Onco - Approach to Patient with Cancer Flashcards
1
Q
Most significant risk factor for cancer overall
A
Age
2
Q
2/3 of all CA cases were those in what age?
A
> 75 y.o.
3
Q
Most common cause of cancer deaths
A
Lung CA
4
Q
second most common cause of cancer deaths in females?
A
Breast cancer
5
Q
second most common cause of cancer deaths in males?
A
colorectal
6
Q
Arrange the following from most to least common cause of cancer deaths in males:
Colorectal, Prostate, Lung
A
Lung> colorectal> prostate
7
Q
Arrange the following from most to least common cause of cancer deaths in females:
Colorectal, breast, Lung
A
Lung> breast> colorectal
8
Q
Overall lifetime risk of developing cancer (men)
A
44%
9
Q
Overall lifetime risk of developing cancer (women)
A
38%
10
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
11
Q
Second most common cancer
A
Breast CA
12
Q
Cancers more common in developed countries
A
Lung
Breast
Prostate
Colorectal
13
Q
Cancers more common in developing countries
A
liver
cervical
esophageal
14
Q
Most common cancers in Africa
A
Cervical
Breast
Liver
15
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
16
Q
Importance of Review of Systems in History taking for possible cancer patients
A
to catch symptoms of metastatic disease or a paraneoplastic syndrome
17
Q
Cornerstone of cancer diagnosis. Diagnosis should never be made without this
A
Invasive tissue biopsy
18
Q
T/F fine needle aspiration is acceptable diagnostic procedure for thyroid nodules
A
T
19
Q
Molecular marker for Burkitt’s lymphoma
A
t(8;14) translocation
20
Q
Best approach to management of cancer patient
A
Multidisciplinary Collaboration
21
Q
First priority in patient management after diagnosis of cancer is established and shared with the patient
A
determine extent of disease
22
Q
Relationship of curability of tumor with tumor burden
A
inversely proportional
23
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
24
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
25
Major determinants of treatment outcome in cancer patients
Performance status
| Staging
26
Give four importance of cancer staging
1. determines optimal treatment plan
2. Helps to evaluate prognosis
3. helps to determine effectivity of treatment plan
4. Provides a standardized description of disease extent
27
Karnofsky Performance index
Normal activity with effort, some signs or symptoms of the disease
80
28
Karnofsky Performance index
Requires considerable assistance and frequent medical care
50
29
Dead
0
30
Performance status scales (ECOG)
| Normal activity
0
31
Performance status scales (ECOG)
| Symptomatic but ambulatory
1
32
Performance status scales (ECOG)
| Dead
5
33
Performance status scales (ECOG)
| In bed >50% of the time
3
34
Performance status scales (ECOG)
| Bed ridden
4
35
Performance status scales (ECOG)
| in bed <50% of the time
2
36
Staging based on PE, Radiographs, isotopic scans, CT scans, other imaging
Clinical Staging
37
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.
Pathologic Staging
38
International federation of gynecologists and obstetricians classification: gynecologic CA :: __________: colorectal CA
Dukes classifcation
39
Dukes classification: colorectal CA :: _________ : Hodgkin's disease
Ann Arbor classification
40
Meaning of ECOG
Eastern cooperative oncology group
41
Karnofsky performance status with poor prognosis
<70
42
ECOG performance status with poor prognosis
>=3
43
T/F
Morphology is capable of discerning certain distinct subsets of patients whose tumors have different set of abnormalities
F; not capable
44
T/F
tumors that look quite different from one another histologically can share genetic lesions that preduct responses to treatments
T
45
most common side effects of cancer treatment (3-4)
nausea and vomiting, febrile neutropenia, myelosuppresion
46
T/F treatment induced toxicity is quite acceptable if the goal of therapy is palliation
F; less acceptable
47
T/F new symtpoms developing the the course or cancer treatment should not be assumed to be reversible
F; it should always be assumed reversible until proven otherwise
48
three symptoms of reversible intercurrent cholecyistits
anorexia
weight loss
jaundice
49
What should be done if a patient on cancer treatment develops CNS symptoms that look like metastatic disease or may mimic paraneoplastic syndromes
pursue a definitive diagnosis; may require repeat biopsy
50
Cancer treatment response
>50% reduction in the sum of the products of the perpendicular diameters of all measurable lesions
Partial Response
51
Definition of complete response to cancer treatment
disappearance of all evidence of the disease
52
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.
