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BRCA-related hereditary breast and ovarian CA syndromes
- BRCA: highly penetrant germline mutations in BRCA1 or BRCA2 (autosomal dominant)
- ~20% of patients with a hereditary breast and ovarian cancer syndrome have a mutation in BRCA 1 or 2
- Also confer higher risk of second breast CA (often contralateral breast), MALE breast CA, fallopian tube CA, primary peritoneal CA, pancreatic CA, melanoma, endometrial CA
- Unaffected BRCA carriers?
- Clinical breast exams every 6 to 12 months beginning at age 25
- Annual breast magnetic resonance imaging (MRI) from ages 25 to 29 years
- Annual mammogram and breast MRI from ages 30 to 75
- Consideration of chemoprevention and risk-reducing mastectomy
Posted 11/22/16 09:12:47 AM by Matthew Cummings
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Classic Chemotherapy/Onc Drug Toxicities
- Gemcitabine/mitomycin --> TTP
- Bleomycin/MTX --> ILD (pulmonary fibrosis)
- 5-FU --> mucositis
- Tacrolimus/cyclosporine/s/p BMT --> PRES
- Alkylating agents (cyclophosphamide, busulfan) --> myelodysplasia
- Thalidomide/lenalidomide --> VTE (DVT/PE)
- Rasburicase/dapsone/sulfa (less likely) --> hemolysis in G6PD deficiency
- Anthracyclines (doxorubicin), trastuzumab --> cardiomyopathy
- Cyclophosphamide/ifosfamide --> hemorrhagic cystitis
- Peripheral neuropathy --> vincristine
Posted 11/22/16 09:38:51 AM by Matthew Cummings
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Cardiac Tumors -- Clinical Manifestations
- Embolization (usually systemic, can be pulmonic, embolic risk highest w/ LA tumors)
- CHF via valvular/outflow obstruction or valvular regurgitation
- Direct invasion of the myocardium (decreased LV function arrhythmias, heart block, pericardial effusion)
- Invasion of adjacent lung -- cough, SOB
- Constitutional symptoms
Cardiac Sarcomas
- Incredibly rare
- Imaging crucial to plan diagnostic/therapeutic approach (surgery vs no surgery) --> TTE, CT, MRI
- Angiosarcoma, rhabdomyosarcoma, fibrosarcoma, leiomyosarcoma
Posted 11/22/16 09:44:39 AM by Matthew Cummings
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Olaratumab for soft-tissue sarcoma
- Standard therapy had long been doxorubicin +/- ifosphamide
- Lancet 2016 (Dr. Schwartz senior author): data supporting olaratumab (human anti-platelet derived growth factor MAB) + doxorubicin as preferred therapy for soft-tissue sarcoma
Posted 11/22/16 09:52:14 AM by Matthew Cummings
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For further reading...
Posted 11/22/16 09:55:21 AM by Matthew Cummings
Created by Christopher Kelly
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