1. 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

2. Current Diagnosis and Treatment: Surgery
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.

3. Medical Student Small Group Discussion Topics
Colon, Breast and Lung Cancer
A 72 year-old man presents after routine testing revealed guiac positive stool

4. ? 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?

5. ? 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?

6. ? 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?

7. ? 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?

8. ? 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?

9. ? 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?

10. ? 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?

11. ? 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?

12. ? 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?

13. 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.

14. ? 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 diagnostic test(s) would you recommend?

15. ? 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?

16. 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.

17. 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.

18. 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?

19. 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?

20. 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?

21. ? 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 does TNM staging relate to prognosis for colon cancer?

22. 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?

23. 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?

24. 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.

25. ? 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?

26. ? 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?

27. ? 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 additional history would you like to elicit from the patient?

28. 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?

29. ? 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?

30. 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.

31. ? 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?

32. ? 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?

33. 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?

34. ? 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.
What radiographic findings suggest benign vs. malignant disease?

35. 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.

36. ? 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 is the most likely diagnosis in this patient?

37. ? 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.
What, if any, would your next step be in evaluating this mass?

38. ? 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.
Pathology confirms your clinical suspicion. What is your next step?

39. 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?

40. ? 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?

41. 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.

42. ? 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?

43. 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.

44. ? 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 is your next step in managing this patient?

45. 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.
This reveals infiltrating ductal carcinoma

46. ? 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 is your next step in managing this patient?

47. ? 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?

48. ? 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?

49. ? 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?

50. ? 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?

51. ? 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?

52. 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.

53. ? 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?

54. ? 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?

55. ? 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?

56. ? 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?

57. ? 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?

58. ? 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?

59. ? 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?

60. ? 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?

61. ? 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?

62. 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.

63. ? 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?

64. ?