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Z Clinical Medicine - Midterm > Neoplastic Disorders > Flashcards

Neoplastic Disorders Flashcards

1
Q

Cancer

  • mortality
  • risk factors
A

2nd leading cause of death USA (25%)

Most significant = age (2/3 are >65 yo)
Overall, men have 44% risk in lifetime, women 38%

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2
Q

Cancer

  • top incidence (3)
  • top death
A

Breast/prostate
Lung
Colorectal

Lung

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3
Q

Cancer

  • diagnosis
  • staging
  • treatment planning
A

Invasive tissue biopsy

Determine extent of disease

Consider prognosis, pt wishes
Determine curative or palliative
Multiple members of healthcare team

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4
Q

Lung Cancer

  • define
  • prevalence
A

Tumors arising from respiratory epithelium

Rare before 1900, epidemic since mid-20th century
Most common cause of cancer death in USA
Uncommon before age 40

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5
Q

Lung Cancer

  • major risk factor
  • genetic factor?
A

Cigarette smoking

  • 10x or more risk vs non-smokers
  • one genetic mutation per 15 cigarettes smoked
  • 1/5 females and 1/12 males who get it never smoked

Inherited predisposition is a factor

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6
Q

Lung Cancer
-pathophysiology
—4 major types in 2 different categories

A

Small-cell lung cancer (SCLC)

Non-small-cell lung cancer (NSCLC)

  • adenocarcinoma
  • squamous cell carcinoma
  • large-cell carcinoma
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7
Q

Lung Cancer

-common symptoms (5)

A 
Cough
Weight loss
Dyspnea
Chest pain
Hemoptysis
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8
Q 
Lung Cancer
-diagnosis, staging
—diagnosis (3)
—at time of diagnosis
—staging - 2 parts
A

Tissue sampling required to confirm
Biopsy
Sputum cytology (lower yield)

Most have locally advanced or metastatic disease

Anatomic - location
Physiologic - pt’s ability to withstand treatments

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9
Q

Lung Cancer
-treatment
—commonly employed (3)
—newer options (2)

A

Surgical resection, radiotherapy, chemotherapy

Targeted treatments, immunotherapy

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10
Q

Lung Cancer

-OD implications (2)

A

Choroidal metastases
-overall most common primary tumor
—in women breast > lung

Horner’s syndrome
-NSCLC is most common for pancoast tumor

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11
Q

Breast Cancer

  • define
  • prevalence
A

Malignant proliferation of epithelial cells

Most common type of cancer in women (~1/3)

Rarely men (females 150:1 males)

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12
Q

Breast Cancer

-risk factors

A

Age
-75% >50 y.o.

Hormone-dependent (lifetime exposure/buildup)

  • much less likely in those w/o functioning ovaries or experience early menopause w/o HRT
  • oral contraceptives incr risk slightly - more than offset by protective effects against ovarian/endometrial
  • HRT incr risk for breast cancer, CV events - but also decr osteoporosis and colorectal cancer
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13
Q

Breast Cancer

-screening, diagnosis, staging

A

Mommography reduces mortality

Biopsy required for diagnosis - fine-needle aspiration

Correct staging extremely important - therapeutic decision making

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14
Q

Breast Cancer
-treatment
—primary
—systemic

A

Surgical, radiation

Systemic to cover any micro-metastases not seen yet
Chemotherapy, endocrine therapy, anti-HER2 therapy

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15
Q

Breast Cancer

-OD implications (2)

A

Choroidal metastases - breast most common in women

Tamoxifen = endocrine therapy

  • dry eye
  • corneal deposits
  • cataract
  • retinopathy - CME
  • optic neuropathy
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16
Q

Paraneoplastic Syndromes

  • define
  • example
A

Disorders that accompany benign or malignant tumors, but are not directly related to mass effects or invasion

Hypercalcemia from ectopic production of a hormone similar to PTH that binds to PTH receptors

17
Q 
Paraneoplastic Syndromes
-Cancer Associated Retinopathy (CAR)
—define
—most common associated cancers (3)
—pathophysiology
A

Retinal degeneration due to antibodies directed tumor tissue that cross-react with retinal tissue antigens

SCLC, breast, gynecologic

Autoimmunity -> cell apoptosis/death -> retinal degeneration

18
Q

Paraneoplastic Syndromes
-Cancer Associated Retinopathy (CAR)
—signs/symptoms

A

Acute/subacute painless vision loss over weeks-months

  • often assoc w/ positive visual phenomena and photosensentivity
  • visual loss often precedes diagnosis

Usually bilateral

Fundus can initially be normal

Progression -> RPE thinning, mottling, arteriole attenuation, ON pallor

19
Q

Paraneoplastic Syndromes
-Cancer Associated Retinopathy (CAR)
—diagnosis

A

No set diagnostic criteria

Symptoms + findings + dx of systemic cancer + positive Abs against retinal proteins
-Abs alone are not a diagnosis

20
Q

Paraneoplastic Syndromes
-Cancer Associated Retinopathy (CAR)
—management
—vision prognosis

A

Main = long-term immunosuppression

May get mild-mod transient VA/VF improvement, but overall no significant long-lasting improvement

21
Q

Paraneoplastic Syndromes
-Melanoma Associated Retinopathy (MAR)
—difference from CAR
—Abs directed

A

Has vision changes after (vs before)

Toward retinal bipolar cell antigens

Z Clinical Medicine - Midterm (9 decks)

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