Chapter 1 WS Part 2 Flashcards
early symptom of laryngeal cancer
very hoarse voice
What region of the larynx are the true vocal cords located in?
glottic or glottis
Explain why laryngeal cancer has a much better prognosis than ovarian cancer?
Early symptoms of laryngeal cancer cause patients to seek medical attention in the early stage. Ovarian cancer has such vague symptoms that medical attention is not sought until the cancer has progressed to a later stage. In general, the later the stage at diagnosis, the worse the prognosis
screening test for cervical cancer
pap smear
screening test for colorectal cancer
fecal occult blood testing and colonoscopy
screenng test for breast cancer
mammogram
Define “sensitive” with regard to screening tests?
The test must be able to give a true-positive result. It can identify a tumor in its early stages. Ex. Pap Smear can help detect carcinoma of the cervix before the disease become invasive. A sensitive test will not result in a false-negative finding
Define “specific” with regard to screening tests?
The test must be able to give a true-negative result. Also a specific test will be able to identify a specific type of cancer. Ex. PSA test for prostate cancer
What is a “false Negative” finding?
Test shows that there appears to be no cancer present when actually there is cancer. A “false Positive” finding indicates disease is present when it isn’t
what info in obtained in a workup
the type, location, and size of the tumor;
the degree the tumor has invaded normal tissue;
the presence or absence metastasis,
lymph node involvement and
possibilities of different treatment regimens.
what is tumor staging
means of defining the tumor size and extension of the tumor at the time of diagnosis
important reasons for tumor staging
Provides a means of communication about the tumors,
helps determine best treatment,
aids in the predicting the prognosis,
provides a means for continuing research.
UICC
International Union Against Cancer
AJCC
American Joint Committee on Cancer
How has advanced imaging technology aided in the treatment of cancer
Treatment has become more effective because much of the guesswork is eliminated which allows for smaller treatment volumes as only areas of known disease are being treated. This limits the dose to normal tissue which then causes fewer short term and chronic treatment side effects to the patient
Explain the TNM staging system.
T-defines the size or extent of the primary tumor (1-4 or x
N-designates the status of lymph nodes and extent of lymph node involvement (0-4 or x)
M defines the presence and extent of metastasis (0, 1, or x).
What staging system is used for gynecologic cancers
international federation of gynecology and obstetrics (FIGO)
what is clinical staging
Staging that is performed without the use of invasive procedures. Staged using physical exam, imaging studies
what is surgical/pathologic staging
Offers the most accurate information about the tumor and the extent of disease spread. The physician can perform a biopsy of suspicious looking tissue, obtain a sample of lymph nodes for microscopic examination, and observe the tumor and surrounding tissues and organs
what are BRCA1 and BRCA2 genes and how are they related to breast and ovarian cancer?
These are gene mutations.
BRCA1 (BReast CAncer number 1) found on chromosome 17 and BRCA2 (BReastCAncer number 2) found on Chromosome 13.
These gene mutations are linked to hereditary breast and ovarian cancers. `
how is the grade of a tumor determined
by examining the cells under a microscope
what is the grade of a tumor based on
based on the degree of differentiation
What are the four categories of differentiation for grading a tumor?
Well differentiated –cells characteristics are most like the original cells,
moderately well differentiated,
poorly differentiated, and
undifferentiated-cells are barely distinguishable from the original cells
what is the purpose of a tumor board and who are the participants
Purpose: to allow cancer specialists to work together to review information about newly diagnosed tumors and devise effective treatment plans that also allow the patient to maintain a high quality of life if possible.
Participants: surgeons, radiation oncologists, medical oncologists, radiologists, pathologists, social workers, plastic surgeons, and other medical personnel
define palliation
Noncurative treatment to relieve pain and suffering.
a patient with what size tumor is the best candidate for surgery
small tumors that have not spread to neighboring tissues or organs
- Would a patient with cancer to the nasopharynx be a good candidate for surgery?
why or why not?
no
accessibility is difficult because the cancer is close to the base of the brain and the cranial nerves
two examples of surgical prodcedures being use for palliation
Removal of an obstruction of the bowel for symptom relief
cutting nerves to reduce or eliminate pain caused by the tumor.
- List the benefits of patients with laryngeal cancer or prostate cancer or breast cancer having radiation therapy treatment rather than surgery
Laryngeal cancer- preserves the voice;
Prostate-helps preserve sexual function;
Breast-better cosmetic results (less disfigurement
what is a radical mastectomy
Sometimes referred to as the Halstead mastectomy. It involves the removal of the breast with overlying skin, the pectoralis muscles, and all the axillary lymph nodes
what is a sentinel node
The primary drainage lymph node located closest to the tumor `
describe instances in which rad therapy is used for palliation
1) Bone metastasis to relieve pain and reduce risk of pathological fractures.
2) To reduce the size of a tumor that is pressing on nerves
What is the difference between an x-ray and a gamma ray.
The mechanism of production. X-rays are produced by the interaction of electrons striking a target, whereas gamma rays are produced through radioactive decay
what radioactive source is used in a machine that treats with gamma rays
Cobalt 60
What type of external beam treatment is used to treat superficial tumors.
electrons
what is brachytherapy
Is a short distance therapy, which uses radioactive materials (cesium-137, iridium 192, palladium 103, iodine 125). These radioactive materials can be placed next to or directly into the tumor.
The energy of the radioactive sources is low so a high dose can be delivered to the tumor, while the nearby normal tissues receive a very small dose. P
Permanent seed implants for prostate cancer uses what two types of radioactive material
Palladium 103 or iodine 125
- What is the difference between low-dose brachytherapy (LDR)and high-dose brachytherapy(HDR)?
