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2020 > Med Onc > Flashcards

Med Onc Flashcards

1
Q

3 Criteria that must be met for low dose CT annually x 3 years for lung ca screening?

A

Criteria (need all 3)

  1. Age 55-74 years
  2. ≥ 30 pack-year smoking history
  3. Current smoker or quit within the past 15 years
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2
Q

High risk population for breast cancer screening?

A

High risk population (> 25% lifetime risk)
o Known hereditary gene mutation (BRCA 1/2, TP53, PTEN, CDH1, PALB 1/2*) o 1st degree relative has a known hereditary gene mutation
o Personal or FHx of breast/ovarian cancer
o Radiation to the chest when < 30 yrs old, at least 8 yrs ago

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3
Q

Age cut-offs for mammography recommendations?

A

o 40-49 yrs – Recommend AGAINST screening
o 50-74 yrs – Recommend FOR screening mammogram q2-3 yrs
o ≥ 75 yrs – No evidence of benefits/harms to make formal recommendation

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4
Q

Recommended colorectal screening for age 50-74?

A

Screen with FIT or gFOBT q2 yrs
OR
Flex sigmoidoscopy q10 yrs

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5
Q

Recommenced CRC screening for patient with ≥ 1 First-degree relative with colon cancer OR advanced adenoma (aka increased risk)

A

Age 50 yrs or 10 yrs before earliest age of relative’s diagnosis:
o Screen with Colonoscopy q5 yrs if family member < 60 at age diagnosis
o Screen with Colonoscopy q10 yrs if family member ≥ 60 at age diagnosis

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6
Q

Recommendations for CRC screening for HNPCC/Lynch syndrome? (hereditary nonpolyposis CRC)

A

Age 20 or 10 yrs prior to earliest age of relative’s diagnosis – Colonoscopy q1-2 yrs

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7
Q

Recommendations for CRC screening for FAP?

A

Send for genetic counselling. Start at age 10-12. Screen with sigmoidoscopy annually

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8
Q

Recommendations for CRC screening for IBD, pancolitis and L-sided?

A

o Hx of Pan-colitis – Colonoscopy q1-3 yrs. Start 8 yrs after diagnosis
o Hx of Left-sided colitis – Colonoscopy q1-3 yrs. Start 12-15 yrs after diagnosis

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9
Q

These high risk populations warrant q6mo US for HCC screening.

A 
o Cirrhosis 
 o Hep B carrier (sAg +) AND...
•
§ Asian males ≥40, Asian females ≥50
§ African or North American blacks ≥20
§ FHx of HCC in 1st degree relative (starting screening at age 40) 
§ All HIV co-infected patients (starting screening at age 40)
§ All Cirrhotics (irrespective of age)
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10
Q

Who should be screened q3years with pap + cytology?

A

Women ages 25-69 – Screen with cervical cytology q3 years

§ Includes HPV-vaccinated women & women who have sex with women

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11
Q

What imaging should be sent for Breast Cancer work-up?

A
  • Bilateral breast mammogram & ultrasound

* Axillary ultrasound

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12
Q

Indications for adjuvant chemo for breast cancer?

A
  • Stage II/III for ER/PR+ breast cancer
  • Stage II/III for HER2+ tumor (chemo + Trastuzumab (Herceptin®))
  • Stage I-III for “Triple negative” (ER-, PR-, HER2-) breast cancer
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13
Q

Lifetime risk of breast cancer with BRCA 1 and BRCA 2

A

BRCA 1 = ↑ Lifetime risk of Breast ca (70%) and Ovarian ca (45%)
• BRCA 2 = ↑ Lifetime risk of Breast CA (70%), Ovarian Ca (20%), Prostate Ca,Pancreatic Ca, Gastric Ca

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14
Q

Imaging as part of work-up for Lung Ca?

A

• ALL patients – CT C/A/P, CT/MRI brain, Bone scan

• If no obvious metastatic disease
o PET scan – look for occult metastases
o Mediastinum nodal staging (mediastinoscopy or EBUS

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15
Q

Work-up (Pre-op) for CRC?

A

C-scope to terminal ileum, CT c/ap, CEA

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16
Q

CRC staging

A

Stage I -invades into muscle wall
Stage II -Invades through muscle wall
Stage III -Lymph node involvement
Stage IV -Distant metastases

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17
Q

Side effects of androgen deprivation therapy (ADT) for prostate Ca?

A

Osteoporosis
Decreased libido
Gynecomastia

18
Q

Side effects of Docetaxel for prostate Ca?

