Oncology Flashcards
What is the number two killer in the US?
Cancer
What is the number one killer in the US?
Heart disease
What is the number one cancer killer among both men and women?
Lung and bronchus cancer
What ethnicity is most likely to develop cancer?
African Americans
What percentage of men develop cancer?
50%
What is the highest probability of developing cancer in men?
Prostate cancer
What percentage of women develop cancer?
33%
What is important about cancer incidence in children?
Incidence is higher than the mortality rate
What are the two most common types of cancer in children?
Leukemia and brain cancer
Why do kids have a lower death rate than adults?
Tend to bounce back quicker
What can a sedentary lifestyle lead to?
Cancer
What can smoking lead to?
Heart disease and a higher risk for cancer
What can a high BMI lead to?
Cancer
What sex and ethnicity has the highest prevalence of sunburn?
Sex = males Ethnicity = Caucasians
What can sun exposure lead to?
Skin cancer
What is important about getting adequate fruits and vegetables?
Can prevent cancer, but prevalence of those getting actual daily amount needed is very low
What is cancer?
An abnormal growth of cells - cancer cells do not have normal triggers to stop dividing
What are three important characteristics of cancer?
- Lack of senescence
- Loss of contact inhibition
- Ability to divide without anchorage
How are tumors classified?
- Size of tumor
- Where tumor originated
- Cell type
- Location
- Degree of differentiation
- Benign vs. malignant
- Cellular characteristics
- Hormone production or sensitivity
What does the treatment of cancer depend on?
Morphology of the tumor
What are the different cell types of cancer?
Epithelial, connective, muscle, nerve, lymph, and hematopietic
Differentiate benign tumors vs malignant tumors.
Benign - does not spread
Malignant - spreads
What is a type of cell/cancer that is fed by a hormone and what is the effect?
Breast cels are fed by estrogen which can cause the cells to grow and get bigger
What are different treatment options for cancer?
- Do nothing
- Surgery
- Radiation
- Chemotherapy
- Biological therapy
- Hormonal therapy
What is an example of a slow growing cancer?
Prostate cancer
What is biological therapy?
Targeted therapy - creates antibodies that are specific to the tumor type
What is the main type of treatment for cancer?
Surgery
What are the functions of surgery regarding cancer?
Debulk tumor, remove precancerous lesions, control symptoms, and create a clean margin
What is a clean margin?
Goal of surgery in order to have an area of healthy tissue surrounding the tumor to ensure that all of the tumor was removed
What is radiation therapy?
Localized non-selective treatment to cancer (does not care that the skin it is going through is healthy)
What are the goals of radiation therapy?
Pain relief, prevention of fracture, and decrease tumor size
What is important about radiation therapy?
There are many types
What are the side effects of radiation therapy?
Fatigue, skin can become dry or reddened, decreased ROM, nausea, vomiting, infertility, etc
What is the medical term for radiation therapy?
XRT
What are the two types of chemotherapy and what do they target?
- Cell specific - targets a specific phase of the growth cycle
- Non-cell specific - does not target a specific phase
Are chemotherapy agents specific or non-specific?
Non-specific - does not target a specific cell, attacks the whole body
What are the side effects of chemotherapy?
Acute toxicity, specific organ toxicity, and long term complications
What is the goal of chemotherapy?
Maximize tumor kill while minimizing side effects, cure, slow progression, shrink tumor to ease surgical approach, and palliation
What are PT implications regarding chemotherapy drug classes?
PT’s should understand how the classes of drugs work and their main side effects
What are long term complications associated with chemotherapy?
Early onset cardiac issues, pulmonary fibrosis, learning disabilities, hearing loss, neuropathy (pain and balance), and secondary cancers
What types of cancers are sensitive to hormones?
Breast cancer, testicular cancer, and prostate cancer
What is the treatment for hormone sensitive cancers?
Hormone therapy - block receptors for hormone
What are side effects of hormone therapy?
Hormonal changes, hot flashes, edema, decreased bone density, sexual dysfunction, and some have an increased risk for blood clots
What is monoclonal antibodies (MAB’s)?
A cancer treatment that targets specific antigens or proteins on the surface of the cancer cells - helps the body recognize these cells as foreign
Describe the staging regarding cancer.
Staging according to size and mestastasis:
0 - pre-cancerous
1 - small tumor that has not spread
2,3 - intermediate size that has spread
4 - large tumor that has spread to a different area of the body
What is TNM?
T - tumor (# tells the size of the cancer)
N - node (spread to lymph, # tells how much and size)
M - mestastasis (spread, # tells how much and size)
What is the importance of developing a malignant tumor in the brain or spinal cord?
Chances are very low: <1%
What sex is more likely to develop a malignant brain or spinal cord tumor?
Males
What is the relationship between secondary tumors and brain and spinal cord tumors?
Brain and spinal cord tumors are more likely to be caused by secondary tumors
What are risk factors for brain and spinal cord tumors?
Genetics, family history, rare genetic disorders, environment (pesticides), and radiation
What are the two types of space occupying lesions for CNS tumors?
- Benign
2. Malignant
What are characteristics of space occupying lesions of CNS tumors?
Direct compression (nerve symptoms), block CSF (increase in intracranial pressure), and destruction of bone (nerve compression)
What do the symptoms of brain tumors depend on?
LOCATION
What are some symptoms associated with brain tumors?
Seizure, loss of movement or sensation in the arm. imbalance, loss of vision or hearing, confusion, or nausea
What is a supratentorial brain tumor?
