Cancer Flashcards
what is the reccomended exercised dosage for those with cancer - minutes
150 min
what is the reccomended exercised dosage for those with cancer - aeorbic
moderate-intensity aer-
obic exercise spread over 3–5 days
what is the reccomended exercised dosage for those with cancer - resistance
2-3 days per week
8–10 muscle groups,
8–10 repetitions, 2 sets
each session should include
Each session should include a warm-up and
cool-down
what is the best risk predictor for cancer
age
80% of all cancers are diagnosed in people age BLANK
55+
~1/3 of projected cancer deaths related to what modifiable factors
obesity/ overweight,
inactivity,
poor nutrition
cancer and SES relationship
People with low SES have higher death rates than those with higher SES
Uninsured and minority patients are more likely to be diagnosed in what stage of cancer
later stage
what is the most common type of cancer
non-melanoma skin cancer
other leading cancers
Breast
Lung
Prostate
Colorectal
What is Cancer?
A large group of diseases characterized by uncontrolled cell proliferation and spread of abnormal cells.
Benign
non-cancerous
Pre-Cancerous
Carcinoma in Situ
A group of abnormal cells that could become cancerous
Malignant
Cancerous
Cells have the ability to invade and destroy nearby tissue and spread to other parts of the body
why is cancer staging important
Important to determine prognosis and to be able to compare one type of cancer to another
is staging the same for every cancer
Staging is different for every cancer!
TNM Staging - T
size and invasiveness of the primary tumor (0-4)
If multiple tumors are present in one organ, use highest T
TNM Staging - N
regional lymph node involvement (usually 0-4)
The N# does NOT reflect the exact # of nodes involved!
Low N = better prognosis
High N = surgically inaccessible, worse prognosis
TNM Staging - M
Distant spread (mets) to anatomical sites
X = not determined
0 = no distant mets
1 = distant metastasis
Anatomic Staging - what is it based on
0-IV staging based on size and spread
Anatomic Staging 0
Pre-malignant; “carcinoma in situ”
Anatomic Staging 1
Like stage 0, but confirmed malignant
Anatomic Staging 11
Local, but high risk of spread due to size
Anatomic Staging 111
Local cancer beginning to spread locally
Anatomic Staging 1V
Confirmed Metastasis (distant site)
what is Grading
A measure of cancer cell abnormality when compared to healthy cells.
Each cancer has unique grading systems
Generally, follows grade 1-4:
Grading 1
Most closely resemble normal cells; well-differentiated tumors; low grade.
Grading 2
Somewhat abnormal; moderately differentiated; intermediate grade
Grading 3
Very abnormal; poorly differentiated, since they no longer have an architectural structure or pattern; high grade
Grading 4
undifferentiated cancers; most abnormal looking cells; highest grade and typically grow and spread faster than lower grade tumors.
What is Metastasis?
cancer cells break away from where they first formed (primary cancer), travel through the blood or lymph system, and form new tumors (metastatic tumors) in other parts of the body.
Is the metastatic tumor is the same type of cancer as the primary tumor?
yes
Cells break away from the primary tumor site and travel through the body via 3 pathways:
Hemotogenous
Lymphatic
Transcoelomic (direct extension)
Most Common Sites of Metastases
Lymph nodes
Liver
Lungs
Bone
Brain
Osteolytic
a progressive condition where bone tissue is destroyed.
Osteoblastic
bone formation
Initial Signs of Cancer
Anemia
Thrombocytopenia
Elevated CRP, ESR
Pallor/Jaundice
Fever
Constipation/Diarrhea
Initial Symptoms of Cancer
Pain
Changes in Basic Functions
Changes in Normal Appearance
Bleeding/Bruising
Cough
Indigestion
Fatigue out of proportion to exertion
Poor temperature regulation
Swelling/Lumps
Weight gain/loss of unknown origin
what is Antiangiogenic
a type of cancer treatment
suppresses blood supply formation
Diagnose surgery
biopsy
determine extent of disease
Traditional axillary lymph node dissection removes removes what
portion of lymph nodes
what is Sentinel lymph node dissection
Instead of removing 10 or more lymph nodes and analyzing all of them to look for cancer, remove only the one node that is most likely to have it.
If this node is clean, chances are the other nodes have not been affected.
tumor removal surgery
often curative and is sometimes followed by additional treatment to be sure any remaining cancer is eradicated
reconstruction following removal surgery
Sometimes tumor removal may result in significant body changes such as amputation or breast removal
BRCA+. surgery indication
BRCA are the breast cancer genes 1 & 2.
