Transcript Colon, Breast and Lung Cancer

Medical Student Small Group
Discussion Topics
Colon, Breast and Lung Cancer
Suggested Reading: Current Diagnosis and Treatment: Way and Doherty
SUGGESTED READING
Current Diagnosis and Treatment: Surgery
Chapter 30. Large Intestine
Cancer of the Large Intestine
Chapter 17. Breast Disorders
Chapter 18. Neoplasms of the Lung
Primary Lung Cancer
Unusual Pulmonary Neoplasms
Special Problem: The Solitary Pulmonary Nodule
Secondary Lung Cancer
Schwartz's Principles of Surgery, 9e
Chapter 29. Colon, Rectum, and Anus
Adenocarcinoma and Polyps
Chapter 17. The Breast
Chapter 19. Chest Wall, Lung, Mediastinum, and Pleura
Lung
Current Diagnosis & Treatment: Surgery, Thirteenth Edition
Edited by Gerard M. Doherty
Copyright © 2010 by The McGraw-Hill Companies, Inc.
Schwartz's Principles of Surgery, 9e
F. Charles Brunicardi, Dana K. Andersen, Timothy R. Billiar, David L. Dunn, John G. Hunter, Jeffrey B.
Matthews, Raphael E. Pollock
Copyright © 2010, 2005, 1999, 1994, 1989, 1984, 1979, 1974, 1969 by The McGraw-Hill Companies, Inc.
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 72 year-old man presents after routine testing revealed guiac positive stool
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 72 year-old man presents after routine testing revealed guiac positive stool
How do you instruct a patient to
perform outpatient guiac
(Hemoccult) testing for blood in
the stool?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 72 year-old man presents after routine testing revealed guiac positive stool
How do stool cards and developer
test for occult blood?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 72 year-old man presents after routine testing revealed guiac positive stool
What dietary changes should a
patient make before completing a
stool guiac test?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 72 year-old man presents after routine testing revealed guiac positive stool
How do medications affect the test
results?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 72 year-old man presents after routine testing revealed guiac positive stool
What is the positive predictive
value of guiac testing for colon
cancer, and how does it help you
counsel the patient?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 72 year-old man presents after routine testing revealed guiac positive stool
What is the differential
diagnosis for guaiac positive
stools?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 72 year-old man presents after routine testing revealed guiac positive stool
What are some important
questions to ask the patient to
identify risk factors for colon
cancer?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 72 year-old man presents after routine testing revealed guiac positive stool
What are important aspects of the
physical examination in this
patient?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 72 year-old man presents after routine testing revealed guiac positive stool
Should repeat guiac testing be
performed in the office in
conjunction with a digital rectal
examination?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 72 year-old man presents after routine testing revealed guiac positive stool
On rectal examination you are
unable to feel any masses.
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 72 year-old man presents after routine testing revealed guiac positive stool
What diagnostic
test(s) would you
recommend?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 72 year-old man presents after routine testing revealed guiac positive stool
What screening techniques could you
employ in asymptomatic people to
detect colon cancer? What are the
advantages and disadvantages of these?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 56 year-old man has a complaint of crampy lower abdominal pain and constipation.
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 56 year-old man has a complaint of crampy lower abdominal pain and constipation..
His physician finds no rectal mass and
recommends a colonoscopy. At
colonoscopy, a large, friable mass
partially obstructing the sigmoid colon at
35 cm is biopsied and is positive for
adenocarcinoma. No other colonic
lesions are noted.
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 56 year-old man has a complaint of crampy lower abdominal pain and constipation..
What other diagnostic
study(ies) besides
colonoscopy might have
been used to make this
diagnosis?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 56 year-old man has a complaint of crampy lower abdominal pain and constipation..
What preoperative tests
would you order specific for
evaluation of the carcinoma?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 56 year-old man has a complaint of crampy lower abdominal pain and constipation..
Describe the TNM
classification of colon and
rectal cancer. What are the
stages of colon cancer and
how do these relate to
prognosis?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 56 year-old man has a complaint of crampy lower abdominal pain and constipation..
How does TNM staging
relate to prognosis for colon
cancer?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 56 year-old man has a complaint of crampy lower abdominal pain and constipation..
How might this patient’s
presentation be different if
he had a right colon
carcinoma?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 56 year-old man has a complaint of crampy lower abdominal pain and constipation..
How do you follow a patient
postoperatively after
resection of a colon cancer?
What methods are currently
available to detect
recurrences?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 40 year-old woman comes to your office with a left breast mass.
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 40 year-old woman comes to your office with a left breast mass.
What are the risk factors for
development of symptomatic
fibrocystic breast disease?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 40 year-old woman comes to your office with a left breast mass.
What are the risk factors for
development of malignant breast
disease?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 40 year-old woman comes to your office with a left breast mass.
What additional history
would you like to elicit from
the patient?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 40 year-old woman comes to your office with a left breast mass.
What physical
examination elements
are important in
evaluating this patient?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 40 year-old woman comes to your office with a left breast mass.
What history and physical findings
suggest benign vs. malignant
disease?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 40 year-old woman comes to your office with a left breast mass.