Located between the two hemispheres above the brainstem and the cerebellum
What is the main symptom of supratentorial brain tumors?
Focal deficits
Also: seizures, headaches, mental status changes, and similar symptoms of TIA
What are symptoms associated with brainstem and cerebellum tumors?
Vomiting, ataxia, facial droop, dysphagia, dysarthria, and visual changes
What are symptoms associated with frontal lobe brain tumors?
Personality changes, hemiplegia, seizures, anosmia (smell), and visual changes
What are symptoms of spinal cord tumors?
Valsalva - pain around thorax when holding breath, sneezing, etc
What are the main categories of brain and spinal cord tumors?
Gliomas, astrocytomas, oligodendroglioma, meningiomas, meduloblastomas, and schwanomas
What is a glioma?
Tumor that starts in the glial cells
What fraction of brain tumors are gliomas?
3/10
Are glioma’s bimodal?
Yes: seen in both children and adults
2-10 years
45-55 years
What are the three support neurons for glioma’s?
- Astrocytes - nutritional support
- Oligodendrocytes - produce myelin
- Ependymal cells - line ventricles of brain
What is a malignant glioma?
Glioblastoma multiform
What population is most likely to develop a malignant glioma and what is the prognosis?
Adults 50-60 years old
50% 1 year survival rate
<15% 2 year survival rate
What are the most common brain tumors in adults?
Meningiomas - begin in the meninges
What sex is more likely to develop a meningioma?
Women
What is a neurinoma?
Tumor of the Schwann cells
What population is most likely to develop neurinomas?
Middle aged adults 40-50 years old
What is the most common manifestation of neurinomas?
Acoustic neuroma (CN 8) - progressive hearing loss, balance dysfunction, facial numbness, and headache
What type of malignant tumor is most common in children?
Medulloblastoma - originates in vermis of cerebellum
What is the prognosis of medulloblastoma?
Can spread to spine
> 60% 5 year survival rate
What are the diagnostic tools for brain tumors?
MRI (best), fMRI, CT scan, cerebral angiography (use of dye to see blood vessels in brain), chest x-ray/body scan, and CT guided sterotactic needle biopsy
What are treatment options for brain tumors?
Craniotomy - remove piece of bone to access tumor
What are the complications with surgery regarding brain tumors?
Edema, infection, hemorrhage, and hydrocephalus
What is the difference between chemotherapy and radiation therapy regarding the BBB?
Specific agents are permitted to cross - BBB blocks off chemo agents
What is the incidence of musculoskeletal neoplasms?
Not very common
Where can musculoskeletal tumors occur?
Muscle, cartilage, nerve, collagen, skin, or bone
What is the ratio of MS tumors for males and females?
3:1 - males more common
Are MS tumors benign or malignant?
Both: can spread to lungs, liver, and bone
What are risk factors for MS tumors?
Radiation, pesticides, and chemotherapy
What are the two characteristics of MS tumors?
- Osteoblastic - forms new bone
2. Osteolytic - lesions where there is bone/areas in the body with more bone formation
What are signs and symptoms of MS tumors?
Pain with weight bearing, edema, or lumps
What are the diagnostic tools for MS tumors?
Radiograph, MRI, bone scans, CT scans, biopsy, or lab tests (CRP)
How are MS tumors staged?
TNM system
What is the treatment of MS tumors?
Marginal excision, wide excision, or limb salvage/sparing
What is the order of treatment regarding MS tumors?
Surgery first followed by radiation therapy (most of the time not effective) or chemotherapy
What is a type of malignant bone tumor?
Osteosarcoma - 15-20% of all malignant tumors - most common in femur - develop from osteoblast cells
What is the incidence of osteosarcomas in males and females?
Equal until adolescence and then males increase in incidence
Are osteosarcomas bimodal?
Yes: peak 15 year olds
50
What are risk factors for osteosarcomas?
Paget’s disease, radiation, and chromosomal abnormalities
What are signs/symptoms of osteosarcomas?
Pain, arthralgia’s, joint effusion, ROM deficits, and fractures
Where is a common site for osteosarcomas to spread to?
Lungs
What is the prognosis for osteosarcomas?
5 year cure rate 70-80% (may go down if spread to the lungs)
What is the treatment for osteosarcoma?
Chemotherapy and limb salvage
What is Ewing’s sarcoma?
Malignant bone tumor due to a genetic abnormality (translocation of chromosome 11 and 22)
What population is most likely to get Ewing’s sarcoma?
<20 years old
Where are Ewing’s sarcomas usually found?
Pelvis and LE
What are signs/symptoms of Ewing’s sarcoma?
Pain, edema, fracture, flu-like symptoms
What is the diagnostic tool for Ewing’s sarcoma?
Radiograph
What is the treatment for Ewing’s sarcoma?
Radiation, chemotherapy, and limb salvage
What is the prognosis for Ewing’s sarcoma?
5 year survival >70%
What is rhabdomyosarcoma?
Malignant soft tissue tumor that originates from a primitive muscle
What sex and population is more likely to develop rhabdomyosarcomas?
Sex = males Population = children (2-6 and 15-19)
Where do rhabdomyosarcomas occur?
Head/neck, GI tract, extremities, and lungs - may spread to lungs and bone
What is a major sign/symptom of rhabdomyosarcomas?
Painless soft tissue lump
What is the treatment for rhabdomyosarcomas?
Chemotherapy and surgery
What is the prognosis for rhabdomyosarcomas?
50% 5 year survival rate
What is the highest probability of developing cancer in women?
Breast cancer
