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Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
Suggested Reading: Current Diagnosis and Treatment: Way and Doherty
SUGGESTED READING
Current Diagnosis & Treatment: Surgery, Thirteenth EditionEdited by Gerard M. DohertyCopyright © 2010 by The McGraw-Hill Companies, Inc.
Chapter 30. Large IntestineCancer of the Large Intestine
Chapter 17. Breast DisordersChapter 18. Neoplasms of the Lung
Primary Lung CancerUnusual Pulmonary NeoplasmsSpecial Problem: The Solitary Pulmonary NoduleSecondary Lung Cancer
Schwartz's Principles of Surgery, 9e
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.
Chapter 29. Colon, Rectum, and AnusAdenocarcinoma and Polyps
Chapter 17. The BreastChapter 19. Chest Wall, Lung, Mediastinum, and Pleura
Lung
Current Diagnosis and Treatment: Surgery
Medical Student Small Group Discussion TopicsColon, Breast and Lung Cancer
A 72 year-old man presents after routine testing revealed guiac positive stool
Medical Student Small Group Discussion TopicsColon, Breast and Lung Cancer
?How do you instruct a patient to perform outpatient guiac
(Hemoccult) testing for blood in the stool?
A 72 year-old man presents after routine testing revealed guiac positive stool
Medical Student Small Group Discussion TopicsColon, Breast and Lung Cancer
?How do stool cards and developer test for occult
blood?
A 72 year-old man presents after routine testing revealed guiac positive stool
Medical Student Small Group Discussion TopicsColon, Breast and Lung Cancer
?What dietary changes should a patient make before
completing a stool guiac test?
A 72 year-old man presents after routine testing revealed guiac positive stool
Medical Student Small Group Discussion TopicsColon, Breast and Lung Cancer
?How do medications affect the test results?
A 72 year-old man presents after routine testing revealed guiac positive stool
Medical Student Small Group Discussion TopicsColon, Breast and Lung Cancer
?What is the positive predictive value of guiac
testing for colon cancer, and how does it help you counsel
the patient?
A 72 year-old man presents after routine testing revealed guiac positive stool
Medical Student Small Group Discussion TopicsColon, Breast and Lung Cancer
?What is the differential diagnosis for guaiac
positive stools?
A 72 year-old man presents after routine testing revealed guiac positive stool
Medical Student Small Group Discussion TopicsColon, Breast and Lung Cancer
?What are some important questions to ask the patient
to identify risk factors for colon cancer?
A 72 year-old man presents after routine testing revealed guiac positive stool
Medical Student Small Group Discussion TopicsColon, Breast and Lung Cancer
?What are important aspects of the physical examination in
this patient?
A 72 year-old man presents after routine testing revealed guiac positive stool
Medical Student Small Group Discussion TopicsColon, Breast and Lung Cancer
?Should repeat guiac testing be performed in the office in
conjunction with a digital rectal examination?
A 72 year-old man presents after routine testing revealed guiac positive stool
Medical Student Small Group Discussion TopicsColon, 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 TopicsColon, Breast and Lung Cancer
?What diagnostic test(s) would you
recommend?
A 72 year-old man presents after routine testing revealed guiac positive stool
Medical Student Small Group Discussion TopicsColon, Breast and Lung Cancer
?What screening techniques could you employ in asymptomatic
people to detect colon cancer? What are the advantages and
disadvantages of these?
A 72 year-old man presents after routine testing revealed guiac positive stool
Medical Student Small Group Discussion TopicsColon, Breast and Lung Cancer
A 56 year-old man has a complaint of crampy lower abdominal pain and constipation.
Medical Student Small Group Discussion TopicsColon, 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 TopicsColon, 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 TopicsColon, 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 TopicsColon, 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 TopicsColon, 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 TopicsColon, 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 TopicsColon, 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 TopicsColon, Breast and Lung Cancer
A 40 year-old woman comes to your office with a left breast mass.
Medical Student Small Group Discussion TopicsColon, Breast and Lung Cancer
?What are the risk factors for development of
symptomatic fibrocystic breast disease?
