Clinical Oncology Flashcards
Most significant risk factor for cancer development?
Age
Cancer Cases: M vs. F
In order of most to least cases:
Males: prostate, lung, colon/rectum, urinary bladder, and melanoma
Females: breast, lung, colon/rectum, uterine, and thyroid
Cancer Deaths: M vs. F
In order of most to least deaths:
Males: lung, prostate, colon/rectum, pancreas, and liver/intrahepatic
Females: lung, breast, colon/rectum, pancreas, ovary
Dx of Cancer
VERY DEPENDENT ON TISSUE BIOPSY
- HISTOLOGY
- GRADE OF THE TUMOR
- INVASIVENESS
- CELL SURFACE TUMOR MARKER
- MOLECULAR MARKERS
Fine Needle Aspirate
FNA -= FINE NEEDLE ASPIRATE - A. THYROID NODULES B. PULMONARY NODULES C. BREAST MASSES D. TRANS RECTAL USING ULTRASOUND E. TRANS TRACHAEL
Curability and Symptoms
Curability of a tumor is inversely proportional to the tumor burden
Most patient are dx when symptoms appear related to the cancer caused by mass effect of the tumor or by alterations associated with the production of cytokines or hormones by the tumor
Cancer Screening Guidelines
For patients > 20 years old, a cancer check up should include health counseling and include pertinent physical examination of thyroid, oral cavity, skin, lymph nodes, testes, and ovaries
Breast Cancer Screening
YEARLY MAMMOGRAMS STARTING AT AGE 40 FOR AN AVERAGE RISK FEMALE AND CONTINUE YEARLY AS LONG AS THE WOMEN IS IN GOOD HEALTH
CLINICAL BREAST EXAMINATIONS SHOULD OCCUR ABOUT EVERY THREE YEARS FOR WOMEN IN THEIR 20’S AND 30’S AND YEARLY AFTER 40
WOMEN AT MODERATE RISK –(15-20% LIFETIME RISK) SHOULD TALK TO THEIR HEALTH CARE PROVIDER ABOUT THE ADVANTAGES OF ADDING AN MRI TO THEIR YEARLY MAMMOGRAM
YEARLY MRI IS NOT RECOMMENDED FOR WOMEN WITH A LIFE TIME RISK LESS THAN 15%.
Colon and Rectal Cancer Screening
BEGINNING AT AGE 50, MEN AND WOMEN AT AVERAGE RISK FOR COLO-RECTAL CANCERS SHOULD USE ONE OF THE FOLLOWING SCREENING METHODS
FLEXIBLE SIGMOIDOSCOPY EVERY 5 YEARS
COLONOSCOPY EVERY 10 YEARS
DOUBLE CONTRASTED BARIUM ENEMA EVERY 5 YEARS
VIRTUAL COLONOSCOPY EVERY 5 YEARS
Cervical Cancer Screening
ALL WOMEN SHOULD BEGIN CERVICAL SCREENING AT AGE 21.
WOMEN BETWEEN AGES 21 AND 29 SHOULD HAVE A PAP EVERY THREE YEARS.
HPV TESTING SHOULD NOT USED IN THIS AGE GROUP UNLESS IT IS NEEDED AFTER AN ABNORMAL PAP TEST RESULT
WOMEN BETWEEN THE AGES OF 30 AND 65 SHOULD HAVE A PAP TEST PLUS AN HPV TEST EVERY FIVE YEARS. THIS IS THE PREFERRED APPROACH, BUT IT IS ALSO SATISFACTORY TO HAVE A PAP TEST ALONE EVERY THREE YEARS.
WOMEN OVER THE AGE OF 65 WHO HAVE HAD REGULAR CERVICAL CANCER TESTING WITH NORMAL RESULTS SHOULD NOT BE TESTED. ONCE TESTING IS STOPPED, IT SHOULD NOT BE RESUMED.
Uterine Cancer Screening
WOMEN SHOULD, AT THE AGE OF MENOPAUSE, BE INFORMED OF THE RISKS AND SYMPTOMS OF ENDOMETRIAL CANCER AND STRONGLY ENCOURAGED TO REPORT TO THEIR HEALTH CARE PROVIDER ANY UNEXPECTED BLEEDING OR SPOTTING.
Prostate Cancer Screening
THIS DISCUSSION SHOULD INCLUDE THE OFFER FOR TESTING WITH A SERUM PSA LEVEL AND A DIGITAL RECTAL EXAMINATION, BEGINNING AT AGE 50, FOR MEN AT AN AVERAGE RISK FOR PROSTATE CANCER AND WHO HAVE AT LEAST A 10 YEAR LIFE EXPECTANCY.