The patient has no family history of breast
disease. She first noticed the mass one
month ago. She has regular periods, and
no change in the mass was noted through
one menstrual cycle. She has experienced
no recent trauma. The mass is located in
the upper outer quadrant of the left
breast and is 1.5 cm in diameter.
It is smooth, non-tender with no skin
retraction, no fixation to the chest wall,
and the axilla is negative.
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 40 year-old woman comes to your office with a left breast mass.
What is the differential diagnosis
for this mass?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 40 year-old woman comes to your office with a left breast mass.
What is the most likely diagnosis
in a 20 year old woman? A 65 year
old?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 40 year-old woman comes to your office with a left breast mass.
What diagnostic tests
besides physical exam would
you consider to help
evaluate this mass?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 40 year-old woman comes to your office with a left breast mass.
What radiographic findings
suggest benign vs. malignant
disease?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 40 year-old woman comes to your office with a left breast mass.
Mammogram demonstrates no
areas of microcalcification.
Ultrasound shows a solid mass in
this area.
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 40 year-old woman comes to your office with a left breast mass.
What is the most likely
diagnosis in this patient?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 40 year-old woman comes to your office with a left breast mass.
What, if any, would your
next step be in evaluating
this mass?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 40 year-old woman comes to your office with a left breast mass.
Pathology confirms
your clinical
suspicion. What is
your next step?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 40 year-old woman comes to your office with a left breast mass.
What criteria do you use to
determine the usefulness of
a screening tool such as
mammography?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 40 year-old woman comes to your office with a left breast mass.
What are the present
recommendations for mammography
in high-risk women? In normal risk
women?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 70 year-old woman with a biorads 4 mammographic abnormality of the left
breast.
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 70 year-old woman with a mammographic abnormality of the left breast.
What are the types of breast
cancer that this patient might
have?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 70 year-old woman with a mammographic abnormality of the left breast.
The findings were noted on a
routine screening mammogram.
There is no nipple retraction or skin
changes and no palpable mass.
There is no palpable axillary or
supraclavicular lymphadenopathy.
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 70 year-old woman with a mammographic abnormality of the left breast.
What is your next step in
managing this patient?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 70 year-old woman with a mammographic abnormality of the left breast.
This reveals infiltrating ductal
carcinoma
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 70 year-old woman with a mammographic abnormality of the left breast.
What is your next step in
managing this patient?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 70 year-old woman with a mammographic abnormality of the left breast.
What features of the physical
examination and surgical specimen
determine the clinical and pathological
stage, respectively?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 70 year-old woman with a mammographic abnormality of the left breast.
What is the rationale for the use
of radiation and/or hormonal,
and/or chemotherapy in breast
cancer?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 70 year-old woman with a mammographic abnormality of the left breast.
What are the expected survival
and recurrence rates for treated
stage 1 and stage 2 disease?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 70 year-old woman with a mammographic abnormality of the left breast.
Describe the role of hormone
receptors in the treatment of
breast cancer?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 70 year-old woman with a mammographic abnormality of the left breast.
Discuss the role of BRCA 1 and 2
testing in the screening of
asymptomatic women for breast
cancer. How would your
management change for an
asymptomatic woman found to
have these markers versus one
without these markers?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 62 year-old African American man presents with a right lung hilar nodule found
on routine chest x-ray.
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 62 year-old African American man presents with a right lung hilar nodule found on
routine chest x-ray.
What are some important questions
to ask the patient?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 62 year-old African American man presents with a right lung hilar nodule found on
routine chest x-ray.
What is the differential diagnosis?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 62 year-old African American man presents with a right lung hilar nodule found on
routine chest x-ray.
What is the next step in your
work up?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 62 year-old African American man presents with a right lung hilar nodule found on
routine chest x-ray.
What characteristics on CT scan
would you look for to assist in
determining whether the lesion is
malignant or benign?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 62 year-old African American man presents with a right lung hilar nodule found on
routine chest x-ray.
How would you definitively
determine the diagnosis?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 62 year-old African American man presents with a right lung hilar nodule found on
routine chest x-ray.
What characteristics on CT scan
would you look for to assist in
determining whether the lesion is
resectable?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 62 year-old African American man presents with a right lung hilar nodule found on
routine chest x-ray.
If the nodule proved to be
malignant, what further
preoperative studies, in addition to a
CT scan would you recommend?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 62 year-old African American man presents with a right lung hilar nodule found on
routine chest x-ray.
What are the risk factors for the
development of lung cancer?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 62 year-old African American man presents with a right lung hilar nodule found on
routine chest x-ray.
What anatomical structures are
located in the lung hilum?
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 62 year-old African American man presents with a right lung hilar nodule found on
routine chest x-ray.
The patient does reasonably well
for the next 12 months. At a
subsequent follow up visit he
states he has lost 10 pounds in the
past 6 months despite only a
modest change in his appetite. CT
scan shows tumor recurrence
with diffuse metastatic disease.
Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 62 year-old African American man presents with a right lung hilar nodule found on
routine chest x-ray.
What is the likely cause of weight
loss in this patient? How can you
treat this?