Step III - Onc
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| What screening test lowers cancer mortality the most | Mammogram above age 50
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| When should women start screening for breast cancer and how often until what age | >40 q1-2yrs up until 50yo
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| Women who are 50yo and above should be screened for breast cancer how often | Yearly
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| An abnormal mammo should be followed up by | Biopsy
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| Pt has abnormal mammo and you go for breast bx which confirms cancer. What do you do next | Sentinel node bx
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| You obtain a sentinel node bx and it reveals cancerous cells. How does that change your operative approach to the patient | Do axillary node dissection
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| What is the best initial tx for breast CA | lumpectomy w/ radiation tx
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| What do you use if the pt is ER+ and/or PR+ | Tamoxifen/raloxifene
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| Adjuvant chemo is used under what circumstances | cancer >1cm or axillary lymph nodes are (+) for cancer (number does not matter)
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| What are the AE of tamoxifen | DVT, hot flashes, endometrial CA
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| What is the MOA of tamoxifen | Selective estrogen receptor AGONIST
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| What is the MOA of aromatase inhibitors on estrogen | Pure estrogen antagonist
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| Based on the MOA of aromatase (-) what AE would you expect | Osteoporosis b/c it (-) estrogen-R in bones
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| What is a side effect of tamoxifen that anastrazole does not have | DVT
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| Name some aromatase (-) | Anastrazole, exematase, letrozole
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| Adjuvant therapy is most efficacious in what type of patients | Menstruating pts
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| Tamoxifen and aromatase (-) are least effective in what type of pts | Menstruating pts
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| What breast CA drug is a monoclonal Ab against HER2/NEU, has few side effects, moderate efficacy, and useful in metastatic dz | TRASTUZUMAB
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| Pt has multiple first degree relatives w/ breast CA. What primary preventive therapy should you recommend | Tamoxifen
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| What two risk associations are involved with having the BRCA gene | Familial breast CA and ovarian CA
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| Name the cancer associated with Tamoxifen use and BRCA gene, respectively | Endometrial CA, ovarian CA
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| What is the general tx for colon CA | surgical resection and chemo using 5-FU
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| When patient reaches age 50, what routine colon CA procedures/tests are initiated | Colonoscopy, FOBT, double contrast barium enema
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| After routine initial colon CA screening tests/procedures are done, how often are they repeated | Colonoscopy q10yrs, FOBT q1yr, double contrast barium enema q3-5yrs
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| If colonoscopy is done q10yrs what is performed in the interval time period | Sigmoidoscopy q3-5yrs
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| If pt has FmHx of colon CA then at what age should colonoscopies be performed | 40yo or 10yrs earlier than date of family member’s dx (pick whichever is earlier)
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| If pt has h/o 3 family members with colon CA over 2 generations with 1 member having it prematurely (before age of 50) then how often/when should you start colonoscopy screening | 25 yo q1-2yrs
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| What is the screening rec for pts with FAP | SIGMOIDscopy @12yo q1-2yrs
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| What is screening rec for pts with Juv polyposis, Peutz Jeghers, Turcot, Gardner’s | none
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| Under what circumstances would you do an excisional lung biopsy | Smoker w/ solitary lung nodule >1cm; more urgency if pt >50yo
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| What are conditions in which surgery CAN NOT be used as tx for lung CA | B/L dz, mets, malignant pleural effusion, lesion 1-2cm from carina, involvement w/ aorta, heart, vena cava
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| If a pap smear comes back with low/high grade dysplasia what is the next step | Colposcopy and biopsy
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| If the pap comes back as ACUS then what is the next step | Test patient for HPV
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| Pt had ACUS on pap and HPV testing is (+). What is the next step | colposcopy
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| Pt had ASCUS on pap and HPV testing is (-). What is the next step | Repeat pap in 6 mos
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| Pt with ASCUS, HPV(-), and 6 mos pap follow up is (-). What screening schedule will pt follow now | Resume normal screening q2-3 yrs until age 65
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| When should women start getting pap smears | At 21 yo or within 3 yrs of sexual activity whichever comes first
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| How often should pap smears be performed | At least q3yrs until age 65 when it can be stopped
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| Pt is 65 yo and not had prior screening with pap smear. What do you do next | Tell her to get her pap on!
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| When should quadrivalent HPV vaccx be given to females | 13 – 26yo
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| What is the recommended screening test and time interval for prostate cancer | None
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| If patient requests prostate cancer screening what you should you do | Order PSA and do DRE
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| What is the most important prognostic factor for prostate cancer (other than spread of dz) | Gleason score based on histology of cells (high = aggressive)
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| Name the the two tx methods for localized prostate cancer | Surgery and external radiation/implanted radioactive pellets
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| Compare the efficacy of implanted radioactive pellets vs external radiation in the tx of prostate cancer | Nearly equal
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| What is the general mechanism/approach for tx prostate cancer | Androgen blockade
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| What is the standard of care tx for prostate cancer | Flutamide + leuprolide/goserelin
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| What is the MOA of flutamide | Testosterone-R blocker
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| What is MOA of leuprolide | GnRH AGONIST
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| What is the MOA of finasteride | 5α-reductase (-)
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| What is finasteride used for | BPH and male pattern baldness (NOT prostate cancer!)
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| Pt is woman >50yo c/o weight loss but increasing abdominal girth. Dx | Ovarian cancer
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| What is the screening and diagnostic test for ovarian cancer | None
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| What is measured to follow the progression and tx of ovarian cancer | CA-125
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| What is the treatment for ovarian cancer that is localized | Surgical debulking + chemo
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| What is the treatment for ovarian cancer that has mets | Same as localized (surg debulk + chemo); surgery responsive metastatic cancer is unique to ovarian CA
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| Painless scrotal lump in male <35yo. Dx | Testicular cancer
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| Diagnostic testing for testicular cancer | Inguinal orchiectomy of affected testicle
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| Most testicular cancers are of what type cell tumor | Germ cell tumors
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| What are the different types of germ cell tumors that lead to testicular cancer | Seminoma and non-seminoma
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| What marker is unique to non–seminoma germ cell tumors | AFP
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| In addition to AFP, what other lab measures do you obtain | LDH, βHGC (incr)
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| What diagnostic study is used to stage testicular cancer | CT abdomen/pelvis
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| What is the tx for localized testicular cancer | radiation
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| What is the tx for testicular CA w/ mets | chemo
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Created by:
DrINFJ
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