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American Board of Internal Medicine COPY > Oncology - Solid > Flashcards

Oncology - Solid Flashcards

1
Q
  1. Name three indications for prophylactic bilateral mastectomy.
  2. When is mastectomy NOT indicated?
A
  1. Fhx multiple premenopausal or bilateral CA
  2. BRCA1 or BRCA2
  3. p53 gene mutation (Li-Fraumeni)

**NOT indicated if metastatic disease (use hormonal therapy alone) unless for local cancer control

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2
Q

When is radiation considered after mastectomy (3)?

A
  1. Close surgical margins
  2. Dermal invasion
  3. Postive LN >= 4
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3
Q

What is used for HER2 positive breast cancer?

A

Trastuzumab (AKA Herceptin) with/without chemotherapy

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4
Q
  1. What are two options for ER/PR positive breast cancer?
  2. When are they indicated?
  3. What is their pharmacology?
A
  1. Tamoxifen
    • premenopausal
    • SERM (selective ER modulator)
  2. Aromatase inhibitors
    • postmenopausal (bc ovarian stim)
    • prevent precursor conversion to estrogen
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5
Q

When should screening mammograms begin (4 scenarios, consider early screening)?

A

> 40-50 years old OR

25 years in BRCA1 or BRCA2 carrier OR

5 years before FHx case OR

8 years after thoracic XRT

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6
Q

Name four histopathological breast cancers.

A
  1. In Situ - no stromal invasion
    a. Ductal
    b. Lobular
  2. Invasive - stromal invasion
    a. Infiltratring - most common invasive
    b. Lobular - mostly bilateral and multifocal
    c. Tubular
    d. Medullary - rapid growth
    e. Mucinous - slow growth
    f. Papillary
  3. Inflammatory - angioinvasive, poor prognosis
  4. Paget Disease - invades nipple
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7
Q

What is the differnence between Tamoxifen and Raloxifene?

A

Tamoxifen - INCREASED risk of endometrial cancer and thromboembolic disease

Raloxifene - DECREASED incidence of invasive breast cancer and vertebral factures and LESS risk of DVT/PE

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8
Q

Name three Aromatase Inhibitors

A
  1. Anastrozole
  2. Letrozole
  3. Exemestane
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9
Q
  1. Which breast cancer is treated with lumpectomy (2 types)?
  2. What is always used with lumpectomy?
  3. What is not used?
A
  1. a. Tumor < 0.5 cm
    b. Ductal Carcinoma In Situ
  2. Lumpectomy with RADIATION
  3. No hormonal or chemotherapeutic agents
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10
Q

In which population is prophylactic oophorectomy offered (2)?

A
  1. Women who are BRCA1/BRCA2 positive

2. Women with >2 first degree relatives with ovarian cancer

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11
Q

What work-up can be done for ovarian cancer (2)?

A
  1. CA-125

2. Ultrasound (pelvic or transvaginal)

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12
Q

What clinical finding increases the concern for ovarian cancer?

A

Peritoneal Carcinomatosis

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13
Q

Which two labs are obtained for work-up of testicular cancer? Which of these helps distinguish which type of cancer?

A
  1. alpha-fetoprotein (nonseminoma [yolk sac, liver])
  2. beta-hCG

**Remember Seminoma = primary testicular (semen) thus Nonseminoma = not primary testicular

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14
Q

After orchiectomy, how are treatments for Seminomas and Non-seminomas different?

A

Seminoma:

  • Stage I (or tumor <5m Stage II) - retroperitoneal radiation
  • Stage II - Cisplatin-based chemotherapy

Non-seminoma:

  • Stage I - Retroperitoneal LN dissection
  • Stage II - RLN dissection OR Ciplastin chemotherpy
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15
Q

What are three strategies for colon cancer screening?

A
  1. FOBT yearly
  2. Sigmoidoscopy every 5 years
  3. Colonoscopy every 10 years
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16
Q

Name four exceptions to the standard colon cancer screening schedule, and when should they occur?

A
  1. First-degree relative with colon cancer or adenomatous polyp - Age 40 or 10 years younger than earliest diagnosis
  2. Hereditary Nonpolyposis Colorectal Cancer - Age 20 or 10 years younger than earliest diagnosis
  3. Familial Adenomatous Polyposis - Age 12 with annual SIGMOIDOSCOPY
  4. Pancolitis (IBD) - 8-10 years after initial diagnosis, every 1-2 years
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17
Q

Name the two ONLY scenarios when surgery is indicated in the setting of metastatic colon cancer?

A
  1. Control of bleeding

2. Relief of obstruction

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18
Q
  1. What is the inheritance pattern of the BRCA gene?

2. Which BRCA gene is responsible for male breast cancer?

A
  1. Autosomal Dominant

2. BRCA2

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19
Q

What are contraindications for breast cancer post-surgical radiation (3)?

A
  1. Prior radiation (Hodgkin’s, prior breast CA)
  2. Scleroderma or other CVD
  3. Lack of access x 6-7 weeks
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20
Q

For inflammatory breast cancer, what is the first stage of treatment?

A

Chemotherapy first, then mastectomy and radiation

21
Q

What lab should be checked, and with what frequency and duration, after resection of colorectal surgery?

A

CEA every 3 months for TWO years

22
Q

Of the four types of lung cancer, which area of the lung do they normally manifest?

A

Central: Squamous Cell and Small-Cell
Peripheral: Adenocarcinoma and Large-Cell

23
Q

Of the four types of lung cancer, list the order in which they occur in smokers?

