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Clinical medicine A > Intro to Onc part 1 (brendans) > Flashcards

Intro to Onc part 1 (brendans) Flashcards

1
Q

What are characteristics of normal cells?

A

Small, uniformly shaped nuclei
Large cytoplasmic volume
Conformity in cell size, shape, arrangement
Differentiated cell structures, normal cell surface markers
Lower levels of dividing cells
Clear boundaries

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2
Q

What are characteristics of cancer cells?

A

Large, variable shaped nuclei
Small cytoplasmic volume
Variation in size, shape, arrangement
Loss of specialized features
Increased expression of certain cell markers
Large number of dividing cells
Poorly defined tumor boundaries

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3
Q

How many deaths in the US are caused by cancer?

A

1 in 4

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4
Q

What is the second leading cause of death in the US? Whats the first?

A

Cancer

CVD (first leading cause)

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5
Q

how many americans will be diagnosed with cancer in their lifetime?

A

40%

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6
Q

What are the 4 most common cancers?

A

Lung
Colon
Breast
Prostate

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7
Q

What are the current treatment techniques for cancer?

A

Surgery
Radiation therapy
Chemotherapy
Biologic therapy

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8
Q

What ethnicity are cancers the most deadly for?

A

African Americans

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9
Q

What is the most significant risk factor for cancer?

A

Age
2/3 of all cases occur in those older than 65

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10
Q

are men or women more likely to develop cancer in their lifetime?

A

Men
men are 44% risk of developing cancer in their lifetime
women are 38% risk.

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11
Q

What are the burdens of cancer? (4)

A

Cost of Cancer
Physical morality
Emotional distress
Reduction in QoL

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12
Q

What are some factors that makes a person susceptible to cancer?

A

Exposure to a certain environmental factor (how long and often, also including diet and hormones)
Genetic makeup
Age and gender

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13
Q

Improved understanding of carcinogenesis has allowed for what?

A

Specific interventions (reducing mortality by preventing cancer in high risk patients)
Effective screening (for early detection and treatment of cancer)

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14
Q

What do we concern with for cancer prevention?

A

Identification and manipulation of…
Biologic factors
Environmental factors
Social factors
Genetic factors

all of which play a role in cancer developement

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15
Q

What is the focus of primary prevention?

A

Prevent a cancer from developing
Delay the development on a malignancy

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16
Q

What does primary prevention usually consist of

A

Health promotion and addressing risk factors. Social and genetic factors.

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17
Q

If an individual has a high risk for cancer, what are the primary prevention methods?

A

May include the use of:

Chemopreventive agents
Prophylactic surgery

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18
Q

What is the most preventable cause of cancer death?

A

Tobacco

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19
Q

How many cancer deaths are due to tobacco?

A

30%

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20
Q

What is the most linked cancer with smokers?

A

Lung cancer

> 80% of lung cancer cases

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21
Q

what about smokers is correlated with their risk of lung cancers

A

the number of cigarettes smoked per day and the level of inhalation of cigarette smoke

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22
Q

Are low-tar cigarettes safer than regular cigarettes? why or why not?

A

no, because smokers tend to inhale them more frequently and deeply

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23
Q

How can smokers harm other people?

A

Secondhand or passive smoke that causes lung cancer and other cardiopulmonary diseases in non smokers

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24
Q

Smoking 1 or 2 cigars increases what the risk of what cancers? What about 3 or 4 cigars?

A

1 to 2 cigars a day have 2x risk of oral and esophageal cancers
3 to 4 cigars a day have 8x risk of oral and esophageal cancers

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25
Q

What health problems are smokeless tobacco linked with?

A

Dental caries
Oral Leukoplakia
Gingivitis
Pancreatic cancer
Oral cancer
Esophageal cancer

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26
Q

What are some primary prevention methods?

A

Physical activity
Dietary modifications
Avoid alcohol

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27
Q

Physical activity reduces the risk of what cancers?

A

Colon and breast cancer

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28
Q

The risk of cancers increases with what BMI?

A

> 25

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29
Q

What cancers are linked to obesity?

