• 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
    • Breast
    • GI cancers
  
  

  Posted 08/23/16 10:03:48 AM by Anna Krigel

• 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

• 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

• 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

• 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

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