AYA Oncology & Survivorship, ASPHO Flashcards
1
Q
NCI def of AYA onc?
A
cancer diagnosis age 15-39y, represents 5% of cancer dx
2
Q
15-19 yo: most common cancers?
A
Lymphoma (primarly HL)>leukemia>sarcoma>CNS tumours
3
Q
Breast cancer: better or wrose prog in AYA?
A
worse
4
Q
Colorectal cancer: better or worse prognosis in AYA?
A
worse
5
Q
Melanoma: better or worse prog in AYA?
A
better
6
Q
thyroid cancer: better or wrose prog in AYA?
A
same
7
Q
testicualr cancer: better or worse prog in AYA?
A
same
8
Q
describe B-ALL biology in AYA
A
more likely to have Ph+ t(9.22), PH-like and less likely to have ETV6-RUNX1, hyperdiploidy
9
Q
Describe T-ALL bio in AYA?
A
HOX+
10
Q
Describe RMS bio in AYA
A
more likely alveolar/chrom 13 translocs
11
Q
Describe findings of NBL in AYA
A
more likely stage 4 disease
12
Q
describe bresat cancer bio in AYA
A
more likely estrogen neg, progest neg, HER2 neg= triple negative disease= poor prog
13
Q
describe colorectal cancer in AYA
A
more likely mucinosis adenocarcinoma
14
Q
describe DLBCL bio in AYA
A
less likely to have t(14;18)….this means favourable for AYA
15
Q
describe melanoma bio in AYA
A
more likely to have BRAF .. this means favourable for AYA
16
Q
breast cancer in AYA: look into possibly of what triggers?-
A
- past chest rads
- BRCA1, BRCA2, p53
17
Q
colon cancer in AYA: look into what triggers?
A
- FAP
- hereditary non-polyposis colon cancer
- survivors of childhood cancer treated with abdo rads
18
Q
thyroid cancer in AYA is often a ___ cancer
A
secondary
19
Q
factors taht can cause increased toxicity in AYA?
A
- changing vol of distribution
- protein binding
- hepatic/renal function
- obesity
- epigenetic factors
20
Q
toxciities taht tend to be seen more in AYA? 4
A
PONG Osteonecrosis Glucose intolerance Pancreatitis thrombosis Neuropathy pain n/v renal tox
21
Q
adolescents are __ likely to be treated at comprehensive cancer centres
A
LESS (vs. peds)
22
Q
3 reasons why AYA might have worse outcomes?
A
- 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
23
Q
AYA do better when treated on peds regimen for certain cancers, 2 egs?
A
ALL
AML
Ewing sarcoma
HL
24
Q
causes of mort in survivors?
A
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
25
1 major issue for AYA?
18% of 5 yrs survivors had died by 30 yrs after their dx
26
cumulative mortalty in survivors is ___ over time
decreasing
27
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
28
eval neuro seq from rads how? when do changes become evident?
neuropsychological evaluation...1-2 yrs after rads
29
3 RFs for rad-associated neurocog sequelae associated with rads?
young age
VP shunt
stroke
hearing/motor impariment
30
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
31
most common late effect re: eyes?
cataracts
32
3 rfs for cataracts long term?
- long term corticosteroids
- busulfan
- cranial/orbital rads, including TBI
33
screen for cataracts how?
- annual fundoscopic exam
| - eval by eye doctor after rads
34
other than cataracts, give 3 other late effects for eyes?
dry eye=xeropthalmia
glaucoma
retinopathy
orbital hypoplasia
35
3 rfs for otoxocity?
- cisplatin
- myeloablative carboplatin
- radiation
- loop diuretics
- aminoglycoside
- surgery involvign CN 8
36
2 RFs for otox?
- combination exposures
- higher doses
- younger age
- genetics
37
main diagnoses that are associated with otox?
- CNS tumours
- hepatoblastoma
- GCT tumours
- NBL
- osteosarcoma
38
screening for otox if previously normal, by age group?
<5 ys: q yr
6-12: q2 yrs
13+: q5 yrs
39
how does platinum therapy affect hearing?
get sensorinueral loss due to destruction of the cochelear hair cells
40
for platinum therapy, which hearing freq affected first?
high frequency (>2000 Hz)
41
what can reduce risk of hearing loss associated with platinum? how?
Sodium thiosulfate...antioxidant properties and forming inactive complexes with cisplatin
42
2 late effects pertaining teeth?
- tooth/root agenesis or malformations
| - increased caries= enamel dysplasia
43
what is associated with teeth late effects?
```
high dose alkylators
high dose rads
younger age (don't have permanent teeth yet)
```
44
which cancers are associated with teeth defects?
RMS
| NBL
45
screen for teeth late effects how?
routine dental care
46
other than teeth issues, 2 other oral late effects?
