AYA Oncology & Survivorship, ASPHO Flashcards
NCI def of AYA onc?
cancer diagnosis age 15-39y, represents 5% of cancer dx
15-19 yo: most common cancers?
Lymphoma (primarly HL)>leukemia>sarcoma>CNS tumours
Breast cancer: better or wrose prog in AYA?
worse
Colorectal cancer: better or worse prognosis in AYA?
worse
Melanoma: better or worse prog in AYA?
better
thyroid cancer: better or wrose prog in AYA?
same
testicualr cancer: better or worse prog in AYA?
same
describe B-ALL biology in AYA
more likely to have Ph+ t(9.22), PH-like and less likely to have ETV6-RUNX1, hyperdiploidy
Describe T-ALL bio in AYA?
HOX+
Describe RMS bio in AYA
more likely alveolar/chrom 13 translocs
Describe findings of NBL in AYA
more likely stage 4 disease
describe bresat cancer bio in AYA
more likely estrogen neg, progest neg, HER2 neg= triple negative disease= poor prog
describe colorectal cancer in AYA
more likely mucinosis adenocarcinoma
describe DLBCL bio in AYA
less likely to have t(14;18)….this means favourable for AYA
describe melanoma bio in AYA
more likely to have BRAF .. this means favourable for AYA
breast cancer in AYA: look into possibly of what triggers?-
- past chest rads
- BRCA1, BRCA2, p53
colon cancer in AYA: look into what triggers?
- FAP
- hereditary non-polyposis colon cancer
- survivors of childhood cancer treated with abdo rads
thyroid cancer in AYA is often a ___ cancer
secondary
factors taht can cause increased toxicity in AYA?
- changing vol of distribution
- protein binding
- hepatic/renal function
- obesity
- epigenetic factors
toxciities taht tend to be seen more in AYA? 4
PONG Osteonecrosis Glucose intolerance Pancreatitis thrombosis Neuropathy pain n/v renal tox
adolescents are __ likely to be treated at comprehensive cancer centres
LESS (vs. peds)
3 reasons why AYA might have worse outcomes?
- less likely to be treated at comprehensive cancer cetnres
- decreased tx compliance
- increased tx toxciity
- less clinical trial enrolment
- decreased access to healthcare, often related to insurance/access to HCPs
AYA do better when treated on peds regimen for certain cancers, 2 egs?
ALL
AML
Ewing sarcoma
HL
causes of mort in survivors?
initially, death from recurrence, but this starts to level off at 15 years…while non recurrence, non external causes accelerates at 20 years and by 30 yrs wins out as leading cause of death
1 major issue for AYA?
18% of 5 yrs survivors had died by 30 yrs after their dx
cumulative mortalty in survivors is ___ over time
decreasing
neurocog sequelae of radiation includes?
- changes in attn
- executive functioning
- memory
- processing speed
- visual spatial skills
- learning diffs with math adn reading
- IQ may drop over time
eval neuro seq from rads how? when do changes become evident?
neuropsychological evaluation…1-2 yrs after rads
3 RFs for rad-associated neurocog sequelae associated with rads?
young age
VP shunt
stroke
hearing/motor impariment
other than rads, what can –> neuro cog sequelae? who is most at risk? (2)…what happens with IQ in these cases?
-HD and IT Mtx
HD-cytarabine
-young age, females
-global intellectual function relatively preserved
most common late effect re: eyes?
cataracts
3 rfs for cataracts long term?
- long term corticosteroids
- busulfan
- cranial/orbital rads, including TBI
screen for cataracts how?
- annual fundoscopic exam
- eval by eye doctor after rads
other than cataracts, give 3 other late effects for eyes?
dry eye=xeropthalmia
glaucoma
retinopathy
orbital hypoplasia
3 rfs for otoxocity?
- cisplatin
- myeloablative carboplatin
- radiation
- loop diuretics
- aminoglycoside
- surgery involvign CN 8
2 RFs for otox?
- combination exposures
- higher doses
- younger age
- genetics
main diagnoses that are associated with otox?
