Principles of Oncology Flashcards
What is cancer staging
Determining the extent of disease BEFORE ANY DEFINITIVE TREATMENT IS INITIATED
What information comes from staging cancer
Prognosis (overall survival), treatment selection, treatment evaluation, research and education
T/F: Stage 4 cancer patient do not get surgery because it does not influence overall outcomes
True
What is TMN classification
Tumore (T1-T4), Node (N1-N4), Metastasis (M+,M-)
How does the number of nodes effect the prognosis
More nodes are involved indicating a worse prognosis
What are the types of hematologic malignancies
Leukemia, lymphomas
T/F: Hematologic malignancies metastasis can be dangerous because they spread all over the body
False: Hematologic malignancies DO NOT have a PRIMARY tumor, therefore they CANT METASTASIZE
What are two common scales for performance of a patient
ECOG scale (mostly used in US) and Karnofsky scale (mostly used in Europe)
What are the five parameters of the ECOG scale
0: Fully active, able to carry on all pre-cancer activities without restriction
1: Restricted in physically strenuous activity but ambulatory and to carry light or sedentary work
2: Ambulatory and capable of all self-care but unable to carry out work activities (up during 50% of waking hours)
3: Capable of only limited self care, confined to bed or chair ( up during 50% of waking hours)
4: Completely disabled. Cannot carry on any self-care, totally confined to bed or chair
5: Death
What are the goals of cancer treatment
Cure, prolong survival, relieve symptoms
When the goal of therapy is to cure what measures should be take to secure this outcome
Discourage dose delays, dose reductions, assist with treatment decisions regarding toxicity management
When the goal of thereapy is non-curative what measures should be taken
Likely to hold, reduce dose and discontinue therapy, assists with treatment decisions regarding therapy selection (PROLONG SURVIVAL)
What is induction therapy
High-dose, combinatoin, INTENT of INDUCING COMPLETE REMISSION when initiating a curative regiment
What is consolidation therapy
REPETITION OF THE INDUCTION REGIMEN in a patient who has ACHIEVED A COMPLETE REMISSION AFTER INDUCTION, intention is to increase cure rate or prolong remission
Which tissue origin is associated with consolidation
Hematologic malignancies
What is maintenance therapy
Chemotherapy administered after primary therapy over a specified period of time in patients with remission of their disease to prevent relapse or a primary therapy to prevent progression of disease (must illicit a response to prolong the response)
What is adjuvant therapy
Short course, high dose, combination chemo in a patient with no evidence of cancer after surgery or radiotherapy, given with the INTENT of DESTROYING a low number of RESIDUAL TUMOR CELLS
What is neo-adjuvant therapy
Adjuvant chemo given in the pre-operative period (applies only to SOLID TUMORS)
What is palliative therapy
Chemotherapy given to control symptoms or prolong life in a patien in whom a cure is unlikely
How is the response to anticancer therapy measured, why
Response Evaluation Criteria in Solid Tumors (RECIST), response after initial treatment can often predict remission and survival
What are the outcomes of RECIST
Cure: Entirely free of disease with same life expectancy of cancer-free individual
Stable Disease: Tumor size neither grows nor shrinks
Progressive Disease (failure): greater than a 20% increase over small sum observed or development of new lesion while receiving treatment
T/F: A partial response is at least a 30% decrease in the sum of diameters of target lesions
True
T/F: A complete response is complete disappearance of all target lesions and no evidence of new disease for greater than one month after treatment
True
What is the equation for overall response
Complete response PLUS partial response (doesn’t always mean an increase in survival)
What is the most important evaluation of chemotherapy
Overall survival
What is progression free survival, what does it only apply to
Duration of time before patient progresses onto different therapy, only applies to metastatic disease
What is disease free survival and what does it only apply to
Length of time after primary threat until patient survives, only applies to patient’s that were cured
What does a waterfall plot tell
If there is a response to a drug and what type of response
What does a swimmers plot tell you
when they had their response and how long was the response
What is the universal language of chemotherapy toxicity, what are the two extremes of grading
Common toxicity criteria grading system (CTC)/ 0 = no response while 5 = fatal toxicity due to the drug
What toxicity grades usually continue therapy and provide supportive care, which usually modify therapy
Toxicity grade 1-2, toxicity grade 3-4 (reduce dose or discontinue treatment)
Which cancer treatment guidlelines update most often
Nation Comprehensive Cancer Network, (NCCN)
What are the NCCN categories
Category 1: Based upon high-level evidence , uniform NCCN consensus that the intervention is appropriate
Category 2a: Based upon lower-evidence, theire is uniform NCCN consensus that the intervention is appropriate
Category 2B: Based upon lower evidence, there is NCCN consensus that the intervention is appropriate
Category 2: Regardless of any level of evidence, threis major NCCN disagreement that the intervention is appropriate
