Oncology--Pedo Flashcards
gold standard for cancer Dx
tissue sample–bx–no non-invasive means
Most common cancer men vs women (3 each)
Men: 1. prostate 2. lung 3. colorectal
women: 1. breast 2. lung 3. colorectal
when approaching the literature about cancer be mindful of
the dirrerence btwn the INCIDENCE and DEATH RATE from that cancer
any new growth of tissue–benign or malignant
neoplasm
an abnormal tissue mass– benign or malignant
tumor
benign def
growth not recurrent, progressive, or invasive in nature–not dangerous
if person treated for cancer and still cancer-free after 5 years they are _______
“cured” – used to quantify survival rates, meaningless for some cancers
malignant aka & def
Cancer,
a neoplasm that grows uncontrollably and is locally invasive or spreads to other sites
classification of cancer as benign or malignant based on (4)
- rate of neoplasm growth
- propensity of surrounding tissue invasion
- local area spread
- propensity for metastatic spread
very aggressive cancer cell
blastoma (used to imply a tumor of primitive, incompletely differentiated cells)
lung cancer:
- rates
- death rates
- 2nd highest cancer for men/women
- 1st highest cancer for men/women
tumor names based on
histology of the tumor–cell derivative and “look” of cell
biggest cancers in children
hematologic (leukemia, lymphocytic)
cancers of connective tissue (bone, cart, fat, nerve)
sarcoma
malignant growth derived from “true” epithelium
carcinoma
- MALIGNANT epithelial carcinoma arising from glandular structures or that contain secretory structures sim to glands
- BENIGN epithelial tumor w/ secretary (glandular) structures (pituitary, adrenal)
- adenocarcinoma
2. adenoma
NET aka + def
neuroendocrine tumor,
tumor of endocrine or neural tissues
cancer confined to its site of origin
cancer in situ CIS (sometimes referred to as “pre-cancerous”)
Dysplasia + rating (3)
tissue w/ an abnormal size, shape, organization of mature cells.
Rated: mild, moderate, severe dysplasia (likely to become cancer)
extreme loss of muscle and body mass associated w/ many dz states esp. end stage cancer
cachexia
- critical discriminating feature btwn neoplasia and hyperplasia
the “clonal” origin–cancers originate from a single cell!
neoplasia vs. hyperplasia
neoplasias are uncoordinated and lack normal regulatory control over the normal events of mitosis seen in non-cancerous cells
telomerase
an enzyme that prevents or repairs the shortening of telomeres
a gene which has the ability to cause autonomous cell growth and differentiation (cancer)
oncogene – an uncontrolled oncogene directly affects cellular growth in a positive manner.
a normal gene which may become an oncogene due to mutation
proto-oncogene
tumor-suppressor genes
control cell division (cell birth) or cell death–essentially they restrain cell growth–lost in cancer
gene the provides genome stability by preventing the accumulation of mutations
caretaker genes–affect the ability of the cell to maintain the integrity of its genome. Missing these = ^ cancer
gate keeper genes…
encode a system of checks and balances that monitor cell division and death. I.e. when tissue damage occurs, products of gate keeper genes ensure that balance of cell growth over cellular death remains in check.
genes that foster stromal environment conducive to cell proliveration
landscaper genes–target of future chemo drugs
Normally, these (3) cells “read” the HMC1 of cancer cells and eliminate them
- CD4 and CD8 lymphocytes
2. NKCs
Cancer techniques for avoiding elimination (2)
- missing antigenic surface tumor antigens
2. inadequate immune surveillance (immunosuppression or immundeficiency)
oncogenes strongly associated w/ BREAST, OVARIAN, prostate, pancreatic, and colon cancers. (2)
- *BRCA-1 (angelina jolie)
2. BRCA-2
40% of retinoblastoma inherited in ______ _______ manner
autosomal dominant
estrogen or testosterones may activate cell division in cells w/ malignant potential phonotypes and lead to (5)
- breast
- ovary
- endometrium
- prostate
- testis
Common environmental exposure factors implicated in cancer (6)
- benzene (petrolium derived)
- asbestos
- ionizing radiation
- UV light (tanning beds)
- polycyclic hydrocarbons (cigs)
- industrial agents (arsenic, funficides, etc)
Newly discovered gene associated w/ breast cancer
PALB-2
Viruses associated w/ cancer (6)
- Chronic Viral Hepatitis B or C
- HPV
- Herpes virus-8
- EBV (Burkett’s Lymphoma)
- HIV (Kaposi’s sarcoma)
- CMV
Food and drugs related to cancer risk (6)
- *DES (Diethylstilbestrol) (synthetic estrogen) (clear-cell carcenoma of vagina in daughters)
- nitrates, nitrites
- high fat diet
- lack of fruits and vegies (less antioxidants)
- alcohol + cigs synergistically carcinogenic
- anticancer agents
Clinical manifestations of cancer (5)
- pain (“worse at night”)
- abnormal masses (primary tumor or enlarged lymph node)
- pain (“worse at night”)
- Unintended weight loss (tumor caloric burden, cytokines)
- bleeding (seen and unseen)
