principles of oncology pt 1 Flashcards
1
Q
how can a tumor develop?
A
- Unregulated cell division
- Avoidance of cell death
- Tissue invasion
- The ability metastasize
2
Q
cancer is the ___ leading cause of death in the US
A
second
3
Q
what are the 4 most common cancers
A
- lung
- colon
- breast
- prostate
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)
5
Q
Cancers are more often deadly in what race
A
african americans
6
Q
what is MC cancer death
A
lung cancer
7
Q
what are the burdens of cancer
A
- cost
- physical morbidity
- emotional distress
- reduction in quality of life
8
Q
The chance that someone will develop cancer in response to a environmental exposure depends on ?
A
- how long of exposure
- how often of exposure
- Exposure to certain environmental factors (including diet, hormones)
- Genetic makeup
- Age and gender
9
Q
Improved understanding of carcinogenesis has allowed for:
A
- specific interventions - reduces mortality by preventing cancer in those at risk
- Effective screening - early detection of cancer
10
Q
prevention of cancer concerns for what factors
A
identification and manipulation of:
- biologic
- environmental
- social
- genetic
factors
11
Q
what is the primary prevention of cancer
A
healthy lifestyle - avoid carcinogen exposure and promote health
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
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
14
Q
what is the MC preventable cause of cancer death
A
tobacco
> 80% of lung cancer cases occur in smokers
15
Q
why are light- and low-tar cigarettes not safer?
A
smokers tend to inhale them more frequently and deeply
16
Q
Any strategy for cancer control must include the goal of
A
markedly reducing, if not eliminating, tobacco use
17
Q
what is secondhand or passive smoke
A
Environmental tobacco smoke that cause lung cancer and other cardiopulmonary diseases in nonsmokers
18
Q
what type of tobacco that when smoked daily can double the risk for oral and esophageal cancers
A
cigars
19
Q
3-4 cigars daily can increases the risk of oral cancers and esophageal cancer more than ?
A
eightfold and esophageal cancer fourfold
20
Q
what tobacco product is linked to dental caries, gingivitis, oral leukoplakia, and oral cancer
A
smokeless tobacco
21
Q
what type of cancer is linked to carcinogens in tobacco dissolved in saliva and swallowed
A
esophageal cancer
22
Q
what type of primary prevention is associated with reduced risk of colon and breast cancers
A
physical activity
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.
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)
25
what type of diet is associated with a reduced risk of colonic polyps and invasive cancer of the colon
dietary fiber
26
how does alcohol affect the risk of cancer
- 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
27
the early detection and treatment of subclinical, asymptomatic, or early disease in individuals without obvious signs or symptoms of cancer
secondary prevention
28
goal of secondary prevention
1. identifying people who are at risk for developing malignancy
2. implementing appropriate screening recommendations based on the risk assessment
29
screenings including physical examinations, self-examinations, radiologic procedures, laboratory tests
are examples of what type of prevention
secondary
30
purpose of screenings
early detection in asymptomatic individuals, with the goal of decreasing morbidity and mortality
31
A screening tests accuracy is described by:
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_
32
what cancers have screenings that are more beneficial for certain age groups
1. cervical
2. colon
3. prostate
4. breast
33
what screening may be beneficial depending on age and smoking history
lung cancer screening
34
Yearly mammograms are recommended starting at age ?
40
35
for Colorectal Cancer and Polyps
Beginning at age 45, both men and women should follow one of these testing schedules:
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)
36
Cervical cancer screening should begin at age ?
21
37
When should women between ages 21 and 29 have a Pap test
every 3 years
38
when should women between the ages of 30 and 65 have a Pap test? what additional test do they need?
plus an HPV test
every 5 years
39
when should women over age 65 who have had regular cervical cancer testing with normal results be tested?
none
40
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.