- xerostomia
- TMJ dysfunction
- osteoradionecrosis
47
6 major pit hormones?
```
GH
ACTH
FSH
LH
TSH
Prolactin
```
48
Pit dysfunction occurs ___ to ___ after cranial rad
months to decades
49
of the anterior pit hormones, which is the most common def and first to develop after cranial rads?
Growth hormone def
50
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
51
cause of scoliosis?
radiation
52
most common late effect?
hypothyroidism
53
2 causes of hypothryodiism?
- radiation (head/neck/mantle/tbi)
- systemic MIBG
- I-131 tx for thryoid cancer
54
2 lung late effects?
pulmonary fibrosis
| pneumonitis
55
3 rfs for lung tox?
- lung rads
- bleomycin
- busulfan
- BCNU
- CCNU
- thoracic surgery
56
screen for pulm tox how?
PFTs...advise smoking cessation
57
what is the leading cause of non-onc death in survivors?
cardiovasc disease
58
cardiomyopathy/CHF due to?
athracycline (due to free radicals)
59
what can prevent cardiotox? how?
dexrazoxane; acts as iron chelator to prevent cardiotox
60
acute cardiotox: rev or no
reversible
61
chronic cardiotox: risk incrases with? tends to be progressive and is tx'ed how?
- longer time since tx
| - beta blocker
62
2 risk factors for cardiovasc disease?
```
-anthracyclin >250/m2
chest rads >15 Gy or with
-athracyclins
-younger age
-comorbidties
-genetics
```
63
what is worse for cardiotox, doxorubicin or daunorubicin?
doxo (2x as much)...use relative doxo expsoure to measure cumulative dose
64
worst anthracyclins for cardio tox?
mitoxantrone, idarubicin
65
coronary artery disease risk factor?
radiation...ischemia heart disease= most common cause of cardiac death after rads
66
other than cardiomyopathy and CAD, other heart issues from tx?
pericarditis, valvular heart disease, conduction abnormalities
67
screen for heart disease how?
EKG at baseline, ECHO based on anthracycline/XRT exposures
68
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
69
who gets cardio screening every 5 yrs?
- rads at least 15 Gy
| - anthra less than 250 mg/m2
70
who gets NO cardiac screening?
- rads<15 Gy
| - no anthras
71
expsoures --> renal tox? 3
- cisplatin (worse than carbo)
- carboplat
- nephrectomy
- ifosfamide
- radiation
72
how does ciplatin hurt the kidney?
glomerular and distal tubular dysfunction, hypomg can be severe
73
ifos hurts kidneys how?
proximal tubular dysfunction...~5% get Fanconi syndrome
74
screen for renal tox how?
creatinine and lytes at baseline, ua/creat q yr after nephrectomy
75
expsoures--> liver tox?
thioguanine
6MP
mtx
radiation
76
screen for GI tox how?
LFTs
77
GI tox other than hepatic?
esoph stricture, fistulae, enterocolitis, obstruction, cholelithiasis due to rads, constipation, fecal incont due to spinal cord dysfunction
78
osteopenia causes?
steroids, mtx
79
RFs for osteopenia?
```
white race
gonadal failiure
GH def
hypoT4
decreased BMI
decrease ca intake
decreased activity
```
80
cause of AVN?
-steroids
81
AVN most likely to occur where?
femoral head
82
rsik factors for AVN?
- dexmethasone> pred
- older age
- female
- radiation
- high BMI
- white race
83
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
84
leading cause of non-relapse death?
secondary malig
85
most common secondary cancer
nonmelanoma skin cancer>breast>meningioma>thryoid
86
treatment related MDS/AML usually occurs when?
<3 yrs after therapy
87
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
88
MDS/AML due to epipodophyllotoxins and anthracyclins associated with what genetic change? what about for alkylating agents?
11q23
| alk: chromosome 5 and 7 mutations
89
solid tumour secondary mliag associated with? seen in?
radiation...tx at younger age, CPS, increased dose, increased time from rads
90
which chemos are associated with secondary solid tumours?
-platinums
-alk agents
-anthracyclines
ALL DOSE-RELATED (except thyroid carcinoma, which eventually decreases)
91
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
92
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)
93
lung cancer screening?
consider spiral CT for high risk pts
94
skin cancer screening?
self exam q month
| -derm exam q year
95
thryoid cancer screen?
palpate thryoid q year vs. ultrasound q 3-5 yrs
96
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
```
97
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
98
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
99
fert preservation in pre-pub males
- experimental only: testicular tissue cryopreservation
| - gonadal shielding during rads
100
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
101
fert pres for pre-pub girls?
- ovarian tissue cryopresevation (limited success)
| - gonadal shielding for rads
102
how to assess fert in males?
- semen analysis
| - FSH and inhibin for htose unable to obtain
103
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