A

Breast
Endometrium
Gallbladder
Liver
Pancreas
Ovary
Colon
Kidney
Esophagus
Thyroid

BEGLPOCKET

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30
Q

High fat diets have an increased of what cancers?

A

Breast
Colon
Prostate
Endometrium

Weight gain which increase risk of cancers

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31
Q

What are the benefits of dietary fiber in relation to cancer?

A

Reduced risk of colonic polyps
Invasive cancer of colon

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32
Q

Clinical pearls for fat in diet in relation to cancer prevention

A

limit fat from red meat or processed meat
make plant foods the focus
high fat diets = weight gain = obesity = cancer

33
Q

How is fiber correlated with cancer

A

dietary fiber is associated with a reduced risk of colonic polyps and invasive cancer of the colon.

34
Q

Alcohol consumption increase the risk of what cancers?

A

Mouth
Throat
Liver
Voice box
Esophagus
Stomach
Breast

35
Q

What is secondary prevention? What does it consist of?

A

Early detection and treatment of subclinical, asymptomatic or early diseases in individuals without obvious signs or symptoms of cancer

this consists of identifying people at risk for cancer and implementing appropriate screening recommendations based on the risk assessment.

36
Q

What are some screenings for secondary prevention?

A

Physical examinations
Self-examinations
Radiologic procedures
Lab tests

37
Q

What does screening mean?

A

Early detection in asymptomatic individuals with the goal of decreasing morbidity and mortality

38
Q

What are the components of screening tests?

A

Sensitivity
Specificity
Positive predictive value
Negative predictive value

39
Q

What is sensitivity?

A

Proportion of persons with the disease who test positive in the screen

40
Q

What is specificity?

A

Proportion of persons who do not have the disease that test negative in the screening test

41
Q

What is a positive predictive value?

A

Proportion of persons who test positive that actually have the disease

42
Q

What is a negative predictive value?

A

Proportion testing negative that do not have the disease

43
Q

What cancers screenings are more beneficial for certain age groups?

A

Cervical
Colon
Prostate
Breast

lung depending on age and smoking hx

44
Q

When and what screening tools should be used to find breast cancer?

A

Starting at age of 40 for women
CBE no longer recommended for women of average-risk
Breast self-exam(BSE) option for women in 20s
MRI for women with higher risk (genetics, family hx)

45
Q

When and what screening tools should be used to find colorectal cancer and polyps?

A

Both men and women at 45 should follow ONE of these testing schedules:

Tests for finding polyps and cancer:
Flexible sigmoidoscopy every 5 years
Colonoscopy every 10 years
Double-contrast barium enema every 5 years
CT colonography (virtual colonoscopy) every 5 years

Specifically for finding only cancer:
Yearly fecal occult blood test (gFOBT)
Yearly fecal immunochemical test (FIT) every year
Stool DNA test (sDNA)

46
Q

When and what screening tools should be used to find cervical cancer?

A

Start at age 21
21-29 Pap test every 3 years
30-65 Pap test+HPV test (co-testing) every 5 years
65+ with normal results form regular testing should NOT be tested
Hx of cervical pre-cancer continue testing for at least 20 years, no matter the age

47
Q

What is “CAUTION” (warning signs of cancer)?

A

Change in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in the breasts, testicles or elsewhere
Indigestion or difficulty swallowing
Obvious change in the size, color, shape or thickness of a wart, mole, or mouth sore
Nagging cough or hoarseness

48
Q

What other findings would you find to suspect cancer?

A

Night sweats
Unexplained weight loss/loss of appetite
Repeat infection
Skin changes (hyperpigmentation, jaundice, erythema, itching, hirsutism)
Persistent low-grade fever
Chronic pain, especially in the bones
Persistant fatigue, N/V

49
Q

What test is HEAVILY relied on for diagnosing cancer?

A

Invasive tissue biopsy

50
Q

What does a tissue biopsy tell us?

A

Histology of tumor
Grade of tumor
Invasiveness/characteristics of tumor

51
Q

Once the diagnosis of cancer is made, the management of the patient is best undertaken in what way?

