Oncology

Question 1

breast cancer screening with mammography begins at what age?

Answer 1

50

Question 2

breast cancer screening with mammography is not routinely indicated at what age?

Answer 2

75

Question 3

if a mammogram shows an abnormality, next step?

Answer 3

biopsy

Question 4

what is the “sentinel node” in a sentinel node biopsy?

Answer 4

the FIRST node where the tracer goes

Question 5

if sentinel node is FREE of cancer, then?

Answer 5

axillary node dissection is NOT necessary

Question 6

if sentinel node HAS cancer, then?

Answer 6

axillary lymph node dissection

Question 7

should BRCA genetic testing routinely be done?

Answer 7

NO

Question 8

BRCA is associated with?

Answer 8

increased risk of familial breast cancer and ovarian cancer

Question 9

best INITIAL treatment for breast cancer

Answer 9

lumpectomy WITH radiation

Question 10

when should primary preventive treatment of breast cancer be given, at what age, and what should be given?

Answer 10

• multiple first-degree relatives with breast cancer
• age 40
• tamoxifen

Question 11

treatment for estrogen receptor + or progesterone receptor + breast cancer

Answer 11

tamoxifen, or raloxifene

Question 12

adverse effects of tamoxifen (3)

Answer 12

1. DVT
2. hot flashes
3. endometrial cancer

Question 13

MOA of aromatase inhibitors (anastrozole, letrozole, exemestane)

Answer 13

pure estrogen antagonists

Question 14

adverse effect of aromatase inhibitors (anastrozole, letrozole, exemestane)

Answer 14

osteoporosis

Question 15

when should adjuvant chemotherapy be given in breast cancer?

Answer 15

• cancer in axilla
• cancer larger than 1cm
• patient is still menstruating

Question 16

trastuzumab MOA

Answer 16

monoclonal Ab against HER-2/NEU

Question 17

when do you use trastuzumab?

Answer 17

metastatic breast cancer

Question 18

colon cancer treatment

Answer 18

surgical resection and 5-FU

Question 19

colon cancer screening: routine

Answer 19

• colonoscopy starting at age 50

- every 10 years

Question 20

colon cancer screening: single family member with colon cancer

Answer 20

• colonoscopy at age 40 or 10 years EARLIER than age at which family member was diagnosed
• every 10 years

Question 21

colon cancer screening: HNPCC (3 family members, 2 generations, or one premature (less than 50 yoa))

Answer 21

• colonoscopy at age 25

- every 1-2 years

Question 22

colon cancer screening: FAP

Answer 22

• sigmoidoscopy at age 12

- every 1-2 years

Question 23

colon cancer screening: juvenile polyposis, Peutz-Jeghers, Turcot syndrome, Gardner syndrome

Answer 23

• no additional screening

- same as routine screening guidelines: start at age 50, every 10 years

Question 24

which patients should be screened for lung cancer?

Answer 24

• more than 30 pack-years smoking history
• between ages 55-75
• chest CT scan at age 55

Question 25

when and what is the treatment for lung cancer?

Answer 25

- if disease is LOCALIZED ENOUGH | - surgery

Question 26

when is surgery not an option for lung cancer? (5 scenarios)

Answer 26

1. B/L disease 2. metastases 3. malignant pleural effusion 4. involvement of aorta, vena cava, or heart 5. lesions w/i 1-2cm of carina

Question 27

is small-cell lung cancer resectable, and why?

Answer 27

NO, bc 1 of these features is present in more than 95% of cases 1. B/L disease 2. metastases 3. malignant pleural effusion 4. involvement of aorta, vena cava, or heart 5. lesions w/i 1-2cm of carina

Question 28

is size alone a reason lung cancer is not resectable?

Answer 28

no, as long as it's peripheral, and without metastases

Question 29

when do you start cervical cancer screening?

Answer 29

- age 21 - repeat every 3 years until age 29 - then do Pap WITH HPV every 5 years

Question 30

abnormal Pap smear with low-grade or high-grade dysplasia; next step in management

Answer 30

COLPoscopy and biopsy

Question 31

if Pap smear shows atypical squamous cells of undetermined significance (ASCUS); next step in management

Answer 31

test for HPV

Question 32

if patient is HPV POSITIVE; next step in management

Answer 32

COLPoscopy, or repeat Pap in 6-12 months

Question 33

when do you stop screening for cervical cancer?

Answer 33

greater than 65 yoa

Question 34

should screening be performed for prostate cancer?

Answer 34

NO, not recommended

Question 35

besides SPREAD OF DISEASE, most important PROGNOSTIC factor for prostate cancer

Answer 35

Gleason score | higher score, more aggressive cancer

Question 36

LOCALIZED prostate cancer treatment

Answer 36

SURGERY, AND either external radiation, or implanted radioactive pellets

Question 37

METASTATIC prostate cancer treatment

Answer 37

ANDROGEN blockade (flutamide), AND GnRH agonist (leuprolide, or goserelin)

Question 38

- woman greater than 50 yoa - increasing abdominal girth - weight loss

Answer 38

ovarian cancer

Question 39

marker of progression and response to therapy in ovarian cancer

Answer 39

CA-125 (carcinoma Ag)

Question 40

treatment for ovarian cancer

Answer 40

surgical debulking, then chemotherapy

Question 41

- man under 35 yoa | - painLESS scrotal lump

Answer 41

testicular cancer

Question 42

diagnostic test for suspected testicular cancer

Answer 42

inguinal orchiectomy | do NOT do a needle biopsy

Question 43

95% of all testicular cancers are

Answer 43

GERM CELL TUMORS (seminoma and nonseminoma)

Question 44

AFP is secreted ONLY by this type of testicular cancer

Answer 44

NONSEMINOMA

Question 45

what should be measured in testicular cancer?

Answer 45

- AFP - LDH - B-HCG

Question 46

how do you stage testicular cancer?

Answer 46

CT scan of abd/pelvis

Question 47

treatment for testicular cancer after orchiectomy: LOCAL disease

Answer 47

radiation

Question 48

treatment for testicular cancer after orchiectomy: WIDESPREAD disease

Answer 48

chemotherapy