Oncology Flashcards
what is cancer
A disease in which abnormal cells divide without control and are able to invade other tissues; cancer cells can spread to other parts of the body through the blood and lymph systems
intrinsic factors
heredity, hormones, immunity, age
extrinsic factors
exposure to external, ingested, and/or inhaled substances
malignant
- rapid rate of growth
- invades surrounding tissue
- metastasizes via the bloodstream and lymphatic system
- usually poor cell differentiation
benign
- slow rate of growth
- expands in the same tissue
- does not spread
nearly normal cell differentiation
types of metastatic invasion
lymphatic, arteriovenous, serous cavity, CSF
most common types of cancer in Canada
Lung, breast, colorectal and prostate cancer
lung cancer accounts for __% of all new cancer cases
14%
breast cancer accounts for about __% of all new cancer cases in women
25%
colorectal cancer accounts for __% of all new cancer cases
13%
primary prevention
- Identify risk factors
- Healthy diet
- Moderate alcohol intake
- Sun safety
- Avoid known carcinogens (tobacco products, asbestos)
- Wear PPE when working with carcinogens
- Vaccines (HPV)
early detection uses the acronym
CAUTION
what does CAUTION stand for
Change in bowel or bladder habits
A sore that doesn’t heal
Unusual bleeding or discharge
Thickening of a lump in the breast or elsewhere
Indigestion or difficulty swallowing
Obvious changes in a wart or mole
Nagging cough or hoarseness
what is cancer staging
Describes the extent or severity of cancer based on the extent of spread in the body
why is staging important
- Estimates the patient’s prognosis
- Plan treatment
- Important in identifying clinical trials (research studies) that may be suitable for a particular patient
elements of staging
- Location of the primary tumor
- Tumor size & number of tumors
- Lymph node involvement
- Presence or absence of metastasis
what is the TNM system
- The extent of the tumor (T)
- The extent of spread to the lymph nodes (N)
- The presence of metastasis (M)
situ mean
Early cancer present only in the layer of cells in which it began
localized
Limited to the organ in which it began
regional
Spread beyond its primary site to nearby lymph nodes or organs and tissues
distant
Spread from primary site to distant organs or distant lymph nodes
stage 0
Carcinoma in situ
stage I, II, and III
Higher numbers indicate more extensive disease: larger tumor size and/or spread of the cancer beyond the organ in which it first developed to nearby lymph nodes and/or organs adjacent to the location of the primary tumor.
stage IV
The cancer has spread to other organs.
tumor grading
Is a system used to classify cancer cells in terms of how abnormal they look under a microscope and how quickly the tumor is likely to grow and spread
how is grade determined
- A biopsy is taken and then examined by a pathologist
- The pathologist determines whether the tumor is benign or malignant, and the tumor grade
Grade 1 tumor
mild dysplasia; well differentiated
Grade 2 tumor
moderate dysplasia; mod. differentiated
Grade 3 tumor
severe dysplasia; poorly differentiated
Grade 4 tumor
anaplasia; undifferentiated
how does tumor grade affect a pts options?
