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Med Onc Flashcards

1
Q

Breast Cancer screening guidelines

A

Ages 50-74: Screening mammogram every 2-3 years

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2
Q

Screening criteria for lung cancer

A

Need all 3 of:
Age 55-74
≥ 30-pack-year smoking history
Current smoker or quit within the past 15 years

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3
Q

How to screen for lung cancer

A

Annual low-dose CT every year up to 3 consecutive years

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4
Q

When to screen for colorectal cancer and average risk patients and how

A

Age 50-74
**FIT **every 2 years or flex sigmoidoscopy every 10 years
Do not use colonoscopy

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5
Q

Went to screen for colorectal cancer in a patient with increased risk and how

A

Which ever is youngest:
Age 40 to 50 years OR
10 years before earliest age of relatives diagnosis

Colonoscopy every 5 to 10 years
FIT every 1-2 years can be considered as second line alternative

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6
Q

Who to screen for hepatocellular carcinoma

A

All patients with cirrhosis, regardless of age or etiology
(Maybe do not have to screen for Childs Pugh C cirrhosis unless they are a transplant candidate)

Hepatitis B carrier open (sAg) AND
* Endemic country: males ≥40, females ≥50
* African or North American blacks ≥20 yrs
* FHx of HCC in 1st degree relative (start at age 40)
* All HIV co-infected patients (start at age 40)
* All Hep D co-infected patients

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7
Q

How to screen for hepatocellular carcinoma

A

Ultrasound every 6 months or ultrasound and AFP every 6 months

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8
Q

Who to screen for cervical cancer

A

Ages 26-69
Cervical cytology Pap test every 3 years
Stop screening at age 70 and ≥ 3 negative tests in the last 10 years

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9
Q

When the screen for esophageal cancer

A

Will only screen if they have Barrett’s disease and chronic GERD with alarm symptoms such as dysphagia, odynophagia, weight loss, anemia, bleeding, loss of appetite

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10
Q

Who is high risk for breast cancer and therefore needs different screening age

A

Germline mutation
Personal history of breast or ovarian cancer
Less than 30 years Of age previous radiation to chest

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11
Q

When to screen for breast cancer in high risk women

A

Age 30-69 every year with mammogram and MRI of the breasts

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12
Q

Risk factors for breast cancer

A

Female
Older age
Hormone exposure (early age of menarche, lack of breast-feeding, late age of menopause, hormone replacement therapy)
Family history, BRCA1 and BRCA2
Alcohol use

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13
Q

How to diagnose breast cancer

A

Diagnostic bilateral mammogram and ultrasound of the breast and axilla

Ultrasound-guided core needle **biopsy **and receptor status testing: ER, PR, HER2

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14
Q

Management for breast cancer

A

Surgery
* Primary Tumor- 2 options
* * Mastectomy
* * Lumpectomy (Breast Conserving Surgery) + Whole Breast Radiation
* Regional lymph node Management
* Sentinel Lymph Node Biopsy or Axillary Lymph Node Dissection

Bottom Line for early stage Breast CA: Mastectomy or Lumpectomy + Lymph Node Sampling/ Dissection.

Based on Surgical Path-> Complete Staging -> Decide on further treatment

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15
Q

Management for breast cancer postsurgery

A

Staging Post Surgery
* Stage I (LN negative): No further tests
* Stage II (LN+ up to 3): No further tests unless symptoms
* Stage III (T4 or ≥ 4 LN positive):STAGE - Bone scan, CT C/A/P

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16
Q

Adjuvant therapy for hormone receptor positive breast cancer: Not metastatic

A

Tamoxifen Or letrozole/anastrozole/exemestane for 5 to 10 years

Post menopause: Tamoxifen or aromatase inhibitor
Premenopause:Only tamoxifen

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17
Q

Adjuvant therapy for HER2 positive breast cancer: Not metastatic

A

Stage I: No treatment

Stage II or III: Chemotherapy and anti-HER2

Chemotherapies: Doxorubicin or epirubicin + cyclophosphamide plus docetaxel/paclitaxel

