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