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Oncology > After Term Test 3 > Flashcards

After Term Test 3 Flashcards

1
Q

What are the risk factors of prostate cancer

A

Age
Family history
Race
Environmental

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2
Q

What race has the highest incidence of prostate cancer

A

African American

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3
Q

What diet related substances increase risk of prostate cancer

A
  • fat
  • sugar sweetened beverage
  • lycopenes
  • vitamin E
  • selenium
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4
Q

What are the screening procedures of prostate cancer

A
  • digital rectal examination
  • prostate specific antigen (PSA)
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5
Q

Why are DREs not very recommended

A
  • can cause false positives and negatives not very accurate
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6
Q

How do PSAs work

A

PSAs use biomarkers a protein found in seminal fluid and manufactured by the prostate. Gives insight into a biological process or predicts a biological endpoint.

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7
Q

Describe the accuracy of a PSA test

A
  • 5 receive a false positive
  • 2 cases are missed
  • 3 are found
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8
Q

What are the positives and negatives of PSA screeening

A

Positive: lowers prostate cancer specific mortality
Negative
- overdiagnosis
- false positives
- harms of biopsy
- harms of treatment

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9
Q

What are the early signs and symptoms of prostate cancer

A
  • LUTS (lower urinary track symptoms)
  • hesitancy
  • dribbling
  • weak system
  • sensation of bladder not fully empty
  • urgency
  • frequent urination
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10
Q

What are advanced stage symptoms of prostate cancer

A
  • back / hip pain
  • numbness of lower limb
  • edema
  • weight loss
  • fatigue due to anemia
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11
Q

What are the signs of prostate cancer

A
  • hardening of prostate
  • elevated PSA
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12
Q

After a high PSA test, what would be the next step I suggested

A
  • transrectal ultrasound (TRUS)
  • biopsy
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13
Q

What are the 3 categories that can predict behaviour of prostate cancer

A
  • biopsy
  • T stage
  • level of PSA in blood
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14
Q

What does the Gleason score grade ? And how does it work ?

A
  • adenocarcinoma level of aggressiveness
  • 2 growth patterns identified
  • each graded from 1 - 5
  • GS = sum of two grades
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15
Q

What is considered low, intermediate, and high in the Gleason score

A
  • 2-6 low
  • 7 intermediate
  • 8-10
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16
Q

What is the T staging for prostate cancer

A

T1: the tumour of cancer cannot be felt by the doctor during examination
T1a: histological finding in <5% resected tissue
T1b: >5% of tissue resected
T2: the cancer can be felt but it has not spread outside the prostate
T2a: found <1/2% of one lobe
T2b: > 1/2 of one love or in both lobes
T3: the cancer has spread outside the prostate into nearby tissues
T3a: invasion of bladder neck
T3b: invasion of seminal vesicles
T4: the cancer has spread into nearby organs such as the bladder

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17
Q

What are the common routes of spread for prostate cancer

A
  • to lymphnodes
  • distant spread
    Bone (90%)
    Lung (46%)
    Liver (25%)
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18
Q

What are the PSA levels are favourable, intermediate, or unfavourable

A

< 10
10-20
>20

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19
Q

What PSA level would usually have metastatic disease

A

> 100

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20
Q

What does a risk stratification system/group predict

A
  • how quickly the cancer grows
  • chance of cancer being outside the prostate
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21
Q

What are the treatment procedures for LOW risk prostate patients

A

Active surveillance
Prosectomy
Brachytherapy
External beam RT

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22
Q

What is the active surveillance procedure in prostate cancer

A
  • PSA every 3-6 months
  • DRE every year
  • TRUS biopsy once every 12 months then once every 3-5 years
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23
Q

What can trigger treatment in the active surveillance stage

A
  • progression of Gleason
  • clinical local progression
  • increased PSA
  • patient’s preference
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24
Q

What are the types surgery in prostate cancer

A
  • open
  • laparoscopic
  • robot assisted
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25
Q

What is the duration and recovery period of surgery in prostate cancers

A

2-4 hours
4-6 weeks

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26
Q

What are some side effects of prostate surgery

A
  • incontinence
  • erectile dysfunction
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27
Q

