Onco - Approach to Patient with Cancer Flashcards by 18 22 | Brainscape

Q

Most significant risk factor for cancer overall

A

Age

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Q

2/3 of all CA cases were those in what age?

A

> 75 y.o.

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Q

Most common cause of cancer deaths

A

Lung CA

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Q

second most common cause of cancer deaths in females?

A

Breast cancer

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Q

second most common cause of cancer deaths in males?

A

colorectal

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Q

Arrange the following from most to least common cause of cancer deaths in males:

Colorectal, Prostate, Lung

A

Lung> colorectal> prostate

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Q

Arrange the following from most to least common cause of cancer deaths in females:

Colorectal, breast, Lung

A

Lung> breast> colorectal

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Q

Overall lifetime risk of developing cancer (men)

A

44%

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Q

Overall lifetime risk of developing cancer (women)

A

38%

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Q

Continents ranking on cancer cases:

Africa, Central/South America, Europe, North America, Australia/NewZealand, Asia

A

Asia > Europe > North America > Central/South America > Africa > Australia/New Zealand

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Q

Second most common cancer

A

Breast CA

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Q

Cancers more common in developed countries

A

Lung
Breast
Prostate
Colorectal

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Q

Cancers more common in developing countries

A

liver
cervical
esophageal

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Q

Most common cancers in Africa

A

Cervical
Breast
Liver

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Q

9 Modifiable risk factors responsible for 1/3 of cancers worldwide

A

SOAP FUCCS

Smoking
Obesity
Air Pollution
Physical inactivity
low Fruit and vegetable consumption
Unsafe Sex
Contaminated injection
Consumption of Alcohol
Smoke (indoor) from household fuels

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Q

Importance of Review of Systems in History taking for possible cancer patients

A

to catch symptoms of metastatic disease or a paraneoplastic syndrome

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Q

Cornerstone of cancer diagnosis. Diagnosis should never be made without this

A

Invasive tissue biopsy

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Q

T/F fine needle aspiration is acceptable diagnostic procedure for thyroid nodules

A

T

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Q

Molecular marker for Burkitt’s lymphoma

A

t(8;14) translocation

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Q

Best approach to management of cancer patient

A

Multidisciplinary Collaboration

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Q

First priority in patient management after diagnosis of cancer is established and shared with the patient

A

determine extent of disease

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Q

Relationship of curability of tumor with tumor burden

A

inversely proportional

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Q

T/F Ideally, tumor will be diagnosed before symptoms develop or as a consequence of screening efforts. A very high proprotion of such patients can be cured.

A

T

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Q

True of Cancer diagnosis EXCEPT

a. A patient with a metastatic disease process that is defined as cancer on biopsy may have no apparent primary site of disease
b. Particular attention should be focused on ruling out the most lethal cause
c. Both
d. Neither

A

B

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Q

Major determinants of treatment outcome in cancer patients

A

Performance status

Staging

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Q

Give four importance of cancer staging

A

determines optimal treatment plan
Helps to evaluate prognosis
helps to determine effectivity of treatment plan
Provides a standardized description of disease extent

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Q

Karnofsky Performance index

Normal activity with effort, some signs or symptoms of the disease

A

80

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Q

Karnofsky Performance index

Requires considerable assistance and frequent medical care

A

50

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Q

Dead

A

0

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Q

Performance status scales (ECOG)

Normal activity

A

0

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Q

Performance status scales (ECOG)

Symptomatic but ambulatory

A

1

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Q

Performance status scales (ECOG)

Dead

A

5

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Q

Performance status scales (ECOG)

In bed >50% of the time

A

3

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Q

Performance status scales (ECOG)

Bed ridden

A

4

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Q

Performance status scales (ECOG)

in bed <50% of the time

A

2

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Q

Staging based on PE, Radiographs, isotopic scans, CT scans, other imaging

A

Clinical Staging

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Q

Staging based on information obtained via intraoperative palpation, resection of regional lymph nnodes and / or tissue adjacent to the tumor, and inspection and biopsy of organs commonly involved in disease spread.

