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Based on MTB and U.S. Preventive Services Task Force http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm

Current recommendation on who gets a mammogram?

The USPSTF recommends biennial screening mammography for women aged 50 to 74 years.

Current recommendation on breast self exam?

The USPSTF recommends against teaching breast self-examination (BSE).

Purpose of a mammogram even after being scheduled for a biopsy?

5-10% of breast CA is bilateral.

2 reasons to recommend an ultrasound in evaluating a breast mass?

Mass is painful
Mass varies in pain and size with menstruation

What is the purpose of PET scan in evaluation of Breast CA?

Determines content of lymph nodes found by imaging eg CT shows hilar adenopathy

What 2 cancers does BRCA1 gene predispose to?

Breast and ovarian

When is a sentinel lymph node biopsy done and why?

In all patients undergoing a lumpectomy or mastactomy.
Negatve sentinel node eliminates need for axillary dissection

Purpose of testing for ER and PR?

If positive, patient undergoes hormone manipulation.

Purpose of radiation therapy in treatment of breast CA?

Prevention of recurrence.

What are the two types of drugs available for hormonal manipulation in the treatment of breast CA. Give an example of each. Which had the better mortality benefit?

SERMs: Tamoxifen, Raloxifene
Aromatase inhibitors: Anastrozole, Letrozole, Examestane
Aromatase inhibitors have a slight benefit over SERMs.

AE of SERMs?

Endometrial Ca and clots

AE of aromatase inhibitors? (exemestane, anastrozole, lotrozole)

Osteoporosis

Purpose of testing for Her2/neu?

Her2/neu positive should receive Trastuzumab?

Benefit of Trastuzumab?

Decreases recurrence.

Purpose of adjuvant chemotherapy in the treatment of breast cancer?

To clean up presumed microscopic cancer cells to small to be detected.

What drug can be given to lower the risk of breast cancer and who should receive it?

Tamoxifen.
Given to those with multiple first degree relatives with breast CA

2 indications for adjuvant chemotherapy in the treatment of breast CA?

Lesions >1cm
Positive axillary lymph nodes

Differentiate adjuvant from neoadjuvant chemotherapy,

Adjuvant: radio- or systemic therapy given after main treatment to improve disease-specific symptoms and overall survival
Neoadjuvant: is the administration of therapeutic agents before a main treatment

8 things that lower mortality in breast cancer?

Mammogram
ER/PR testing than tamoxifen or raloxifene
Aromatase inhibitors (exemestane, anastrozole, lotrozole)
Adjuvant chemotherapy
Lumpectomy and radiation
Modified radical mastectomy
Trastuzumab
Prophylaxis with tamoxifen

Current recommendation for getting PSA for prostate CA screening?

The USPSTF recommends against PSA-based screening for prostate cancer.

Most common presentation of prostate CA?

Asymptomatic

Is surgery or radiotherapy for prostate CA more likely to cause erectile dysfunction?

Surgery

Purpose of Gleason score?

Determines aggressiveness or malignant potential of prostate CA

Different treatment modalitites of prostate CA?

Radical prostatectomy
External beam radiotherapy
Brachytherapy
Androgen deprivation therapy

What are the methods for androgen deprivation therapy in treatment of prostate CA?

Orchiectomy
GnRH agonists (Leuprolide, Goserelin, Triptorelin, Histrelin)
Androgen receptor blockers (DHT and testosterone) (Flutamide, Bicalutamide, Nilutamide)

Benefit of radical prostatectomy for localized prostate CA vs expectant managment of prostate CA?

Radical prostatectomy for localized prostate cancer less likely to develop distant metastases or die from the cancer than expectant management.
(http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageAction=displayProduct&productID=99#336)

Does radiation or hormonal therapy improve outcomes in the treatment of prostate CA?

Insufficient evidence to determine whether radiation or hormonal therapy results in fewer deaths or cancer progressions than expectant management.
(http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageAction=displayProduct&productID=99#336)

Benefit of ultrasound screening, lumpectomy, chemotherapy or hormonal manipulation in management of prostate CA?

None

Pre-op FEV 1 needed to be a candidate of pneumectomy?

> 2 L or >80% predicted

3 conditions wheree surgery would not be recommended as treatment for lung cancer?

Bilateral disease
Malignant pleural effusion
Involvement of heart, carina, aorta or vena cava

Who should be screened for ovarian cancer?

The U.S. Preventive Services Task Force recommends against routine screening for ovarian cancer.

3 conditions with increased risk of ovarian cancer

BRCA 1
Dermatomyositis
Lynch syndrome aka HNPCC

Pelvic US findings associated with ovarian cancer?

Solid component
Thick septations
+ Color flow on Doppler
+ Ascites
Peritoneal masses, LN, matted bowel

Man with painless lump in the scrotum that does not transilluminate. Dx?

Testicular cancer

Current recommendations for pap smear?

Pap smear q3 years for women 21-65 or
Pap smear + HPV testing q5 years for women 30-65
USPSTF Recommendations

2 types of germ cell testicular cancer? Diofferentiate the 2 in terms of response to ChemoTx, Rtx and aggressiveness.

Seminoma: Chemosensitive, RTx sensitive, less aggressive
Non-seminoma (embryonal, chorioCa, yolk sac tumor): Chemosensitive, RTx resistant, aggressive

What lymph nodes does testicular cancer metastasize to?

Para-aortic

Standard surgical treatment of testicular CA?

Orchiectomy

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