- CNS tumours
- hepatoblastoma
- GCT tumours
- NBL
- osteosarcoma
screening for otox if previously normal, by age group?
<5 ys: q yr
6-12: q2 yrs
13+: q5 yrs
how does platinum therapy affect hearing?
get sensorinueral loss due to destruction of the cochelear hair cells
for platinum therapy, which hearing freq affected first?
high frequency (>2000 Hz)
what can reduce risk of hearing loss associated with platinum? how?
Sodium thiosulfate…antioxidant properties and forming inactive complexes with cisplatin
2 late effects pertaining teeth?
- tooth/root agenesis or malformations
- increased caries= enamel dysplasia
what is associated with teeth late effects?
high dose alkylators high dose rads younger age (don't have permanent teeth yet)
which cancers are associated with teeth defects?
RMS
NBL
screen for teeth late effects how?
routine dental care
other than teeth issues, 2 other oral late effects?
- xerostomia
- TMJ dysfunction
- osteoradionecrosis
6 major pit hormones?
GH ACTH FSH LH TSH Prolactin
Pit dysfunction occurs ___ to ___ after cranial rad
months to decades
of the anterior pit hormones, which is the most common def and first to develop after cranial rads?
Growth hormone def
3 things taht can lead to decreased linear grwoth in cancer survivors?
- cranial radiation (–> GH def, hypot4)
- spinal rads (growth plate tox)
- prolonged steroids (grwoth plate damage, less GH release)
- retinoids (premat fusion of grwoth plates)
- TKIs
cause of scoliosis?
radiation
most common late effect?
hypothyroidism
2 causes of hypothryodiism?
- radiation (head/neck/mantle/tbi)
- systemic MIBG
- I-131 tx for thryoid cancer
2 lung late effects?
pulmonary fibrosis
pneumonitis
3 rfs for lung tox?
- lung rads
- bleomycin
- busulfan
- BCNU
- CCNU
- thoracic surgery
screen for pulm tox how?
PFTs…advise smoking cessation
what is the leading cause of non-onc death in survivors?
cardiovasc disease
cardiomyopathy/CHF due to?
athracycline (due to free radicals)
what can prevent cardiotox? how?
dexrazoxane; acts as iron chelator to prevent cardiotox
acute cardiotox: rev or no
reversible
chronic cardiotox: risk incrases with? tends to be progressive and is tx’ed how?
- longer time since tx
- beta blocker
2 risk factors for cardiovasc disease?
-anthracyclin >250/m2 chest rads >15 Gy or with -athracyclins -younger age -comorbidties -genetics
what is worse for cardiotox, doxorubicin or daunorubicin?
doxo (2x as much)…use relative doxo expsoure to measure cumulative dose
worst anthracyclins for cardio tox?
mitoxantrone, idarubicin
coronary artery disease risk factor?
radiation…ischemia heart disease= most common cause of cardiac death after rads
other than cardiomyopathy and CAD, other heart issues from tx?
pericarditis, valvular heart disease, conduction abnormalities
screen for heart disease how?
EKG at baseline, ECHO based on anthracycline/XRT exposures
cardio screening: who gets screening every 2 yrs?
- rads at least 35 Gy
- anthra at least 250 mg/m2
- anthra less than 250 mg/m2 BUT did get rads at least 15 Gy
who gets cardio screening every 5 yrs?
- rads at least 15 Gy
- anthra less than 250 mg/m2
who gets NO cardiac screening?
- rads<15 Gy
- no anthras
expsoures –> renal tox? 3
- cisplatin (worse than carbo)
- carboplat
- nephrectomy
- ifosfamide
- radiation
how does ciplatin hurt the kidney?
glomerular and distal tubular dysfunction, hypomg can be severe
ifos hurts kidneys how?
proximal tubular dysfunction…~5% get Fanconi syndrome
screen for renal tox how?
creatinine and lytes at baseline, ua/creat q yr after nephrectomy
expsoures–> liver tox?
thioguanine
6MP
mtx
radiation
screen for GI tox how?
