Cancer Basics

Question 1

Men and Women cancer risk

Answer 1

1:2 for men and 1:3 for women

Question 2

T (Tumor Metastasis Nodes system)

Answer 2

x,0,in situ or TIS,1-4: 1 (not palpable or visible), 2 (Tumor is confined), 3 (Extends to neighboring tissues), 4 (Metastatic)

Question 3

Joint Committee Grading System (Histologic Grade)

Answer 3

Gx-G4 (undetermined- high grade or undifferentiated)

How differentiated or different the tumor cells appear from normal cells.

Question 4

5 most common cancer types for men?

Answer 4

Prostate, lung, colon, urinary bladder, melanoma

Question 5

5 most common cancer types for women?

Answer 5

Breast, lung, colon, uterine and thyroid

Question 6

Cancer is the ___ most common cause of death in the U.S

Answer 6

2nd

5yr survival 67%

Question 7

Name the different types of cancer screening tests.

Answer 7

Physical exam*, Blood test, Imaging procedure, Molecular test
*Most common

Question 8

Examples of molecular testing

Answer 8

Genotyping or gene expression assays to find genetic mutations linked to CA

Question 9

Example of a cancer screening blood test for prostate CA.

Answer 9

Prostate Specific Antigen testing (PSA)

Question 10

What is nuclear grade

Answer 10

Size and shape of nucleus and percentage of actively dividing cells.

Question 11

Cell Cycle

Answer 11

Gap 0-resting, Gap 1-synth protein/ RNA, Synthesis- synth DNA, Gap 2- more RNA/ spindle forms, Mitosis- cell division

Question 12

Innate v. Adaptive immune system

Answer 12

Innate= macrophage, Adaptive= T cell cytokines, B cell antibody and cytokines
*Biotherapy targets the immune system

Question 13

Radiation therapy particle types

Answer 13

Alpha particles, Gamma rays (radioactive iodine), Beta particles

Question 14

Neoadjuvant

Answer 14

1-2 modalities before primary txt such as surgery

Question 15

Chemoprevention

Answer 15

Prevent in high risk (for example tamoxifen)

Question 16

Myeloablation

Answer 16

Deplete bone marrow before transplant

Causes immunosuppression

Question 17

Adjuvant therapy

Answer 17

After primary txt

Question 18

What can impact txt regimen

Answer 18

Drug resistance, tumor burden, growth rate

Question 19

What causes CA

Answer 19

Abnormal cell proliferation, lack of controlled growth. Caused by transcription of DNA to RNA changed due to SNP, environment/ chemical exposure, genetics, viral, spontaneous

Question 20

Treatment modalities

Answer 20

Chemo/ hormonal therapy, surgery, RT, biotherapy

Question 21

Brachytherapy

Answer 21

Temp or permanent placement of radioactive material near the tumor. Also available is radiopharmaceutical therapy and radioimmunotherapy. For example use of radioactive iodine in thyroid RT. SE: N/V/D/ cramping, mucositis etc

Question 22

RT types

Answer 22

External beam (cCy), Three dimensional Conformal (CT), Intensity modulated (3D-CRT), Image guided (repeat scans), Stereotactic Radiosurgery, Total Body Irradiation

Question 23

Goals of Therapy

Answer 23

Chemoprevention= delay risk/ development
Adjuvant- after primary txt
Definitive= RT as primary 
Neoadjuvant= modalities before primary txt
Palliation
Prophylaxis (ie RT for mets)

Question 24

Allogenic v Autologous tsp

Answer 24

Donor vs own marrow cells.

Question 25

``` Myelosuppression Neutropenia Anemia Thrombocytopenia Cytopenia Hematopoiesis ```

Answer 25

Dec neutrophils, megakaryocytes, erythrocytes in bone marrow. Dec Neutrophils ANC <1500- Neutrophils detect infection w/o fever. Treat w/ colony stimulating factors which have SE of skin issues, low vitamin D, HTN, myalgia Hgb <12g/dL <100,000 platelets formation of blood cells Note RBC life span = 90-120 days but 7-12 hr in neutrophil

Question 26

General Cancer SE spectrum over time

Answer 26

During: N/V/D, mucositis, dysgeusia, fatigue, pain, anorexia, body weight changes, drug-nutrient interactions Post: fatigue, pain, endocrine disorders, body comp changes, cognitive defects, dental issues Long term: wt changes, osteoporosis, endocrine disorders, cardiovascular complications, cognitive & dental issues

Question 27

Prevention biochem obesity

Answer 27

Excess wt: leads to insulin resistance, IGF-1 mitogen protein kinase pathway, inc cell growth, dec apoptosis, adipose produces estrogen, inc leptin = inc proliferation, dec adiponectin (dec insulin resistance, inflammation and inc apoptosis), inc inflammation Energy dense foods= excessive micronutrients and food contaminants

Question 28

Screening Assessments for Oncology Patients

Answer 28

Patient Generated -Subjective Global Assessment (PG-SGA). Malnutrition Screening Tool (MST). Malnutrition screening tool for cancer patients (MSTC). Malnutrition Universal Screening Tool (MUST).

Question 29

Malnutrition statistics

Answer 29

40% are malnourished prior to dx and 40-80% will experience this during txt. 80% of GI cancer patients have lost weight. Weight loss pf 6% predicts reduced response to txt, reduced survival and lower QOL.

Question 30

Malnutrition Diagnosis

Answer 30

``` Acute: <75% x7d/ 50% x5d 1-2/ >2 x1wk 5/ >5 x1mo 7.5/ >7.5 x3mo Mild/ Moderate muscle/ fat Chronic: Same as above AND 75% po or less x1mo 10/>10% x6mo 20/>20 x1yr mild/ svr fat/ muscle ```

Question 31

Nutrient needs

Answer 31

1.2-2g protein for catabolically stressed. Cancer 1.0-1.5, Cachexia 1.5-2.0. Fluid 1-1.5ml/kcal Fat- 20-35%, CHO 45-65%, Prot 10-35% During inflammation as in CA- se, cu, fe, zn, decrease through loss

Question 32

Estimated calorie needs

Answer 32

Cancer repletion/ wt gain: 30-35 Cancer inactive/ not stressed: 25-30 Cancer hypermetabolic: 35 Sepsis: 25-30 Hematopoietic stem cell transplant: 30-35 Obese: 14-18kcal or 22kcal/kg w/o renal or hepatic disease *Note Refeeding: start 20kcal/kg or 25% needs and advance as tol or over 3-5 days slowly monitoring electrolytes

Question 33

Fish oil

Answer 33

Reduce inflammation, increase apoptosis, slower progression of CA

Question 34

Stress Management

Answer 34

Stress increases epinephrine and cortisol which are immune suppressants.

Question 35

Alkaline Diet

Answer 35

Avoids red meat, sugar, white rice, dairy. May need Ca/ vit D supplementation. No data to support this.