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Clin Med2- Hematology > Hem/Onc - waldron > Flashcards

Hem/Onc - waldron Flashcards

1
Q

What is cancer

A

a group of related diseases characterized by: unregulated growth, invasion of neighboring tissues or spaces, and sitand spread

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2
Q

what are the characteristics of malignant cells

A

unchecked growth
immortality (loss of apoptosis and senescence)
sustained angiogenesis (ability to grow new BV)
ability to invade neighboring tissues and build metastases at distant sites
ability to evade the immune system

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3
Q

What are proto-oncogenes and oncogenes

A

dominant- only one gene copy needs to be mutated

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4
Q

what are tumor suppressor genes

A

both gene copies need to be mutated to lose function

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5
Q

what are DNA repair genes

A

mismatch pair

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6
Q

What type of cancer is the most common cancer diagnosis

A

breast cancer

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7
Q

what is the second most common cancer diagnosis

A

lung and bronchus cancer

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8
Q

what is the leading cancer diagnosis among men

A

prostate cancer

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9
Q

what are the most common kinds of children cancers (ages 0-14)

A

acute lymphocytic leukemia
Brain and CNS
neuroblastoma
non-hodgkin lymphoma

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10
Q

what are the most common kinds of adolescent cancers (15-19)

A

Hodgkin lymphoma
thyroid carcinoma
brain and CNS
Testicular germ cell tumors
Non-hodgkin lymphoma

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11
Q

what are the risk factors for cancer

A

Age
childhood cancers

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12
Q

what are modifiable risk factors of cancer

A

Tobacco
Obesity
Sun Exposure
Alcohol
Infections
Physical activity
Diet

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13
Q

why is cancer more common in older pateints

A

takes time to develop - increased number of exposures to carcinogens, more prolonged exposures to carcinogens, accumulate DNA damage
immune system weakness with age
aging cells are less effective at repair

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14
Q

what is the leading cause of death in children in the US

A

Accidents

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15
Q

what is the leading cause of death due to disease in children in the US

A

cancer

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16
Q

What is the median age of cancer diagnosis in the US

A

66 years old

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17
Q

what is the median age of death due to cancer in the US

A

72 years old

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18
Q

What are the 3 things to evaluation with Oncology

A

Confirm diagnosis
determine the extent - staging
determine how healthy is the patient

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19
Q

What is the TNM system of staging cancer

A

Tumor: size (or depth) of the primary tumor
Nodes: number and size of regional lymph nodes
Metastases: presence of metastases

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20
Q

What are the different types of tumor

A

TX: primary tumor cannot be evalutated
T0: No evidency of a primary
Tis: carcinoma in situ - cancer cells have not invaded into surrounding tissues have not broken through the basement membrane
T1-T4: depending upon size and/or depth of invasion higher number means bigger or deeper tumor

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21
Q

What are the different Nodes staging

A

NX: nodes cannot be evaluated
X0: no regional lymph nodes involved
N1-N3: size and number of nodes involved

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22
Q

What are the different Metastases staging

A

M0: no evidence of metastatic disease
M1: presence of metastatic disease

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23
Q

what is cTNM

A

clinical staging
based on physical exam, imaging studies; no tissue biopsy

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24
Q

what is pTNM

A

pathologic staging
based on results of surgery and biopsies

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25
Q

what are the different two types of staging

A

clinical staging (cTNM) and Pathologic staging (pTNM)

26
Q

What is stage 1

A

small amount of local disease, usually no lymph node involvement

27
Q

what is stage 2-3

A

locally advanced (regional)

28
Q

what is stage 4

A

metastatic disease

29
Q

what is the standard blood work with the presumption of cancer

A

CBC (blood counts, bone marrow function)
CMP (liver and kidney function, electrolytes)

30
Q

when are cancer marker labs taken

A

after biopsy confirmation

31
Q

what are the cancer markers - dependent on type of cancer

A

Prostate-specific antigen (PSA) - prostate cancer
Cancer antigen 125 (CA125) - ovarian cancer
Calcitonin - medullary thyroid cancer
Alpha-fetoprotein (AFP) - liver cancer
Human Chorionic gonadotropin (HCG) - germ cell tumors

32
Q

what are patient issues regarding the treatment of cancer

A

patient preferences
physiologic age
life expectancy
comorbidities

33
Q

what are tumor issues regarding the treatment of cancer

A

aggressiveness and type of cancer
stage of cancer
curative vs palliative
likelihood that the cancer will cause symptoms, disability and death
how much benefit to treatment
side effects of treatment