What are the doses for brachytherapy in low risk early stage prostate cancer LDR

A

145 Gy (80-100 seeds)

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28
Q

What are some contraindications for brachytherapy

A
  • large prostate (bigger than 60cc)
  • pubic arch interference
  • poor urinary functions
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29
Q

In how many cases does seed migration occur

A

40-60%

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30
Q

What are the side effects of brachytherapy

A

Swelling and feeling of heaviness
Pain during urination
Burning sensation
Urgency
Dysuria
Urinary obstruction

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31
Q

What are the doses for EBRT for moderate hypofractionation and ultra hypofractionation prostate

A

240 - 349 cGy
> 500 cGy

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32
Q

What are the side effects of EBRT for prostate cancer

A

Proctitis, cystitis, prostatitis
Impotence
Late rectal bleeding

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33
Q

What is the treatment procedure for intermediate risk groups

A

Prosectomy
Brachytherapy
External beam RT
Brachy + EBRT

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34
Q

What are the treatment options for high risk groups for prostate

A

EBRT + ADT
Prostectomy + EBRT + ADT
EBRT + brachytherapy + ADT
ADT

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35
Q

What is HDR brachytherapy

A
  • US or MR guided
  • iridium 192
    Remote after loading through catheter
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36
Q

what are the doses of HDR brachytherapy prostate

A

15 Gy / 1
EBRT 37.5 / 15

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37
Q

Where are androgens produced

A

90% released by luteinizing hormone releasing hormone
10% produced in adrenal glands

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38
Q

What are the two mechanisms in ADT

A
  • suppressing testosterone production
    (Orichiectomy, LHRH agonist)
  • suppressing testosterone action
    (Anti androgen)
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39
Q

What are forms of LHRH agonist

A

Zoladex lupron

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40
Q

What are forms of anti androgens

A

Casodex

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41
Q

What is the difference between short and long term androgen deprivation therapy

A

Short term (3-6 months)
- before (neoadjuvant)
Shrinks prostate, improves local control
- during (adjuvant)
Improves local control, reduces distant metastasis, improves survival

Long term (2-3 years)
- improves survival for men with higher risk cancer

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42
Q

What are the side effects of ADT

A

Hot flashes
Impotence
Weight gain, loss of muscle mass
Loss of body hair
Fatigue, anemia, cholesterol, bone

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43
Q

What is CRPC

A

Castrate resistant prostate cancer
- biochemical progression following total androgen blockage
- androgen independent growth

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44
Q

What is the role of EBRT in metastatic disease for prostate cancer

A

Palliative
Improve survival for low metastatic burden

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45
Q

What are the risk factors of kidney cancer

A

Age / gender
Smoking
Overweight / obesity
Hypertension
Alcohol (not rlly)
Exposure to TCE
Family history
Genetic disorder < 5%
(Von hippel lindau disease)
(HRPC)

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46
Q

Why are some presenstations of kidney cancer

A

Abdominal and back pain
Painless haematuria
Reoccurring fever
Fatigue
Weight loss
High blood pressure
Swelling in ankles
Mass in abdomen
Anemia or erythrocytosis
Symptoms of metastatic disease

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47
Q

What are the common pathologies of kidney cancer

A

Renal cell carcinoma (90%)
Clear cell (80%)
Non clear cell
Papillary
Chromophobe
Collecting duct
Renal pelvis transitional cell (10%)

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48
Q

What are the forms of surgery for kidney cancer

A

Radical nephrectomy
Partial nephrectomy
Tumour ablation: RFA and cryoblation

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49
Q

When is systemic therapy used for kidney cancer

A

Metastatic disease

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50
Q

In what situations is SABR a good alternative kidney cancer

A
  • does not want general anaesthetic
  • peri hilar tumours
  • large tumours
  • non invasive
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51
Q

What are the doses for SABR / SBRT for kidney disease for tumours < 5 cm and tumours >5cm

A
  • 26 Gy / 1
  • 40 Gy / 3-5 fractions

Tutorial: 27.5-40 / 5 on alternate days

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52
Q

What is the 5 year survival for each kidney stage
T1a, T1b- T2, T3, T4 or node positive , distant Mets