- PAINLESS jaundice (yellowing of sclera w/out hep)
- indigestion or difficulty swallowing
- non-healing sore
- Unintended weight loss (tumor caloric burden, cytokines)
leading causes of lung cancer in US (2)
- smoking
2. radon exposure
paraneoplastic syndromes def
a grouping of clinical manifestation of cancer resulting from a tumor’s presence in the body–but NOT due to MASS EFFECT
paraneoplastic syndrome example symptoms()
- fever
- anorexia
- fatigue
- hypertrophic osteoarthropathy (clubbing, arthritis)
- SIADH
- hypoK+, hyper/hypoNa+, hyperphosphatemia
- HYPERCALCEMIA
- Cushing syndrome
- paraneoplastic sensory neuropathy
- myasthenia gravis
substances that are produced by cancer or by other cells of the body in response to cancer or certain benign conditions
tumor markers
tumor markers are usually _________, but more recently, paters of ______ ______ are being used
proteins, gene expression (changes to DNA)
Common tumor markers (6)
- Alphafetroprotein (AFP)
- carcinoembryonic antigen (CEA)
- CA-125
- Prostate specific antigen (PSA)
- Estrogen receptor (ER)
- HER2/neu
tumor marker used to help Dx liver cancer
Alphafetroprotein
tumor marker used to check whether colorectal cancer has spread
carcinoembryonic antigen
tumor marker associated w/ prostate cancer
prostate specific antigen
estrogen receptor (tumor marker) used to
determine whether tx w/ hormonal therapy is appropriate
tumor marker used to determine whether tx w/ TRASTUZUMAB is appropriate
HER2/neu
when a dx of cancer is made the next step is
to “Stage” the cancer
staging will determine (2)
- a treatment pathway
2. prognosis
Roman numeral cancer staging 0-IV
0: in situ carcinoma I: small and localized II: locally advanced III: higher degree of local advancement IV: metastasis
uses of tumor markers (5)
- cancer presence? (CAN”T DX CANCER W/ MARKERS)
- response to tx
- recurrence
- prognostic
- DIRECTED CHEMO
T/F We can make a dx of cancer w/ tumor markers
F
TNM staging system (KNOW box on page 12 of notes)
Tumor size
Nodal involvement?
Metastisis?
Generally, the ______ and _______ the tumor, the more likely lymph node involvement or metastisis
larger and older
staging system for cancers w/out central location (leukemia, myeloma, and lymphoma)
ann arbor staging system
histological grading for aggressiveness of tumor based on appearance
Gleason score
more _______ cancer cells tend to be more aggresive
primative (i.e. blasts) (more differentiated cells less aggresive)
(3) broad categories of oncologic emergency
- pressure or obstruction from space occupying lesion
- metabolic or hormal problems (paraneoplastic syn)
- Tx-related complications
structural/ obstructive oncologic emergencies (7)
- Superior Vena Cava Syndrome
- Intestinal obstruction
- Malignant Spinal Cord Compression MSCC
- Pericardial Effusion/Tamponade
- Urinary Obstruction
- Malignant Biliary Obstruction
- Increased Intracranial Pressure
Dz process resulting in impairment of venous return from the head, neck, and upper extremities. +presenting features (6) + X-ray findings
Superior vena cava syndrome, 1. puffy EYES, head, neck 2. dyspnea 3. cough 4. dilated neck veins 5. increased collateral veins covering ant chest wall 6. cyanosis X-Ray: widening of R superior mediastinum
Dz process resulting in Pain (colicky in nature) + presenting features (4)
Intestinal obstruction,
- ascites
- visible peristalsis
- *high-pitched bowel sounds
- tumor mass
Oncological emergency presenting w/ LOCALIZED back pain and a history of cancer
Malignant Spinal Cord Compression MSCC
Dz process presenting w/ low back pain, low sensation over buttocks, SADDLE SIGN (perineal numbness), rectal/ bladder dysfunction, leg weakness
Cauda equine syndrome
oncological emergency presenting w/ flank pain, recurrent UTI, persistent proteinuria/hematuria, dydronephrosis
Urinary obstruction (prostate or gyno malignancies)
liver or pancreatic cancers may lead to
malignant biliary obstruction
Oncological emergency presenting w/ headache, nausea, vomiting, AMS, seizures, and focal neuro changes
Increased intracranial pressure
Metabolic oncological emergencies (2)
- Hypercalcemia (Tumor production of PTHrP)
2. SIADH (hyponatremia may be asymp or severe)
most common metabolic paraneoplastic syndrome symp
hypercalcemia
hyperkalemia, hyperphosphatemia, and hypocalcemia may result from
massive destruction of a large # of rapidly proliferating neoplastic cells –> may lead to death or renal failure (CHEMO)
(3) cancer treatment categories
- curative (may have to move to control)
- control
- palliative
Radiation and Chemotherapy targets rapidly proliferating cell indiscriminately thus leading to (3)
- myelosupression (bone marrow suppression)
- Mucositis (mouth, throat, vag, rectal)
- taste or smell changes
Hormone therapy used for some responsive cancers, primarilly (2) – Tx example (1)
- breast
- prostate
- -Tamoxifen
______ __ ______ late complication of bone marrow and stem cell transplantation
Graft vs. Host Dz
