principles of oncology pt 1 Flashcards
how can a tumor develop?
- Unregulated cell division
- Avoidance of cell death
- Tissue invasion
- The ability metastasize
cancer is the ___ leading cause of death in the US
second
what are the 4 most common cancers
- lung
- colon
- breast
- prostate
The most significant risk factor for cancer overall is ?
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)
Cancers are more often deadly in what race
african americans
what is MC cancer death
lung cancer
what are the burdens of cancer
- cost
- physical morbidity
- emotional distress
- reduction in quality of life
The chance that someone will develop cancer in response to a environmental exposure depends on ?
- how long of exposure
- how often of exposure
- Exposure to certain environmental factors (including diet, hormones)
- Genetic makeup
- Age and gender
Improved understanding of carcinogenesis has allowed for:
- specific interventions - reduces mortality by preventing cancer in those at risk
- Effective screening - early detection of cancer
prevention of cancer concerns for what factors
identification and manipulation of:
- biologic
- environmental
- social
- genetic
factors
what is the primary prevention of cancer
healthy lifestyle - avoid carcinogen exposure and promote health
what is the focus of primary cancer prevention
prevent a cancer from ever developing or to delay the development of a malignancy
what does primary cancer prevention look like with particularly high risk pt
may include the use of chemopreventive agents or prophylactic surgery
what is the MC preventable cause of cancer death
tobacco
> 80% of lung cancer cases occur in smokers
why are light- and low-tar cigarettes not safer?
smokers tend to inhale them more frequently and deeply
Any strategy for cancer control must include the goal of
markedly reducing, if not eliminating, tobacco use
what is secondhand or passive smoke
Environmental tobacco smoke that cause lung cancer and other cardiopulmonary diseases in nonsmokers
what type of tobacco that when smoked daily can double the risk for oral and esophageal cancers
cigars
3-4 cigars daily can increases the risk of oral cancers and esophageal cancer more than ?
eightfold and esophageal cancer fourfold
what tobacco product is linked to dental caries, gingivitis, oral leukoplakia, and oral cancer
smokeless tobacco
what type of cancer is linked to carcinogens in tobacco dissolved in saliva and swallowed
esophageal cancer
what type of primary prevention is associated with reduced risk of colon and breast cancers
physical activity
what other disease shows an increased risk of cancer
obesity
increases as body mass index increases to more than 25 kg/m2.
what type of diet increases risk for cancers of the breast, colon, prostate, and endometrium
high fat
(Many studies have since failed to correlate cancer risk with high fat diet, but it is wise to avoid)
what type of diet is associated with a reduced risk of colonic polyps and invasive cancer of the colon
dietary fiber
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
the early detection and treatment of subclinical, asymptomatic, or early disease in individuals without obvious signs or symptoms of cancer
secondary prevention
goal of secondary prevention
- identifying people who are at risk for developing malignancy
- implementing appropriate screening recommendations based on the risk assessment
screenings including physical examinations, self-examinations, radiologic procedures, laboratory tests
are examples of what type of prevention
secondary
purpose of screenings
early detection in asymptomatic individuals, with the goal of decreasing morbidity and mortality
A screening tests accuracy is described by:
- Sensitivity - proportion of persons with the disease who test positive in the screen
- Specificity - proportion of persons without the disease that test negative in the screening test
- Positive predictive value - proportion of persons who test positive that actually have the disease
- Negative predictive value - proportion testing negative that do not have the disease
what cancers have screenings that are more beneficial for certain age groups
- cervical
- colon
- prostate
- breast
what screening may be beneficial depending on age and smoking history
lung cancer screening
Yearly mammograms are recommended starting at age ?
40
for Colorectal Cancer and Polyps
Beginning at age 45, both men and women should follow one of these testing schedules:
- 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 - Tests that primarily find cancer
- Yearly fecal occult blood test (gFOBT)
- Yearly fecal immunochemical test (FIT) every year
- Stool DNA test (sDNA)
Cervical cancer screening should begin at age ?