A

T1a: 90-95%
T1b - T3: 80-85%
T3: 60%
T4 or node positive: 8%
Distant Mets: <5%

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53
Q

What is the peak age for testicular cancer

A

15-44

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54
Q

What are tumour markers for testicular cancer

A

HCG (beta human chorionic gonadotrophin)
Alpha fetoprotien (AFP)
Lactate dehydrogenase (LDH)

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55
Q

What is the histology of testicular cancer

A

Germ cell tumours >95%
- seminoma
- non seminoma

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56
Q

Define the staging of testituclar cancer T stage

A

T: tumour limited to testis and epididymis no vascular/ lymphatic invasion
T2: limited to testis and epididymis with vascular lymphatic invasion
T3: tumour invades spermatic cord
T4: tumour invades scrotum

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57
Q

Define the staging of testituclar cancer N stage

A

N0 : no regional node metastatsis
N1: metastasis in single or multiple nodes 2 cm or less in greatest dimension
N2: metastasis in single or multiple nodes in 2-5cm greatest dimension
N3: metastasis in lymphnodes > 5cm in max diameter

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58
Q

Define the staging of testituclar cancer M stage

A

M0 - no
M1a - non regional lymph node or pulmonary metastasis
M1 b - non pulmonary visceral metastasis

59
Q

Define the staging of testituclar cancer S stage

A

S0 - within normal limits
S1 - LDH < 1.5 x N and HCG < 5000 and AFP < 1000
S2 - LDH 1.5 - 10 x N or HCG 5000 - 500000 or afp 1000 - 10000
S3 - LDH > 10 x N or HCG > 50,0000 or AFP > 10,000

60
Q

What would be the treatment for stage I testicular cancer seminoma

A
  • surgery
  • surveillance
  • adjuvant radiotherapy
  • adjuvant chemotherapy
61
Q

What would be the treatment for stage I testicular cancer non seminoma

A
  • surgery
  • surveillance
  • adjuvant chemotherapy - nerve sparing retroperitoneal LN dissection (RPLND)
62
Q

How does the surveillance period work for testicular cancer

A
  • examination of CT abdomen and pelvis
  • every 4 months for 2 years
  • every 6 months for 3-5 years
  • annually for 5-10 years
63
Q

What is the fractionation for stage I testicular cancer

A

25/20 or 20/10

64
Q

What is the fractionation for stage II testicular cancer

A

25/20 + 10 Gy dose

65
Q

What is the fractionation for stage II testicular non seminoma

A

No role

66
Q

What is the chemo therapy for stage I testicular cancer

A
  • adj chemo in seminoma: Carboplatin
  • adj chemo in non seminoma: BEP , belomycin, eptoposide and cisplatin
67
Q

What is the chemo therapy for stage II testicular cancer

A
  • adj chemo in seminoma: IIB
  • adj chemo in non seminoma: BEP x3 cycles (IIa/b)
68
Q

What is the chemo therapy for stage IIc-III testicular cancer

A
  • adj chemo in seminoma: BEP x3 cycles
  • adj chemo in non seminoma: BEP 3-4 cycles
69
Q

What are the symptoms of bladder cancer

A
  • hematuria
  • urinary frequency, dysuria, recurrent infections
  • symptoms of metastatic disease
70
Q

What are the diagnostic tools for bladder cancer

A
  • urine cytology
  • cytoscopy and biopsy
  • TURBT (transurethral resection of bladder tumour)
  • CT abdomen and pelvis
  • MRI pelvis
  • Chest x ray
  • bone scan if symptoms
71
Q

What is the pathology of bladder cancer

A
  • Urothelial 90%
  • squamous cell 5%
  • adeno <2%
  • others
72
Q

Define the T staging of bladder cancer

A

Ta: non invasive papillar
Tis: flat carcinoma in situ
T1: invades into laminate propria
T2: invades muscle
PTA: inner half
PTB: outer half
T3: invades perivesical tissue
T3a: microscopic
T3b: macroscopic
T4: invades surrounding organs

73
Q

What percentage of bladder cancers are non muscle invasive vs muscle invasive

A

70% non muscle invasive
- 70% Ta (low risk)
- 10% Tis (intermediate risk)
- 20% T1 (high risk)
30% muscle invasive (T2-T4)

