Oncology Part 1 - Paulson Flashcards
What does the T in TNM stand for
Tumor
What does the N in TNM staging stand for
Nodes
What does the M in TNM staging stand for
Metastasis
What does TNM staging do?
Help determine the stage of the cancer
What is TX
Tumor can’t be measured
What is T0
Tumor cannot be found
What is Tis
tumor in situ
What does in situ mean?
The cancer is only growing in superficial tissue (best case scenario)
When describing tumors (T1-T4) which is worse, 1 or 4?
4 (the higher the number the worse it is)
What is NX
The nodes cannot be evaluated (for ex: the nodes were previously removed)
What is N0
No nodal involvement
What does N1-N3 describe
The size, location, and/or number of lymph nodes effects
What does T1-T4 describe
The tumor size and spread into adjacent structures
What is M0
There is no distant metastasis
What is M1
There are distant metastases
What cancers are most likely to metastases to the bone
Prostate, thyroid, breast, lung, and kidney (PT Barnum Loves Kids)
What are common presenting issues of bone metastases
Hypercalcemia
Pathological fractures
Pain
Spinal cord compression
What type of imaging is best for bone matastases
No one imaging type is best, it depends on the primary tumor and location of pain
What medication is often used as analgesia for pts with bone mets
Opioids
What medication is used for bone mets therapy to decrease skeletal related events (SREs) and help with pain
Osteoclast inhibitors (biphosphonates- boniva)
When is surgery recommended for pts with bone mets
When they have a completed or impending pathological fracture
When a pt has bone mets, what is external beam radiation therapy used for?
Often used to reduce pain (rather than eradicate the cancer)
What is stereotactic body radiotherapy (SBRT)
An extremely targeted form of radiation that can be used to treat bone/brain mets
What is more common, primary or metastatic tumors of the brain
metastatic
What cancers most commonly metastasize to the brain
Lung
Breast
Kidney
Colorectal
Melanoma
What cancers are rarely associated with brain metastasis
Prostate
Esophagus
Oropharynx
Non-melanoma skin cancers
What is the most common mechanism of brain metastasis
Hematogenous spread
What are the common presenting symptoms of brain metastasis
HA
Focal neuro dysfunction
Cognitive dysfunction
Sz
Stroke
What is the preferred method of detection for brain metastasis
MRI with gadolinium contrast
When is surgical resection utilized with brain mets
If it is a singular large tumor or if you need to send biopsy to pathology
What are the tx options for brain mets
Surgical resection
Stereotactic radiosurgery
Whole brain radiation therapy (WBRT)
Steroids
Anti-SZ meds
What are the s/e of stereotactic radiosurgery of the brain
transient swelling
nausea
dizziness
vertigo
sz
HA
When is WBRT recommended for pts with brain mets
If a pt has multiple large tumors
What are the early and late s/e of WBRT
Early: alopecia, fatigue
Late: brain atrophy, dementia, radiation necrosis, NPH, cerebrovascular disease, neuroendocrine dysfunction
Why are steroids used to tx brain mets
It reduces inflammation and edema of surrounding tissues
How do cancers metastasis to the lung
vascular
lymphatic
direct spread
What are the most common presenting complaints for pulmonary mets
cough
hemoptysis
dyspnea/hypoxia
malignant pleural effusion
What are the primary methods of diagnosing pulmonary mets
chest imaging
thoracentesis fluid evaluation
What are the tx options for pulmonary mets
sx resection
sterotactic body radiotherapy
PleurX catheter (if recurrent pleural effusion)
radioablation
cryotherapy
What are the common general s/e of radiation
skin dryness/irritation/blistering/peeling
fatigue
secondary cancer
What are the head and neck s/e of radiation
xerostomia
tooth decay
dysphagia
sores of mouth and gums
What are the chest s/e of radiation
radiation pneumonitis
pain
radiation fibrosis
dysphagia
What are the pelvic s/e of radiation
diarrhea
bladder irritation
infertility
rectal bleeding
sexual dysfunction
menstrual disturbance
What are the chemo s/e
N/V
fatigue
neuropathy
pain
mucositis
cytopenias
cognitive dysfunction
infertility
hair loss
No notecards made on elements of quality of life, refer if necessary to slides 15-17
…
What are the goals of palliative care
Comfort and improving quality of life (while still receiving curative medical tx)
What are the requirements that must be fulfilled for a pt to receive hospice
2 physicians must certify the pt is not expected to survive for >6 months
Must meet disease specific criteria
Does palliative care or hospice provide assign a pt a complete care team
hospice (palliative care is more a referral to a “specialist” who focuses on quality of life)
What is the goal of hospice
To improve quality of life for a pt who is no longer pursuing curative tx for a terminal illness
What is required for a pt to undergo Death with Dignity
The mentally competent adult with a terminal diagnosis (by 2 physicians stating <6 months to live) may voluntarily request a prescription for medication that will hasten their death
How many waiting periods are required before a pt can receive medications that will assist in death
two
What are the general physiological changes that occur when a pt is dying
weakness
fatigue
functional decline
What are the physiological changes that occur during death when a pt is experiencing diminished blood perfusion
Tachycardia
Hypotension
Peripheral cooling
Cyanosis
Mottling of the skin
Loss of peripheral pulses
What is a common breathing pattern associated with dying
Cheyne stokes breathing
What is the first line tx of pain and dyspnea in dying pts
roxanol (liquid morphine)
(any opioid is appropriate but this is commonly used)
What medications are used to tx nausea in dying pts
Zofran
Compazine
Haldol
Medical marijuana
What meds are used to tx anxiety/terminal restlessness in dying pts
ativan (lorazepam)
Haldol (halperidol)
What medications can be used to tx xerostomia in dying pts
glycerin swabs
biotene
artificial saliva
pilocarpine
What medications are used to tx secretions (death rattle) in dying pts
D/C IVF or TF
Atropine drops
Scopolamine patch
Glycopyrrolate
What medications can be used to tx anorexia in dying pts
megace
glucocorticoids
When should you be tx anorexia in dying pts
Only if they request it to improve their quality of life (shouldn’t be your first choice due to medication side effects)
What are the s/e of megace (megestrol acetate)
Edema
VTE
Death
Look at Slide 29 for statistics on CPR effectiveness
Mostly know it isn’t that effective even if you are in the hospital and rarely does it preserve neuro fxn
Why is advanced care planning so important
Higher rates of completion of advanced directives
Increased likelihood that staff and families respect wishes
Reduction of hosp. at end of life
Receipt of less intensive tx at the end
Increased utilization of hospice services
increase likelihood that a pt will die at his/her preferred place
Higher satisfaction with quality of care
When do advanced directives need to be completed
When a pt has decisional capacity
When should an advanced directive be followed
Only when a pt loses the capacity to make decisions
When can an advanced directive be revoked
At any time so long as the pt has the capacity to do so
What are the POLST/MOST forms (and which one is used in CO)
A medical order for the treatments a pt wants in case of emergency- specifically used for pts with advanced illness or frailty
MOST is used in CO
