Here are two case studies to emphasize the necessity of evaluating a cancer family history when determining medical management for your patients:

Case #1

Case #2

Patient #1

Patient Information:

62-Year-Old Female
Presented 5 years ago with Stage 2 Breast Cancer
  • Her2/neu-
  • ER/PR+
Patient #2

Patient Information:

62-Year-Old Female
Presented with Stage 2 Colon Cancer
Treatment Plan #1

Treatment Plan:

Lumpectomy
Radiation
Chemotherapy
Endocrine Therapy
Treatment Plan #2

Treatment Plan:

Test for KRAS mutation (negative)
Oncologist run Adjuvant Online and recommends against Chemotherapy
Surgical Options
  • Hemicolectomy
  • 12 Node Sampling
Recommended Management #1

Recommended Management:

Post-treatment follow up
Recommended Management #2

Recommended Management:

Common recommendations may include:
  • Tubal occlusion (Essure®)
  • Tubal ligation
  • Vasectomy (for partner)
Consider the patient's cancer family history:
Patient Cancer Family History
RELATIVECANCER SITEAGE OF Dx
Maternal AuntBreast49
Maternal GrandmotherOvarian44

REVISED Recommended Management:

What if hereditary cancer was the cause?

Breast Surgery options would have been presented differently
  - Preventive mastectomy given increased risk for 2nd primary breast cancer OR
  - Annual breast MRI and annual mammogram

Radiation therapy would likely have been avoided

Ovarian risk would be address with:
  - Prophylactic BSO
  - If patient declines, could consider:
    - TVU every 6 months
    - CA-125 every 6 months

Consider the patient's cancer family history:
Patient Cancer Family History
RELATIVECANCER SITEAGE OF Dx
FatherColon76
Paternal AuntEndometrial48

REVISED Recommended Management:

What if hereditary cancer was the cause?

Consider total colectomy with ileorectal anastomosis
  - If partial colectomy performed, colonoscopy every 1-2 years for life

Prophylactic TAH-BSO is a risk-reducing option that should be considered in select patients
  - If patient doesn't undergo TAH-BSO, could consider:
    - Annual endometrial aspiration
    - TVU and CA-125

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