MEN SHOULD PLAY AN ACTIVE ROLE IN THIS CHOICE AND BE INFORMED OF THE PRO’S AND CON’S OF EARLY DETECTION AND TREATMENT
THIS DISCUSSION SHOULD TAKE PLACE AT AGE 45 FOR MEN AT HIGH RISK OF PROSTATE CANCER.
THIS INCLUDES AFRICIAN AMERICAN MEN AND MEN WITH A FIRST DEGREE RELATIVE WITH PROSTATE CANCER, (FATHER, BROTHER, SON), DIAGNOSED AT AN EARLY AGE (LESS THAN 65 YEARS)
THIS DISCUSSION SHOULD OCCUR AT AGE 40 WITH MEN AT EVEN A HIGHER RISK HAVING A FIRST DEGREE RELATIVE WITH PROSTATE CA AT AN EARLY AGE.
PSA
PSA >1.0 AND AGES 45-49 – REPEAT IN 1-2 YEARS
PSA 3.0 – CONSIDER POSITIVE
Lung Cancer Screening
IF PATIENTS ARE AT HIGH RISK AND MEET ALL CRITERIA BELOW, THEY MAY BE CONSIDERED FOR LOW DOSE CT SCREENING.
A. BETWEEN AGES OF 55-74
B. GOOD HEALTH
C. 30 PACK YEAR HISTORY AND EITHER STILL SMOKING OR QUIT WITHIN THE LAST 15 YEARS.
Otherwise screening is not recommended
Staging Elements
CLINICAL
RADIOGRAPHIC
SURGICAL
PATHOLOGICAL
Clinical Staging
CLINICAL STAGING IS BASED ON PHYSICAL EXAMINATION, RADIOGRAPHS, NUCLEAR MEDICINE STUDIES, COMPUTED TOMOGRAPHY STUDIES, MRI, ULTRASOUND, AND PET SCAN
Pathological Staging
PATHOLOGIC STAGING INCLUDES INFORMATION OBTAINED DURING A SURGICAL PROCEDURE, INTRAOPERATIVE PALPATION, RESECTION OF REGIONAL LYMPH NODES, AND/OR TISSUE ADJACENT TO THE TUMOR, AND INSPECTION AND BIOPSY OF ORGANS COMMONLY INVOLVED IN DISEASE SPREAD
PATHOLOGIC STAGING INCLUDES HISTOLOGIC EXAMINATION OF ALL TISSUE REMOVED DURING THE OPERATIVE PROCEDURE.
SURGICAL PROCEDURE PERFORMED MAY INCLUDE A SIMPLE LYMPH NODE BIOPSY OR MORE EXTENSIVE PROCEDURES SUCH AS A THORACOTOMY, MEDIASTINOSCOPY, OR LAPORATOMY. SURGICAL STAGING MAY OCCUR IN A SEPARATE PROCEDURE OR MAY BE DONE AT THE TIME OF DEFINITIVE RESECTION
TNM System
T-1 - T-4 : THE HIGHER THE “T” NUMBER -INDICATES THE GREATER THE SIZE OF THE PRIMARY TUMOR.
