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Cancers that metastasize to bone:
- Predominantly osteoblastic lesions:
- Prostate
- Carcinoid
- SCLC
- Hodgkin lymphoma
- Predominantly osteolytic lesions
- Renal cell carcinoma
- Melanoma
- Multiple myeloma
- NSCLC
- Thyroid
- Non-Hodgkin lymphoma
- Mixed osteoblastic/osteolytic
Posted 08/23/16 10:03:48 AM by Anna Krigel
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Urine dipstick for urinalysis detects only albumin and not immunoglobulins, thus not picked up in multiple myeloma
Posted 08/23/16 10:05:05 AM by Anna Krigel
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Clinical evaluation of palpable breast masses
- Diagnostic mammogram
- Ultrasound
- Breast MRI - only used in cases of diagnostic dilemma, useful in detecting contralateral lesions
Posted 08/23/16 10:23:50 AM by Anna Krigel
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Breast biopsy
- Histology - invasive ductal most common followed by invasive lobular
- Test for estrogen receptor positivity and progesterone receptor positivity - any positivity >1% is counted as positive
- Test for HER2 positivity
- ER/PR positivity has better prognostic indications while HER2 positivity has worse prognosis
- Ki67 = proliferation marker, anything <14% is a good prognostic marker
Posted 08/23/16 10:26:16 AM by Anna Krigel
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Hormonal treatment
- Selective estrogen receptor modulators - tamoxifen (SEs include endometrial cancer (1/1,000), hot flushes, VTE)
- Aromatase inhibitors - contraindicated in premenopausal women
- Estrogen receptor antagonist - fulvestrant
- CDK 4/6 inhibitor - palbociclib
HER2 positive treatment
- trastuzumab
- pertuzumab
- T-DM1 - Ado-trastuzumab emtansine
Posted 08/23/16 10:38:32 AM by Anna Krigel
Created by Christopher Kelly
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