Heme/Onc 4 Flashcards
what account for 2/3 of all cancers in the US?
smoking
obesity
poor diet
inactivity
what types of cancer can a moderate amount of alcohol raise the risk for
raises risks for colon, breast, esophageal, and oropharyngeal cancer
what can be protective for cancer in moderate drinkers of alcohol?
folate supplements
what cancer is exposure to asbestos associated with?
mesothelioma
what infections can be a risk factor for CA?
hepatitis C
HIV
HPV
antiestrogen therapies
Tamoxifen, raloxifene
drugs used for prevention in prostate cancer. But if they did get prostate cancer it was more agressive.
Finasteride
only cancer screening test that has proven to increase lifespan
HPV screening test
what are the most common male cancer (highest to lowest)
prostate
lung/ bronchus
colon/ rectum
bladder
what are the most common female cancers
breast
lung/bronchus
colon/rectum
endometreum
what type cancer causes the most deaths?
lung/ bronchus
risk factors for lung cancer
Tobacco Radiation therapy asbestor radon metals (arsenic, chronium, nickel) ionizing radiation (environment) polycylic aromatic hydrocarbons
what lung condition is a risk factor for lung CA
pulmonary fibrosis
infection that is a risk for lung cancer
HIV infection
are CXRs, sputum cytology useful for lung cancer screening?
No
what may be useful for screening for lung cancer?
low dose CT scan in high risk populations
most common type of lung cancer
adenocarcinoma (including bronchioalveolar carcinoma)
where are small cell lung cancers typically
closer to hilum and mediastinum
where are adenocarcinomas typically?
peripheral
what does the prefix adeno mean?
gland formation
so the cancer lines the glands
Lung cancer that form keratin globules
squamous cell carcinoma
symptoms of lung CA
cough hemoptysis chest pain SOB hoarseness pleural involvement
what does SVC look like (due to an SVC obstruction)
purple look to face
variscosities on the chest
Type of lung tumor that presents in the apex of the lung. Right against the nerve plexus. Present with extreme shoulder and arm pain + numbness
Pancoast tumor
where does lung cancer often metastasize to?
Brain
Liver
Bone
Adrenal (rarely symptomatic)
with small cell lung cancer where is there common radiation?
Brain
what causes hypercalcemia with lung cancer?
PTHrP or bone mets
what type of lung cancer can cause SIADH
Small cell lung cancer
syndrome that looks like Myasthenia Gravis, associated w/ lung cancer (parneoplastic syndrome)
Lambert-Eaton myasthenic syndrome (LEMS)
Tx for small cell lung cancer, is limited (within the thoracic cavity) but unresectable
Chemo/ XRT
tx for small cell lung cancer that is advanced
chemo for palliation.
is the TNM system used for small cell lung cancer?
No
Tx for non small cell lung cancer
Sx, chemo, radiation depending on stage
what type of lung cancer may respond to anti-EGFR therapies?
non squamous non small cell carcinoma
what is a drug that women +/- Asians who have non squamous, non small cell carcinoma may respond to
Erlotinib
how do most breast cancer begin
Intraductally
protective factors for breast cancer
breast feeding
multi parity
who should get CA-125 screening for ovarian cancer?
BRCA
what is Eczematous lesion of the skin of the nipple
paget’s disease
is breast pain common with breast cancer?
No, only <10%
after 5 years does ER positive breast cancer risk go away?
No
Are ER positive or ER negative breast cancers more aggressive?
ER negative
medication for Her-2 positive breast cancer
Herceptin
what is the most common non-skin cancer in men?
prostate cancer
what ethnicity has a increased incidence w/ prostate cancer?
African American
what increases risk of prostate cancer
altered estrogen and androgen metabolite
prostatic intraepithelial neoplasia (PIN)
high fat diet
what occupational exposures put people at a higher risk of prostate cancer
Cadmium Loggers
Chemists Textile Workers
Painters Farmers
when should men have a yearly DRE?
> 50 (high risk <40)
S/S of prostate cancer
hesitancy dribbling urgency poor urine stream nocturia back pain terminal hematuria
what PSA level indicates a low risk?
<10
what score measures the pathologic agressiveness of prostate cancer?
Gleason score (<6 low risk)
Tx for early prostate cancer?
radical prostatectomy external beam radiation therapy brachytherapy (seeds of RT) cryotherapy androgren derivation therapy (ADT)
Tx of advanced prostate cancer
standard chemo taxane + steroid
Abiraterone
Enzalutimide
where are ok sites for prostate ca mets?
bone and lymph nodes
where do you not want to see mets w/ prostate ca
liver and lungs
What are S/S of androgen deficiency in adult males
gynecomastia
osteoporosis
>fat
hot flashes
who has a higher risk of colon and rectal cancer?
lowest socioeconomic status
what is a major risk of colon cancer
age
screening for colorectal cancer
stool occult blood
colonoscopy
when should screening for colorectal cancer start
age 50
Tx for colon cancer stage I-III (no mets)
hemicolectomy
adjuvant chemo
if someone has rectal cancer what might they need before a hemicolectomy?
neoadjuvant chemo / XRT
what type cancer can tamoxifen cause?
endometrial cancer
what can cisplatin cause?
renal toxicity
ototoxicity
neurotoxicity
why can SIADH occur w/ cancer
excessive vasopressin produced by tumors
what inhibits effects of vasopressin
demeclocycline
causes of superior vena cava syndrome
lung cancer
lymphoma
thrombosis of central venous catheters
Presents As Facial Swelling, Dyspnea, Cough, Tracheal Obstruction
superior vena cava syndrome
tx for spinal cord compression
Radiation emergently reverses neuro
4-6mg IV or Po Dexamethasone Q4h
tx for febrile neutropenia
consider culture results but begin w broad spectrum ABX e.g. ceftazidime 1GM IV q 8h. Coverage should include Gram + & Gram – organisms
what types of lung cancer are more central?
squamous
small cell
