Clin med/pathophys

Question 1

adjuvant therapy

Answer 1

the use of additional therapy to the primary therapy. (ex: surgery to remove a tumor would be primary therapy, and radiation to destroy neighboring cells/tissues is adjuvant therapy; done after the resection).

Question 2

neoadjuvant therapy

Answer 2

in treating cancer, the use of chemotherapy before radiation or surgery.

Question 3

remission

Answer 3

the period when no evidence of underlying disease exists.

Question 4

cure

Answer 4

restoration to health, no cancer evident.

Question 5

prognosis

Answer 5

prediction of the course and end of a disease, and the estimate for chance of recovery.

Question 6

5-year survival rate

Answer 6

the percentage of pts who will survive a certain type of cancer for within 5 years (ex: of all the pts who have bladder cancer, 78 out of 100 are still living 5 years after diagnosis; 78% 5 year survival rate).

Question 7

5-year disease free survival rate

Answer 7

the number of pts with cancer who achieve remission (they no longer have signs of cancer in their body) within 5 years.

Question 8

top 3 most common cancers in men in US

Answer 8

prostate, lung, colorectal

Question 9

top 3 most common cancers in women in US

Answer 9

breast, lung, colorectal

Question 10

top 3 cancers in US males w highest mortality

Answer 10

lung, prostate, colorectal

Question 11

top 3 cancers in US females w highest mortality

Answer 11

lung, breast, colorectal

Question 12

primary preventions in cancer: lifestyle modifications

Answer 12

Changes in ADL that can prevent or greatly reduce to risk of developing cancer→ smoking cessation, weight loss, increased physical activity, balanced diet, no excessive EtOH, avoidance of UV and other radiation, avoidance of certain viruses

Question 13

primary preventions in cancer: chemoprophylaxis

Answer 13

Use (ingestion, topical) of a substance (exogenous or supplementation of something endogenous) to reduce risk of/ prevent cancer.
● May be initiated by a provider in people at high risk; cost-benefit analysis of drug side effects vs. cancer risk
● In breast cancer, selective estrogen receptor modulators (SERMs)= tamoxifen, raloxifene
● In prostate cancer, finasteride and dutasteride
● In colon cancer, ASA & NSAIDs

Question 14

TNM method of staging solid tumors: T

Answer 14

Tumor: size and location of primary tumor
■ TX: Primary tumor cannot be evaluated
■ T0: No evidence of primary tumor
■ Tis: Carcinoma in situ (CIS; abnormal cells are present but have not spread to neighboring tissue; although not cancer, CIS may become cancer and is sometimes called preinvasive cancer)
■ T1-4: Size and/or extent of the primary tumor varied

Question 15

TNM method of staging solid tumors: N

Answer 15

Nodes: Lymph node involvement (presence, location and/or metastases)
■ NX: Regional lymph nodes cannot be evaluated
■ N0: No regional lymph node involvement
■ N1, N2, N3: Based on degree of regional lymph node involvement (number and location of lymph nodes)

Question 16

TNM method of staging solid tumors: M

Answer 16

Metastases: presence or absence of distant metastases
■ MX: Distant metastasis cannot be evaluated
■ M0: No distant metastasis
■ M1: Distant metastasis is present

Question 17

cervical cancer typically metastasizes to

Answer 17

vagina, lung, liver, peritoneum

Question 18

breast cancer typically metastasizes to

Answer 18

bone, brain, liver, lung

Question 19

colon cancer typically metastasizes to

Answer 19

liver, lung, peritoneum

Question 20

lung cancer typically metastasizes to

Answer 20

adrenal gland, bone, brain, liver, other lung

Question 21

prostate cancer typically metastasizes to

Answer 21

adrenal gland, bone, liver, lung

Question 22

testicular cancer typically metastasizes to

Answer 22

virchows node, lung, liver, brain

Question 23

paraneoplastic syndrome

Answer 23

disorders that accompany tumors but are not directly related to mass effects or invasion

Question 24

paraneoplastic syndrome: cushing syndrome

Answer 24

● most common endocrinopathy associated with paraneoplastic syndromes
● results from tumor production of adrenocorticotropic hormone (ACTH) or an ACTH-like peptide → excessive cortisol production
● signs: truncal obesity, hirsutism, moon facies, acne, buffalo hump, purple striae, hypertension, and diabetes
● bronchogenic carcinomas, thymomas, medullary thyroid cancers, and carcinoids are frequent causes; also direct elaboration from adrenal neoplasms

Question 25

paraneoplastic syndrome: carcinoid syndrome

Answer 25

● Carcinoid tumors contain numerous hormones, amines, prostaglandins, among other chemicals, that can be released in sufficient amounts to cause symptoms
● Flushing and diarrhea are the two most common symptoms and they often occur together
● cardiac manifestations also occur → formation of fibrotic plaques
● also wheezing or asthma-like symptoms and pellagra-like skin lesions
● dx relies on measurement of urinary or plasma serotonin or its metabolites in the urine; 5-HIAA is used most frequently
● can tx the symptoms (avoid flushing triggers, antidiarrheals, bronchodilators for asthma, diuretics for heart failure); only cure is resection of carcinoid tumor

Question 26

paraneoplastic syndrome: hypercalcemia

Answer 26

● seen in bone mets
● can generally be attributed to two causes:
○ Multiple myeloma and cancers that metastasize to bone can raise serum calcium levels through lytic bone metastases
○ Solid tumors (breast, lung, and renal cancers) can secrete a molecule called parathyroid hormone–related peptide (resembles parathyroid hormone), which can bind parathyroid hormone receptors and mimic its action; it is not subject to feedback inhibition like parathyroid hormone, and elaboration of large quantities of this molecule can cause severe hypercalcemia

Question 27

paraneoplastic syndrome: hyponatremia/SIADH

Answer 27

●caused by a variety of vasopressin-secreting tumors (and also CNS disorders, pulmonary disorders, and drugs)
●Small cell bronchial carcinoma is an important cause of SIADH
●SIADH is due to secretion of vasopressin in excess → limits excretion of water in urine; thirst is not suppressed and causes volume expansion & hyponatremia
●neurologic symptoms are the result of osmotic fluid shifts causing brain edema and elevated intracranial pressures; can treat with water restriction and underlying cause of hyponatremia

Question 28

paraneoplastic syndrome: Lambert-Eaton myasthenic syndrome

Answer 28

●characterized by proximal muscle weakness, decreased DTRs and autonomic symptoms (dry mouth, constipation, erectile failure), widespread anhidrosis
●sometimes associated with an antibody attack of P/Q-type voltage-gated calcium channels of axon nerve terminals which are integral to release of ACh during action potential → any calcium ion flow impairment = muscle weakness
●associated with malignancy in 60% of cases (often older men who smoked and have lung cancer); can precede malignancy detection by several years
●tx of malignancy can help dramatically; otherwise tx is supportive