Oncology Flashcards
(50 cards)
Screening mammography should begin at age ….. , and it is not routinely indicated at age ….
- 50
- 75
Abnormality is found in mammography, do the following (and why)
- Biopsy (cancer or not, est/prog receptors, HER2/new overexpression)
- Sentinel node biopsy into operative field (if positive –> axillary dissection)
2 or more first-degree relatives with breast cancer. How to decrease risk
use 1. tamoxifen or 2. raloxifene or 3. aromatase inhibitors
Breast cancer treatment (only names)
- Lumpectomy with radiation to the site (equal to modified radical mastectomy)
- hormonal inhibition therapy
- adjuvant chemo
- trastuzumab + pertuzumab
- atezolizumab (PD-1 inhibitor)
best initial treatment for breast cancer
Lumpectomy with radiation to the site (equal to modified radical mastectomy)
Breast cancer - hormonal inhibition therapy (medications, mechanism, when to use)
- tamoxifen: if either estrogen or prog receptors are positive (best response if both +) - they are also selective agonist
- aromatase inhibitors: inhibit adrongen conversion to estrogens)
tamoxifen - SE
- DVT
- Hot flashes
- endometrial cancer
NO OSTEOPOROSIS
aromatase inhibitors - names and SE
- anastrozole
- letrozole
- exemestane
SE: osteoporosis. (NO DVT)
Breast cancer - Adjuvant chemotherapy - when
- cancer larger than 1 cm or
2. (+) axilla
Breast cancer in menstruating women (what differences)
- adjuvant chemo works better
2. it will not likely be controlled by estrogen inhibitors (tamoxifen or aromatase inh)
Breast cancer - Atezolizumab (anti-PD-1)
the only drug for triple-negative breast cancer
Breast cancer - Trastuzumab + pertuzimab - when to use
in combination for metastatic disease
Breast cancer - Trastuzumab + pertuzimab - mechanism / disadvantages
- monoclonal against HER/neu
- disadvantages: a. modest efficacy
b. some cardiotoxicity
Breast cancer - prevention (what, when indicated, when to start, efficacy)
- tamoxifen
- if multiple first-degree relatives with breast cancer
- start at age 40
- reduces the risk by 50%
colon cancer screening is different for the 5 groups - what are these groups
- General population
- single family member with Colon cancer
- 3 family members or 2 generations or 1 age <50
- FAP, Gardner, Peutz-jeghers, Turcot’s
- Juvenile polyposis
colon cancer screening - general population
- start at 50
2. colonoscopy every 10 yrs
colon cancer screening - single family member with Colon cancer
start screening at 40 or 10 years earlier than the age at which the family member contracted cancer
colon cancer screening - 3 family members or 2 generations or 1 age <50
- start screening at 25
- colonoscopy every 1-2 years
colon cancer screening - FAP, Gardner, Peutz-jeghers, Turcot’s
- start screening at 12
- sigmoidoscopy every 1-2 years (for Peutz-jeghers at age 8)
colon cancer screening - Juvenile polyposis
screen upper and lower tract starting at age 12
What is important to manage for colonoscopy? (+explain)
anticoagulation:
- Stop novel oral anticoagulants (NOACs): 1d before and restart the day after
- Stop warfarin 3-5 days before (depends on the reason, id mental valve should be the shortest period)
colon cancer - treatment
- surgical resection
- chemo centered around a5-fluorouracil regimen (if stage 2 or more)
Lung cancer - screening
Chest CT if smoker with >30 pack-years
age: 55-75
has not quit in past 15 years
Accidental finding of a calcified nodule in the lung of a 52 yo M. No symptoms –> next step
excisional biopsy in every solitary nodule larger than 1 cm in smokers
If calcified is against malignancy, however age, size, and history of smoking are more important