LDR-Brachytherapy at a dose rate of less than 2 Gy/hr.
HDR-Brachytherapy treatment at a dose rate that exceeds 12Gy/hr.
It takes longer to deliver a prescribed dose using LDR than it does for HDR. As a result, LDR treatments usually involves the radioactive material being placed in the patient and the patient staying in the hospital until the prescribed dose is delivered. HDR is what you will see most often at clinic. The patient will come in and have a radioactive source placed inside the body via catheters. The source will stay in the patient for a designated period of time then the source will be removed
What are cytotoxic drugs?
drugs that have the ability to kill cancer
Describe the different methods of administering chemotherapeutic agents
oral-by mouth intra-arterial injection anracavitary intraperitonel intrathecal intravenous
what is lupron
An injectable hormone therapy used to treat prostate cancer. It is injected under the skin or into a muscle. It can help slow down cancer growth.
why do radiation therapist need to know about chemo drugs
Give 2 examples.
Some chemo drugs have a synergistic effect with radiation.
Adriamycin is toxic to the heart and in combination with radiation therapy has a much greater toxic effect.
Bleomycin and radiation has a greater toxic effect on lungs
what are radiosensitizers
Chemicals and drugs that help enhance the lethal effects of radiation
what are radioprotectors
Certain chemicals and drugs that diminish the response of cells to radiation
explain immunotherapy
Immunotherapy is treatment that uses certain parts of a person’s immune system to fight diseases such as cancer by either stimulating a person’s own immune system to work harder or smarter to attack cancer cells or by giving a person immune system components, such as man-made immune system proteins.
what are monoclonal antibodies
Researchers produce antibodies to react to a specific antigen. The patient is given the monoclonal antibodies that seek out and destroy the specific antigen found on the surface of the tumor cells.
what are interferons
Naturally occurring body proteins capable of killing or slowing the growth of cancer cells
define prognosis
An estimation of the life expectancy of a cancer patient based on all the information obtained about the tumor and from clinical trials.
define exophytic tumors
tumors grow outward
define endophytic tumors
tumors grow inward
which has better prognosis (Endo/exophytic) tumors
Exophytic tumors has better prognoses as they do not tend to invade and ulcerate underlying tissues and does not invade blood vessels and lymphatic vessels until later in in the disease.
three ways cancer mets
blood, lymph, and seeding
where does prostate cancer most commonly mets
bones
how does ovarian cancer mets
seeding to the abdominal cacity
in what manner and where does medulloblastoma of the brain metastasize
Via seeding into the spinal canal by means of the cerebrospinal fluid
What tumor-related factors are significantis prognostic factors?
Grade, stage, tumor size, status of lymph nodes, depth of invasion, and histology
What patient-related factors are significate prognostic factors?
age, gender, race, and medical condition
main prognostic indicator for breastcancer
statusof axillary lymph nodes
main prognostic indicator for soft tissue sarcoma
histologic grade
what is purpose of clinical trials
to provide research-based evidence about specific treatment effectiveness. To determine the most effective treatment with the fewest long-term side effects.
what are retrospective studies
Studies that review information from a group of patients treated in the past.
what are prospective studies
A clinical trial that is planned before treatment, with eligibility criteria for patient selection.
explain randomized studies
Several methods of treatment are used to determine which method results in the best outcome. Patients are randomly selected for one of the types of treatment (patient had to meet the eligibility requirements first). The purpose of it being randomized is to eliminate any unintentional “stacking of the deck” and to increase the accuracy of the results and conclusions.
How is information about the status of the disease reported at the end point of survival reporting
As Alive with NED, disease free, or Alive with disease
How are treatment failures classified at the end point of survival reporting
Local, locoregional, and distant and are based on tumor recurrences at the primary or nearby lymph node sites or metastatic disease.
advantages to retrospective studies
info can be quickly obtained; dont have to wait years to see results of a treatment
advantages to prospective studies
- investigators know the info that is essentail to the study, leading to a more complement and accurate documentation of study
- better control of external factors that may influence the results
disadvantages of retrospective studies
- complete info about the treatment is not always available
- outside factors may have influenced the treatment, results were not controlled, and may ot have been documented accurately
disadvantages to prespective studies
- long amount of time needed to observe the results of a particular treatment (could be 5 years or longer)
used to determine the maximum tolerance dose for a specific treatment
phase I
Used to determine whether the Phase I treatment is significantly effective-given the acute and/or long-term side effects- to continue study.
phase II
Used to compare the experimental treatment with standard treatment with a randomized sample
phase III
patients alive at the endpoint and those who have died are counted.
absolute survival reporting
includes patients who died from other causes and had no evidence of disease (NED) at the time of their deaths.
adjusted survival reporting
the normal mortality rate of a similar group of people based on factors such as age, gender, and race.
relative survival reporting
Requires an infusion pump connected to a catheter that has been placed in an artery near the tumor. Used for retinoblastoma
intr-arterial injection
The drugs are instilled directly into the cavity. Ex. bladder cancer-drugs administered into the bladder
intracavitary
ntroduced into the abdomen through a catheter or implanted port. May be used with stomach cancer or ovarian cancer. May be done following debulking of a tumor after surgery to kill left behind cancer cells that may have broken off.
intraperitonel
Instilled into the space containing cerebrospinal fluid.
intrathecal
who must perform intrathecal injection?
a physician
administrered by using a syringe entering the vein directly or piggybacked with other fluids
intravenous
