Workup and diagnosis
This tumor marker is most commonly elevated in pancreatic cancer
CA 19-9
Treatment for ER positive DCIS
Lumpectomy, radiation, and adjuvant endocrine therapy
No need to perform surgical evaluation of axillar, however if patient unable to have breast conservation therapy, then sentinel lymph node biopsy indicated
According to the USPSTF, what age do we start breast cancer screening?
Biennial screening mammography for women 50-74 years
Rituximab
Added to CHOP regiment for NH lymphoma
(Cyclophosphamide, doxorubicin, vincristine, and prednisone)
Which team won both the 1979 and 1980 European Cup (now known as the Champions league)
Nottingham Forest
This criteria is used to evaluate for transplant in HCC
Milan Criteria
Solitary lesion < 5 cm or 3 lesions < 3 cm
No gross vascular invasion, LN, or distant mets
This is the most important prognostic factor in early stage breast cancer
Nodal involvement
Current research is looking Ki-67 and urokinase plasminogen activator system
According to the USPSTF, who and when do we screen for prostate cancer?
Men aged 55-69 should practice shared decision making
Recommend not screening over the age of 70
Used for locally advanced or metastatic NSCLC that expresses an abnormal ALK gene
Crizotinib
Also approved for ROS1 mutated lung cancer
Side effect of vision change within the first 2 weeks of starting the medication
Who was Friar Tuck in English Folk law
One of Robin Hoods Merry men!
Describe the Ann Arbor staging system (4 stages)
1: Single lymph node or nodal group
2: 2 or more nodal groups on same side of diaphragm
3: Lymph node groups on both sides of the diaphragm
4: Disseminated extranodal disease
A - no B symptoms - B - fever, >10% weight loss, or night sweats
Adjuvant chemotherapy is used in early stage breast cancer when which two criteria are met?
Nodal involvement
What are the screening recommendations for BRCA 1/2 positive females?
Annual mammogram + breast MRI starting at age 25
Ovarian cancer - no definite recommendations but consider TV ultrasound +/- CA 125 q6m at age 30
Pembrolizumab was initially approved to treat metastatic melanoma back in 2015. In May of 2018, NEJM published a study leading to its approval for what other melanoma indication?
High risk stage 3 melanoma s/p resection
At 1 year showed decrease in reoccurrence
What countries make up Great Britain?
England, Scotland, and Wales
For the UK, add in Northern Ireland
Trastuzumab can be added to which two HER-2 positive breast cancers?
Breast and esophageal adenocarcinoma
* Need a baseline MUGU/ECHO as 2-7% have reversible cardiomyopathy
Triple negative breast cancer carries the worst prognosis of all breast cancers. It accounts for close to 20% of all breast cancers. Five risk factors associated with the diagnosis of TNBC include...
Obesity
BRCA +
Race - African-American women have a higher risk
Pre-menopausal
Nulliparity is associated with a lower risk for TNBC
What are the CRC screening recommendations for Lynch syndrome?
Colonoscopy starting at age 20-25 or 2 years before first diagnosed relative
Repeat yearly
If not a candidate for surveillance then recommend subtotal colectomy
What percent of PD1 expression is needed for use in second line monotherapy in NSCLC?
Greater than or equal to 1%
Compared with 50% expression for use in first line monotherapy for metastatic NSCLC
London - 8,103,467
Birmingham – 1,073,045
Leeds – 751,485
Sheffield – 552,698
Manchester – 503,127
Liverpool – 466,415
This staging system is used in melanoma?
T staging - based off Breslow thickness
T1 < 1.00mm
T2 1.01 mm - 2.00 mm
T3 2.01 mm - 4.00 mm
T4 > 4.00 mm
This oral PARP inhibitor was shown to be superior to chemotherapy in advanced breast cancer patient with the germline BRCA mutation
Talazoparib showed significant benefit over standard chemotherapy with respect to progression free survival
8.6 months vs. 5.6 months
What are the male MRCA mutation screening recommendations?
Self breast exams aged 35 q6-12 months
Mammogram and prostate exam starting at age 40
This agent plus ipilimumab showed benefit over standard chemotherapy in high mutation (>10 mutations) NSCLS regardless of PD-L1 expression
Nivolumab
PD-1 monoclonal antibody
Also can be used first line in patient who don't have BRAF mutation
Indicated in metastatic squamous NSCLC as well as RCC
Where is the oldest functional pub in England and what year did it pour its first pint?
Ye Olde Trip to Jerusalem in Nottingham
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