21
When should women between ages 21 and 29 have a Pap test
every 3 years
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
when should women over age 65 who have had regular cervical cancer testing with normal results be tested?
none
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
warning signs of cancer
- Change in bowel or bladder habits
- A sore that does not heal
- Unusual bleeding or discharge
- Thickening or lump in the breasts, testicles or elsewhere
- Indigestion or difficulty swallowing
- Obvious change in the size, color, shape or thickness of a wart, mole, or mouth sore
- Nagging cough or hoarseness
(CAUTION)
s/s of cancer
- Classic symptoms: Nightsweats, Unexplained weight loss or loss of appetite, Persistent low-grade fever
- Chronic pain, especially in the bones
- Persistent fatigue, nausea or vomiting
- Repeated infection
- Skin changes - hyperpigmentation, jaundice, erythema, itching, hirsutism
diagnosis of cancer relies mostly on what
invasive tissue biopsy ONLY
no noninvasive diagnostic test is sufficient to define a disease process as cancer
what does a tissue biopsy tell us
- histology of tumor
- grade of tumor
- invasiveness/characteristics of tumor
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
what 2 components are essential to cancer management
- staging - determines the extent of disease; helps determine prognosis and best treatment plan
- monitoring - detects the reappearance or progression
How do you communicate bad news to pts
Individualized yet systematic approach can help you feel more confident and reduce your patients’ suffering
- Assess your pt’s understanding
- Give a “warning shot”
- Use words the pt/family can understand
- Be quiet and listen
- Provide additional information
- Develop a plan for follow-up care
- Be accurate without destroying all hope
- Use the words “cancer” or “malignant”
- Avoid “fatal” or “terminal”
- Discuss prognosis
- Support patient and family members
what are the series of emotional states that cancer pts may experience
- Denial
- Hostility
- Regression
- Withdrawal
to diagnose a pt with depression battling cancer, they must:
- have a depressed mood (dysphoria) and/or
- a loss of interest in pleasure (anhedonia) for at least 2 weeks.
symptoms of depression
- appetite change, sleep problems, psychomotor retardation
- agitation, fatigue, feelings of guilt
- worthlessness, inability to concentrate, and suicidal ideation.
what tx to give for cancer and depression
- serotonin reuptake inhibitor (fluoxetine)
- sertraline (zoloft)
- paroxetine (10–20 mg/d)
- tricyclic antidepressant (amitriptyline, desipramine)
allowing 4–6 weeks for response.
Effective depression therapy should be continued at least how long
6 months after resolution of symptoms
The first priority in patient management is
determine the extent of disease.
the extent of disease is evaluated by a variety of noninvasive and invasive diagnostic tests and procedures
staging
based on physical examination, radiographs, isotopic scans, CT scans, and other imaging procedures
clinical staging
takes into account info from a surgical procedure and inspection and biopsy of organs commonly involved in disease spread.
pathologic staging
3 ways how info obtained from staging is used to define the extent of disease
- localized
- regional - spread outside of the organ of origin
- metastatic - distant sites
The most widely used system of staging is the
TNM (tumor, node, metastasis) system
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
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
3 markers for physiologic reserve used include the:
- patient’s age
- Karnofsky performance status
- Eastern Cooperative Oncology Group (ECOG) performance status
oncology tx recommendations depend upon what 3
- extent of disease
- prognosis
- patient wishes
treatment has successfully eradicated all traces of a person’s cancer, and the cancer will never recur
cure
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
return of signs and symptoms of a person’s cancer - treatment of a relapse is known as “salvage” therapy
relapse
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
what is not specific enough to permit a diagnosis of malignancy to be made
tumor markers
tumor markers are best used to ?
assess response to treatment
Gestational trophoblastic disease, gonadal germ cell tumor
what marker?
Human chorionic gonadotropin (HCG)
what marker results in pregnancy
Human chorionic gonadotropin (HCG)
Medullary cancer of the thyroid
what marker
Calcitonin
Hepatocellular carcinoma, gonadal germ cell tumor
what marker
α Fetoprotein
what marker shows in cirrhosis, hepatitis
α Fetoprotein
what marker is seen in Adenocarcinomas of the colon, pancreas, lung, breast, ovary
Carcinoembryonic antigen (CEA)
what marker is seen in Pancreatitis, hepatitis, inflammatory bowel disease, smoking
Carcinoembryonic antigen (CEA)
what tumor marker is seen in Lymphoma, Ewing’s sarcoma
Lactate dehydrogenase
what marker is seen in Hepatitis, hemolytic anemia, many others
Lactate dehydrogenase
what tumor marker is seen in Prostate cancer
Prostate-specific antigen
what marker is seen in Prostatitis, prostatic hypertrophy
Prostate-specific antigen
what tumor marker is seen in Ovarian cancer, some lymphomas
CA-125
what marker is seen in Menstruation, peritonitis, pregnancy
CA-125
what tumor marker is seen in Colon, pancreatic, breast cancer
CA 19-9
what marker is seen in Pancreatitis, ulcerative colitis
CA 19-9
if a pt is fully active, able to carry on all predisease performance without restriction
what is their ECOG grade
0
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
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
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
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
