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Oncology USMLE Step 3 > Section 1: Breast, Colon and Lung Cancers > Flashcards

Section 1: Breast, Colon and Lung Cancers Flashcards

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USMLE® Step 1 flashcards
1
Q

Which of the following screening tests lowers mortality the most?

a. Mammography above age 50
b. Mammography above age 40
c. Colonoscopy
d. Pap smear
e. Prostate-specific antigen (PSA)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 8325-8335). Kaplan Publishing. Kindle Edition.

A

A. Mammography above age 50 lowers mortality the most. Although screening should start at the age of 50, the mortality benefit is also greatest above the age of 50, because the number of cases of cancer detected will be greater above the age of 50. The age cutoff for mammography is somewhat controversial. Step 3 will likely avoid the issue.

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2
Q

When should screening for mammography begin?

At what age is screening mammography no longer considered evidently beneficial?

A

At 50 years of age

At age 75 years

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3
Q

Following an abnormal mammogram, enumerate the steps to take

A
  1. Biopsy
  2. Test for the presence of estrogen and progesterone receptors

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 8338-8344). Kaplan Publishing. Kindle Edition.

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4
Q

Sentinel node:

  1. What is a sentinel node?
  2. How is the sentinel node detected?
  3. What is the next step if the node is cancer free?
  4. What is the next step if the node is cancerous?
A
  1. This is first node that is biopsied for cancer detection
  2. A dye or tracer is placed into the operative field. The first node it goes to is biopsied. This is the “sentinel node.”
  3. No need for an axillary node dissection
  4. An axillary lymph node dissection is performed.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 8342-8345). Kaplan Publishing. Kindle Edition.

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5
Q

True or False:

Lumpectomy + Radiation Rx = Modified radical mastectomy

A

True

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6
Q

BRCA

  1. Is genetic testing for BRCA is a routine testing
  2. List the cancers for which there is an increased risk in those who have BRCA mutation
A
  1. No
  2. Increased risk in
    • Familial breast cancer
    • Ovarian cancer
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7
Q

Breast Cancer

  1. Best initial Rx of BC
  2. Primary preventive therapy
A
  1. Lumpectomy + radiation treatment
  2. Tamoxifen should be used in any patient with multiple first-degree relatives (mother, sister) with breast cancer
    • Tamoxifen decreases risk by 30 percent.
    • Start at age 40.
    • Use tamoxifen if 2 or more first-degree relatives have breast cancer

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 8351-8367). Kaplan Publishing. Kindle Edition.

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8
Q

A 42-year-old woman has a 2-cm breast cancer tumor removed by lumpectomy, and the breast is irradiated. The cancer is negative for estrogen receptors and positive for progesterone receptors. Three of 14 nodes removed from the axilla are positive for cancer. What is the next best step in management?

a. Adjuvant chemotherapy and radiation of the axilla
b. Tamoxifen for 5 years
c. Anastrozole (aromatase inhibitor) for 5 years
d. Tamoxifen, adjuvant chemotherapy, and radiation of the axilla
e. Oophorectomy and chemotherapy

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 8351-8367). Kaplan Publishing. Kindle Edition.

A

D. Tamoxifen is used whenever there are either estrogen receptors or progesterone receptors positive. If both receptors are positive, tamoxifen will be of greater benefit. Adjuvant chemotherapy is used whenever the axillary nodes are positive or the cancer is > 1 cm in size.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 8351-8367). Kaplan Publishing. Kindle Edition.

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9
Q

Indications for tamoxifen or raloxifene

A

Breast cancer that is either the estrogen or progesterone receptors are positive. The response is greater if both are positive.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 8369-8377). Kaplan Publishing. Kindle Edition.

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10
Q

Adverse effects tamoxifen

A
  • Deep venous thrombosis (DVT)
  • Hot flashes
  • Endometrial cancer

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 8369-8377). Kaplan Publishing. Kindle Edition.

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11
Q

Aromatase inhibitors (AI) are pure estrogen antagonists. They do not have the selective estrogen receptor agonist (stimulatory) activity that tamoxifen does.

  1. List examples of AI
  2. List one advantage they have over tamoxifen
  3. Main disadvantage
A
  1. Aromatase inhibitors
    • Anastrozole
    • Letrozole
    • Exemestane
  2. Do not lead to DVT
  3. Can lead to osteoporosis, because they are antagonistic to estrogen receptors in the bone.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 8369-8377). Kaplan Publishing. Kindle Edition.

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12
Q

Indications for adjuvant chemotherapy in breast cancer

A
  • Cancer is in the axilla
  • Cancer is larger than 1 cm

It is more efficacious when the patient is still menstruating. Breast cancer in menstruating women will not likely be controlled with estrogen antagonists, such as tamoxifen or aromatase inhibitors

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 8381-8391). Kaplan Publishing. Kindle Edition.