- A lower grade generally indicates a better prognosis
- Grading is a factor in developing a treatment plan
goals of treatment
- cure (eradicates the disease)
- control spread
- palliative (controls disease and distressing symptoms)
chemotherapy
Treatment with chemicals that disrupts the cell cycle and kills malignant cells
2 types of chemotherapy
(1) cell cycle phase non-specific
(2) cell cycle phase specific
goal of chemotherapy
to reduce number of cells
radiation
- Use of ionizing radiation to destroy cancer cells
- Breaks the chemical bonds in DNA, leading to damage of the cells
- Aims for non-clonogenic cells → cells cannot regenerate
- Skin reactions common S/E
general side effects of chemotherapy & radiation
- Fatigue
- Bone marrow suppression
skin side effects of chemotherapy & radiation
- Erythema
- Dry/moist desquamation
- Alopecia
brain side effects of chemotherapy & radiation
cerebral edema
mouth side effects of chemotherapy & radiation
- Mucositis
- Opportunistic infections
- Dry mouth
- Taste changes
- Dental decay
neck side effects of chemotherapy & radiation
- Pharyngitis
- Laryngitis
- Esophagitis
thorax side effects of chemotherapy & radiation
- Pneumonia
- Pulmonary toxicity
abdomen and pelvis side effects of chemotherapy & radiation
- N&V
- Diarrhea
- Cystitis (hemorrhagic)
- Altered sexual dysfunction
- Infertility
- Premature menopause
two types of lung cancer
- Non-small cell lung cancer (NSCLC)
- Small cell lung cancer (SCLC)
small cell lung cancer (SCLC)
- Small cell carcinoma
- Combined small cell carcinoma
non-small cell lung cancer (NSCLC)
- Squamous cell carcinoma
- Adenocarcinoma
- Large cell undifferentiated carcinoma
squamous cell carcinoma
- almost always caused by cigarrete smoking , common in men
- 30% of lung cancers, arises in bronchial epithelium
- does not commonly metastasize
- surgical resection common
adenocarcinoma
- associated with lung scarring and fibrosis (not related to smoking)
- 40% of lung cancers, usually women, arises in peripheral portion of lungs
- usually no manifestations until widespread
- surgical resection common, does not respond to chemo well
large cell undifferentiated carcinoma
- associated with cigarette smoking and environmental carcinogens
- 10% of lung cancers, highly metastatic, commonly peripheral
- surgery not usually attempted due to high rate of metastases
small cell anaplastic undifferentiated
- associated with cigarette smoking and environmental carcinogens
- 20-25% of lung cancers, commonly central
- most malignant form/poor
prognosis* - spreads via lymphatic system and bloodstream
- chemotherapy and adjuvant radiation therapy
- average median survival is 12-18 months
signs and symptoms of lung cancer
- Recurrent pneumonia and/or bronchitis
- Persistent cough +/- sputum
- Blood tinged sputum (hemoptysis)
- Persistent mild to severe localized chest pain
- Dyspnea and wheezing if bronchial obstruction
- Hoarseness
later manifestations of lung cancer
- Pleural effusion
- Bone pain
- Dysphagia
- Neurological changes (weakness; headaches; numbness in a limb; dizziness; seizures
treatment of lung cancer
- Surgical (pneumonectomy; lobectomy; segment or wedge resection; laser)
- Chemotherapy
- Radiation
- Targeted therapies (for some types of NSCLC)
- Liessa (gefetinib)
- Tarceva (erlotinib) - Photodynamic therapy
oncological emergencies
spinal cord compression, superior vena cava syndrome, leukostasis
spinal cord compression
- Metastatic disease in the vertebral column, most commonly at the level of C5 - C6
- Can result in permanent neurological damage
Clinical manifestations of spinal cord compression
Pain, motor weakness, sensory impairment
diagnosis of spinal cord compression
MRI
treatment of spinal cord compression
surgery, chemotherapy, radiation and drugs (corticosteroids)
superior vena cava (SVC) syndrome
- Obstruction of the SVC through development of a thrombosis; tumor invasion of the SVC; external compression of the SVC by a tumor
- Malignant disease of the thorax most common
- venous enlargement d/t venous drainage in the upper trunk
clinical manifestations superior vena cava syndrome
- speed at which the obstruction develops
- degree of blood flow obstruction
treatment for superior vena cava syndrome
depends on the cause of the obstruction
leukostasis
- Partial or complete obstruction of blood flow d/t ↑↑ numbers of circulating leukocytes
- Increased blood viscosity & aggregation→ slower blood flow through capillaries → impaired capillary circulation and end-organ damage (brain & lungs)
clinical manifestations of leukostasis
neurological, pulmonary, kidney, heart
