Hem/Onc - waldron Flashcards
What is cancer
a group of related diseases characterized by: unregulated growth, invasion of neighboring tissues or spaces, and sitand spread
what are the characteristics of malignant cells
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
What are proto-oncogenes and oncogenes
dominant- only one gene copy needs to be mutated
what are tumor suppressor genes
both gene copies need to be mutated to lose function
what are DNA repair genes
mismatch pair
What type of cancer is the most common cancer diagnosis
breast cancer
what is the second most common cancer diagnosis
lung and bronchus cancer
what is the leading cancer diagnosis among men
prostate cancer
what are the most common kinds of children cancers (ages 0-14)
acute lymphocytic leukemia
Brain and CNS
neuroblastoma
non-hodgkin lymphoma
what are the most common kinds of adolescent cancers (15-19)
Hodgkin lymphoma
thyroid carcinoma
brain and CNS
Testicular germ cell tumors
Non-hodgkin lymphoma
what are the risk factors for cancer
Age
childhood cancers
what are modifiable risk factors of cancer
Tobacco
Obesity
Sun Exposure
Alcohol
Infections
Physical activity
Diet
why is cancer more common in older pateints
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
what is the leading cause of death in children in the US
Accidents
what is the leading cause of death due to disease in children in the US
cancer
What is the median age of cancer diagnosis in the US
66 years old
what is the median age of death due to cancer in the US
72 years old
What are the 3 things to evaluation with Oncology
Confirm diagnosis
determine the extent - staging
determine how healthy is the patient
What is the TNM system of staging cancer
Tumor: size (or depth) of the primary tumor
Nodes: number and size of regional lymph nodes
Metastases: presence of metastases
What are the different types of tumor
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
What are the different Nodes staging
NX: nodes cannot be evaluated
X0: no regional lymph nodes involved
N1-N3: size and number of nodes involved
What are the different Metastases staging
M0: no evidence of metastatic disease
M1: presence of metastatic disease
what is cTNM
clinical staging
based on physical exam, imaging studies; no tissue biopsy
what is pTNM
pathologic staging
based on results of surgery and biopsies
what are the different two types of staging
clinical staging (cTNM) and Pathologic staging (pTNM)
What is stage 1
small amount of local disease, usually no lymph node involvement
what is stage 2-3
locally advanced (regional)
what is stage 4
metastatic disease
what is the standard blood work with the presumption of cancer
CBC (blood counts, bone marrow function)
CMP (liver and kidney function, electrolytes)
when are cancer marker labs taken
after biopsy confirmation
what are the cancer markers - dependent on type of cancer
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
what are patient issues regarding the treatment of cancer
patient preferences
physiologic age
life expectancy
comorbidities
what are tumor issues regarding the treatment of cancer
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
What is Adjuvant therapy
therapy given after primary tumor has been removed
what is neo-adjuvant therapy
therapy given before primary tumor has been removed
what is localized therapy
surgery
radiation therapy
what is systemic therapy
chemotherapy and biologic therapy
what are the benefits of surgical therapy for cancer
prophylactic - removing premalignant polyps
diagnostic
staging
treatment - 40% of cancer pts cured with surgery
Palliation
need to weigh risks and benefits
what are the three main kinds of radiation therapy
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
what is IMRT
Intensity Modulated Radiotherapy
what is the benefits of IMRT
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
What is Photon and Proton radiotherapy
targets tumor with a beam of energy which damages DNA and kills cancer cells
What is Gama Knife
gamma rays are emitted to the tumor from different angles, affecting only the tumor with a 0.15mm accuracy
what are the short term side effects of radiation
fatigue, nausea, vomiting
Burns
Mucositis
bone marrow toxicity
what are the chronic side effects of radiation
cataracts
thyroid failure
MI
Pulmonary fibrosis
what is included with chemotherapy
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
what are the side effects of chemotherapy
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
what is neutropenic fever
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
what is biologic therapy
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”
What is hospice care
end of life care
What is Palliative care
can benefit any patient with illness-related suffering, should be considered in all patients regardless of prognosis
What is the palliative care framework
goals of care directed by pts values and preferences
involves a great deal of communication
need coordination of providers, skilled nursing and family
what are the major domains of palliative care
physical symptoms
psychological/psychiatric/cognitive symptoms
illness understanding and preferences for care
social and economic concerns
religious/spiritual issues
what are the common cancer symptoms/complaints
pain
SOB
fatigue
dry mouth
lack of appetite
weight loss
nausea
sadness, grief and depression
anxiety
loss of autonomy/independence/identity
what are the benefits of hospice care
significantly better quality of life for patients and families
significantly reduced risk of PTSD and prolonged grief disorder among bereaved family members
how do you break the bad news
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)
how do you respond to the emotions
use their name
show understanding, empathy
respect
offer support
explore what their thinking; guilt, abandonment/loneliness, anxiety/depression
what are the advanced directives
Living will
durable power of attorney for health care
physician orders for life-sustaining treatment (POLST)
DNR orders
what is a living will
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
what is the durable power of attorney for Health care
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
what is POLST
physician orders for life-sustaining treatment
form that accompanies patient to different sites of care
orders regarding treatment
who signs depends upon the state