A

Pathologic Staging

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Q

International federation of gynecologists and obstetricians classification: gynecologic CA :: __________: colorectal CA

A

Dukes classifcation

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Q

Dukes classification: colorectal CA :: _________ : Hodgkin’s disease

A

Ann Arbor classification

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Q

Meaning of ECOG

A

Eastern cooperative oncology group

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Q

Karnofsky performance status with poor prognosis

A

<70

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Q

ECOG performance status with poor prognosis

A

> =3

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Q

T/F

Morphology is capable of discerning certain distinct subsets of patients whose tumors have different set of abnormalities

A

F; not capable

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Q

T/F

tumors that look quite different from one another histologically can share genetic lesions that preduct responses to treatments

A

T

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Q

most common side effects of cancer treatment (3-4)

A

nausea and vomiting, febrile neutropenia, myelosuppresion

Q

T/F treatment induced toxicity is quite acceptable if the goal of therapy is palliation

A

F; less acceptable

Q

T/F new symtpoms developing the the course or cancer treatment should not be assumed to be reversible

A

F; it should always be assumed reversible until proven otherwise

Q

three symptoms of reversible intercurrent cholecyistits

A

anorexia
weight loss
jaundice

Q

What should be done if a patient on cancer treatment develops CNS symptoms that look like metastatic disease or may mimic paraneoplastic syndromes

A

pursue a definitive diagnosis; may require repeat biopsy

Q

Cancer treatment response

> 50% reduction in the sum of the products of the perpendicular diameters of all measurable lesions

A

Partial Response

Q

Definition of complete response to cancer treatment

A

disappearance of all evidence of the disease

Q

Cancer treatment response

appearance of any new lesion or an increase in >25% in the sum of the products of the perpendicular diameters of all measurable lesions.

A

Progressive disease

Q

Tumor shrinkage or growth that does not meet any criteria for other 3 responses

A

Stable disease

Q

Cancer treatment response

RECIST definition of progressive disease

A

increase of 20% in the sums of the longest diameters by RECIST

Q

Site of involvement that are considered unmeasurable

A

bone

Q

Pattern of involvement conisdered unmeasurable

A

lymphangitic lung

diffuse pulmonary infiltrates

Q

No respoonse is complete without ____ documentation

A

biopsy

Q

T/F biopsy is not needed to evaluate partial responses especially if there is clear objective progression

A

T

Q

Definition of minimal residual disease negativity

A

If flow cytometric assay/ genetic assay do not determine the presence of residual tumor cells (thechniques can reliably detect as few as 1 tumor cell among 10,000 cells)

Q

Incidence of depression in cancer patients

A

25%

Q

Two major symptoms of depression

A

dysphoria (depressed mood)

anhedonia (loss of interest in pleasure)

Q

Minor symptoms of depression

A

appetite change
sleep problems
psychomotor retardation or agitation
fatigue
feelings of guilt or worthlessness
inability to concentrate
suicidal ideation

Q

2 main drug classes for medical therapy of depression

A

Serotonin reuptake inhibitor

2. TCA

Q

Examples of SRI for depression in cancer

A

paroxetine
sertraline
fluoxetine

Q

Examples of TCA for depression in cancer

A

amitriptyline

desipramine

Q

Response should be expected in antidepressant therapy within

A

4-6 weeks

Q

Minimum duration of antidepressant medication

A

6 months after resolution of symptoms

Q

Frequency of follow up during the first year of completion of treatment, and being disease free

A

monthly

Q

Frequency of follow up during the third year of completion of treatment, and being disease free

A

every other month

Q

Frequency of follow up during the 5th year of completion of treatment, and being disease free

A

every 6 months

Q

Major investigation performed during follow up after cancer patients become disease free

A

history and physical exam

Q

% of patients in pain with progressive disease

A

75%

Q

Major concerns of supportive care (7)

A

PPENNED

Pain
Psychosocial support
Effusions
Nutrition
Nausea
End of Life Decisions
Death and Dying

Q

% of pain in cancer patients that is caused by the tumor itself

A

70%

Q

% of patients that will have pain relief from pharmacologic intervention

A

85%

Q

Three forms of emesis

A

Acute emesis
Delayed emesis
Anticipatory emesis

Q

most common variety of emesis

A

acute emesis

Q

When does acute emesis occur?