Progressive disease
53
Tumor shrinkage or growth that does not meet any criteria for other 3 responses
Stable disease
54
Cancer treatment response
RECIST definition of progressive disease
increase of 20% in the sums of the longest diameters by RECIST
55
Site of involvement that are considered unmeasurable
bone
56
Pattern of involvement conisdered unmeasurable
lymphangitic lung
| diffuse pulmonary infiltrates
57
No respoonse is complete without ____ documentation
biopsy
58
T/F biopsy is not needed to evaluate partial responses especially if there is clear objective progression
T
59
Definition of minimal residual disease negativity
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)
60
Incidence of depression in cancer patients
25%
61
Two major symptoms of depression
dysphoria (depressed mood)
| anhedonia (loss of interest in pleasure)
62
Minor symptoms of depression
```
appetite change
sleep problems
psychomotor retardation or agitation
fatigue
feelings of guilt or worthlessness
inability to concentrate
suicidal ideation
```
63
2 main drug classes for medical therapy of depression
1. Serotonin reuptake inhibitor
| 2. TCA
64
Examples of SRI for depression in cancer
paroxetine
sertraline
fluoxetine
65
Examples of TCA for depression in cancer
amitriptyline
| desipramine
66
Response should be expected in antidepressant therapy within
4-6 weeks
67
Minimum duration of antidepressant medication
6 months after resolution of symptoms
68
Frequency of follow up during the first year of completion of treatment, and being disease free
monthly
69
Frequency of follow up during the third year of completion of treatment, and being disease free
every other month
70
Frequency of follow up during the 5th year of completion of treatment, and being disease free
every 6 months
71
Major investigation performed during follow up after cancer patients become disease free
history and physical exam
72
% of patients in pain with progressive disease
75%
73
Major concerns of supportive care (7)
PPENNED
```
Pain
Psychosocial support
Effusions
Nutrition
Nausea
End of Life Decisions
Death and Dying
```
74
% of pain in cancer patients that is caused by the tumor itself
70%
75
% of patients that will have pain relief from pharmacologic intervention
85%
76
Three forms of emesis
Acute emesis
Delayed emesis
Anticipatory emesis
77
most common variety of emesis
acute emesis
78
When does acute emesis occur?
within 24 hrs of tx
79
when does delayed emesis occur?
1-7 days after treatment
80
When does anticipatory emesis occur?
Before administration of chemotherapy drug
81
Where is the vomiting center located
medulla
82
Emesis related to bowel inflammation from chemotherapy
Delayed emesis
83
T/F
Anti emetic agents should be given just as chemotherapy is given
False, before
84
Antiemetic and dosage given for mild to moderate emitogenic agents, to prevent acute emesis
prochloperazine 5-10 mg PO or
| 25 mg PR
85
Drug given to enhance efficacy of prochlorperazine
Dexamethasone 10-20mg IV
86
Give 4 highly emitogenic chemotherapy drugs
1. Cisplatin
2. Mechlorethamine
3. Dacarbazine
4. Streptozocin
87
Drug for highly emitogenic chemotherapeutic drugs
Ondansetron 8mg PO every 6h
88
Timing of Ondansentron 8mg PO every 6h for acute emesis
6-24 h before treatment
89
T/F Emesis is easier to prevent than to alleviate
T
90
Best strategy for preventing anticipatory emesis
control emesis in the early cycles of therapy
91
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
E
92
most common cancers causing pleural effusion
Lung Cancer
Breast Cancer
Lymphoma
93
Effusion/serum protein ratio for pleural effusion
>=0.50
94
Effusion/serum LDH ration
=>0.60
95
Initial management for symptomatic pleural effusion in cancer
Thoracentesis
96
When will chest tube drainage be done in pleural effusion in cancer?
if symptoms recur within 2 weeks after thoracentesis
97
In chest tube drainage, fluid is aspirated until the flow rate is
<100mL in 24h
98
When will chest tube be pulled out?
if <100mL drains over the next 24h
99
What is done after chest tube is removed?
radiograph is taken 24 h later
100
Tumor derived factors causing altered metabolism in cancer patients
bombesin
| adrenocorticotropic hormone
101
Host derived factors causing altered metabolism in cancer patients
TNF
IL1
IL6
GH
102
Threshold for nutritional intervention
% unexplained body weight loss
<10%
103
Threshold for nutritional intervention
serum transferrin level
<1500 mg/L (150 mg/dL)
104
Threshold for nutritional intervention
serum albumin
<34 g/L (3.4g/dL)
105
Progestational agent advocated as pharmacologic intervention to improve nutritional status
Megestrol acetate
106
Most pervasive and threatening concern for cancer patients
fear of relapse
107
what is Damocles sydrome
fear of relapse
108
Most common causes of death in patients with cancer (4)
infection
respiratory failure
hepatic failure
renal failure
109
% of patients with dyspnea preterminally
70%
110
Three phases of unsuccessful cancer treatment
1. optimism
2. tumor recurs: hope to live with disease
2. imminent death: adjustment
111
fatiuge, disengagement from patients and colleagues and a loss of self fulfillment in attending physician of cancer patient
burnout syndrome