Anti-HER2 drug: Trastuzumab

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18
Q

Adjuvant therapy for triple positive breast cancer: Not metastatic

A

No treatment for stage I

For stage II-III:
Chemotherapy AND anti-HER2 drug AND endocrine therapy

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19
Q

Adjuvant therapy for triple negative breast cancer: Not metastatic

A

Chemotherapy for Stages 1-3

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20
Q

Therapy for metastatic breast cancer: HR positive

A

Endocrine therapy AND palbociclib/ribociclib

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21
Q

Therapy for metastatic breast cancer: HER2 positive

A

Double HER2 blockade (trastuzumab AND pertuzumab) AND chemotherapy (docetaxel/paclitaxel plus cyclophosphamide)

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22
Q

Therapy for metastatic breast cancer: Triple positive

A

Double HER2 blockade AND chemotherapy AND endocrine therapy

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23
Q

Metastatic therapy for triple negative breast cancer

A

Immunotherapy (pembrolizumab) and chemotherapy

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24
Q

What are the side effects of endocrine therapy

A

Tamoxifen:
↑ Endometrial cancer
↑ Thrombosis
↑ Arthralgias
↑ Hot flashes

Aromatase inhibitor:
↑ Osteoporosis
↑ Cardiovascular risk
↑ ↑ Arthralgias
↑ Hot flashes

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25
Q

What of the side effects of trastuzumab/epratuzumab

A

Reversible cardiomyopathy
Diarrhea
Infusion reactions

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26
Q

What are the side effects of chemotherapy for breast cancer treatment

A

Anthracyclines:
IRREVERSIBLE cardiomyopathy
Secondary leukemia
Alopecia
Tissue necrosis

Taxanes
Peripheral neuropathy
Infusion reactions: Fever, dyspnea, rash
Myalgias/arthralgias
Alopecia
Febrile neutropenia

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27
Q

Management of bone metastases and breast cancer

A

Bisphosphonates: Zoledronic acid, ibandronate, clodronate
Or denosumab

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28
Q

Surveillance guidelines for breast cancer

A

Annual mammogram, history, physical and breast exam

Lifestyle: Same recommendations as cardiac guidelines

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29
Q

Diagnosis/definition of febrile neutropenia

A

Single oral temperature ≥ 38.3 °C or ≥ 38 °C for ≥ 1 hour
Neutropenia: ANC <500 or 0.5 OR <1000 cells per microliter with predicted nadir <500 cells per microliter

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30
Q

Management of febrile neutropenia: Outpatient

A

Ciprofloxacin 500 mg p.o. BID + amoxicillin/clavulanate 500 mg p.o. TID
Or
Clindamycin if allergic to penicillin

No G-CSF

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31
Q

Management of febrile neutropenia For the inpatient

A

Carbapenem, pip-tazo, cefepime, ceftazidime
Add vancomycin if suspect gram-positive infection
Antifungal if persistent fever after 4 to 7 days with no clear source

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32
Q

Who is at increased risk for colorectal cancer

A

≥ 1 first-degree relatives with colon cancer OR advanced adenoma

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33
Q

What do you do if you have mastitis not responding to antibiotics?

A

Ultrasound + mammogram then Biopsy to rule out Paget’s disease/inflammatory breast cancer

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34
Q

Examples of CDK 4/6 inhibitor

A

Palbociclib, ribociclib

35
Q

Example of double HER2 blockade

A

Trastuzumab + Pertuzumab

36
Q

examples of chemotherapy for breast cancer

A

taxanes (Docetaxel, paclitaxel) + cyclophosphamide

37
Q

example of immunotherapy for breast cancer

A

pembrolizumab

38
Q

treatment for non-small cell lung cancer stage I

A

Fit or surgery: Surgery
Unfit for surgery: Stereotactic body radiation treatment

39
Q

treatment for stage II and III/resectable non-small cell lung cancer

A

surgery + adjuvant chemotherapy

40
Q

treatment for stage III/unresectable non-small cell lung cancer

A

concurrent chemoradiation + immunotherapy/Durvalumab x 1 year

41
Q

treatment for radiation pneumonitis

A

steroids

Radiation pneumonitis typically presents 1 to 3 months post radiation, so typically by the time they presents they’re no longer immunosuppressed by chemotherapy

