Clin med/pathophys Flashcards
adjuvant therapy
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).
neoadjuvant therapy
in treating cancer, the use of chemotherapy before radiation or surgery.
remission
the period when no evidence of underlying disease exists.
cure
restoration to health, no cancer evident.
prognosis
prediction of the course and end of a disease, and the estimate for chance of recovery.
5-year survival rate
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).
5-year disease free survival rate
the number of pts with cancer who achieve remission (they no longer have signs of cancer in their body) within 5 years.
top 3 most common cancers in men in US
prostate, lung, colorectal
top 3 most common cancers in women in US
breast, lung, colorectal
top 3 cancers in US males w highest mortality
lung, prostate, colorectal
top 3 cancers in US females w highest mortality
lung, breast, colorectal
primary preventions in cancer: lifestyle modifications
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
primary preventions in cancer: chemoprophylaxis
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
TNM method of staging solid tumors: T
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
TNM method of staging solid tumors: N
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)
TNM method of staging solid tumors: M
Metastases: presence or absence of distant metastases
■ MX: Distant metastasis cannot be evaluated
■ M0: No distant metastasis
■ M1: Distant metastasis is present
cervical cancer typically metastasizes to
vagina, lung, liver, peritoneum
breast cancer typically metastasizes to
bone, brain, liver, lung
colon cancer typically metastasizes to
liver, lung, peritoneum
lung cancer typically metastasizes to
adrenal gland, bone, brain, liver, other lung
prostate cancer typically metastasizes to
adrenal gland, bone, liver, lung
testicular cancer typically metastasizes to
virchows node, lung, liver, brain
paraneoplastic syndrome
disorders that accompany tumors but are not directly related to mass effects or invasion
paraneoplastic syndrome: cushing syndrome
● 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
paraneoplastic syndrome: carcinoid syndrome
● 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
paraneoplastic syndrome: hypercalcemia
● 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
paraneoplastic syndrome: hyponatremia/SIADH
●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
paraneoplastic syndrome: Lambert-Eaton myasthenic syndrome
●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
