Based on MTB and U.S. Preventive Services Task Force
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)
Purpose of testing for Her2/neu?
Her2/neu positive should receive Trastuzumab?
Benefit of Trastuzumab?
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?
Is surgery or radiotherapy for prostate CA more likely to cause erectile dysfunction?
Purpose of Gleason score?
Determines aggressiveness or malignant potential of prostate CA
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?
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?
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.