Oncology Flashcards
three most common types of cancer for males and females
male prostate 27 % , lung, colon/rectum
females breast 29% lung, colon/rectum
who were the most likely race to get cancer
blacks
what leads to the decline in prostate CA
the detection of the prostate antigen believed to be a huge link to prostate CA.
probability of developing breast CA for women and probability of developing prostate CA for men
Women is 1 in 8 and men is 1 in 7
survival rates for CA
women is stage 0 100 stage 1 100 stage 2 92 stage 3 stage4 72 stage 5 22 stages for men for survival stage 0 100 stage 1 96 stage 2 84 stage 3 52 stage 4 24
how different types of CA are there
over 200
how to grade the size of the CA
t = tumor n = nodule m= metasis
Stage I: T≤2cm, N=0, M=0
Stage II: T>2-5, N=any, M=0 or T=any, N=large#, M=0
Stage IV: Any T; Any N; M=1 (metastatic-terminal, not curable)
common sites for CA to spread to
brain liver lungs are the most common of spreading
common signs of CA
pain, discomfort
fatigue difficulty sleeping
shortness of breath
swelling/lymphedema
failure to improve
w/P.Tdifficulty w/ADLs (i.e.-work, household chores, family responsibilities
CA risk factors
Genetics
Diet and Exercise
BMI
alcohol
UV exposure
Tobacco Cigarette Cigar Second hand smoke Smokeless
Typical causes of skin CA
Most common cancer… UV/Sun exposure (severe sunburns as a child) Light skin Family history (1st degree relative) # of moles (50-100+) Types of moles Previous h/o skin CA Occupational exposures
Most common types of skin CA
Non-melanoma
Basal Cell Carcinoma (BCC) most common type of skin CA sun exposure (head, neck, trunk, arm, back of hands) fair skin > dark skin grows slowly and rarely spreads
Squamous Cell Carcinoma (SCC) Second most common type Sun exposure (ear rim, face, neck, trunks, arm, lips)
Most deadly form of CA and what is the deadliest and what is the number one reason for it
Melanoma
presents as a mole or new dark spot
deadliest form of skin CA
8,500+ Americans die every year (1 person every hour)
5 yr survival 91%
Localized 98% (84% of people are diagnosed)
Regional 62%
International Prevalence of Indoor Tanning – A Systematic Review and Meta-Analysis.” – JAMA Dermatol. 2014;150(4):390-400
Number of skin cancer cases due to tanning is higher than number of lung cancer cases due to smoking. In US alone, 419,254 cases of skin cancer can be attributed to indoor tanning. Out of this number, 6,199 are melanoma cases
what are the ABCDE’s for screening for moles
asymmetry - one half doesn’t match the other half
border- the edges are notched or ragged
color- the edges varied shades are black or brown
diameter- greater than 6 mm
evolving- change in size shape or color
treatment options for removing the mole
Freezing (liquid nitrogen) Laser therapy Photodynamic therapy (PDT) Curettage and electrodessication Mohs surgery Excisional surgery Radiation therapy Chemotherapy Biological therapy (interferon and interleukin-2
What is the probability of developing prostate CA.
what people are at risk for developing prostate CA??
what are the treatment options??
Risk – 1 in 7 men will be dx’d 15% of men will develop increases w/age (median age dx: 66 yo) Race (African Americans > chance than Caucasian) family hx 1 relative with h/o prostate CA = 2x risk factor 2+ relatives “ = 4x “ diet & lifestyle (obesity) social and environmental factors
Treatment Watch and wait Radical prostatectomy Radiation therapy (external beam radiation or brachytherapy) Chemotherapy Clinical Trials Diet modification
Cervical and Ovarian CA what casues them and how are they detected??
Ovarian CA (3%) -- 1 in 73 risk Epithelial (85-90% carcinomas) Germ cell (2%) Stromal (1%) **most deaths – female reproductive system
Cervical CA – successfully treatable
Squamous cell carcinoma
Adenocarcinoma (85-90%)
**abnormal PAP smear – early detection
Treatment options for Ovarian CA
Surgery Radiation therapy Chemotherapy Targeted therapy Hormone therapy
October is Breast Cancer Awareness Month.
