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Hem/Onc > principles of oncology pt 1 > Flashcards

principles of oncology pt 1 Flashcards

1
Q

how can a tumor develop?

A
  1. Unregulated cell division
  2. Avoidance of cell death
  3. Tissue invasion
  4. The ability metastasize
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2
Q

cancer is the ___ leading cause of death in the US

A

second

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3
Q

what are the 4 most common cancers

A
  1. lung
  2. colon
  3. breast
  4. prostate
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4
Q

The most significant risk factor for cancer overall is ?

A

age
2/3 of all cases occur in those older than age 65 years
(as we get older, the chances of having cancer increases significantly)

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5
Q

Cancers are more often deadly in what race

A

african americans

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6
Q

what is MC cancer death

A

lung cancer

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7
Q

what are the burdens of cancer

A
  1. cost
  2. physical morbidity
  3. emotional distress
  4. reduction in quality of life
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8
Q

The chance that someone will develop cancer in response to a environmental exposure depends on ?

A
  1. how long of exposure
  2. how often of exposure
  3. Exposure to certain environmental factors (including diet, hormones)
  4. Genetic makeup
  5. Age and gender
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9
Q

Improved understanding of carcinogenesis has allowed for:

A
  1. specific interventions - reduces mortality by preventing cancer in those at risk
  2. Effective screening - early detection of cancer
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10
Q

prevention of cancer concerns for what factors

A

identification and manipulation of:
- biologic
- environmental
- social
- genetic
factors

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11
Q

what is the primary prevention of cancer

A

healthy lifestyle - avoid carcinogen exposure and promote health

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12
Q

what is the focus of primary cancer prevention

A

prevent a cancer from ever developing or to delay the development of a malignancy

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13
Q

what does primary cancer prevention look like with particularly high risk pt

A

may include the use of chemopreventive agents or prophylactic surgery

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14
Q

what is the MC preventable cause of cancer death

A

tobacco
> 80% of lung cancer cases occur in smokers

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15
Q

why are light- and low-tar cigarettes not safer?

A

smokers tend to inhale them more frequently and deeply

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16
Q

Any strategy for cancer control must include the goal of

A

markedly reducing, if not eliminating, tobacco use

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17
Q

what is secondhand or passive smoke

A

Environmental tobacco smoke that cause lung cancer and other cardiopulmonary diseases in nonsmokers

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18
Q

what type of tobacco that when smoked daily can double the risk for oral and esophageal cancers

A

cigars

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19
Q

3-4 cigars daily can increases the risk of oral cancers and esophageal cancer more than ?

A

eightfold and esophageal cancer fourfold

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20
Q

what tobacco product is linked to dental caries, gingivitis, oral leukoplakia, and oral cancer

A

smokeless tobacco

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21
Q

what type of cancer is linked to carcinogens in tobacco dissolved in saliva and swallowed

A

esophageal cancer

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22
Q

what type of primary prevention is associated with reduced risk of colon and breast cancers

A

physical activity

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23
Q

what other disease shows an increased risk of cancer

A

obesity
increases as body mass index increases to more than 25 kg/m2.

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24
Q

what type of diet increases risk for cancers of the breast, colon, prostate, and endometrium

A

high fat
(Many studies have since failed to correlate cancer risk with high fat diet, but it is wise to avoid)

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25
Q

what type of diet is associated with a reduced risk of colonic polyps and invasive cancer of the colon

A

dietary fiber

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26
Q

how does alcohol affect the risk of cancer

A
  • increased risk of cancers of the mouth, throat, liver, voice box, and esophagus, and stomach
  • There is evidence for an increased risk of breast cancer
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27
Q

the early detection and treatment of subclinical, asymptomatic, or early disease in individuals without obvious signs or symptoms of cancer

A

secondary prevention

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28
Q

goal of secondary prevention

A
  1. identifying people who are at risk for developing malignancy
  2. implementing appropriate screening recommendations based on the risk assessment
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29
Q

screenings including physical examinations, self-examinations, radiologic procedures, laboratory tests
are examples of what type of prevention

A

secondary

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30
Q

purpose of screenings

A

early detection in asymptomatic individuals, with the goal of decreasing morbidity and mortality

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31
Q

A screening tests accuracy is described by:

A
  1. Sensitivity - proportion of persons with the disease who test positive in the screen
  2. Specificity - proportion of persons without the disease that test negative in the screening test
  3. Positive predictive value - proportion of persons who test positive that actually have the disease
  4. Negative predictive value - proportion testing negative that do not have the disease
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32
Q

what cancers have screenings that are more beneficial for certain age groups

A
  1. cervical
  2. colon
  3. prostate
  4. breast
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33
Q

what screening may be beneficial depending on age and smoking history

A

lung cancer screening

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34
Q

Yearly mammograms are recommended starting at age ?

