Flashcards in Oncology - Solid Deck (49):
1. Name three indications for prophylactic bilateral mastectomy.
2. When is mastectomy NOT indicated?
1. Fhx multiple premenopausal or bilateral CA
2. BRCA1 or BRCA2
3. p53 gene mutation (Li-Fraumeni)
**NOT indicated if metastatic disease (use hormonal therapy alone) unless for local cancer control
When is radiation considered after mastectomy (3)?
1. Close surgical margins
2. Dermal invasion
3. Postive LN >= 4
What is used for HER2 positive breast cancer?
Trastuzumab (AKA Herceptin) with/without chemotherapy
1. What are two options for ER/PR positive breast cancer?
2. When are they indicated?
3. What is their pharmacology?
- SERM (selective ER modulator)
2. Aromatase inhibitors
- postmenopausal (bc ovarian stim)
- prevent precursor conversion to estrogen
When should screening mammograms begin (4 scenarios, consider early screening)?
>40-50 years old OR
25 years in BRCA1 or BRCA2 carrier OR
5 years before FHx case OR
8 years after thoracic XRT
Name four histopathological breast cancers.
1. In Situ - no stromal invasion
2. Invasive - stromal invasion
a. Infiltratring - most common invasive
b. Lobular - mostly bilateral and multifocal
d. Medullary - rapid growth
e. Mucinous - slow growth
3. Inflammatory - angioinvasive, poor prognosis
4. Paget Disease - invades nipple
What is the differnence between Tamoxifen and Raloxifene?
Tamoxifen - INCREASED risk of endometrial cancer and thromboembolic disease
Raloxifene - DECREASED incidence of invasive breast cancer and vertebral factures and LESS risk of DVT/PE
Name three Aromatase Inhibitors
1. Which breast cancer is treated with lumpectomy (2 types)?
2. What is always used with lumpectomy?
3. What is not used?
1. a. Tumor < 0.5 cm
b. Ductal Carcinoma In Situ
2. Lumpectomy with RADIATION
3. No hormonal or chemotherapeutic agents
In which population is prophylactic oophorectomy offered (2)?
1. Women who are BRCA1/BRCA2 positive
2. Women with >2 first degree relatives with ovarian cancer
What work-up can be done for ovarian cancer (2)?
2. Ultrasound (pelvic or transvaginal)
What clinical finding increases the concern for ovarian cancer?
Which two labs are obtained for work-up of testicular cancer? Which of these helps distinguish which type of cancer?
1. alpha-fetoprotein (nonseminoma [yolk sac, liver])
**Remember Seminoma = primary testicular (semen) thus Nonseminoma = not primary testicular
After orchiectomy, how are treatments for Seminomas and Non-seminomas different?
- Stage I (or tumor <5m Stage II) - retroperitoneal radiation
- Stage II - Cisplatin-based chemotherapy
- Stage I - Retroperitoneal LN dissection
- Stage II - RLN dissection OR Ciplastin chemotherpy
What are three strategies for colon cancer screening?
1. FOBT yearly
2. Sigmoidoscopy every 5 years
3. Colonoscopy every 10 years
Name four exceptions to the standard colon cancer screening schedule, and when should they occur?
1. First-degree relative with colon cancer or adenomatous polyp - Age 40 or 10 years younger than earliest diagnosis
2. Hereditary Nonpolyposis Colorectal Cancer - Age 20 or 10 years younger than earliest diagnosis
3. Familial Adenomatous Polyposis - Age 12 with annual SIGMOIDOSCOPY
4. Pancolitis (IBD) - 8-10 years after initial diagnosis, every 1-2 years
Name the two ONLY scenarios when surgery is indicated in the setting of metastatic colon cancer?
1. Control of bleeding
2. Relief of obstruction
1. What is the inheritance pattern of the BRCA gene?
2. Which BRCA gene is responsible for male breast cancer?
1. Autosomal Dominant
What are contraindications for breast cancer post-surgical radiation (3)?
1. Prior radiation (Hodgkin's, prior breast CA)
2. Scleroderma or other CVD
3. Lack of access x 6-7 weeks
For inflammatory breast cancer, what is the first stage of treatment?
Chemotherapy first, then mastectomy and radiation
What lab should be checked, and with what frequency and duration, after resection of colorectal surgery?
CEA every 3 months for TWO years
Of the four types of lung cancer, which area of the lung do they normally manifest?
