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Clin Med II > Oncology Part 1 - Paulson > Flashcards

Oncology Part 1 - Paulson Flashcards

1
Q

What does the T in TNM stand for

A

Tumor

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2
Q

What does the N in TNM staging stand for

A

Nodes

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3
Q

What does the M in TNM staging stand for

A

Metastasis

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4
Q

What does TNM staging do?

A

Help determine the stage of the cancer

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5
Q

What is TX

A

Tumor can’t be measured

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6
Q

What is T0

A

Tumor cannot be found

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7
Q

What is Tis

A

tumor in situ

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8
Q

What does in situ mean?

A

The cancer is only growing in superficial tissue (best case scenario)

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9
Q

When describing tumors (T1-T4) which is worse, 1 or 4?

A

4 (the higher the number the worse it is)

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10
Q

What is NX

A

The nodes cannot be evaluated (for ex: the nodes were previously removed)

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11
Q

What is N0

A

No nodal involvement

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12
Q

What does N1-N3 describe

A

The size, location, and/or number of lymph nodes effects

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13
Q

What does T1-T4 describe

A

The tumor size and spread into adjacent structures

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14
Q

What is M0

A

There is no distant metastasis

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15
Q

What is M1

A

There are distant metastases

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16
Q

What cancers are most likely to metastases to the bone

A

Prostate, thyroid, breast, lung, and kidney (PT Barnum Loves Kids)

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17
Q

What are common presenting issues of bone metastases

A

Hypercalcemia
Pathological fractures
Pain
Spinal cord compression

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18
Q

What type of imaging is best for bone matastases

A

No one imaging type is best, it depends on the primary tumor and location of pain

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19
Q

What medication is often used as analgesia for pts with bone mets

A

Opioids

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20
Q

What medication is used for bone mets therapy to decrease skeletal related events (SREs) and help with pain

A

Osteoclast inhibitors (biphosphonates- boniva)

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21
Q

When is surgery recommended for pts with bone mets

A

When they have a completed or impending pathological fracture

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22
Q

When a pt has bone mets, what is external beam radiation therapy used for?

A

Often used to reduce pain (rather than eradicate the cancer)

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23
Q

What is stereotactic body radiotherapy (SBRT)

A

An extremely targeted form of radiation that can be used to treat bone/brain mets

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24
Q

What is more common, primary or metastatic tumors of the brain

A

metastatic

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25
Q

What cancers most commonly metastasize to the brain

A

Lung
Breast
Kidney
Colorectal
Melanoma

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26
Q

What cancers are rarely associated with brain metastasis

A

Prostate

Esophagus

Oropharynx

Non-melanoma skin cancers

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27
Q

What is the most common mechanism of brain metastasis

A

Hematogenous spread

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28
Q

What are the common presenting symptoms of brain metastasis

A

HA

Focal neuro dysfunction

Cognitive dysfunction

Sz

Stroke

29
Q

What is the preferred method of detection for brain metastasis

A

MRI with gadolinium contrast

30
Q

When is surgical resection utilized with brain mets

A

If it is a singular large tumor or if you need to send biopsy to pathology

31
Q

What are the tx options for brain mets

A

Surgical resection

Stereotactic radiosurgery

Whole brain radiation therapy (WBRT)

Steroids

Anti-SZ meds

32
Q

What are the s/e of stereotactic radiosurgery of the brain

A

transient swelling

nausea

dizziness

vertigo

sz

HA

33
Q

When is WBRT recommended for pts with brain mets

A

If a pt has multiple large tumors

34
Q

What are the early and late s/e of WBRT

A

Early: alopecia, fatigue

Late: brain atrophy, dementia, radiation necrosis, NPH, cerebrovascular disease, neuroendocrine dysfunction

