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Step III

Step III - Onc

QuestionAnswer
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