Central: Squamous Cell and Small-Cell
Peripheral: Adenocarcinoma and Large-Cell
Of the four types of lung cancer, list the order in which they occur in smokers?
100% Small Cell
95% Squamous Cell
Describe three clinic features of a Pancoast tumor.
1. Shoulder pain
2. Lower Brachial Plexopathy
3. Horner's Syndrome
c. Miosis (constricted)
Based on its stage, what are treatment options for NSCLC (Ia, Ib, II, III, IV). Include chemotherapy agent.
Stage Ia - Lobectomy
Stage Ib - Lobectomy + Chemo (cisplatin)
Stage II - Lobectomy + Chemo (cisplatin)
Stage III - Chemo and Radiation
Stage IV - Chemo (cisplatin) and brain met resection?
Name three Androgen-deprivation agents
What are two treatment options for metastatic prostate cancer?
1. Bilateral orchiectomy
2. Gonadotropin-releasing hormone agonists (GnRH-As): Leuprolide, Goserelin, Buserelin
Which type of testicular cancer is radiosensitive?
Seminoma - think radiation to fetus!
Which type of testicular cancer is likely to metastasize?
What diagnostic test should not be performed if concerned about testicular cancer?
What should be done with AFP is:
1. >20 ng/mL
2. >400 ng/mL
1. Order CT or MRI
2. (In cirrhosis) if liver mass, diagnose HCC
Where can metastases appear with gastric cancer (4 with eponyms)?
1. Periumbilical LN (Sister Mary Joseph)
2. Left Supraclavicular LN (Virchow node)
3. Enlarged Ovary (Krukenberg tumor)
4. Rectal cul-de-sac (Blumer shelf)
Name 5 clinical manifestations of carcinoid tumors
1. Episodic flushing after EtOH or stress
2. Venous telangiectasia
3. Secretory diarrhea
5. Cardiac valvular lesions
What can be use for treatment of symptoms for carcinoid tumors?
Octreotide for flushing or diarrhea
List three options for treatment of UN-resectable pancreatic cancer
1. Radiation alone
2. 5-fluorouracil + radiation
3. Chemotherapy (usually Gemcitabine)
What are the paraneoplastic syndromes associated with SCLC (6)?
2. Cushing Syndrome - ectopic ACTH
3. Eaton-Lambert Myasthenic Syndrome
4. Cerebellar Degeneration
5. Encephalomyelitis - HA, confusion, memory loss
6. Peripheral Neuropathy
1. Which feature constitutes Stage III colorectal cancer?
2. What would be indicated for this stage?
1. Positive LN
2. Adjuvant chemotherapy
For work-up of prostate cancer, what is the next steps after labs revealing:
1. PSA > 20
2. PSA > 30
1. Bone scan, also Gleason >7
2. CT abdomen and pelvis
What is indicated for treatment of metastatic lytic bone lesions?
Zoledronic Acid (bisphosphonate IV)
1. What are the two stage-categories of SCLC?
2. How are their treatment options different?
Limited Stage - confined to one hemithorax
**chemotherapy + radiation
**prophylactic brain irradiation
Extensive Stage - outside of one hemithorax
**radiation only for symptom palliation (brain)
Which antidepressants should be avoided with Tamoxifen, and why?
**CYP2DP inhibitors which lower endoxifen levels
How does Lambert-Eaton Myasthenic Syndrome differ on exam compared to Myasthenia Gravis?
Lambert-Eaton = IMPROVES after isometric exercises
What type of lung cancer leads to hypercalcemia and why?
SQUAMOUS Cell = PTHrP
1. What population is affected by lung adenocarcinoma?
2. What class of drugs can improve survival?
1. East Asian women
2. EGFR-tyrosine kinase inhibitors:
1. What lab test is performed when suspecting carcinoid tumors?
2. What imaging is performed?
1. 24-hour urin 5-HIAA
2. Abdominal CT with somatostatin receptor scintigraphy
1. Name three GnRH agonists
2. What should be given prior to GnRH agonists and why?
**Give androgen suppression first because LH surge can occur after giving GnRH agonists.
What are the stages for Colorectal Cancer?
I - Does not invade full thickness
II - Invasion through full thickness
III - >=1 LN
IV - Metastatic disease
What are the treatments for Rectal Cancer based on the stages?
I - Surgery
II - Chemo-radation, surgery, chemotherapy
III - Chemo-radation, surgery, chemotherapy
IV - Surgery for palliation and/or chemotherapy