Master the board step 3

Master the Boards: USMLE Step 3
The table below shows the recommended screening for colon cancer.
Juvenile Polyposis,
Routine
Single Family
Member with
Colon Cancer
HNPCC
Three Family
Members, Two
Generations, One
Premature (< 50)
Familial
Adenomatous
Polyposis
Peutz-Jeghers,
Turcot’s
Syndrome,
Gardner’s
Syndrome
• Colonoscopy
starting at age
50, then every 10
years
• Occult blood
testing starting
at age 50, then
yearly
Colonoscopy at age
40 or 10 years
earlier than the
age at which the
family member
contracted cancer,
whichever is
earlier, then every
10 years
Colonoscopy at age
25, then every
1–2 years
Screening
sigmoidoscopy
at age 12, then
every 1–2 years
No additional
screening
There is no screening test
for lung cancer. Routine
chest x-rays yearly and CT
scanning have not been
shown to be beneficial (to
lower mortality); those
answers are wrong.
Lung Cancer
A 52-year-old smoker has a 1.5-cm calcified nodule found on chest x-ray done for
other reasons. He has no symptoms. What should you do?
Answer: Excisional biopsy should be done on solitary lung nodules > 1 cm in size in
patients who are smokers. Age > 50 lends additional urgency to the need for biopsy.
Even though calcification goes against malignancy, the age of the patient, size of the
nodule, and history of smoking are more important.
Diagnostic Testing
Lung cancer screening should be performed in all smokers with more than
30 pack-years of smoking history between the ages of 55–80. A chest CT
should be performed.
Treatment
The most important issue in the treatment of lung cancer is whether the disease
is localized enough to be surgically resectable. Surgery cannot be performed
if any of the following are present:
··
Bilateral disease
··
Metastases
··
Malignant pleural effusion
··
Involvement of the aorta, vena cava, or heart
··
Lesions within 1–2 cm of the carina
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