35
Q

Why are steroids used to tx brain mets

A

It reduces inflammation and edema of surrounding tissues

36
Q

How do cancers metastasis to the lung

A

vascular

lymphatic

direct spread

37
Q

What are the most common presenting complaints for pulmonary mets

A

cough

hemoptysis

dyspnea/hypoxia

malignant pleural effusion

38
Q

What are the primary methods of diagnosing pulmonary mets

A

chest imaging

thoracentesis fluid evaluation

39
Q

What are the tx options for pulmonary mets

A

sx resection

sterotactic body radiotherapy

PleurX catheter (if recurrent pleural effusion)

radioablation

cryotherapy

40
Q

What are the common general s/e of radiation

A

skin dryness/irritation/blistering/peeling

fatigue

secondary cancer

41
Q

What are the head and neck s/e of radiation

A

xerostomia

tooth decay

dysphagia

sores of mouth and gums

42
Q

What are the chest s/e of radiation

A

radiation pneumonitis

pain

radiation fibrosis

dysphagia

43
Q

What are the pelvic s/e of radiation

A

diarrhea

bladder irritation

infertility

rectal bleeding

sexual dysfunction

menstrual disturbance

44
Q

What are the chemo s/e

A

N/V

fatigue

neuropathy

pain

mucositis

cytopenias

cognitive dysfunction

infertility

hair loss

45
Q

No notecards made on elements of quality of life, refer if necessary to slides 15-17

A

…

46
Q

What are the goals of palliative care

A

Comfort and improving quality of life (while still receiving curative medical tx)

47
Q

What are the requirements that must be fulfilled for a pt to receive hospice

A

2 physicians must certify the pt is not expected to survive for >6 months

Must meet disease specific criteria

48
Q

Does palliative care or hospice provide assign a pt a complete care team

A

hospice (palliative care is more a referral to a “specialist” who focuses on quality of life)

49
Q

What is the goal of hospice

A

To improve quality of life for a pt who is no longer pursuing curative tx for a terminal illness

50
Q

What is required for a pt to undergo Death with Dignity

A

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

51
Q

How many waiting periods are required before a pt can receive medications that will assist in death

A

two

52
Q

What are the general physiological changes that occur when a pt is dying

A

weakness

fatigue

functional decline

53
Q

What are the physiological changes that occur during death when a pt is experiencing diminished blood perfusion

A

Tachycardia

Hypotension

Peripheral cooling

Cyanosis

Mottling of the skin

Loss of peripheral pulses

54
Q

What is a common breathing pattern associated with dying

A

Cheyne stokes breathing

55
Q

What is the first line tx of pain and dyspnea in dying pts

A

roxanol (liquid morphine)

(any opioid is appropriate but this is commonly used)

56
Q

What medications are used to tx nausea in dying pts

A

Zofran

Compazine

Haldol

Medical marijuana

57
Q

What meds are used to tx anxiety/terminal restlessness in dying pts

A

ativan (lorazepam)

Haldol (halperidol)

58
Q

What medications can be used to tx xerostomia in dying pts

A

glycerin swabs

biotene

artificial saliva

pilocarpine

59
Q

What medications are used to tx secretions (death rattle) in dying pts

A

D/C IVF or TF

Atropine drops

Scopolamine patch

Glycopyrrolate

60
Q

What medications can be used to tx anorexia in dying pts

A

megace

glucocorticoids

61
Q

When should you be tx anorexia in dying pts

A

Only if they request it to improve their quality of life (shouldn’t be your first choice due to medication side effects)

62
Q

What are the s/e of megace (megestrol acetate)

A

Edema

VTE

Death

63
Q

Look at Slide 29 for statistics on CPR effectiveness

A

Mostly know it isn’t that effective even if you are in the hospital and rarely does it preserve neuro fxn

64
Q

Why is advanced care planning so important

A

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

65
Q

When do advanced directives need to be completed

A

When a pt has decisional capacity

66
Q

When should an advanced directive be followed

A

Only when a pt loses the capacity to make decisions

67
Q

When can an advanced directive be revoked

A

At any time so long as the pt has the capacity to do so

68
Q

What are the POLST/MOST forms (and which one is used in CO)

A

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

Clin Med II (8 decks)

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