Approach To The Patient With Cancer

Question 1

What is the most common cancer in men?

Answer 1

Prostate

Question 2

What is the most common cancer in women?

Answer 2

Breast

Question 3

What is the deadlier cancer regardless of gender?

Answer 3

Lung and bronchus

Question 4

What caused a decrease in stomach cancer?

Answer 4

Decrease in the amount of smoked foods consumed

Question 5

How is cancer diagnosed?

Answer 5

Biopsy must be obtain for diagnosis

Biopsy also helps determine type of cells , prognosis and treatment options

Question 6

What is the first priority after diagnosis of cancer?

Answer 6

Extent of the disease and prognosis

Curability of a tumor is inversely proportional to the tumor burden

Question 7

How is treatment determine?

Answer 7

By staging
Clinical staging- physical exam, CT
Pathological staging- obtained by surgical procedure

Question 8

What is the TNM classification ?

Answer 8

Tumor size- range from 1-4: the greater the number the greater the size
Nodal involvement-0: no node involved,1: presence of nodal involvement
Metastatic presence-0: absence, 1: presence

Question 9

What are other scoring systems used?

Answer 9

Dukes classification for colorectal cancers
Ann Arbor classification for Hodgkins
Gleason scoring for prostate

Question 10

What is the physiologic reserve?

Answer 10

How is a patient likely to cope with the physiologic stresses imposed by the cancer and treatment
Used 2 indices:
Karnofsky performance index
ECOG performance scale

Question 11

What are the characteristics of the Karnofsky performance index?

Answer 11

Ranges from 100-0
100: normal
0: dead
70 is used as a marker of doing well in chemo
60 is debatable
Anything under 60 need to get stronger before being a candidate for chemo

Question 12

What are the characteristics of the ECOG performance scale?

Answer 12

Range from 0-5
Grade 0: normal, fully active
Grade 5: dead
Grade 2-3 is used as a marker of doing well with chemo

Question 13

What are the steps involved in making a treatment plan?

Answer 13

Extent of the disease
Prognosis
Physiologic reserve
Patients wishes

Question 14

What are the treatment options in cancer?

Answer 14

Chemotherapy
Radiation
Surgical treatment
Can be done in combination

Question 15

What to be aware in cancer patient management ?

Answer 15

Complications of the disease- damage organs

Complications of treatment-nausea, vomiting, fatigue; radiation consequences

Question 16

What are the different responses to treatment?

Answer 16

To assess response periodic repeating of imaging test is required
Complete response - absence of cancer
Partial response- 50% drop in tumor size
Progressive disease-25% increase in size
Stable disease- not better or worse

Question 17

What are some tumor markers in cancer?

Answer 17

Tumor markers are not used for diagnostic but rather for indication of how well treatment is going
PSA- prostate
Monoclonal immunoglobulins -myeloma
CA-125- ovarian cancers

Question 18

What is the timing for long term follow up?

Answer 18

First year every month for 6-12 months
2nd year every other month
3rd year every 3 months 
4th year every 4 months
5th year every 6 months
After 5 year annually