A

40

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35
Q

for Colorectal Cancer and Polyps
Beginning at age 45, both men and women should follow one of these testing schedules:

A
  1. Tests that find polyps and cancer
    - Flexible sigmoidoscopy every 5 years
    - Colonoscopy every 10 years
    - Double-contrast barium enema every 5 years
    - CT colonography (virtual colonoscopy) every 5 years
  2. Tests that primarily find cancer
    - Yearly fecal occult blood test (gFOBT)
    - Yearly fecal immunochemical test (FIT) every year
    - Stool DNA test (sDNA)
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36
Q

Cervical cancer screening should begin at age ?

A

21

37
Q

When should women between ages 21 and 29 have a Pap test

A

every 3 years

38
Q

when should women between the ages of 30 and 65 have a Pap test? what additional test do they need?

A

plus an HPV test
every 5 years

39
Q

when should women over age 65 who have had regular cervical cancer testing with normal results be tested?

A

none

40
Q

Women with a history of a serious cervical pre-cancer should continue to be tested for ___ after that diagnosis, even if testing continues past age 65.

A

20 years

41
Q

warning signs of cancer

A
  1. Change in bowel or bladder habits
  2. A sore that does not heal
  3. Unusual bleeding or discharge
  4. Thickening or lump in the breasts, testicles or elsewhere
  5. Indigestion or difficulty swallowing
  6. Obvious change in the size, color, shape or thickness of a wart, mole, or mouth sore
  7. Nagging cough or hoarseness
    (CAUTION)
42
Q

s/s of cancer

A
  1. Classic symptoms: Nightsweats, Unexplained weight loss or loss of appetite, Persistent low-grade fever
  2. Chronic pain, especially in the bones
  3. Persistent fatigue, nausea or vomiting
  4. Repeated infection
  5. Skin changes - hyperpigmentation, jaundice, erythema, itching, hirsutism
43
Q

diagnosis of cancer relies mostly on what

A

invasive tissue biopsy ONLY
no noninvasive diagnostic test is sufficient to define a disease process as cancer

44
Q

what does a tissue biopsy tell us

A
  1. histology of tumor
  2. grade of tumor
  3. invasiveness/characteristics of tumor
45
Q

Once the diagnosis of cancer is made, the management of the patient is best undertaken as a ____

A

multidisciplinary collaboration
- PCP, medical oncologists, surgical oncologists, radiation oncologists
- Pharmacists, social workers, rehabilitation medicine specialists
- Counselors, psychiatrists

46
Q

what 2 components are essential to cancer management

A
  1. staging - determines the extent of disease; helps determine prognosis and best treatment plan
  2. monitoring - detects the reappearance or progression
47
Q

How do you communicate bad news to pts

A

Individualized yet systematic approach can help you feel more confident and reduce your patients’ suffering

  1. Assess your pt’s understanding
  2. Give a “warning shot”
  3. Use words the pt/family can understand
  4. Be quiet and listen
  5. Provide additional information
  6. Develop a plan for follow-up care
  7. Be accurate without destroying all hope
    - Use the words “cancer” or “malignant”
    - Avoid “fatal” or “terminal”
    - Discuss prognosis
    - Support patient and family members
48
Q

what are the series of emotional states that cancer pts may experience

A
  1. Denial
  2. Hostility
  3. Regression
  4. Withdrawal
49
Q

to diagnose a pt with depression battling cancer, they must:

A
  1. have a depressed mood (dysphoria) and/or
  2. a loss of interest in pleasure (anhedonia) for at least 2 weeks.
50
Q

symptoms of depression

A
  1. appetite change, sleep problems, psychomotor retardation
  2. agitation, fatigue, feelings of guilt
  3. worthlessness, inability to concentrate, and suicidal ideation.
51
Q

what tx to give for cancer and depression

A
  1. serotonin reuptake inhibitor (fluoxetine)
  2. sertraline (zoloft)
  3. paroxetine (10–20 mg/d)
  4. tricyclic antidepressant (amitriptyline, desipramine)

allowing 4–6 weeks for response.