42
Q

management for non-small cell lung cancer that is metastatic and EGFR mutation positive

A

osimertinib plus referral to palliative care

43
Q

management of long small cell lung cancer that is metastatic and has other driver mutations

A

chemotherapy +/- therapy + palliative care

44
Q

management for limited stage small cell lung cancer

A

curative intent concurrent chemoradiation +/- prophylactic cranial irradiation

45
Q

management for extensive stage small cell lung cancer

A

incurable/palliative intent chemotherapy + immunotherapy + prophylactic cranial radiation

46
Q

lists paraneoplastic syndromes for small cell lung cancer

A

SIADH
Lambert Eaton myasthenic syndrome: Anti-VGCC antibody positive
Encephalomyelitis & sensory neuropathy: Anti-Hu Ab
Cushing syndrome: Ectopic ACTH production. NOT suppressed by dexamethasone suppression test

47
Q

listed paraneoplastic syndromes for adeno non-small cell lung cancer

A

hypertrophic osteoarthropathy: Symmetrical, painful arthropathies of the ankles, knees, wrists, elbows, clubbing

48
Q

list some paraneoplastic syndromes for squamous non-small cell lung cancer

A

hypercalcemia: PTHrP production

49
Q

tumor markers for colorectal cancer

A

carcinoembryonic antigen (CEA)

50
Q

management for colorectal cancer stage 1–3

A

surgery
Adjuvant chemotherapy for an stage III and selected stage II

51
Q

management for stage IV/metastatic colorectal cancer that is oligometastatic/isolated liver or lung lesions, undefined number of mets

A

metastectomy sign chemotherapy that is curative intent

52
Q

management for nonoperable stage IV/metastatic colorectal cancer

A

chemotherapy +/- either veg F inhibitor/bevacizumab or EGFR inhibitor

53
Q

colorectal cancer surveillance for stage I

A

colonoscopy 1 year post resection
Subsequent colonoscopies based on findings of previous scope (not annually), if negative, every 5 years

54
Q

surveillance for stage II – 3 colorectal cancer

A

colonoscopy 1 year postresection
Years 1–3: Q.6 month history, physical exam, CEA, CT chest abdomen and pelvis
Year 4–5: Annual history, physical exam, CEA, CT chest abdomen and pelvis

55
Q

risk factors for squamous cell gastroesophageal cancer

A

alcohol
Caustic injury
Smoking

56
Q

risk factors for adenocarcinoma gastroesophageal cancer

A

Barrett’s esophagus
GERD
Obesity
Smoking

57
Q

management for early/localized castrate sensitive prostate cancer

A

active surveillance with PSA monitoring
Radical prostatectomy +/- lymph node dissection
Radiation

58
Q

management of metastatic prostate cancer

A

and again deprivation therapy + chemotherapy + second-generation antiandrogen

59
Q

treatment side effects of androgen deprivation therapy

A

osteoporosis
Decreased libido
Gynecomastia
Hot flashes
Fatigue

60
Q

treatment side effects of docetaxel/chemotherapy for prostate cancer

A

peripheral neuropathy
Nausea and vomiting
Hair loss

61
Q

which should all patients on androgen deprivation therapy be on?