34
Q

What is Adjuvant therapy

A

therapy given after primary tumor has been removed

35
Q

what is neo-adjuvant therapy

A

therapy given before primary tumor has been removed

36
Q

what is localized therapy

A

surgery
radiation therapy

37
Q

what is systemic therapy

A

chemotherapy and biologic therapy

38
Q

what are the benefits of surgical therapy for cancer

A

prophylactic - removing premalignant polyps
diagnostic
staging
treatment - 40% of cancer pts cured with surgery
Palliation

need to weigh risks and benefits

39
Q

what are the three main kinds of radiation therapy

A

External beam: beams of radiation aimed at a tumor within a pt
Brachytherapy: encapsulated source of radiation implanted into a tumor “seeds”
Systemic: inject radio-nucleotides that are targeted to a tumor

40
Q

what is IMRT

A

Intensity Modulated Radiotherapy

41
Q

what is the benefits of IMRT

A

form of high precision radiotherapy that can deliver extremely controlled doses of radiation to malignant tumors.

radiation bean is shaped and intensity varied to target the tumor and protect vital organs

42
Q

What is Photon and Proton radiotherapy

A

targets tumor with a beam of energy which damages DNA and kills cancer cells

43
Q

What is Gama Knife

A

gamma rays are emitted to the tumor from different angles, affecting only the tumor with a 0.15mm accuracy

44
Q

what are the short term side effects of radiation

A

fatigue, nausea, vomiting
Burns
Mucositis
bone marrow toxicity

45
Q

what are the chronic side effects of radiation

A

cataracts
thyroid failure
MI
Pulmonary fibrosis

46
Q

what is included with chemotherapy

A

includes hormonal therapies - most common breast and prostate cancer
used both cure and pallitation
often given as combinations: “alphabet soup”
ABVD, CHOP, CMF,AC, then T, FOLFOX

47
Q

what are the side effects of chemotherapy

A

side effects depend on drugs and dosages
bone marrow suppression
N/V
Neuropathy
Cardiac toxicity
cold intolerance
mucositis
hair loss
decreased fertility/premature menopause
development of secondary malignancies

48
Q

what is neutropenic fever

A

MEDICAL EMERGENCY
increased risk of death if neutropenic in the presence of fever
fever: greater than 100.4 for an hour, single temp over 101
Neutropenia: ANC <500, <1,000 and expected to fall to <100
pts are often admitted to the hospital for broad spectrum antibiotics

49
Q

what is biologic therapy

A

antibodies that are directed towards specific target on tumor cells: Trastuzumab (herceptin) for breast cancer, Rituximab targets CD-20, used in lymphoma
Cytokines - interferon
Immune system activators: Keytruda et al - use may be limited by “itis’s”

50
Q

What is hospice care

A

end of life care

51
Q

What is Palliative care

A

can benefit any patient with illness-related suffering, should be considered in all patients regardless of prognosis

52
Q

What is the palliative care framework

A

goals of care directed by pts values and preferences
involves a great deal of communication
need coordination of providers, skilled nursing and family

53
Q

what are the major domains of palliative care

A

physical symptoms
psychological/psychiatric/cognitive symptoms
illness understanding and preferences for care
social and economic concerns
religious/spiritual issues

54
Q

what are the common cancer symptoms/complaints

A

pain
SOB
fatigue
dry mouth
lack of appetite
weight loss
nausea
sadness, grief and depression
anxiety
loss of autonomy/independence/identity

55
Q

what are the benefits of hospice care

A

significantly better quality of life for patients and families
significantly reduced risk of PTSD and prolonged grief disorder among bereaved family members

56
Q

how do you break the bad news

A

preparation, setting, who should be there
assess pts perception and understanding
inform: direct, simple language, no jargon, allow for silence
address the emotions
summary and planning (pts goals and needs)

57
Q

how do you respond to the emotions

A

use their name
show understanding, empathy
respect
offer support
explore what their thinking; guilt, abandonment/loneliness, anxiety/depression

58
Q

what are the advanced directives

A

Living will
durable power of attorney for health care
physician orders for life-sustaining treatment (POLST)
DNR orders

59
Q

what is a living will

A

specifics vary from state to state
document that describes treatments that the patient does or does not want in the events of a terminal illness or permanent vegetative state - statement of wishes
not effective unless pt cant communicate
can be a statutory form, but many courts have recognized unofficial documents

60
Q

what is the durable power of attorney for Health care

A

proxy decision maker with authority to terminate life-sustaining treatments
provider “substituted judgement”
if no one is designated, ask families and next of kin
living wills and DPOAs for HC are often used together

61
Q

what is POLST

A

physician orders for life-sustaining treatment
form that accompanies patient to different sites of care
orders regarding treatment
who signs depends upon the state

Clin Med2- Hematology (8 decks)

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