A

as a multidisciplinary collaboration

aka involving PCP, oncologists, surgeons, radiation oncologists,m pahramasictis, social workers, rehab specialists, counselors, psychiatrists ect.

52
Q

What is staging? Purpose?

A

Determining the extent of disease

Help determine prognosis and best treatment plan

53
Q

What is monitoring?

A

Detecting reappearance and progression of cancer

54
Q

Give the 6 steps of the individualized yet systematic approach that can help you feel more confident when communicating bad news to your patient.

A

Assess your pt’s understanding
Give a “warning shot”
Use words the pt/family can understand
Be quiet and listen
Provide additional information
Develop a plan for follow-up care

55
Q

what are 4 key points for delivering the news to a patient that they have cancer

A

be ACCURATE without destroying all hope
1. use the words “cancer” or “malignant”
2. avoid “fatal” or “terminal”
3. Discuss Prognosis
4. Support patient and family members

56
Q

what are the series of emotional states that cancer patients have been observed to pass through after their diagnosis? what is important to recognize about each of these?

A

denial
hostility
regression
withdrawal

important to recognize that such reactions are a psychological defense mechanism and you should respond in a patient, understanding manner.

57
Q

What is the rate of depression in cancer pts?

A

25%

58
Q

Depressed cancer patients are usually diagnosed with what?

A

Depressed mood(dysphoria)
Loss of interest in pleasure(anhedonia)

For at least two weeks

59
Q

WHat are the symptoms that depressed patients may have?

A

Appetite change
Sleep problems
Psychomotor retardation/agitation
Fatigue
Feelings of guilt or worthlessness
Inability to concentrate
Suicidal ideation

This is basically SIG E CAPS

60
Q

What is the treatment for depression?

A

SSRI (fluoxetine, sertraline, paroxetine)
TCA (amitriptyline, desipramine)
allow 4-6 weeks before expecting a response

Continued at least 6 more months after resolution

61
Q

What non medicational interventions are used to treat depression?

A

Support groups
Psychotherapy

62
Q

What are the types of staging?

A

Clinical staging
Pathologic staging

63
Q

What tests do you run in clinical staging?

A

Physical exams
Radiographs
Isotopic scans
CT scans
Other imaging procedures

64
Q

What information do you obtain to determine pathologic staging?

A

From surgical procedure…
Intraoperative palpation
Resection of regional lymph nodes or tissue adjacent to tumor
Inspection/biopsy of organ involved

65
Q

What terms are used to define the extend of disease?

A

Localized
Metastatic

66
Q

What is the difference between localized and metastatic

A

localized is spread to regional and close sites but not to distant sites

Metastatic is spread to distant sites

67
Q

What system of staging is most used?

A

TNM system (Tumor, node, metastasis)

68
Q

For lung cancer, after determining TNM system how do you group them?

A

Overall stage 0, I, II, III, IV

This process is called stage grouping.

69
Q

What is a physiological reserve?

A

Determinant of how likely to cope with the physiologic stresses imposed by cancer and its treatment

70
Q

What are some markers for physiological reserve?

A

Pt’s age
Karnofsky performance status
Eastern cooperative oncology group (ECOG) performance status

71
Q

what patients have poor prognosis unless poor performance is a reversible consequence of the tumor

A

older patients
those with a karnofsky performance status of<70
ECOG performance status equal to or >3

72
Q

LOOK AT THE KARNOFSKY TABLE ON 76 AND THE ECOG TABLE ON 77

A

okayyyyyyyyy

73
Q

What are treatment recommendations based on?

A

Extent of disease
Prognosis
Pt wishes

74
Q

What are the types of treatment?

A

Curative
Palliative

75
Q

What is the difference between partial or complete remission?

A

In complete remission all signs and symptoms of cancer have disappeared

76
Q

What are the treatment of a relapse known as?

A

“Salvage” therapy

77
Q

What is the goal of palliative care?

A

Improve QoL

NOT to cure

78
Q

What are the tumor markers best used for?

A

Used to assess response to a treatment

Clinical medicine A (32 decks)

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