Basic Oncology Flashcards
Of the head and neck cancers which is the most common?
Cancer of the Oral Cavity
Of the head and neck cancers which is the most deadly?
Cancer of the Esophagus
Of the new cancer cases __% are cancer of the oral cavity, ___% of the larynx and ___% of the esophagus.
2%
- 6%
- 9%
T or F: Head and Neck Cancer is more common in females
false
The estimated 5 year survival ratio is __% for oral cancer, __% for larynx cancer and ___% for esophageal cancer
63%
64%
13%
What are the three main etiologies thought to contribute to head and neck cancer?
tobacco
alcohol
poor oral hygiene
List 5 other possible factors contributing to head and neck cancer:
- human papilloma virus 16
- syphilis
- exposure to wood and metal dusts
- exposure to fumes and chemicals
- genetic disposition may contribute
T or F: HPV (esp. 16) plays a role in the development of a significant number of cancers of the mouth and throat. The exact relationship b/w HPV and oral cancer is not fully understood.
True
Describe four methods of tumourgenesis:
- errors in cell growth
- errors in cell differentiation (can become malignant)
- errors in cell movement (cells move to a different region)
- errors in cell decay (cells don’t die when they should)
All can lead to neoplasias (Tumours)
List the 5 stages of the normal life cycle of a cell:
G0 - resting cells G1 - Postmitotic Period S - DNA Synthesis G2 - Premiotic Period M - Mitosis
List 4 characteristics of tumours:
- Growth
- Invasion of surrounding tissue
- Infiltration of surrounding tissue
- Metastasis
Describe Growth of tumours:
Benign grow slowly
malignant grow aggressively
Describe Invasion of surrounding tissue characteristic of tumours:
The benign or malignant tumour displaces and impacts on tissue
Describe the infiltration of surrounding tissue characteristic of tumours:
The malignant tumour alters tissue
Describe Metastasis:
Malignant tumour cells travel through the body through bloodstream or lymphatic system to create multiple cancer sites. Benign tumours don’t metastasize.
Describe primary and secondary tumours:
Primary tumour is the original tumour (where the process starts). The secondary tumour is the metastasis.
List the components of the lymph system:
Lymph vessels, lymph nodes
Organs such as:
bone marrow, spleen, thymus gland, tonsils, appendix, etc.
List 4 functions of the lymph system:
- absorb excess fluid
- return of excess fluid to the blood stream
- absorption of fat
- immune function
T or F: The lymph system is closely associated with the vessels of the circulatory system with veins and capillaries.
True
T or F: Lymph drainage is an active process
False - passive process. Muscle contractions move fluid through the lymph ducts. If movement stops (ie. hemiplegia) lymph does not drain. Massage can help.
T or F: There are different levels of lymph. Once cancer enters the lymph nodes it spreads to other parts of the body.
True
Describe Lymph oedema:
After the lymph node is radiated the fluid finds it difficult to move through. Laryngeal massage can help.
Describe Waldeyer’s ring:
A ring of lymphatic immune system located around the posterior pharynx. Absorbs threats before they get deeper into the body. Protects from upper respiratory infections. BUT “super highway for cancer cells”
What is the only method of definitive diagnosis of cancer?
Histological analysis of biopsy sample
How is cancer diagnosed:
Imaging: CT or MR scans, scintigraphy, ultrasound.
Blood and Urine analysis: show endocrinological changes
Visual examination and lymph node palpation
What are typical patient complaints?
- neoplastic lesions (new lump)
- pain
- persistent ulceration resistant to antibiotic treatment
- weight loss
How do oropharyngeal tumours cause deferred otalgia?
Vagus, mandibular trigeminal and glossopharyngeal cranial nerves innervate facial structures and ears.
Inner ear pain indicates cancer at the _____. Outer ear pain indicates cancer of the tongue.
posterior tongue base
What are two precursors of oral cancer:
Leukoplakia and Actinic Keratoses
Describe leukoplakia:
A common potential precancerous mouth disease. Involves formation of white spots on the mucous membranes of tongue and inside of mouth.
Describe actinic keratoses:
Scaly or crusty bumps that arise on mucosa surface.
How are pre-canceroses treated:
- surgical resection
- photodynamic therapy (focused UV rays)
- cryotherapy
- Electro-coagulation
- Laser vaporization
Hope is that removing them prevents cancer from forming.
______ are the most frequent form of H&N cancer and account for over 80% of the cases.
squamous cell carcinomas
T or F: Verrucous carcinoma is a slow, well differentiated squamous cell type. It looks like a benign warty outgrowth and isn’t malignant.
False - very malignant
What does TNM stand for:
- T is the size of the tumor
- N is degree of lymph nodes, nodal disease, regional disease
- M is distal metastasis (score of 1 if metastasis)
Describe the TMN system:
The tumour staging depends on the results for the TNM dimensions. It guides the treatment strategies and is the basis for survival prognosis.
T or F: The TNM system makes predictions about functional outcome.