74
Q

What are the characteristics of NMIBC: Ta

A

> 50% of all bladder tumours
90% are low grade
Usually cured by resection

75
Q

What are the characteristics of NMIBC: T1

A
  • usually high grade
  • 80% recurrence following TUR alone
  • understating 30-60% are really T2+
76
Q

How is non muscle invasive bladder treated for stage 1 (Tis)

A

Primary - surgery
Adjuvant BCG: intravesical therapy

77
Q

How is muscle invasive bladder treated for stages 2-3

A

Stage 2-3
Primary treatment
- surgery option 1
- XRT option 2

Option 1
- Neo chemo (cisplatin + gem_
- maybe adjuvant chemo if positive LNs

Option 2
- concurrent CRT (cisplatin, 5FU or mitomycin)
- dose 46/23 + 20/10 or 55/20 How is muscle invasive bladder treated

78
Q

How is muscle invasive bladder treated for stage 4

A
  • primary : XRT or Surgery
  • adjuvant chemo (gemcitabine and cisplatin)
  • or MVAC
  • XRT for symptomatic TRT
79
Q

What are the side effects of surgery bladder

A
  • infection
  • ureteric obstuction
  • stromal complications
  • urinary leaks
  • pouch rupture
  • bowel complication
80
Q

What are the roles of chemotherapy in bladder cancer

A
  • Neo
  • adj
  • metastatic
  • bladder preservation with radiation
81
Q

What is the goal of neoadjuvant chemo therapy in bladder cancer

A
  • treat micro metastatic disease early and make cancer more operable - down staging
  • cisplatin / gemcitabine is mostly used
    Benefit is best for T3 cancers
    Improves survival by 5%
82
Q

What chemos are used in bladder cancer for metastasis

A
  • GC (gemcitabine/cisplatium) or MVAC (methotrexate, visblastine, adriamycin, cysplatin)
  • 46-49%
    Gemcitabine if poor tolerance of platinum agents
  • 25%
83
Q

Why would a patient with muscle invasive bladder cancer go for the treatment without radical cystectomy and choose radiotherapy and chemo therapy

A
  • patient who are not surgical candidates
  • want to preserve bladder
  • early cancers T2 grossly resected who should be considered for preservation
84
Q

What are the histologies of endometrial cancer

A
  • epithelial
    Adenometrioid carcinoma (75-80)
    Adenosquamous
    Papillary
    Clear cell
  • non epithelial
    Sarcomas
    Carcinoma
    Leiomyo
    Endo stromal
    Lymphomas
    Metastatic
85
Q

What is the treatment for cervix cancer for early stage (<4cm, 1A-1B1)

A
  • primary: SX
  • adjuvant RT if high risk
  • concurrent CRT if contraindications to SX
    • EBRT
86
Q

What is the dose regime for early stage and late cervical cancer

A

45/25

87
Q

What is the chemo used for cervix cancer

A

Cisplatin

88
Q

What is the primary treatment for locally advanced cervix cancer (greater than =4cm, 1B2 - IVA)

A
  • primary: RT
  • concurrent CRT (EBRT) + brachy (HDR)
89
Q

What is the dose regime for cervix cancer brachy

A

28/4

90
Q

What are the surgeries done for endometrial cancer

A
  • total abdominal hysterectomy
  • bilateral salpino - oophorerctomy
  • pelvic and par aortic lymphnode dissection
  • omentectomy
91
Q

What are the options of adjuvant radiation therapy in endometrial cancer

A
  • EBRT
  • VBT
92
Q

What is the principle for adjuvant radiation therapy in cervix cancer

A
  • use prognostic factors to tailor therapy
  • when what how
93
Q

What are major negative prognostic factors for early stage endometrial cancers

A
  • age is > 65
  • grade 3
  • LVSI present
  • depth outer half myometrial invasion
94
Q

What is the FIGO staging for endometrial cancer

A
  • based on size and invasion (confined to uterus, invading into vagina, bladder, rectum)
  • based on history and clinical examination
  • does not include LN assessment
95
Q

What is the TNM staging for endometrial cancer

A
  • comparable to FIGO
  • used for determining tx but not for staging
96
Q

What is the treatment for stage I endometrial cancer

A
  • primary surgery
  • EBRT or VBT if 2 or more negative prognostic factors present
97
Q