On average, a mammography detects a tumor that
has been present for ______ years.
6-8 years
On average, a palpable lump is detected after
_____ years
8-10 years
Common forms of breast CA
non-invasive carcinoma vs
invasive carcinoma -
Non-invasive (intraepithelial) – Stage 0 a. (DCIS) Ductal Carcinoma in situ b. (LCIS) Lobular Carcinoma in situ Invasive a. Infiltrating Ductal Carcinoma b. Infiltrating Lobular Carcinoma
Ductal Carcinoma in situ (DCIS)
what is this also known as and is this type of CA harmful??
aka intraductal carcinoma most common form of non-invasive BC pre-cancerous condition confined to milk ducts 5 year survival rate is ≈100% > risk of recurrence/developing new CA *15-30% come back as invasive CA
ways to detect noninvasive ductual CA.
No physical signs or symptoms
small % present w/palpable lump or nipple discharge
mammography findings: microcalcifications
Fine needle aspiration biopsy: small needle removes
cells from suspected site to be further analyzed
Core needle biopsy: large needle inserted via a small incision site made to accommodate size of needle in order to obtain a larger tissue sample to be analyzed
most common form of invasive breast CA
most common form of invasive BC (80%)
started in milk ducts of breast and has spread to surrounding tissue
Lobular Carcinoma in situ (LCIS)
pre-cancerous condition confined to lobules (milk glands) 30% have bilateral involvement 25% will develop BC in their lifetime No physical signs or symptoms (-) mammography findings dx by biopsy
Lobular breast CA
10-15% of invasive BC
starts in lobules and spreads to surrounding tissues
What happens when they remove the breast tissue
removal of breast tissue & some or all of the axillary lymph nodes
pectoralis major is spared
pectoralis minor may or may not be removed to allow easier
access to axilla for dissection
lymphedema risk
Simple (Total) Mastectomy
removes entire breast including nipple and areola
chest wall muscles spared & NO axillary dissection
0% risk of lymphedema as no nodes are removed
prophylatic mastectomies
Extended Simple Mastectomy: involves 1-2 lymph nodes. Considered MRM & give lymphedema precautions
Lumpectomy
removal of tumor & small or large margin of surrounding breast tissue
sentinel node or axillary dissection
risk for lymphedema
Sentinel Lymph Node Biopsies (SLNB)
Lymphoscintigraphy: blue dye & radioactive colloid
injection that maps lymphatic flow
bluest & hottest node where cancer will pass through if going to spread; main drainage route
Benefits: pain
parasthesia
risk for lymphedema
Axillary Lymph Node Dissection (ALND)
Varies, 25-30+ lymph nodes in each axilla
Level I: removal of nodes that lie b/t lats dorsi & lateral border of pec minor
Level II: Level I & mid-axillary nodes, located deep to pec minor
Level III: Levels I, II & those in axilla, located medial to pec minor & below costoclavicular ligament
breast reconstruction surgery things to think about
Considerations:
immediate vs. delayed
pending adjuvant tx (radiation therapy)
minimize further surgical interventions
psychological
Prosthesis (Breast Forms)
non-surgical option
available in a variety of shapes, sizes, & materials
silicone gel, foam, fiberfill interior
weighted or non-weighted
ready made or custom made ($100 - $3,000+)
Saline (Saltwater) or Silicone Gel
KNOW THIS SLIDE
what are some precautions to take
least amount of surgery
tissue expander (balloon type device) inserted under pectoralis muscle
3-6 mo period, saline injected via expander port to stretch skin in prep for permanent implant
6-12+ months commitment
precautions
expanders susceptible to microtears
: avoid direct STM / soft tissue work
: if necessary, apply gentle techniques to soften tissue
avoid strengthening,“bulking up” of pec/ant chest wall muscle