52
Q

Effective depression therapy should be continued at least how long

A

6 months after resolution of symptoms

53
Q

The first priority in patient management is

A

determine the extent of disease.

54
Q

the extent of disease is evaluated by a variety of noninvasive and invasive diagnostic tests and procedures

A

staging

55
Q

based on physical examination, radiographs, isotopic scans, CT scans, and other imaging procedures

A

clinical staging

56
Q

takes into account info from a surgical procedure and inspection and biopsy of organs commonly involved in disease spread.

A

pathologic staging

57
Q

3 ways how info obtained from staging is used to define the extent of disease

A
  1. localized
  2. regional - spread outside of the organ of origin
  3. metastatic - distant sites
58
Q

The most widely used system of staging is the

A

TNM (tumor, node, metastasis) system

59
Q

what certain tumors cannot be grouped on the basis of anatomic considerations?

A

hematopoietic tumors (leukemia, myeloma, and lymphoma)
often disseminated at presentation and do not spread like solid tumors

60
Q

A second major determinant of treatment outcome is the __
a determinant of how a patient is likely to cope with the physiologic stresses imposed by the cancer and its treatment

A

physiologic reserve

61
Q

3 markers for physiologic reserve used include the:

A
  1. patient’s age
  2. Karnofsky performance status
  3. Eastern Cooperative Oncology Group (ECOG) performance status
62
Q

oncology tx recommendations depend upon what 3

A
  1. extent of disease
  2. prognosis
  3. patient wishes
63
Q

treatment has successfully eradicated all traces of a person’s cancer, and the cancer will never recur

A

cure

64
Q

signs and symptoms of a person’s cancer are reduced. Remissions can be partial or complete. In a complete remission, all signs and symptoms of cancer have disappeared.

A

remission

65
Q

return of signs and symptoms of a person’s cancer - treatment of a relapse is known as “salvage” therapy

A

relapse

66
Q

to prevent or treat the symptoms and side effects of the disease and its treatment, in addition to the related psychological, social, and spiritual problems.
The goal is not to cure.

A

palliative care

67
Q

what is not specific enough to permit a diagnosis of malignancy to be made

A

tumor markers

68
Q

tumor markers are best used to ?

A

assess response to treatment

69
Q

Gestational trophoblastic disease, gonadal germ cell tumor
what marker?

A

Human chorionic gonadotropin (HCG)

70
Q

what marker results in pregnancy

A

Human chorionic gonadotropin (HCG)

71
Q

Medullary cancer of the thyroid
what marker

A

Calcitonin

72
Q

Hepatocellular carcinoma, gonadal germ cell tumor
what marker

A

α Fetoprotein

73
Q

what marker shows in cirrhosis, hepatitis

A

α Fetoprotein

74
Q

what marker is seen in Adenocarcinomas of the colon, pancreas, lung, breast, ovary

A

Carcinoembryonic antigen (CEA)

75
Q

what marker is seen in Pancreatitis, hepatitis, inflammatory bowel disease, smoking

A

Carcinoembryonic antigen (CEA)

76
Q

what tumor marker is seen in Lymphoma, Ewing’s sarcoma

A

Lactate dehydrogenase

77
Q

what marker is seen in Hepatitis, hemolytic anemia, many others

A

Lactate dehydrogenase

78
Q

what tumor marker is seen in Prostate cancer

A

Prostate-specific antigen

79
Q

what marker is seen in Prostatitis, prostatic hypertrophy

A

Prostate-specific antigen

80
Q

what tumor marker is seen in Ovarian cancer, some lymphomas

A

CA-125

81
Q

what marker is seen in Menstruation, peritonitis, pregnancy

A

CA-125

82
Q

what tumor marker is seen in Colon, pancreatic, breast cancer

A

CA 19-9

83
Q

what marker is seen in Pancreatitis, ulcerative colitis

A

CA 19-9

84
Q

if a pt is fully active, able to carry on all predisease performance without restriction
what is their ECOG grade

A

0

85
Q

if a pt is restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light housework, office work
what is their ECOG grade

A

1

86
Q

if a pt is ambulatory and capable of all self-care but unable to carry out any work activities. Up and about more than 50% of waking hours
what is their ECOG grade

A

2

87
Q

if a pt is Capable of only limited self-care, confined to bed or chair more than 50% of waking hours
what is their ECOG grade

A

3

88
Q

if a pt is completely disabled. Cannot carry on any self-care. Totally confined to bed or chair
what is their ECOG grade

A

4
5 = ded

Hem/Onc (13 decks)

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