Kaplan High Yield Oncology

1. Breast Cancer
a. Presentation: i. Palpation of a massHard, immobile, fixed to chest wall. ii. Painless lump, skin changes, nipple retraction, nipple discharge b. Types: i. Ductal-80%, Lobular-20% c. Diagnosis i. Biopsy is the best initial test ii. Other methods: 1. FNA (best initial biopsy) a. High false negative rate 10% 2. Core needle biopsy a. Able to tell receptor status (Estrogen/prog) 3. Open surgical biopsy a. Most accurate test d. Mammography i. Screen general population starting at age 50 e. Ultrasound i. Used for indeterminate lesions. ii. Cyst vs. solid iii. PAINFUL & variable w/ menstruation f. Surgery options i. Lumpectomy ii. Modified radical mastectomy iii. Radical mastectomy 1. Not proven to be more beneficial. g. Systemic therapy i. Trastuzumab (anti-HER-2/neu receptor antibody) h. ER + , PR + i. Tamoxifen, Raloxifene 1. SE endometrial cancer & clots ii. Aromatase inhibitors: anastrozole, letrozole, exemestane 1. BETTER CHOICE 2. SE: osteoporosis

2. Prostate Cancer
a. Clinical: i. Obstructive symptoms ii. Palpable mass iii. Elevated or PSA b. Definitive diagnosis BIOPSY c. Gleason score = Tumor Grade d. Treatment i. Prostatectomy 1. Complications: ED & urinary incontinence ii. Radiation therapy iii. Brachytherapy iv. Hormonal therapy 1. Flutamide: Competitive inhibitor of testosterone & DHT 2. Leuprolide, goserelin: GNRH agonist, downregulates LH, FSH. 3. Ketoconazole: Suppresses testosterone 4. Orchiectomy: Stops endogenous production v. Watchful waiting

3. Lung Cancer
a. Who can get surgery? i. #1 factor = SIZE of tumor 1. Small lesions, more likely resectable b. 3 Surgical options: i. Wedge resection ii. Lobectomy iii. Removal of 1 lung. c. Surgery is never an option: i. Bilateral disease ii. Malignant pleural effusion iii. Heart, carina, aorta, vena cava involvement iv. Small cell cancer

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4. Ovarian Cancer
a. Presentation: i. > age 50 ii. Increasing abdominal girth 1. No hx of liver disease iii. Weight loss, fatigue b. Risk factors: i. BRCA , estrogen replacement c. Diagnosis: i. Ultrasound or CT scan ii. Most accurate test BIOPSY d. Treatment: i. Surgery chemotherapy e. Often not diagnosed until stage

5. Testicular cancer
a. Presentation: i. Young men: 20-50 years old ii. Painless lump in scrotum

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iii. Next best step Scrotal ultrasound or Transillumination Differential Diagnosis: i. Epididymitis ii. Hematocele iii. Varicocele Diagnosis: NEVER a needle biopsy! Seminoma i. ELEVATED Placenta Alkaline phosphatase ii. NORMAL AFP, May have hCG iii. LDH correlated w/ disease burden Non-Seminoma i. Yolk sac or endodermal sinus 1. AFP ii. Embryonal 1. AFP & hCG iii. Choriocarcinoma 1. AFP & hCG iv. Teratoma 1. AFP & hCG Staging: i. CT scan of abdomen, pelvis, chest ii. Spreads via lymphatic system to retroperitoneum Treatment: i. Orchiectomy ii. Radiation iii. Chemo

6. Cervical Cancer
a. HPV vaccine: i. Ages 11-26 b. Pap smear i. every 3 years w/ cytology starting at age 21 ii. After age 30, every 5 years iii. Stop at age 65 c. ASCUS i. HPV testing 1. + Colposcopy & biopsy 2. Negative repeat pap in 6 months d. Low-grade & High grade dysplasia: i. Colposcopy & biopsy required e. Presentation: i. Detected on pap