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Special Topics > Oncology > Flashcards

Oncology Flashcards

1
Q

What is cancer?

A
  • a disease caused by an uncontrollable division of abnormal cells in a apart of the body
  • a malignant growth or tumor resulting from the division of abnormal cells
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2
Q

Cancer may be inherited such as

A
  • “germline”
  • BRCA 1, BRCA 2 mutations
  • lynch syndrome
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3
Q

Cancer may be enbironmental such as:

A
  • pollution
  • lifestyle: heavy drinking, smoking
  • obesity
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4
Q

germline mutation

A
  • occurs in the sperm cell or egg cell
  • passed from parent to child at time of conception
  • mutation of that initial cell is copied into every ell within the body
  • 5-20% of all cancers
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5
Q

acquired mutation

A
  • Occurs from damage to genes in a particular cell during a person’s life
  • “sporadic cancer”
  • these are not found in every cell and are not passed from parent to child
  • factors that cause these mutations: tobacco, radiation, viruses, age
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6
Q

Tumor supressor Genes

A

Limit cell growth through:

  • monitoring how quickly cells divide
  • repair mismatched DNA
  • control when a cell dies
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7
Q

DNA repiar genes

A
  • fix mistakes made when DNA is copied

- function like tumor supressor genes

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8
Q

treatment options

A
  • surgery
  • radiation
  • chemotherapy
  • hormonal tx
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9
Q

What is personalized medicine?

A
  • tailors tx of a disease to specific personal characteristics of the patient and charcateristics of the tumor to produce the most effective tx for each person’s disease
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10
Q

goals for personalized medicine

A
  • fewer side effects
  • more effective t
  • improved identification risk of cancer development or reoccurance
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11
Q

tumor profile

A
  • molecular testing on the DNS, RNS and proteins to identify the biomarkers driving a patient’s tumor
  • whole genome sequencing: genetic comparison of paired tumor and normal cells
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12
Q

factors considering when selecting tx:

A
  • cell type, size, and location
  • presence of HER2 protein
  • presence of hormone receptors on cancer cells
  • BRCA1,or 2
  • Pre/post menpausal
  • age
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13
Q

HER2( human epidermal growth factor receptor 2)

A
  • growth promoting protein found on the outside of breast cells
  • dictate type of chem
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14
Q

Lynch syndrome

A
  • germline mutation with alternations in several genes that function in DNA mismatch repair
  • incr risk of developing multiple cancers
  • family hx
  • early and freq colonospcopy and uterine US for early identifictaion of tumor
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15
Q

immunotherapy

A
  • type oc cancer tx that boosts the body’s natural defenses to fight cancer
    -may use substances naturally occuring in the body or substance created
    in a lab: can distinguish between healthy and unhealthy cells
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16
Q

side effects from chemotherapy and radiation

A
  • are due to cells being damaged
  • may not resolve
  • EX: neuropathy
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17
Q

side effects from immunotherapy

A
  • due to overactive immune system
  • can still be very serious, even life threatening
  • skin reactions
  • flulike symptoms
  • SOB
  • swelling in extremities
  • diarrhea
  • Hormone changes
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18
Q

Tumor lysis Syndrome

A
  • when tumor cells are destroyed by tx, cells release their contents into the blood stream
  • tumor lysis syndrome is an electrolyte and metabolic disturbances caused by excessive CA, K, phosphate and uric acid in the blood
  • diagnosis of syndrome requires 2 or more metabolic abnormalities that occur 3 days before or 7 days after initiation of therapy
  • major risks renal insufficiency, seizures, cardiac dysrhythmia, death
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19
Q

General rehab considerations while tx:

fatigue

A
  • incorporate energy conservation and pacing eductaion/strategies
  • eductaion on importance of exercise to combat fatigue
  • decr intensity or length of tx
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20
Q

General rehab considerations while tx:

neuropathy

A
  • may need to incorporate balance assessment/ training or recommend AD
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21
Q

General rehab considerations while tx:

timing of tx

A
  • see pt before tx administered

- inconsideration of nausea

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22
Q

General rehab considerations while tx:

prevention of loss of motion (radiation)

A
  • education of AROM/stretching to decr risk of contratcures in radiated areas
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23
Q