A

Peripheral neuropathy
N/V
Hair loss

19
Q

2 classes of check point inhibitors used as immunotherapy in solid organ malignancy

A

o PD-1 inhibitors (pembrolizumab, nivolumab)

o CTLA-4 inhibitors (ipilimumab)

20
Q

Types of cancers with osteoblastic bone mets

A

Prostate, HL, SCLC, carcinoid

21
Q

Types of cancers with osteolytic bone mets

A

MM, NHL, NSCLC, RCC, melanoma, thyroid

22
Q

Types of cancers with mixed bone mets

A

Breast, GI, Squamous cell carcinomas (NSCLC, H&N, Cervical ca)

23
Q

Types of radio resistant cancers

A

RCC, melanoma, osteosarcoma

24
Q

Right supraclavicular node is suspicious for which Ca?

A

Lung

25
Q

Left supraclavicular (virchow’s) node is suspicious for which Ca?

A

Gastric i.e. gallbladder, pancreas, kidneys, testicles, ovaries, prostate

26
Q

Umbilical nodes (“Sister Mary Joseph Node”) is suspicious for which Ca?

A

GI and GU

27
Q

4 classes of drugs used to treat chemo associated N/V

A 
1. NK1-receptor antagonist
(aprepitant)
2. 5-HT3 antagonists
(ondansetron, granisetron) 
3. Steroid (dexamethasone) 
4. 5-HT2/D2 antagonist
(olanzapine)
28
Q

Management of malignancy associated bowel obstruction?

A
  1. NG decompression + supportive care
  2. Metoclopramide (use if partial MBO, don’t use in complete MBO)
  3. Octreotide SC 100 mcg TID (↓gastric secretions, ↓ motility, ↓ splanchnic blood flow)
  4. +/- Corticosteroids
  5. Gen Sx- stent, venting G tube, palliative resection.
29
Q

MAID eligibility criteria

A
  1. Be eligible for health services funded by government (i.e. have a health card)
  2. Be ≥ 18 years old and mentally competent
  3. Have a grievous and irremediable* medical condition
  4. Make a voluntary request for MAID, free from outside pressure or influence
  5. Provide informed consent

• Must be at a point where a natural death is REASONABLY FORESEEABLE, but does not have any requirements on a specific prognosis

30
Q

MAID process steps

A
  1. A dated, written request is made before 2 independent witnesses
  2. Two MD/NPs will assess eligibility for MAID (see last slide)
  3. Must wait 10 full days, from date patient signed written request, before MAID can be provided, Or <10 days if death is imminent or pt will lose capacity.

Must again give consent right before drugs given.

31
Q

Which cancers classically metastasize to brain?

A
  1. Melanoma
  2. Breast cancer + gastric, advanced stage
  3. SCLC
  4. Lymphoma
32
Q

After how many cycles of Bleomycin is Bleomycin Pneumonitis commonly seen?

A

Rare complication of (1-3%), but is seen in up to 15% of patients on CT.
Dose-dependent and typically seen following the 3rd/4th cycle of chemotherapy. STOP BLEO.

33
Q

Methylnaltrexone (Relistor©) is used for refractory nausea. What is the MOA and what are common and serious side effects?

A
  • mu-opioid receptor antagonist which has restricted ability to cross the blood brain barrier due to its quaternary amine structure.
  • Rare but serious side effects include: Gastrointestinal perforation (more common in patients with conditions affecting the integrity of the gastrointestinal tract), Severe and persistent diarrhea, Opioid withdrawal
34
Q

What is Li-Fraumeni Syndrome?

A

(also called SBLA syndrome = Sarcoma, Breast, Leukemia, Adrenal cancer syndrome). Autosomal dominant. Results from mutation in TP53 gene on chromosome 17. p53

35
Q

What is Lynch Syndrome (HNPCC), and what are the most common cancers associated with it?

A

Disorder caused by germline mutation in a DNA mismatch repair genes. Most common cancer = colorectal (78%). Most common extra-colonic cancer = endometrial cancer (50%), GU (10%)

36
Q

What is the MOA of aprepitant?

A

blocks substance P at NK1 receptor

37
Q

What is suggested treatment for high grade esophageal dysplasia found on EGD?

A

ASPECT Trial (Lancet 2018) demonstrated benefit of high-dose PPI (ie. BID) over ASA or low-dose PPI in high grade dysplasia, esophageal cancer, and death.

38
Q

What is one benefit of prostate cancer screening?

A

PSA screening reduces the chance of dying from prostate cancer, but does not improve overall survival.

39
Q

What are RF’s for EGFR mutation in lung cancer?

A

“Typical” patient with EGFR mutation is Asian, Female, Non- smoker.

BUT screen everyone!

40
Q

What are the benefits of bisphosphonate therapy in the metastatic setting and in the adjuvant setting?

A 
Metastatic setting (bone mets):
1. Improve pain
2.Reduce the risk of fracture
3. Increase the time to having a fracture or needing treatment for a bony met.
They do not improve survival.
 Adjuvant setting (no bone mets):
Do improve survival.
41
Q

Before giving Rasburicase, what must for screen for?

A

G6PD deficiency!

2020 (13 decks)

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