What is the treatment for stage II endometrial cancer

A

primary surgery
EBRT + VBT

98
Q

What is the treatment for stage III endometrial cancer

A
  • primary surgery
    EBRT + VBT and Cx
99
Q

What are the doses for endometrial cancer for EBRT and VBT

A
  • 45/25
  • 21/3
100
Q

What is encompassed in the vaginal CTV for endometrial cancer

A
  • vagina + paravaginal soft tissue
101
Q

How are patients scanned for endometrial cancer to create the ITV

A

With full and empty bladder to take motion into account

102
Q

What is encompassed in the nodal CTV for endometrial cancer

A
  • external iliac , internal iliac, Obturator, presacral nodes (L5-S1)
103
Q

What are the acute side effects of cervix RT

A
  • fatigue
  • bladder irritation
  • rectal irritation
  • 2 weeks after RT resolve 2-4 weeks post RT
104
Q

What are the late side effects of cervix RT

A
  • cystitis (rare)
    Change in bowel habits
    More common in 4 field box than IMRT
    20 percent then 10 percent
105
Q

What are the prognostic factors for cervical cancer patient related

A

Age
Obesity
Co morbidities

106
Q

What are the prognostic factors for cervical cancer treatment related

A

Surgery vs RT

107
Q

What are the prognostic factors for cervical cancer tumour related

A

Stage
Grade
Depth of myoinvasion
LVSI
Histology

108
Q

What are the 5 year survivals for each stage of cervical cancer

A

1- 90
2 - 50-80
3 - 30-40
4 <10

109
Q

What is the treatment for ovarian cancer

A
  • primary surgery
  • neoadjuvant chemo to treat microscopic disease (Carboplatin and taxol)
  • adjuvant RT for non serous subtypes
  • palliation for symptom management (RT or chemo)
110
Q

What is the treatment for vaginal cancer

A
  • surgery mainly in early lesions of upper vagina
  • otherwise concurrent CRT
111
Q

What is the dose for vaginal cancer

A

85 Gy to disease

112
Q

What is the treatment for early vulva cancer

A

Primary - surgery
- adjuvant chemo if risk features
RT if inoperable

113
Q

What are risk features for vulva cancers

A
  • positive or close margins
    > 8 mm
    +ve LVI
    DOI > 5 mm
114
Q

What is the treatment for locally advanced vulva cancer

A
  • primary surgery
  • neoadjuvant concurrent CRT or definitive CRT
  • treatment volume includes groin LNs
115
Q

What are the does for vulva cancer

A

If uninvolved LNs, XRT = 45-50 (microscopic disease)
Definitive XRT, positive lymphnodes : 60-70 GY
Adjuvant XRT, positive lymphnodes: at least 50 Gy

116
Q

What is the histology for ovarian cancers

A
  • epithelial cells (cover the ovary)
  • germ cells (inside the ovary)
  • stromal cells (structural tissue holding ovary together)
117
Q

What are the imaging work ups for ovarian cancer

A
  • Transvaginal ultrasound
  • CT / MR
118
Q

What are the lab workups for ovarian cancer

A

CBC, LFTs, BUN/Cr
- tumour marker : CA - 125

119
Q

What is the staging for ovarian cancer

A

1: only in ovaries
2: tumour has spread beyond the ovaries to the uterus, fallopian tubes, and or other pelvic tissues
3 and 4: malignant cells have grown and spread

120
Q

In ovarian cancer what are the symptoms of Carboplatin and taxol

A
  • Carboplatin : bone marrow suppression
  • taxol: hair loss, bone marrow suppression, pins and needles in hands and feet (neurotoxicity)
121
Q

What are the follow-ups for ovarian cancer

A

History and physical exam every 3 months for 2 years then every 6 months until year 5 then annually

CA - 125 each visit only image if elevated

122
Q

What are the 5 year overall survivals for epithelial ovarian cancers

A

1 - 90
2 - 70
3 - 40
4 - 20

75% of women present with 3-4

123
Q

What are the vulvar cancer specific symptoms

A

Pain
Spotting / bleeding
Discharge
Pruritus
Lump

124
Q

What are the vulvar cancer regional symptoms

A
  • difficulty urinating
    Difficulty defecating
    Dyspareunia
    Lower extremity edema
125
Q

