Pearls from Dr. Kevin Kalinsky
Cancers that metastasize to bone:
- Predominantly osteoblastic lesions:
- Hodgkin lymphoma
- Predominantly osteolytic lesions
- Renal cell carcinoma
- Multiple myeloma
- Non-Hodgkin lymphoma
- Mixed osteoblastic/osteolytic
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
- 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
- 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
- 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
- T-DM1 - Ado-trastuzumab emtansine
Posted 08/23/16 10:38:32 AM by Anna Krigel
When obtaining a Family History - ask how large the family is (will add more depth to our knowledge of predisposing factors).
Posted 11/03/16 08:57:36 AM by Adam Faye
Supraclavicular Nodes - indicate locally advanced disease.
Cervical Lymph Nodes - indicates Stage IV disease.
Posted 11/03/16 09:00:13 AM by Adam Faye
- inflammatory Breast Ca
- More aggressive; it is a Clinical Diagnosis
(not a pathological one)
- Staging usually includes bone scan; CT head only performed if focal neuro findings.
- CA 27.29, 15-3
are used to monitor response/recurrence of disease (Not used for Diagnosis) - debate within the guidelines of whether to use
Posted 11/03/16 09:14:11 AM by Adam Faye
- Bisphosphonates (Rank-Ligand inhibitors as well) have been shown to decrease prevalence of skeletal-related events/hyperCa in Breast Ca. More recently, may be useful for limiting bone mets.
- Anthracyclines are associated with cardiomyopathy (dose dependent) and have increased likelihood of secondary malignancies.
- Paclitaxel (microtubule inhibitor) is associated with peripheral neuropathy.
Posted 11/03/16 09:27:24 AM by Adam Faye
Hormone positive metastatic breast cancer:
- Palbociclib (CDK 4/6 inhibitor) - has shown to prolong progression free survival when combined with fulvestrant (estrogen receptor antagonist)
- Ribociclib - newer agent (similar to palbociclib in mechanism and toxicity) - looked at patients receiving initial systemic treatment for HR+, HER2 (-) breast cancer.
Posted 11/03/16 09:37:36 AM by Adam Faye
For further reading...
Posted 11/03/16 09:33:03 AM by Adam Faye
Created by Christopher Kelly
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The information on the website does not constitute official guidelines except where explicitly stated.
It is not meant to replace the advice of a health professional.