Master the board step 3

Master the Boards: USMLE Step 3
Benefits of Tamoxifen
• ↓ incidence of contralateral breast cancer
• ↑ bone density in postmenopausal women
• ↓ fractures
• ↓ serum cholesterol
• ↓ cardiovascular mortality risk
Adverse Effects of Tamoxifen
• Exacerbates menopausal symptoms
• ↑↑ risk of endometrial cancer (1% in postmenopausal
women after 5 yrs therapy)
• ↑↑ risk of thromboembolism
TIP: All women with a history of tamoxifen use and vaginal
bleeding need evaluation & endometrial biopsy.
When is chemotherapy included in management?
··
Tumor size > 1 cm
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Lymph node-positive disease
When is trastuzumab included in management?
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It is indicated for metastatic breast cancer overexpressing HER2/neu.
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Trastuzumab is a monoclonal antibody directed against the extracellular
domain of the HER2/neu receptor and is used to treat and control visceral
metastatic sites.
If the case describes invasive breast cancer in an
··
HR-negative, pre- or postmenopausal woman
--
Give chemotherapy ± RT alone.
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HR-positive, premenopausal woman
--
Give chemotherapy ± RT + tamoxifen.
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HR-positive, postmenopausal woman
--
Give chemotherapy ± RT + aromatase inhibitor.
Always make sure that
the pregnancy (beta-
HCG/urine pregnancy
test) is negative before
considering leiomyoma or
adenomyosis.
Uterus
Enlarged Uterus
An enlarged uterus may be caused by the following:
1. Pregnancy (discussed in Section 6: Obstetrics)
2. Leiomyoma
3. Adenomyosis
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