General rehab considerations while tx:

chemo holidays

A
  • occurs when pt takes a break from chemo due to inability to tolerate side effects
  • may see large improvements in strength, endurance or function during chemo holidays
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24
Q

Childhood acute lymphoblastic leukemia

A
  • accounts 75% of childhood leukemia

- involves lymphoblasts: prevent production of normal cells; starts in marrow can spread to the CNS and lymph nodes

25
Q

Risk factors for childhood acute lymphoblastic leukemia

A
  • male> female
  • white/Hispanic Race
  • Previous exposure to radiation/chemotherapy
  • HX genetic disorder: DS, neurofibromatosis, kunefelter syndrome,etc
26
Q

S/S of childhood acute lymphoblastic Leukemia

A
  • night sweats
  • discomfort in bones or joints
  • enlarged splee, liver or lymph nodes
  • pain or feeling of fullness below the ribs
  • unexplaines weight loss or loss of appetite
27
Q

Diffuse Large B-cell lymphoma

A
  • most common subtype of non-hodgkin lymphoma usually >60 yrs
  • very aggresive form of cancer
  • can develop in lymph node or any organ may be spread out or localized
28
Q

risk factors for Diffuse Large B-Cell lymphoma

A
  • over 64 yrs old
  • male
  • non-asian or african american
  • immunocompromised
  • HX exposure to radiation and chemotherapy
29
Q

S/S of diffuse large B-cell lymphoma

A
  • lump in th egroin, armpit, or neck
  • fever
  • night sweats
  • weight loss
  • belly or chest pain or pressure
  • SOB or cough
  • itching
30
Q

Multiple myeloma

A
  • blood cancer that involves plasma cells

- trigger osteoclasts to work more: lead to frail bones, incr CA levels in blood

31
Q

S/S of myeloma

A
  • bone pain, weakness, fatigue, weight loss, infection, pathological frcatures
32
Q

complication of all blood disorders

A
  • anemia- low level of red blood cells: fatigue SOB, dizzy, pallor
  • thrombocytopenia: low level of platelets: bruising, prolonged bleeding, nosebleeds, blood in urine, bleeding gums, petechiae
  • leukopenia- low levels of white blood cells: infection,fever
33
Q

myeloablative conditioning

A
  • whole body radiation and chemotherapy to kill the bone marrow cells in preparation for stem cell transplantation
  • can be done inpatient or outpatient
34
Q

stem cell transplantation

A
  • use of healthy immature blood cells found in the bone marrow or blood to replace those that have been destroyed by cancer or cancer tx
  • can be down inpatient or outpatient
35
Q

autologous stem cell transplant

A
  • call are harvested from the patient’s own bone marrow before chemotherapy and are replaced after cancer tx
  • little to no risk of rejection or graft versus host disease
  • graft failure can occur
36
Q

Allogeneic stemcell transplant

A
  • stem cells from a donor who most closely matches the patient
  • used to treat disease that involve cells in the bone marrow,such as leukemia
  • generate a new immune system response to fight cancer: Graft-vs-cancer effect, engraftment
  • increased risk of rejection or GVHD
37
Q

stem cell Donors

A
  • matched with eligible donors by human leukocyte antigen typing
  • the closer the match between the HLA markers of the donor and the less risk of the body rejecting the new stem cells

-usually first degree relative

38
Q

HLA - human leukocyte antigen

A
  • HLA are proteins that exist on the surface of most cells in the body
  • HLA markers help the body distinguish normal cells from foreign cells, such as cancer
39
Q

side effects of stem cell transplantation

A
  • incr risk of infections
  • low blood counts
  • mouth and; throat pain
  • Nausea/vomiting
  • diarrhea
  • loss of appetite and weight
  • Pain
  • fatigue
  • GVHD
40
Q

Graft vs Host disease

A
  • Donor’s T-lymphocytes do not recognize the patient’s cells and attacks them
  • occurs in about 50% of allogeneic SCT patients
41
Q

