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Haem/Onc > AYA Oncology & Survivorship, ASPHO > Flashcards

AYA Oncology & Survivorship, ASPHO Flashcards

1
Q

NCI def of AYA onc?

A

cancer diagnosis age 15-39y, represents 5% of cancer dx

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2
Q

15-19 yo: most common cancers?

A

Lymphoma (primarly HL)>leukemia>sarcoma>CNS tumours

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3
Q

Breast cancer: better or wrose prog in AYA?

A

worse

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4
Q

Colorectal cancer: better or worse prognosis in AYA?

A

worse

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5
Q

Melanoma: better or worse prog in AYA?

A

better

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6
Q

thyroid cancer: better or wrose prog in AYA?

A

same

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7
Q

testicualr cancer: better or worse prog in AYA?

A

same

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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

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9
Q

Describe T-ALL bio in AYA?

A

HOX+

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10
Q

Describe RMS bio in AYA

A

more likely alveolar/chrom 13 translocs

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11
Q

Describe findings of NBL in AYA

A

more likely stage 4 disease

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12
Q

describe bresat cancer bio in AYA

A

more likely estrogen neg, progest neg, HER2 neg= triple negative disease= poor prog

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13
Q

describe colorectal cancer in AYA

A

more likely mucinosis adenocarcinoma

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14
Q

describe DLBCL bio in AYA

A

less likely to have t(14;18)….this means favourable for AYA

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15
Q

describe melanoma bio in AYA

A

more likely to have BRAF .. this means favourable for AYA

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16
Q

breast cancer in AYA: look into possibly of what triggers?-

A
  • past chest rads

- BRCA1, BRCA2, p53

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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
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18
Q

thyroid cancer in AYA is often a ___ cancer

A

secondary

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19
Q

factors taht can cause increased toxicity in AYA?

A
  • changing vol of distribution
  • protein binding
  • hepatic/renal function
  • obesity
  • epigenetic factors
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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
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21
Q

adolescents are __ likely to be treated at comprehensive cancer centres

A

LESS (vs. peds)

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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
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23
Q

AYA do better when treated on peds regimen for certain cancers, 2 egs?

A

ALL
AML
Ewing sarcoma
HL

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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

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25
Q

1 major issue for AYA?

A

18% of 5 yrs survivors had died by 30 yrs after their dx

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26
Q

cumulative mortalty in survivors is ___ over time

A

decreasing

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27
Q

neurocog sequelae of radiation includes?

A
  • changes in attn
  • executive functioning
  • memory
  • processing speed
  • visual spatial skills
  • learning diffs with math adn reading
  • IQ may drop over time
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28
Q

eval neuro seq from rads how? when do changes become evident?

A

neuropsychological evaluation…1-2 yrs after rads

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29
Q

3 RFs for rad-associated neurocog sequelae associated with rads?

A

young age
VP shunt
stroke
hearing/motor impariment

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30
Q

other than rads, what can –> neuro cog sequelae? who is most at risk? (2)…what happens with IQ in these cases?

A

-HD and IT Mtx
HD-cytarabine
-young age, females
-global intellectual function relatively preserved

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31
Q

most common late effect re: eyes?

A

cataracts

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32
Q

3 rfs for cataracts long term?

A
  • long term corticosteroids
  • busulfan
  • cranial/orbital rads, including TBI
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33
Q

screen for cataracts how?

A
  • annual fundoscopic exam

- eval by eye doctor after rads

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34
Q

other than cataracts, give 3 other late effects for eyes?

A

dry eye=xeropthalmia
glaucoma
retinopathy
orbital hypoplasia

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35
Q

3 rfs for otoxocity?

A
  • cisplatin
  • myeloablative carboplatin
  • radiation
  • loop diuretics
  • aminoglycoside
  • surgery involvign CN 8
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36
Q

2 RFs for otox?

A
  • combination exposures
  • higher doses
  • younger age
  • genetics
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37
Q

main diagnoses that are associated with otox?