A

within 24 hrs of tx

Q

when does delayed emesis occur?

A

1-7 days after treatment

Q

When does anticipatory emesis occur?

A

Before administration of chemotherapy drug

Q

Where is the vomiting center located

A

medulla

Q

Emesis related to bowel inflammation from chemotherapy

A

Delayed emesis

Q

T/F

Anti emetic agents should be given just as chemotherapy is given

A

False, before

Q

Antiemetic and dosage given for mild to moderate emitogenic agents, to prevent acute emesis

A

prochloperazine 5-10 mg PO or

25 mg PR

Q

Drug given to enhance efficacy of prochlorperazine

A

Dexamethasone 10-20mg IV

Q

Give 4 highly emitogenic chemotherapy drugs

A

Cisplatin
Mechlorethamine
Dacarbazine
Streptozocin

Q

Drug for highly emitogenic chemotherapeutic drugs

A

Ondansetron 8mg PO every 6h

Q

Timing of Ondansentron 8mg PO every 6h for acute emesis

A

6-24 h before treatment

Q

T/F Emesis is easier to prevent than to alleviate

A

T

Q

Best strategy for preventing anticipatory emesis

A

control emesis in the early cycles of therapy

Q

True about effusions EXCEPT

a. fluid may accumulate in the pleural cavity, pericardium, or peritoneum
b. Asymptomatic malignant effusions require tx
c. Symptomatic effusions occuring in tumors responsive to systemic therapy usually do not require local treatment
d. symptomatic effusions occuring in tumors unresponsive to systemic therapy may require local tx in all patients
e. B and D
f. C and D

A

E

Q

most common cancers causing pleural effusion

A

Lung Cancer
Breast Cancer
Lymphoma

Q

Effusion/serum protein ratio for pleural effusion

A

> =0.50

Q

Effusion/serum LDH ration

A

=>0.60

Q

Initial management for symptomatic pleural effusion in cancer

A

Thoracentesis

Q

When will chest tube drainage be done in pleural effusion in cancer?

A

if symptoms recur within 2 weeks after thoracentesis

Q

In chest tube drainage, fluid is aspirated until the flow rate is

A

<100mL in 24h

Q

When will chest tube be pulled out?

A

if <100mL drains over the next 24h

Q

What is done after chest tube is removed?

A

radiograph is taken 24 h later

Q

Tumor derived factors causing altered metabolism in cancer patients

A

bombesin

adrenocorticotropic hormone

Q

Host derived factors causing altered metabolism in cancer patients

A

TNF
IL1
IL6
GH

Q

Threshold for nutritional intervention

% unexplained body weight loss

A

<10%

Q

Threshold for nutritional intervention

serum transferrin level

A

<1500 mg/L (150 mg/dL)

Q

Threshold for nutritional intervention

serum albumin

A

<34 g/L (3.4g/dL)

Q

Progestational agent advocated as pharmacologic intervention to improve nutritional status

A

Megestrol acetate

Q

Most pervasive and threatening concern for cancer patients

A

fear of relapse

Q

what is Damocles sydrome

A

fear of relapse

Q

Most common causes of death in patients with cancer (4)

A

infection
respiratory failure
hepatic failure
renal failure

Q

% of patients with dyspnea preterminally

A

70%

Q

Three phases of unsuccessful cancer treatment

A

optimism
tumor recurs: hope to live with disease
imminent death: adjustment

Q

fatiuge, disengagement from patients and colleagues and a loss of self fulfillment in attending physician of cancer patient

A

burnout syndrome