A

Calcium, vitamin D supplementation, and bisphosphonate for metastatic disease or low bone mineral density

62
Q

what imaging to order for testicular cancer

A

scrotal ultrasound, CT chest abdomen and pelvis

63
Q

diagnosis of testicular cancer

A

made by radical orchiectomy, never biopsied testicular mass due to risk of tumor seeding

64
Q

tumor markers for testicular cancer

A

beta-hCG, AFP, LDH

65
Q

chemotherapy regimen for testicular cancer

A

BEP
bleomycin, etoposide, cisplatin

66
Q

management of localized testicular cancer

A

surgical orchiectomy

67
Q

management of metastatic testicular cancer

A

chemotherapy

68
Q

tumor markers for seminoma

A

↑ beta-hCG

69
Q

Tumor markers for nonseminoma (yolk sac, teratoma, embryonal, mixed, choriocarcinoma)

A

↑ beta-hCG, ↑AFP

70
Q

Most common malignancies for hypercalcemia

A

breast, lung, multiple myeloma

71
Q

management of hypercalcemia and malignancy

A
  • IV hydration (most effective short-terms) + Lasix
  • Calcitonin
  • Bisphosphonates
  • o Pamidronate 90mg IV
  • o Zoledronic acid 4mg IV x 1 (remember to reduce dose for renal dysfunction)
  • o Max effect 4-7 days post-infusion (therefore NOT short-term solution)
  • o Monitor for hypocalcemia post-treatment
  • Treat underlying malignancy
72
Q

most common etiologies for malignant bowel obstruction

A

ovarian, gastric, breast, lung

73
Q

management of malignant bowel obstruction

A

nonpharmacologic:
IV fluids, electrolyte replacement, NG decompression

Pharmacologic:
Octreotide 100 mcg subcutaneous TID
Dexamethasone
Metoclopramide 10 mg IV q.8h. if partial MBO, do not use incomplete malignant bowel obstruction

procedural:
Consult GEN surge for stent/diverting ileostomy/venting G-tube/feeding tube

74
Q

symptoms/diagnosis of SVC syndrome

A

facial and arm edema
Distended neck and chest veins
Dyspnea
Cough
Facial plethora
Hoarseness/stridor
Neurologic: Confusion altered level of consciousness
Abnormal chest x-ray/CT chest/head and neck

75
Q

management of SVC syndrome

A

life-threatening: Venogram, urgent stent, consider thrombolytics if thrombus

Steroids: For airway obstruction not amenable for stenting or a steroid responsive tumor such as thymoma or lymphoma
Stent for symptom palliation +/- radiation and not chemosensitive tumors such as non-small cell lung cancer and mesothelioma
Systemic chemotherapy for chemosensitive tumors

76
Q

management of leptomeningeal disease/brain metastases

A

urgent MRI brain + full spine
Dexamethasone 10 mg IV x 1 then dexamethasone 4 mg p.o./IV QID
Consulted neurosurgery and radiation oncology

77
Q

chemotherapy side effects

A

diarrhea
Mucositis
nausea
cardiomyopathy

78
Q

management of mucositis

A

baking soda rinses, viscous lidocaine, Magic mouthwash (nystatin + lidocaine + steroid)

79
Q

immunotherapy toxicity management

A

for mild symptoms, hold treatment for supportive management, consider rechallenging the treatment

Make sure to always rule out infection

For moderate to severe symptoms: Hold treatment, IV methylprednisolone 1 mg/kg or prednisone 0.5-1 mg/kg
For GI toxicity, refer to GI for scope, rule out infection. If no response to steroids after 72 hours or worsening symptoms, then try infliximab 5 mg/kg

80
Q

what cancers are most likely when you have right supraclavicular lymph nodes?

A

Lung cancer, esophageal cancer

81
Q

cancer with left supraclavicular nodes/Virchow’s node

A

abdominal malignancy menses via the thoracic duct: Gastric, gallbladder, pancreas, kidneys, testicles, ovaries, prostate
Ipsilateral breast and lung

82
Q

cancers where you have umbilical nodes/Sister Mary Joseph node

A

o GI – Gastric, colon, pancreas
o Gynecologic – Ovarian, endometrial

83
Q
A

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