A
  • CNS tumours
  • hepatoblastoma
  • GCT tumours
  • NBL
  • osteosarcoma
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38
Q

screening for otox if previously normal, by age group?

A

<5 ys: q yr
6-12: q2 yrs
13+: q5 yrs

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39
Q

how does platinum therapy affect hearing?

A

get sensorinueral loss due to destruction of the cochelear hair cells

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40
Q

for platinum therapy, which hearing freq affected first?

A

high frequency (>2000 Hz)

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41
Q

what can reduce risk of hearing loss associated with platinum? how?

A

Sodium thiosulfate…antioxidant properties and forming inactive complexes with cisplatin

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42
Q

2 late effects pertaining teeth?

A
  • tooth/root agenesis or malformations

- increased caries= enamel dysplasia

43
Q

what is associated with teeth late effects?

A 
high dose alkylators
high dose rads
younger age (don't have permanent teeth yet)
44
Q

which cancers are associated with teeth defects?

A

RMS

NBL

45
Q

screen for teeth late effects how?

A

routine dental care

46
Q

other than teeth issues, 2 other oral late effects?

A
  • xerostomia
  • TMJ dysfunction
  • osteoradionecrosis
47
Q

6 major pit hormones?

A 
GH
ACTH
FSH
LH
TSH
Prolactin
48
Q

Pit dysfunction occurs ___ to ___ after cranial rad

A

months to decades

49
Q

of the anterior pit hormones, which is the most common def and first to develop after cranial rads?

A

Growth hormone def

50
Q

3 things taht can lead to decreased linear grwoth in cancer survivors?

A
  • 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
Q

cause of scoliosis?

A

radiation

52
Q

most common late effect?

A

hypothyroidism

53
Q

2 causes of hypothryodiism?

A
  • radiation (head/neck/mantle/tbi)
  • systemic MIBG
  • I-131 tx for thryoid cancer
54
Q

2 lung late effects?

A

pulmonary fibrosis

pneumonitis

55
Q

3 rfs for lung tox?

A
  • lung rads
  • bleomycin
  • busulfan
  • BCNU
  • CCNU
  • thoracic surgery
56
Q

screen for pulm tox how?

A

PFTs…advise smoking cessation

57
Q

what is the leading cause of non-onc death in survivors?

A

cardiovasc disease

58
Q

cardiomyopathy/CHF due to?

A

athracycline (due to free radicals)

59
Q

what can prevent cardiotox? how?

A

dexrazoxane; acts as iron chelator to prevent cardiotox

60
Q

acute cardiotox: rev or no

A

reversible

61
Q

chronic cardiotox: risk incrases with? tends to be progressive and is tx’ed how?

A
  • longer time since tx

- beta blocker

62
Q

2 risk factors for cardiovasc disease?

A 
-anthracyclin >250/m2
chest rads >15 Gy or with 
-athracyclins
-younger age
-comorbidties
-genetics
63
Q

what is worse for cardiotox, doxorubicin or daunorubicin?

A

doxo (2x as much)…use relative doxo expsoure to measure cumulative dose

64
Q

worst anthracyclins for cardio tox?

A

mitoxantrone, idarubicin

65
Q

coronary artery disease risk factor?

A

radiation…ischemia heart disease= most common cause of cardiac death after rads

66
Q

other than cardiomyopathy and CAD, other heart issues from tx?

A

pericarditis, valvular heart disease, conduction abnormalities

67
Q

screen for heart disease how?

A

EKG at baseline, ECHO based on anthracycline/XRT exposures

68
Q

cardio screening: who gets screening every 2 yrs?

A
  • 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
Q

who gets cardio screening every 5 yrs?

A
  • rads at least 15 Gy

- anthra less than 250 mg/m2

70
Q

who gets NO cardiac screening?

A
  • rads<15 Gy

- no anthras

71
Q

expsoures –> renal tox? 3

A
  • cisplatin (worse than carbo)
  • carboplat
  • nephrectomy
  • ifosfamide
  • radiation
72
Q

how does ciplatin hurt the kidney?