LFTs
GI tox other than hepatic?
esoph stricture, fistulae, enterocolitis, obstruction, cholelithiasis due to rads, constipation, fecal incont due to spinal cord dysfunction
osteopenia causes?
steroids, mtx
RFs for osteopenia?
white race gonadal failiure GH def hypoT4 decreased BMI decrease ca intake decreased activity
cause of AVN?
-steroids
AVN most likely to occur where?
femoral head
rsik factors for AVN?
- dexmethasone> pred
- older age
- female
- radiation
- high BMI
- white race
8 consequences of chronic GVHD?
- skin atrophy
- skin hypo/hyperpig
- alopecia
- nail dystrophy
- dry eye
- dry mouth
- dental caries
- oral cancer
- bronchiolitis obliterans
- chronic bronchitis
- liver tox
- functional asplenia
- esosph stricture
- vaginal fibrosis
- joint contratures
leading cause of non-relapse death?
secondary malig
most common secondary cancer
nonmelanoma skin cancer>breast>meningioma>thryoid
treatment related MDS/AML usually occurs when?
<3 yrs after therapy
treatment asscoiated MDS, AML due to what chemos? occurs wehn?
- epipodophyllotoxins and anthracyclins, which inhibit topoisomerase II…6 months-3 yrs later
- alkylating agents…3-7 yrs later
MDS/AML due to epipodophyllotoxins and anthracyclins associated with what genetic change? what about for alkylating agents?
11q23
alk: chromosome 5 and 7 mutations
solid tumour secondary mliag associated with? seen in?
radiation…tx at younger age, CPS, increased dose, increased time from rads
which chemos are associated with secondary solid tumours?
-platinums
-alk agents
-anthracyclines
ALL DOSE-RELATED (except thyroid carcinoma, which eventually decreases)
screen for secondary breats cancer how?
clinical exam q year–> age 25, then q6 months
-mmamogram and breast mri q year as of age 25 or 8 yrs after rads
screen for colorectal cancer how?
-multitarget stool DNA test q3 yrs or colonoscopy q5 yrs starting at age 30 or 5 yrs after rads (which is later)
lung cancer screening?
consider spiral CT for high risk pts
skin cancer screening?
self exam q month
-derm exam q year
thryoid cancer screen?
palpate thryoid q year vs. ultrasound q 3-5 yrs
repro late effects?
preococious puberty gonadotropin insuff hypoadrogenism acute ovarian failure premature ovarian inusff oligo/azospermia retrograde ejaculation anejaculation erectile dysfunction dyspareunia vaginal fibrosis/stenosis uterine vasc insuff uterine growth impairment
risk factors for repro late effects?
- male >female
- younger age protective in FEMALES
- GU cancer
- type/dose/combo therapy
- brain surgery
- brain radiation
- orchiectomy
- radiation to pelvis/bladder/spine
- alkylating agent–> oligospermia
- spinal surgery
- pelvic surgery
- oophorectomy
- uterine/vaginal rads
- higher doses of cyclophosphamide
fert preservation for males who are post-pub (tanner 3+)?
- sperm cyropreservation via masturbation, electroejaculation or testicular sperm extraction
- experimental = testicular tissue cyropreservation
- gonadal shielding during radiation
fert preservation in pre-pub males
- experimental only: testicular tissue cryopreservation
- gonadal shielding during rads
fert pres in post-pub females?
- oocyte/embryo cryopresevation (consider delay of tx, cost)
- ovarian tissue cryopreservation
- hormonal suppression with GnRH agonist is controversial
- gonadal shielding for rads
fert pres for pre-pub girls?
- ovarian tissue cryopresevation (limited success)
- gonadal shielding for rads
how to assess fert in males?
- semen analysis
- FSH and inhibin for htose unable to obtain
how to assess fert in females?
- assess menstrual status
- screen with FSH, estradiol, AMH (evals ovarian reserve)
- consider REI eval to have an antral follicle count