People who inherit harmful variants in one of these genes have increased risks of several cancers - most notably breast and ovarian cancer
palliative surgery
aimed at removing some of the tumor in an effort to make a patient more comfortable and diminish negative side effects.
is Radiation (XRT) selevtive
no it is non-selective
target all tissue is that area
what does radiation do
a cancer treatment that uses high doses of radiation to kill cancer cells and shrink tumors
Targets DNA; Breaks hydrogen bonds to prevent ongoing replication of cancerous cells
Side Effects of XRT depends on what
DOSE and FIELD
XRT Pre-operatively
Shrink tumor
XRT Intra-operative
bolus dose to shrink tumor
XRT Post-operatively
to kill micrometastasis
XRT Palliatively
to decrease pain; seizure activity
XRT normal dosage
5 days/week for 4 weeks
Radiation methods
Teletherapy: external beam, most common
Proton Therapy
Brachytherapy: short distance from sealed radiation source & target, implant radioactive seeds. Best for localized tumors
Systemic – ingestion or injection of radioactive substance
what are the side effects of radiation
radiation dermistis
Mucositis
Fibrosis
Pain
Bone necrosis/ demineralization
High dose XRT causes Osteolysis & AVN
Epiphyseal plate in children is sensitive
Radiation-induced malignancy
signs to watch for in a patient who might be developing radiation dermatitis:
Reddening of white skin or darkening of skin that is black or brown.
Itchy skin.
Dry and peeling skin.
Swelling.
Blistering.
Open sores that may appear where your skin is sweaty or damp, such as your armpits or under your breasts
common side effect of external radiation
Mucositis
when your mouth or gut is sore and inflamed
GI symptoms such as: emesis, cramps, diarrhea, and/or hemorrhage
Radiation fibrosis syndrome (RFS)
a progressive fibrotic tissue sclerosis
late complication of radiation therapy and may occur weeks or even years after treatment
chronic vascular dysfunction and lymphatic issues
myelo-radiculo-plexo-neuro-myopathy
Radiation can damage the spinal cord, nerve roots, plexus, local peripheral nerves, and muscles within the radiation field.
can result in pain, sensory loss, weakness, and other signs and symptoms.
what is Osteoradionecrosis
bone death due to radiation
Bone necrosis/ demineralization
usually reversible
Bone softening in 1st 6-8 weeks
Return to full density may take 6 months
High dose XRT causes what to happen to the bones
Osteolysis & AVN
Epiphyseal plate in children is sensitive so what long term effect can we see
Irreversible LLD and scoliosis
what is Chemotherapy
A wide variety of chemical agents used to destroy cancer cells. These drugs affect cell DNA synthesis or function within the cell cycle
is chemo selevtive or non-selective
Nonselective
Can destroy normal cells, especially hepatic, epithelial, bone marrow and hair cells.
Generally results in toxicities and side effects.
Cocktails chemo
Combinations of drugs used to target cancer cells in various stages of the cell cycle.
Chemotherapy system Side-Effects depends on what
Depends on drug AND combination
chemo dosing - general
Depends on the type of cancer, the drug, the patient, etc
chemo dosing - infusion
1 infusion every 2-4 weeks x6 treatments
each infusion lasts a few hours
chemo dosing - oral
1 week on, 2 weeks off
chemo ADE
CICI
system toxicity
Induced Peripheral Neuropathy
what is Chemotherapy-Induced Cognitive Impairment (CICI)
subtle to moderate impairments in several cognitive domains
what causes CICI
Chemotoxicity
Reduced hormone levels
Proinflammatory immune response
Fatigue, Distress
signs/symptoms of CICI
Disorientation & difficulty multitasking
Slowed performance
Trouble concentrating & learning
Short attention span, Mental fatigue
what should you do if you think someone has CICI
MOCA
MMSE
and then refer the patient
what impact chemo inducer peri neuropathy
can develop or worsen with increasing doses
often occurs as stocking/ glove polyneuropathy
Sesnory fibers are usually affected more than motor and motor more than autonomic.
“coasting” and CIPN
gets worse after chemotherapy is stopped.
Commonly, symptoms occur weeks to months after chemotherapy.
They can get worse with additional cycles of chemotherapy.
what is immunotherapy
uses certain parts of a person’s immune system to fight cancer cell replication and spread.
Stimulate or boost your own immune system
Receive lab-formulated immune cell “assistance”
cancer specific and there are many different types
Cachexia
wasting” disorder that causes extreme weight loss and muscle wasting, and can include loss of body fat.
Sarcopenia
involuntary loss of skeletal muscle mass
what is Cancer Related Fatigue
A persistent, subjective sense of tiredness related to cancer or cancer treatment that interferes with usual functioning
Cancer-Related Fatigue intensity
Intensity generally increases with Rx time
Cancer-Related Fatigue symptoms
Fatigue not relieved by rest
Dyspnea
Decreased concentration
Decreased endurance for daily tasks
factors that influence survivorship
type
stage
treatment protocol
co-morbidites
individual behaviors