N-0 - N-3 : INDICATES THE ABSENCE OR PRESENCE OF NODAL INVOLVEMENT. CERTAIN CANCER MAY HAVE UNIQUE “N” STAGING
M-0 - M-1 : INDICATES THE PRESENCE OF METASTASIS – CANCER SPREAD TO OTHER ORGANS
USUALLY BROKEN INTO I – IV - I – WELL DIFFERENTIATED TUMOR II – MODERATLEY DIFFERENTIATED TUMOR III – POORLY DIFFERENTIATED TUMOR IV – UNDIFFERENTIATED TUMOR
The higher the T and M, the more the burden
The higher the M, the poorer the prognosis
Karnofksy Performance Status
KARNOFSKY PERFORMANCE STATUS – THIS PROVIDES A NUMERICAL VALUE BASED ON THE FUNCTIONAL CAPABILITY OF THE PATIENT AND SHOULD ALWAYS BE ASSESSED BEFORE A ONCOLOGIC THERAPEUTIC PLAN IS SELECTED
OLDER PATIENTS AND THOSE WITH A KARNOFSKY’S PERFORMANCE STATUS OF LESS THAN 70% HAVE A POOR PROGNOSIS UNLESS THIS POOR PERFORMANCE IS A REVERSIBLE CONSEQUENCE OF THE TUMOR
Karnofsky Performance Scoring
100% NORMAL – NO COMPLAINTS
90% ABLE TO CARRY OUR NORMAL ACTIVITY – MINOR SYMPTOMS OF THE DISEASE
80% NORMAL ACTIVITY WITH EFFORT SOME SYMPTOMS OF THE DISEASE
70% CARES FOR SELF – UNABLE TO CARRY ON NORMAL ACTIVITY
60% REQUIRES OCCASIONAL ASSISTANCE BUT CAN CARE FOR MOST NEEDS
50% REQUIRES CONSIDERABLE CARE
40% DISABLED – REQUIRE SPECIAL CARE
30% SEVERLY DISABLED – DEATH IS NOT IMMINENT
20% ACTIVE SUPPORTIVE TREATMENT
10% MORIBUND
Curative vs. Palliative Tx Planning
Curative – eradication of the disease
Palliative: improving quality of life; those with performance under 50%
Sequences Tx Planning
CONCURRENT TREATMENT – OFTEN RADIATION THERPAY AND CHEMOTHERAPTY OFFERED AT THE SAME TIME
SEQUENTIAL TREATMENT – ONE THERAPY FOLLOWED BY THE OTHER TO REDUCE TOXICITY
Management of Disease and Tx: Complications
BECAUSE CANCER THERAPIES ARE TOXIC, PATIENT MANAGEMENT INVOLVES ADDRESSING COMPLICATIONS OF BOTH THE DISEASE AND ITS TREATMENT, AS WELL AS THE COMPLEX PSYCHOSOCIAL PROBLEMS.
IN THE SHORT TERM – PATIENTS FUNCTIONAL CAPACITY MAY DECLINE BUT IMPROVE FOLLOWING RECOVERY FROM THE THERAPY
Side Effects of Chemo vs. Radiation
THE MOST COMMON SIDE EFFECTS FROM RADIATION THERAPY IS SKIN REDNESS, TISSUE DRYNESS, SKIN THICKENING, HAIR LOSS (IF TREATING A HAIR BEARING AREA OF THE BODY), AND SYMPTOMS RELATED TO THE ORGAN OR ORGANS RECEIVING RADIATION THERAPY, AS THIS IS A LOCAL TREATMENT
THE MOST COMMON SIDE EFFECTS OF CHEMOTHERAPY IS NAUSEA AND VOMITING (WELL CONTROLLED WITH CURRENT MEDICATIONS), FEBRILE NEUTROPENIA AND MYELOSUPPRESSION
Measuring Response to Tx
COMPLETE RESPONSE - DEFINED AS DISAPPEARANCE OF ALL EVIDENCE OF DISEASE
PARTIAL RESPONSE - DEFINED AS >50% REDUCTION IN THE SUM OF THE PRODUCTS OF THE PERPENDICULAR DIAMETERS OF ALL MEASURABLE LESIONS
PROGRESSIVE DISEASE - DEFINED AS THE APPEARANCE OF ANY NEW LESIONS OR AN INCREASE OF > 25% IN THE SUM OF THE PRODUCTS OF THE PERPENDICULAR DIAMETERS OF ALL MEASURABLE LESIONS.
TUMOR SHRINKAGE OR GROWTH THAT DOES NOT MEET ANY OF THESE CRITERIA IS CONSIDERED STABLE DISEASE
Follow - Up After Cancer Eradicated
IF THE PATIENT HAS BEEN RENDERED DISEASE FREE FROM THE ORIGINAL TREATMENT, THE PATIENT IS FOLLOWED REGULARLY FOR DISEASE RECURRENCE.
THE OPTIMAL GUIDELEINES ARE NOT SPECIFIC AND RECOMMENDATIONS FOR EACH DISEASE TYPE ARE PROVIDED IN THE NCCN GUDIELINES
AS TIME PASSES, THE LIKELIHOOD OF RECURRENCE OF THE PRIMARY CANCER DIMINISHES. FOR MANY TYPES OF CANCER, SURVIVAL FOR 5 YEARS WITHOUT RECURRENCE IS EQUAL TO A CURE.
HOWEVER, IMPORTANT MEDICAL PROBLEMS CAN OCCUR IN PATIENTS HAVING RECEIVED ONCOLOGIC TREATMENT AND MUST BE EXAMINED.