False - prognosis for survival not function
Describe the stage system:
Stage 1- small tumour no mets
Stage 2- cancer is bigger
Stage 3- large tumour or tumour of any size with one affected lymph node
Stage 4- very large tumour or more than one lymph node affected or a metastices
The multidisiplinary team makes a treatment choice that fits the individual. List the 4 general cancer treatments:
- chemo
- radiation
- surgery
- palliative treatment
List the 5 goals of cancer treatment:
- early detection
- management of pre-cancerous lesions
- therapeutic measures that are least disabling and disfiguring
- early application of measures for max feasible rehabilitation
- effective palliation
List the 4 treatment types:
1) Active therapy
2) Combined active therapy and supportive care
3) Combined palliative and symptomatic therapy
4) Supportive care
Describe active therapy:
treatment meant to cure the cancer
Describe combined active therapy and supportive care:
combined treatment to ease pain as well as cure cancer
Describe combined palliative and symptomatic therapy:
treatment meant to fight other health problems caused by the cancer or treatment
Describe supportive care
Treatment meant to reduce pain and distress and to increase feeling of well-being
The main treatment strategies in H&N cancer are:
- surgery
- radiation therapy
- combined surgery and radiation
- combined radio-chemotherapy
- The choice of treatment depends on the site and TNM stage.
How is oral cancer treated vs cancer of the pharynx and larynx:
Default treatment for oral cancer is surgical resection with possible adjuvant radiation therapy. Default treatment for cancer of the pharynx and larynx is often radiation therapy with surgery as the second option.
List 3 types of side effects of cancer treatments:
1) structural changes
- anatomical neurological and sensory deficits
2) functional changes
- speech and swallowing, reduced saliva
3) psychological and social changes
- internal and external
Describe how radiation therapy works:
When a cell divides its DNA info is vulnerable to high energy radiation. Tumour cells divide more than other cells so there is a greater chance of killing them than the surrounding healthy cells.
T or F: There is a tradeoff between tumour control and tissue damage
True - 90% tumour control =5% radiation necrosis
What is a method to radiate while preserving healthy tissue:
Radiate from different angles that hit different healthy tissue but always the tumour
When do we see the damaging effects of radiation?
The effect is instantaneous but the manifestation is delayed until mitosis which occurs at different times for different cell types (fast for hair, slow for bone).
List 2 types of radiation therapy:
External beam - conventional RT
Brachytherapy - gold pellets are implanted into target site, effective when difficult to access
What is the purpose of a radiation mask?
Formed to patients face to prevent movement, tumour is targeted.
List the acute side effects of radiation therapy:
1) Dermatitis
2) Mucositis
3) Dysgeusis
4) Xerostomia
List the long-term side effects of radiation therapy:
1) Xerostomia
2) Fibrosis
3) Dysgeusis
4) Atrophy
5) Osteoradionecrosis
6) Trismus
7) Hypertrophy
8) Reduced or absent sensation
9) Hypersensitivity
10) Incoordination
Describe Dermatitis:
Inflammation of the skin in the radiation field, skin looks red, burned and cracked.
Describe Mucositis:
Painful inflammation of the mucosa, erythema and edema.
Describe Dysgeusia:
Distortion of taste perception
Describe Xerostomia:
Radiation therapy affects salivary glands. The decreased salvia flow and change of consistency lead to reduced taste sensation and potentially to dysphagia. Decreased intraoral pH leads to more bacteria and caries.
Dermatitis occurs within ___ weeks. It is managed through _________ and ________management.
2-3 weeks
Dermatological and pain management
Mucositis occurs within ___ weeks. It is managed by adjusting ______ and through ________.
4 weeks
diet adjustment and pain management
Dysgeusia occurs within ___ weeks.
12 weeks
Xerostomia is managed through: ______, ______,_____ the application of oil is a less desirable method.
rinsing with water
adding baking soda to increase pH
Artificial saliva
Describe a surgery to help prevent Xerostomia:
the surgeon relocates the submandibular gland into submental space to prevent damage. Complicated to do surgery because radiation decreases healing.
Describe Osteoradionecrosis:
Bone cellsa re late responding to radiation damage because their cell cycle is slow. Bones weaken leading to fractures. In H&N the mandible is at risk.
Describe the management of osteoradionecrosis:
Hyperbaric oxygen - increase O2 to protect bones
Surgical managment - however healing potential of irradiated bone is often poor.
Describe radiation caries:
Teeth are shielded but enamel crumbles. Can’t remove teeth without breaking mandible.
Describe Trismus:
Lock jaw. Muscles are late responding to radiation damage. Irradiation leads to muscle fibrosis of the temporalis and masseter.
Describe the management of Trismus:
Training with jaw exercises (therabite oral exerciser) and surgical management (but it comes back)
Chemotherapy is most indicated for a ______ goal in generalized forms of cancer but less so in H&N sites where side effects outweigh benefits.
curative
List the possible side effects of chemotherapy:
- hair loss
- fatigue
- nausea
- mouth sore
- bladder irritation
- low blood counts
- diarrhea/ constipation
- decreased sex drive
How do we define treatment results:
- disease related (is cancer gone)
- functional
- psychological