Acute GVHD

A
  • develops during the first 100 days s/p transplant first 3 mo
42
Q

chronic GVHD

A
  • develops after 100 days s/p transplant 2-24 mo
43
Q

S/S of GVHD

A
  • Eyes: Dry eyes, sensitivity to light
  • Lungs: SOB, cough, fatigue
  • Mouth: sores, pain, irritation, difficulty opening
  • genitals: dryness, irritation, painful intercourse
  • skin: rash,sensative, itchym dry , darkened, peeling skin , restricted ROM
  • GI: diarrhea, nausea, loss of appetite, abdominal cramps, weight loss
  • Liver: enlarged liver, incr LFT, abdominal tenderness
44
Q

Roles of Physical Therapy

A
  • maintain/restore/ maximize independence with functional mobility
  • promote strength and endurance
  • prevent decline
  • recommend adaptive and durable medical equipment
  • prepare pt and fmaily for safe discharge home or to next level of care
45
Q

Car-Tcell therapy

A
  • t cells are removed, reprogrammed to find and kill cancer cells, and reentered into the body
  • car-T cells can multiple in the body
  • most common use in liquid tumors
46
Q

Why tcells?

A
  • specifically target cells that express peptides (caner)
  • potentially long clonal life
  • potentially significant expansion/replication in vivo
47
Q

cell harvetsing

A
  • T cells are removed from blood via leukopheresis
  • t cells are preserved and sent to lab for engineering
  • modified with viral insertion of specific CAR
  • cells expanded into the hundred of millions-can take 1 to several weeks
  • quality assurance measures
48
Q

types of CAr-T

A

FDA approved

  • Yescarta
  • kymriah

Non-FDA approved:
Juno

49
Q

typical trx course for CAR-T cell

A
  • Lymphodepleting phase: currently inpatient ~3-5wks; soon will become outpatient for some patient
  • administrtaion phase: Day 0, similar to transfusion (30 min). now monitor for fever & neurotoxicity
  • Recovery Phase: 2-3 weeks pending no major complications. blood cell recovery. bone marrow aspiration day 30
50
Q

Cytokine Release Syndrome

A
  • large rapid release of cytokines into the blood stream
  • Primary anticipated effect after T-cell therapy
  • –Symptoms: FEVER,nausea, HA, rash, rapid heartbeat, low blood pressure, and trouble breathing

**cytokine: proteins secreted by leukocytes that modulate immune and inflammatory response

51
Q

Cytokine Release Syndrome

Grade 1

A

Mild reaction, infusion not interrupted
– Fever, nausea, fatigue, headache, myalgia, malaise
– Symptomatic treatment only

52
Q

Cytokine Release Syndrome

Grade 2

A 
Moderate reaction, infusion interrupted
– Hospitalization required for treatment
– Some signs of organ dysfunction
– Oxygen requirement <40%
– Hypotension responsive to fluids/ low dose vasopressors
– Responds quickly to treatment
– Grade 2 organ toxicity
53
Q

Cytokine Release Syndrome

Grade 3

A

Severe reaction, will not respond immediately to treatment
– Oxygen requirement >/= 40%
– Hypotension requires high dose/multiple vasopressors
– Grade 3 organ toxicity

54
Q

Cytokine Release Syndrome

Grade 4

A

Grade 4: Life threatening complications of hypotension and/or hypoxia
– Require ventilator support
– Grade 4 organ toxicity

55
Q

Cytokine Release Syndrome

Grade 5

A

Death

56
Q

CRS tx with Actemra

A
  • Actemra: immunosuppresive drug that binds to cytokines and prevents continued immune repsonse
  • resolve CRS without interfering with T-cell function
  • Pt under CAR-T can receive up to 2 doses
  • can increase risk for potentially fatal infections
57
Q

CRS tx with Corticosteroid

A

Not first line of defense
• Lymphotoxic
– Reduce the effect of CAR-T cell therapy
– Recommended only for cases of tocilizumab-refractory CRS

58
Q

Neurotoxicity

A
  • reversible

- symptoms: TREMOR, confusion, aphasia, attention deficits, handwriting, apraxia, ataxia

59
Q

PT treatment progression during CAR-T

A
  • Pre-CAR-T: maintain, HEP, walking, eductaion
  • Early CAR-T: monitor fevers, neuro checks, subtle changes
  • middle CAR-T: onset CRS/neurotoxicity
  • Late CAR-T: address lasting effects/DC planning

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