A

100% Small Cell
95% Squamous Cell
90% Large-Cell
50% Adenocarcinoma

24
Q

Describe three clinic features of a Pancoast tumor.

A
  1. Shoulder pain
  2. Lower Brachial Plexopathy
  3. Horner’s Syndrome
    a. Ptosis
    b. Anhidrosis
    c. Miosis (constricted)
25
Q

Based on its stage, what are treatment options for NSCLC (Ia, Ib, II, III, IV). Include chemotherapy agent.

A 
Stage Ia - Lobectomy
Stage Ib - Lobectomy + Chemo (cisplatin)
Stage II - Lobectomy + Chemo (cisplatin)
Stage III - Chemo and Radiation
Stage IV - Chemo (cisplatin) and brain met resection?
26
Q

Name three Androgen-deprivation agents

A
  1. BICA-lutamide
  2. NI-lutamide
  3. F-lutamide
27
Q

What are two treatment options for metastatic prostate cancer?

A
  1. Bilateral orchiectomy

2. Gonadotropin-releasing hormone agonists (GnRH-As): Leuprolide, Goserelin, Buserelin

28
Q

Which type of testicular cancer is radiosensitive?

A

Seminoma - think radiation to fetus!

29
Q

Which type of testicular cancer is likely to metastasize?

A

Nonseminomas

30
Q

What diagnostic test should not be performed if concerned about testicular cancer?

A

Transscrotal biopsy

31
Q

What should be done with AFP is:

  1. > 20 ng/mL
  2. > 400 ng/mL
A
  1. Order CT or MRI

2. (In cirrhosis) if liver mass, diagnose HCC

32
Q

Where can metastases appear with gastric cancer (4 with eponyms)?

A
  1. Periumbilical LN (Sister Mary Joseph)
  2. Left Supraclavicular LN (Virchow node)
  3. Enlarged Ovary (Krukenberg tumor)
  4. Rectal cul-de-sac (Blumer shelf)
33
Q

Name 5 clinical manifestations of carcinoid tumors

A
  1. Episodic flushing after EtOH or stress
  2. Venous telangiectasia
  3. Secretory diarrhea
  4. Bronchospasm
  5. Cardiac valvular lesions
34
Q

What can be use for treatment of symptoms for carcinoid tumors?

A

Octreotide for flushing or diarrhea

35
Q

List three options for treatment of UN-resectable pancreatic cancer

A
  1. Radiation alone
  2. 5-fluorouracil + radiation
  3. Chemotherapy (usually Gemcitabine)
36
Q

What are the paraneoplastic syndromes associated with SCLC (6)?

A
  1. SIADH
  2. Cushing Syndrome - ectopic ACTH
  3. Eaton-Lambert Myasthenic Syndrome
  4. Cerebellar Degeneration
  5. Encephalomyelitis - HA, confusion, memory loss
  6. Peripheral Neuropathy
37
Q
  1. Which feature constitutes Stage III colorectal cancer?

2. What would be indicated for this stage?

A
  1. Positive LN

2. Adjuvant chemotherapy

38
Q

For work-up of prostate cancer, what is the next steps after labs revealing:

  1. PSA > 20
  2. PSA > 30
A
  1. Bone scan, also Gleason >7

2. CT abdomen and pelvis

39
Q

What is indicated for treatment of metastatic lytic bone lesions?

A

Zoledronic Acid (bisphosphonate IV)

40
Q
  1. What are the two stage-categories of SCLC?

2. How are their treatment options different?

A

Limited Stage - confined to one hemithorax

 * *chemotherapy + radiation
 * *prophylactic brain irradiation

Extensive Stage - outside of one hemithorax

 * *chemotherapy
 * *radiation only for symptom palliation (brain)
41
Q

Which antidepressants should be avoided with Tamoxifen, and why?

A
  1. Paroxetine
  2. Fluoxetine
  3. Buproprion

**CYP2DP inhibitors which lower endoxifen levels

42
Q

How does Lambert-Eaton Myasthenic Syndrome differ on exam compared to Myasthenia Gravis?

A

Lambert-Eaton = IMPROVES after isometric exercises

43
Q

What type of lung cancer leads to hypercalcemia and why?

A

SQUAMOUS Cell = PTHrP

44
Q
  1. What population is affected by lung adenocarcinoma?

2. What class of drugs can improve survival?

A
  1. East Asian women
  2. EGFR-tyrosine kinase inhibitors:
    a. Erlotinib
    b. Gefitinib
    c. Cetuximab
    d. Pantiumumab
45
Q
  1. What lab test is performed when suspecting carcinoid tumors?
  2. What imaging is performed?
A
  1. 24-hour urin 5-HIAA

2. Abdominal CT with somatostatin receptor scintigraphy

46
Q
  1. Name three GnRH agonists

2. What should be given prior to GnRH agonists and why?

A
  1. Leuprolide
  2. Goserelin
  3. Buserelin

**Give androgen suppression first because LH surge can occur after giving GnRH agonists.

47
Q

What are the stages for Colorectal Cancer?

A

I - Does not invade full thickness
II - Invasion through full thickness
III - >=1 LN
IV - Metastatic disease

48
Q

What are the treatments for Rectal Cancer based on the stages?

A

I - Surgery
II - Chemo-radation, surgery, chemotherapy
III - Chemo-radation, surgery, chemotherapy
IV - Surgery for palliation and/or chemotherapy

49
Q

How does the thickness of the Melanoma dictate the margin depth and further work-up?

A

1mm: Margins 2cm, consider LN biopsy

American Board of Internal Medicine COPY (15 decks)

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