Intro to medical oncology wk8w11 Flashcards Preview

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Flashcards in Intro to medical oncology wk8w11 Deck (13):
1

Breast Cancer Screening

- Breast Self Exam—optional

- Clinical Breast Exam- Every 3 years starting age 20, yearly after age 40

- Mammogram, yearly after age 40

- Women at high risk (>20% lifetime risk of breast cancer) should get yearly MRI and MMG (new 2007 ACS recommendation)

2

Colon cancer screening

Beginning age 50:
- Yearly fecal occult blood + q5yr flex sig
- Double contrast barium enema q5 years
- Colonoscopy q10 years

If high risk (family history cancer, personal history polyps or inflammatory bowel disease) more frequent and may start at younger age

3

Screening for cervical cancer

Pap smears start yearly 3 years after begin vaginal intercourse, no later than 21 yo.

Yearly screening regular pap or q2years with liquid based Pap

Age 30: if 3 normal Pap in a row, can screen q2-3 years or every 3 years if add HPV DNA test

If DES exposure before birth, HIV, immunosuppression continue annual screening

70 years old+, if 3 normal Paps in a row and no abnormal in last 10 years, can stop screening (except above risk groups)
New vaccine

4

Prostate cancer screening

PSA blood test and digital rectal exam (DRE) yearly starting age 50

High risk men (African-American, strong family history) start screening age 40-45.

Discuss risks/benefits (limitations to testing), but should offer to patients

5

Carcinogenic medical agents and disease caused

Estrogens         Endometrial/Breast

Anabolic steroids       Liver

Tamoxifen        Endometrium

Melphalan         Lymphoid tissue

Busulphan        Bone marrow

 

6

life style factors and associated cancers

Tobacco---  lung, bladder, esophagus, mouth, larynx

Betel ----nut oral cavity

Alcohol ----- esophagus, oral, pharynx, liver

UV Rad ----- melanoma, other skin ca

7

PET

Inject radiotracer Fluorine-18-DeoxyGlucose (FDG) (make radionuclide in a cyclotron near PET, b/c short ½-life).

Metabolically active tissues (cancer, infection) uptake glucose and show up on scan

8

Imaging modalities for staging

PET
CT
MRI
Bone scan
Ultrasound
Plain X-rays

9

Bone scan

Technetium-99m-MDP injected then scan with Gamma camera. Half radioactive material localized by bones.

 

More active bone turnover, the more it will be seen. Tumors, fractures, infections and arthritis positive. Not sensitive for lytic lesions.

10

Cancer Staging

American Joint Committee on Cancer (AJCC) TNM
- T = Tumor size (T0, Tis, T1, T2, T3, T4)
- N = Regional Lymph node involvement (NO, 1, 2, 3)
- M = Metastases (MX, M0, M1)

TNM combined into stage: For example-
Stage 0: Tis N0 M0
Stage I:  T1 N0 M0
Stage II: T0-2 N0-1 M0
StageIII: T0-3 N1-2 M0
StageIV: anyT anyN M1
Tumor types not typically staged by TNM
Pediatric; Leukemia/lymphoma; CNS tumors

11

Clinical vs. pathologic staging

Clinical staging (by PE & imaging) guides presurgical (“neoadjuvant”) chemotherapy choices

Pathologic staging helps determine prognosis and guides whether patient should receive post-surgical (“adjuvant”) chemotherapy.
 

12

Oncologic emergencies

Superior Vena Cava syndrome

Spinal cord compression (prostate, breast, lung)

Electrolyte disturbances (tumor lysis, low Na, high calcium, hyperuricemia, etc)

Cardiac tamponade (malignant effusion)

Venous thromboembolism

Febrile neutropenia

13

HER 2 and breast cancer

- HER2 overexpressed in breat cancer 

- Trastuzumab (herceptin)= targets Her2/neu protein on surface of breat cancer

- drug bound to emtansine (toxic), internalized and ph of lysosome causes toxin to be released and kill cell= T-DM1