What is the work up for vulvar cancer

A

H and P
Blood work
EUA
Colposcopy
Biopsy
Imaging: MRI pelvis, CT TAP

126
Q

What is the histology for vulvar cancer s

A

squamous cell carcinoma: 80-90
Melanoma: 10%
Adenocarcinoma: tumours of vestibular glands (bartholins glands)

127
Q

What premalignant conditions may vulvar tumours arise from

A

Lichen sclerosis
Pagets disease
Bowels disease

128
Q

What are the common LOCAL routes of spread for vulvar cancer

A
  • distal to proximal / caudal to cranial
  • direct invasion: lower urethra, vagina, anus
  • more extensive : upper urethra/vagina, bladder, rectum, bony pelvis
129
Q

What are the common NODAL routes of spread for vulvar cancer and what does the risk depend on

A
  • Inguinal femoral nodes (sup and deep)
  • pelvic nodes
  • risk depends on
    Tumour size, depth of stromal invasion, LVI
130
Q

What is the FIGO staging for vaginal cancer

A

1: limited to the vaginal wall
2: involved the subvaginal tissue
3: extended to the pelvic wall
4: beyond the true pelvis or involves bladder or rectum or distant Mets

131
Q

What is the survival for each stage of vaginal cancer

A

I/II median survival 6 years
III/IV medial survival 2.5 years a

132
Q

What is the general workup for vagina cancer

A

Physical exam
MRI pelvis
CT pelvis
Biopsy
CXR
CBC LFTs

133
Q

What is the histology of vagina cancer

A

Squamous cell carcinoma

134
Q

What lymphatics are included in vaginal cancer

A

Upper: internal iliac
Lowe: Inguinal and iliac

135
Q

When can vulvar cancer cannot be resected

A

Extensive vulvar regions without large tissue defect and compromises anal sphincter (definitive RT)

136
Q

What are indications for adjuvant RT for vulvar cancer (risk factors for locally recurrence)

A

Margins < 8 mm
LVSI
DOI > 5 mm

137
Q

What is the CTV (ITV) primary for vulvar cancer

A

Adjuvant : entire vulva and post op bed
Definitive: GTV + 1cm + entire vulva

138
Q

What is the nodal CTV for vulvar cancer

A

Pelvis and inguinofemoral (internal and external Obturator lymphnodes)

139
Q

What is the PTV for vulvar cancer

A

CTV/ITV + 7-10 mm

140
Q

For vulvar cancers
Groin node involvement is prevalent = _______ prognosis
Groin failures are rarely _______
Management of groin nodes is clearly indicated for any patients with tumour invasion greater than ______

A

Poor
Salvageable
1 mm depth

141
Q

What makes a vulva operable

A

margin status
Adequate margin and Local control (heaps)
Planned surgical margin of 1 cm will take into account 20% shrinkage as a result of formalin fixation
Margins <8mm associated with 50% of LR

142
Q

What is the figo staging of vulva cancer

A

1: confined to vulva
1A: less than equal to 2 cm confined to premium, stromal invasion < equal to 1 mm, negative nodes
1B: > 2cm in size or stromal invasion > 1mm, confined to vulva/perinium
2: tumour of any size with extension to adjacent perineal structures, negative nodes
3 tumour of any size with or without extension to adjacent perineal structures, POSITIVE Inguinofemoral lymphnodes
3A: with one lymph node Mets > = 5 mm or one OR two lymphnode Mets less than 5 mm
3B: with two or more lymphnode Mets > = 5mm OR 3 or more lymphnode metastasis > 5 mm

143
Q

What is the general approach to manage the vulva (primary) for resectable and inoperable tumours

A

if resectable
Wide local excision +/- adj RT
If inoperable
CRT +/- resect residual

144
Q

What is the management of the Inguinal femoral LNs

A

clinically node negative
- SLNB or IFL +/- adj RT

Palpable mobile LN
- bilateral IFL +/- adj RT

Fixed / ulcerating LN
- CRT + boost / resect residual

Oncology (7 decks)

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