Cancer Basics Flashcards
Men and Women cancer risk
1:2 for men and 1:3 for women
T (Tumor Metastasis Nodes system)
x,0,in situ or TIS,1-4: 1 (not palpable or visible), 2 (Tumor is confined), 3 (Extends to neighboring tissues), 4 (Metastatic)
Joint Committee Grading System (Histologic Grade)
Gx-G4 (undetermined- high grade or undifferentiated)
How differentiated or different the tumor cells appear from normal cells.
5 most common cancer types for men?
Prostate, lung, colon, urinary bladder, melanoma
5 most common cancer types for women?
Breast, lung, colon, uterine and thyroid
Cancer is the ___ most common cause of death in the U.S
2nd
5yr survival 67%
Name the different types of cancer screening tests.
Physical exam*, Blood test, Imaging procedure, Molecular test
*Most common
Examples of molecular testing
Genotyping or gene expression assays to find genetic mutations linked to CA
Example of a cancer screening blood test for prostate CA.
Prostate Specific Antigen testing (PSA)
What is nuclear grade
Size and shape of nucleus and percentage of actively dividing cells.
Cell Cycle
Gap 0-resting, Gap 1-synth protein/ RNA, Synthesis- synth DNA, Gap 2- more RNA/ spindle forms, Mitosis- cell division
Innate v. Adaptive immune system
Innate= macrophage, Adaptive= T cell cytokines, B cell antibody and cytokines
*Biotherapy targets the immune system
Radiation therapy particle types
Alpha particles, Gamma rays (radioactive iodine), Beta particles
Neoadjuvant
1-2 modalities before primary txt such as surgery
Chemoprevention
Prevent in high risk (for example tamoxifen)
Myeloablation
Deplete bone marrow before transplant
Causes immunosuppression
Adjuvant therapy
After primary txt
What can impact txt regimen
Drug resistance, tumor burden, growth rate
What causes CA
Abnormal cell proliferation, lack of controlled growth. Caused by transcription of DNA to RNA changed due to SNP, environment/ chemical exposure, genetics, viral, spontaneous
Treatment modalities
Chemo/ hormonal therapy, surgery, RT, biotherapy
Brachytherapy
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
RT types
External beam (cCy), Three dimensional Conformal (CT), Intensity modulated (3D-CRT), Image guided (repeat scans), Stereotactic Radiosurgery, Total Body Irradiation
Goals of Therapy
Chemoprevention= delay risk/ development Adjuvant- after primary txt Definitive= RT as primary Neoadjuvant= modalities before primary txt Palliation Prophylaxis (ie RT for mets)
Allogenic v Autologous tsp
Donor vs own marrow cells.
Myelosuppression Neutropenia Anemia Thrombocytopenia Cytopenia Hematopoiesis
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
General Cancer SE spectrum over time
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
Prevention biochem obesity
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
Screening Assessments for Oncology Patients
Patient Generated -Subjective Global Assessment (PG-SGA). Malnutrition Screening Tool (MST). Malnutrition screening tool for cancer patients (MSTC). Malnutrition Universal Screening Tool (MUST).
Malnutrition statistics
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.
Malnutrition Diagnosis
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
Nutrient needs
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
Estimated calorie needs
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
Fish oil
Reduce inflammation, increase apoptosis, slower progression of CA
Stress Management
Stress increases epinephrine and cortisol which are immune suppressants.
Alkaline Diet
Avoids red meat, sugar, white rice, dairy. May need Ca/ vit D supplementation. No data to support this.