A 40 year-old woman comes to your office with a left breast mass.
Medical Student Small Group Discussion TopicsColon, Breast and Lung Cancer
?What are the risk factors for development of malignant
breast disease?
A 40 year-old woman comes to your office with a left breast mass.
Medical Student Small Group Discussion TopicsColon, 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 TopicsColon, 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 TopicsColon, 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 TopicsColon, Breast and Lung Cancer
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.
A 40 year-old woman comes to your office with a left breast mass.
Medical Student Small Group Discussion TopicsColon, Breast and Lung Cancer
?What is the differential diagnosis for this mass?
A 40 year-old woman comes to your office with a left breast mass.
Medical Student Small Group Discussion TopicsColon, Breast and Lung Cancer
?What is the most likely diagnosis in a 20 year old woman? A 65 year old?
A 40 year-old woman comes to your office with a left breast mass.
Medical Student Small Group Discussion TopicsColon, Breast and Lung Cancer
?What diagnostic tests besides physical exam would you consider to
help evaluate this mass?
A 40 year-old woman comes to your office with a left breast mass.
Medical Student Small Group Discussion TopicsColon, 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 TopicsColon, Breast and Lung Cancer
Mammogram demonstrates no areas of
microcalcification.Ultrasound shows a solid
mass in this area.
A 40 year-old woman comes to your office with a left breast mass.
Medical Student Small Group Discussion TopicsColon, Breast and Lung Cancer
?What is the most likely diagnosis in this
patient?
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
What, if any, would your next step be in
evaluating this mass?
A 40 year-old woman comes to your office with a left breast mass.
?Medical Student Small Group Discussion Topics
Colon, Breast and Lung CancerA 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 TopicsColon, Breast and Lung Cancer
?What criteria do you use to determine the usefulness of a
screening tool such as mammography?
A 40 year-old woman comes to your office with a left breast mass.
Medical Student Small Group Discussion TopicsColon, Breast and Lung Cancer
?What are the present recommendations for
mammography in high-risk women? In normal risk women?
A 40 year-old woman comes to your office with a left breast mass.
Medical Student Small Group Discussion TopicsColon, Breast and Lung Cancer
A 70 year-old woman with a biorads 4 mammographic abnormality of the left breast.
Medical Student Small Group Discussion TopicsColon, Breast and Lung Cancer
?What are the types of breast cancer that this patient
might have?
A 70 year-old woman with a mammographic abnormality of the left breast.
Medical Student Small Group Discussion TopicsColon, Breast and Lung Cancer
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.
A 70 year-old woman with a mammographic abnormality of the left breast.
Medical Student Small Group Discussion TopicsColon, 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 TopicsColon, 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 TopicsColon, 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 TopicsColon, Breast and Lung Cancer
?What features of the physical examination and surgical
specimen determine the clinical and pathological stage,
respectively?
A 70 year-old woman with a mammographic abnormality of the left breast.
Medical Student Small Group Discussion TopicsColon, Breast and Lung Cancer
?What is the rationale for the use of radiation and/or
hormonal, and/or chemotherapy in breast
cancer?
A 70 year-old woman with a mammographic abnormality of the left breast.
Medical Student Small Group Discussion TopicsColon, Breast and Lung Cancer
?What are the expected survival and recurrence rates for treated stage 1
and stage 2 disease?
A 70 year-old woman with a mammographic abnormality of the left breast.
Medical Student Small Group Discussion TopicsColon, Breast and Lung Cancer
?Describe the role of hormone receptors in the
treatment of breast cancer?
A 70 year-old woman with a mammographic abnormality of the left breast.
Medical Student Small Group Discussion TopicsColon, Breast and Lung Cancer
?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?
A 70 year-old woman with a mammographic abnormality of the left breast.
Medical Student Small Group Discussion TopicsColon, 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 TopicsColon, 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 TopicsColon, 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 TopicsColon, 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 TopicsColon, 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 TopicsColon, 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 TopicsColon, 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 TopicsColon, 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 TopicsColon, 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 TopicsColon, 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 TopicsColon, 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 TopicsColon, 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?
?