A

glomerular and distal tubular dysfunction, hypomg can be severe

73
Q

ifos hurts kidneys how?

A

proximal tubular dysfunction…~5% get Fanconi syndrome

74
Q

screen for renal tox how?

A

creatinine and lytes at baseline, ua/creat q yr after nephrectomy

75
Q

expsoures–> liver tox?

A

thioguanine
6MP
mtx
radiation

76
Q

screen for GI tox how?

A

LFTs

77
Q

GI tox other than hepatic?

A

esoph stricture, fistulae, enterocolitis, obstruction, cholelithiasis due to rads, constipation, fecal incont due to spinal cord dysfunction

78
Q

osteopenia causes?

A

steroids, mtx

79
Q

RFs for osteopenia?

A 
white race
gonadal failiure
GH def
hypoT4
decreased BMI
decrease ca intake
decreased activity
80
Q

cause of AVN?

A

-steroids

81
Q

AVN most likely to occur where?

A

femoral head

82
Q

rsik factors for AVN?

A
  • dexmethasone> pred
  • older age
  • female
  • radiation
  • high BMI
  • white race
83
Q

8 consequences of chronic GVHD?

A
  • 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
Q

leading cause of non-relapse death?

A

secondary malig

85
Q

most common secondary cancer

A

nonmelanoma skin cancer>breast>meningioma>thryoid

86
Q

treatment related MDS/AML usually occurs when?

A

<3 yrs after therapy

87
Q

treatment asscoiated MDS, AML due to what chemos? occurs wehn?

A
  • epipodophyllotoxins and anthracyclins, which inhibit topoisomerase II…6 months-3 yrs later
  • alkylating agents…3-7 yrs later
88
Q

MDS/AML due to epipodophyllotoxins and anthracyclins associated with what genetic change? what about for alkylating agents?

A

11q23

alk: chromosome 5 and 7 mutations

89
Q

solid tumour secondary mliag associated with? seen in?

A

radiation…tx at younger age, CPS, increased dose, increased time from rads

90
Q

which chemos are associated with secondary solid tumours?

A

-platinums
-alk agents
-anthracyclines
ALL DOSE-RELATED (except thyroid carcinoma, which eventually decreases)

91
Q

screen for secondary breats cancer how?

A

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
Q

screen for colorectal cancer how?

A

-multitarget stool DNA test q3 yrs or colonoscopy q5 yrs starting at age 30 or 5 yrs after rads (which is later)

93
Q

lung cancer screening?

A

consider spiral CT for high risk pts

94
Q

skin cancer screening?

A

self exam q month

-derm exam q year

95
Q

thryoid cancer screen?

A

palpate thryoid q year vs. ultrasound q 3-5 yrs

96
Q

repro late effects?

A 
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
Q

risk factors for repro late effects?

A
  • 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
Q

fert preservation for males who are post-pub (tanner 3+)?

A
  • sperm cyropreservation via masturbation, electroejaculation or testicular sperm extraction
  • experimental = testicular tissue cyropreservation
  • gonadal shielding during radiation
99
Q

fert preservation in pre-pub males

A
  • experimental only: testicular tissue cryopreservation

- gonadal shielding during rads

100
Q

fert pres in post-pub females?

A
  • oocyte/embryo cryopresevation (consider delay of tx, cost)
  • ovarian tissue cryopreservation
  • hormonal suppression with GnRH agonist is controversial
  • gonadal shielding for rads
101
Q

fert pres for pre-pub girls?

A
  • ovarian tissue cryopresevation (limited success)

- gonadal shielding for rads

102
Q

how to assess fert in males?

A
  • semen analysis

- FSH and inhibin for htose unable to obtain

103
Q

how to assess fert in females?

A
  • assess menstrual status
  • screen with FSH, estradiol, AMH (evals ovarian reserve)
  • consider REI eval to have an antral follicle count

Haem/Onc (30 decks)

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