20 years
41
warning signs of cancer
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
6. Indigestion or difficulty swallowing
7. Obvious change in the size, color, shape or thickness of a wart, mole, or mouth sore
8. Nagging cough or hoarseness
(CAUTION)
42
s/s of cancer
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
diagnosis of cancer relies mostly on what
invasive tissue biopsy ONLY
no noninvasive diagnostic test is sufficient to define a disease process as cancer
44
what does a tissue biopsy tell us
1. histology of tumor
2. grade of tumor
3. invasiveness/characteristics of tumor
45
Once the diagnosis of cancer is made, the management of the patient is best undertaken as a ____
multidisciplinary collaboration
- PCP, medical oncologists, surgical oncologists, radiation oncologists
- Pharmacists, social workers, rehabilitation medicine specialists
- Counselors, psychiatrists
46
what 2 components are essential to cancer management
1. staging - determines the extent of disease; helps determine prognosis and best treatment plan
2. monitoring - detects the reappearance or progression
47
How do you communicate bad news to pts
*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
what are the series of emotional states that cancer pts may experience
1. Denial
2. Hostility
3. Regression
4. Withdrawal
49
to diagnose a pt with depression battling cancer, they must:
1. have a depressed mood (dysphoria) and/or
2. a loss of interest in pleasure (anhedonia) for at least 2 weeks.
50
symptoms of depression
1. appetite change, sleep problems, psychomotor retardation
2. agitation, fatigue, feelings of guilt
3. worthlessness, inability to concentrate, and suicidal ideation.
51
what tx to give for cancer and depression
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
Effective depression therapy should be continued at least how long
6 months after resolution of symptoms
53
The first priority in patient management is
determine the extent of disease.
54
the extent of disease is evaluated by a variety of noninvasive and invasive diagnostic tests and procedures
staging
55
based on physical examination, radiographs, isotopic scans, CT scans, and other imaging procedures
clinical staging
56
takes into account info from a surgical procedure and inspection and biopsy of organs commonly involved in disease spread.
pathologic staging
57
3 ways how info obtained from staging is used to define the extent of disease
1. localized
2. regional - spread outside of the organ of origin
3. metastatic - distant sites
58
The most widely used system of staging is the
TNM (tumor, node, metastasis) system
59
what certain tumors cannot be grouped on the basis of anatomic considerations?
*hematopoietic tumors* (leukemia, myeloma, and lymphoma)
often disseminated at presentation and do not spread like solid tumors
60
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
physiologic reserve
61
3 markers for physiologic reserve used include the:
1. patient's age
2. Karnofsky performance status
3. Eastern Cooperative Oncology Group (ECOG) performance status
62
oncology tx recommendations depend upon what 3
1. extent of disease
2. prognosis
3. patient wishes
63
treatment has successfully eradicated all traces of a person’s cancer, and the cancer will never recur
cure
64
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.
remission
65
return of signs and symptoms of a person’s cancer - treatment of a relapse is known as “salvage” therapy
relapse
66
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.
palliative care
67
what is not specific enough to permit a diagnosis of malignancy to be made
tumor markers
68
tumor markers are best used to ?
assess response to treatment
69
Gestational trophoblastic disease, gonadal germ cell tumor
what marker?
Human chorionic gonadotropin (HCG)
70
what marker results in pregnancy
Human chorionic gonadotropin (HCG)
71
Medullary cancer of the thyroid
what marker
Calcitonin
72
Hepatocellular carcinoma, gonadal germ cell tumor
what marker
α Fetoprotein
73
what marker shows in cirrhosis, hepatitis
α Fetoprotein
74
what marker is seen in Adenocarcinomas of the colon, pancreas, lung, breast, ovary
Carcinoembryonic antigen (CEA)
75
what marker is seen in Pancreatitis, hepatitis, inflammatory bowel disease, smoking
Carcinoembryonic antigen (CEA)
76
what tumor marker is seen in Lymphoma, Ewing's sarcoma
Lactate dehydrogenase
77
what marker is seen in Hepatitis, hemolytic anemia, many others
Lactate dehydrogenase
78
what tumor marker is seen in Prostate cancer
Prostate-specific antigen
79
what marker is seen in Prostatitis, prostatic hypertrophy
Prostate-specific antigen
80
what tumor marker is seen in Ovarian cancer, some lymphomas
CA-125
81
what marker is seen in Menstruation, peritonitis, pregnancy
CA-125
82
what tumor marker is seen in **Colon**, pancreatic, breast cancer
CA 19-9
83
what marker is seen in Pancreatitis, ulcerative colitis
CA 19-9
84
if a pt is fully active, able to carry on all predisease performance without restriction
what is their ECOG grade
0
85
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
1
86
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
2
87
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
3
88
if a pt is completely disabled. Cannot carry on any self-care. Totally confined to bed or chair
what is their ECOG grade
4
5 = ded
