Most common extra-colonic cancer?
Most common cancer? COLORECTAL CANCER
Most common extra-colonic cancer? ENDOMETRIAL CANCER
Brain metastasis is part of the early presentation of which cancers?
- MELANOMA
- SMALL CELL LUNG CARCINOMA
