Flashcards in Oncology Deck (41)
next step with a BiRADs 2/3?
Breast USG - differentiates between cystic and solid masses
next step with a BiRADS 4/5?
fine needle aspiration or biopsy of nodule must be done
when should you test for BRCA1/2 mutations?
in women who appear to have genetic risk i.e. multiple relatives w/ breast or ovarian cancer, esp. early onset disease
young woman has a persisent, scaling, eczematous and ulcerated lesion over her nipple/areola; this lesion does not respond to medications - what should you consider?
Paget's dz of the nipple
- do a biopsy
Biopsy finding in Paget's dz of nipple?
malignant, intraepithelial adenocarcinoma cells w/in epidermis of nipple associated w/ underlying invasive ductal cancer
lichen simplex chronicus
localized disorder with intense pruritus, which leads to localized areas of thickened skin with increased and exagerated skin markings due to scratching
a women presents with a palpable breast mass but mammography comes back negative, what is the next best step?
fine-needle aspiration OR ultrasonagraphy
what do you recommend to a woman who just had cyst aspiration of her breast?
come back in 4-6 weeks to evaluate for recurrence or presence of residual lump
in whom should tumor estrogen/progesterone receptor assay be done?
patients with early stage breast cancer to determine optimal systemic therapy
breast conserving therapy
breast lumpectomy + radiation therapy
when do you perform axillary node dissection?
when sentinel LN shows metastatic involvement
screening for CRC in a person with a positive family history of CRC
start screening at age 40 or 10 years earlier than diagnosis of affected member; if normal colonscopy, repeat ever 3-5 years
when do you test for mutations of the APC gene?
in pts with polyposis
screening for CRC in normal-risk people
beginning age 50, then every 10 years if result is normal
screening recommendations for pts with IBD
annual colonoscopy beginning 8 years after diagnosis- take random biopsies in four-quadrants to evaluate for dysplastic changes
what test do you do in a pt presenting with signs of colon cancer?
findings that should prompt investigation for CRC
rectal or abdominal mass
iron deficiency anemia
when can you choose flexible sigmoidoscopy over colonscopy?
pts < 40 yo with rectal bleeding
what is the appropriate follow-up for an asymptomatic patient with a positive FOBT sample?
what is capsule endoscopy used for?
visualization of the small bowel
how do you screen for lung cancer?
what is the appropriate follow-up in a pt who was found to have a 3 mm pulmonary nodule (incidental finding from abdominal CT)?
no further testing needed for pulm nodules < 4 mm bc risk of malignancy is extremely low in low risk patients; if the patient is at high risk for lung cancer, follow-up is with CT-scan at 12 months
first line management of someone with limited SCLC?
chemotherapy plus radiation therapy
- combo of carboplatin/cisplatin and etoposide/irinotecan
what is the next step in a man who comes in with a rising PSA (> 0.75 ng/ml/year)?
do a transrectal biopsy - even if pt is asymptomatic and DRE is non-specific
what is the appropriate screening method for prostate cancer?
inform patient about risks and benefits of screening; offer PSA testing to patients > 50 years old; no screening for men over 75
how do you tx. metastatic prostate cancer?
androgen deprivation therapy, w/ leuprolide or surgical castration (orchiectomy)
- leuprolide should be given with brief course of flutamide to prevent tumor flare
what is docetaxal+prednisone therapy used for?
patients with hormone-refractory prostate cancer
samarium 153 - what is this useful for?
radionuclide taken up by bone - useful in treating prostate cancer with painful bone mets that is unresponsive to other therapies
what is the next step in a female who has ASCUS on pap smear?
test for HPV
- if positive, do a colposcopy w/ biopsy