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13
Q

Indications for Trastuzumab

A
  1. A monoclonal antibody against the breast cancer antigen HER-2/ NEU
  2. Useful in metastatic disease
    • Modest efficacy with few adverse effects

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 8381-8391). Kaplan Publishing. Kindle Edition.

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14
Q

Colon Cancer Screening 1

The most important knowledge to have for Step 3 is the screening schedule and indicators. Colon cancer is treated with surgical resection of the colon and chemotherapy centered around a 5-fluorouracil regimen.

List the routine colon cancer screening

A
  1. Colonoscopy starting at age 50, then every 10 years
  2. Occult blood testing starting at age 50, then yearly

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 8392-8409). Kaplan Publishing. Kindle Edition.

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15
Q

Colon Cancer Screening 2

The most important knowledge to have for Step 3 is the screening schedule and indicators. Colon cancer is treated with surgical resection of the colon and chemotherapy centered around a 5-fluorouracil regimen.

List the colon cancer screening for an individual with a single family member with colon cancer

A

Colonoscopy at age 40 or 10 years earlier than the age at which the family member contracted cancer, whichever is earlier,

  • then every 10 years

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 8392-8409). Kaplan Publishing. Kindle Edition.

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16
Q

Colon Cancer Screening 3:

The most important knowledge to have for Step 3 is the screening schedule and indicators. Colon cancer is treated with surgical resection of the colon and chemotherapy centered around a 5-fluorouracil regimen.

List the colon cancer screening for:

  • HNPCC (Heredirtary Non-Polyposis Colorectal Cancer [Lynch Sndrome])
  • Three Family Members
  • Two Generations
  • One Premature (< 50)
A

Colonoscopy at age 25

  • then every 1– 2 years

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 8392-8409). Kaplan Publishing. Kindle Edition.

17
Q

Colon Cancer Screening 4:

The most important knowledge to have for Step 3 is the screening schedule and indicators. Colon cancer is treated with surgical resection of the colon and chemotherapy centered around a 5-fluorouracil regimen.

List the colon cancer screening for Familial Adenomatous Polypopsis

A

Screening sigmoidoscopy at age 12

  • then every 1– 2 years

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 8392-8409). Kaplan Publishing. Kindle Edition.

18
Q

Colon Cancer Screening 5

The most important knowledge to have for Step 3 is the screening schedule and indicators. Colon cancer is treated with surgical resection of the colon and chemotherapy centered around a 5-fluorouracil regimen.

List the colon cancer screening for those with the following conditions:

  • Juvenile Polyposis
  • Peutz-Jeghers
  • Turcot’s Syndrome
  • Gardner’s Syndrome
A

No additional screening

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 8392-8409). Kaplan Publishing. Kindle Edition.

19
Q

A 52-year-old smoker has a 1.5-cm calcified nodule found on chest x-ray done for other reasons. He has no symptoms. What should you do?

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 8412-8422). Kaplan Publishing. Kindle Edition.

A

Excisional biopsy should be done on solitary lung nodules > 1 cm in size in patients who are smokers. Age > 50 lends additional urgency to the need for biopsy. Even though calcification goes against malignancy, the age of the patient, size of the nodule, and history of smoking are more important.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 8412-8422). Kaplan Publishing. Kindle Edition.

20
Q

True or False

There is no screening test for lung cancer

A

True. Routine chest x-rays yearly and CT scanning have not been shown to be beneficial (to lower mortality); those answers are wrong.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 8412-8422). Kaplan Publishing. Kindle Edition.

21
Q

Rx of lung cancer

The most important issue in the treatment of lung cancer is whether the disease is localized enough to be surgically resectable.

List the indications for non-surgical management of lung cancer

A
  1. Bilateral disease
  2. Metastases
  3. Malignant pleural effusion
  4. Involvement of the aorta, vena cava, or heart
  5. Lesions within 1– 2 cm of the carina

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 8422-8429). Kaplan Publishing. Kindle Edition.

22
Q

Why are small-cell cancers of the lungs usually nonresectable?

A

Small-cell cancer is nonresectable because in > 95 percent of cases, the criteria for non-resectable cancers apply.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 8422-8429). Kaplan Publishing. Kindle Edition.

23
Q

True or False:

Size of the lung lesion is the sole determinant of resectability of lung cancer?

A

False. The size of the lesion alone is not the reason a cancer may be unresectable. If the lesion is large but is peripheral, without metastases, it can be resected.

24
Q

Outline the diagnostic management of a palpable breast mass (use age 30 as cutpoint)

A

Diagnostic management of palpable breast mass

Oncology USMLE Step 3 (2 decks)

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