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causes and consequences > prognosis > Flashcards

prognosis Flashcards

1
Q

what is a prognostic factor

A

a situation or condition, or characteristic of a patient which can be used to estimate the chance of recovery from a disease or the chance the disease comes back

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2
Q

what is a predictive factor

A

measurement that is associated with response or lack or response to a particular therapy

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3
Q

what is overall survival

A

% of people with a specific type and stage of cancer who have not died from any cause during a certain period of time after diagnosis

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4
Q

what is cancer-specific survival

A

% of patients with a specific type and stage of cancer who have not died from their cancer during a certain period of time.

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5
Q

what is disease-free survival

A

% of patients who have no signs of cancer during a certain period of time after treatment

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6
Q

2 other names for disease-free survival

A

recurrence-free and progression-free

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7
Q

why do we need prognostic factors

A

identify people who have a good or bad outcome. those with good outcomes may not benefit from adjuvant therapy

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8
Q

determinants of cancer prognosis (5)

A
  1. What is the tumour
  2. how well is it differentiated
  3. size, how much spread
  4. other clinical factors
  5. is therapy even possible?
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9
Q

example of tumours with excellent prognosis

A

thyroid

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10
Q

example of tumours with moderate prognosis (4)

A

kidney, prostate, cervix and breast

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11
Q

example of tumours with poor prognosis (3)

A

pancreas, brain, oesophagus

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12
Q

what dictates the grade of tumour

A

differentiation

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13
Q

what is pleomorphism

A

variation in size and shape of constituent cells of the tumour

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14
Q

is the grade of the tumour worse or better with more pleomorphism

A

worse, there is more differentiation

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15
Q

how do more mitotic figures indicate worse grade of tumour

A

it indicates more proliferation

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16
Q

what is the mitotic index

A

proportion of cells containing mitotic figures

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17
Q

what is necrosis revelvant for

A

grading sarcomas

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18
Q
A
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18
Q
A
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18
Q
A
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19
Q

characteristics of low grade tumours

A

slow growing, good prognosis

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19
Q

what is a sarcoma

A

cancer that arises from soft tissues

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19
Q

what is the Ki67 index

A

proliferative index of tumours

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19
Q

difference between stage and grade

A

stage is how big the tumour is and how far it has gone and grade is how differentiated it is

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19
Q

characteristics of high grade tumours

A

fast growing, poor prognosis

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19
Q

what is the TNM system

A

Tumoour Node and Metastasis. Based upon the extent of local tumour spread, regional lymph node involvement and the presence of distant metastases

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19
Q

TNM - What does T mean

A

size/ extent/ depth of primary tumour

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19
Q

TNM - What does Tx mean

A

cannot be assessed

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20
Q

TNM - What does Tis mean

A

carcinoma in situ

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21
Q

TNM - What does T0 mean

A

no evidence of tumour

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22
Q

TNM - What does T1, T2, T3, T4 mean

A

depend on increasing size, extent or depth of the primary tumour

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23
Q

TNM - What does N mean

A

degree of involvement of regional lymph nodes

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24
Q

TNM - What does Nx mean

A

cannot be assessed

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25
Q

TNM - What does N0 mean

A

no evidence of tumour in nodes

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26
Q

TNM - What does N1 mean

A

spread to limited number of regional nodes

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27
Q

TNM - What does N2 mean

A

midway between 1/2

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28
Q

TNM - What does N3 mean

A

greater number of regional nodes or distant nodes

29
Q

TNM - What does M mean

A

distant metastases

30
Q

3 most common places for tumours to metastasize to

A

lung, liver and bone

31
Q

TNM - What does M0 mean

A

no distant metastases

31
Q

TNM - What does M1 mean

A

deposits in distant organs

32
Q

TNM - T staging of colon cancer, T1

A

invades submucosa

32
Q

TNM - T staging of colon cancer, T2

A

invades muscularis proproa

32
Q

TNM - T staging of breast cancer. Size in cm for T1

32
Q

TNM - T staging of breast cancer. Size in cm for T2

A

> 2cm but <5cm

32
Q

TNM - T staging of breast cancer. Size in cm for T3

33
Q

TNM - T staging of breast cancer. Size in cm for T4

A

involvement of chest wall, skin or inflammatory breast cancer

34
Q

TNM - T staging of colon cancer, T3

A

invades through the muscularis propria into the subserosa

34
Q

TNM - T staging of colon cancer, T4

A

invades other organs or structures and /or perforates visceral peritoneum

37
Q

TNM - N staging of breast cancer, N1

A

involved lymph nodes in the armpit but the nodes are not stuck to surrounding tissues

37
Q

TNM - N staging of breast cancer - levels

A

1st level: Axillary, 2nd level: internal mammary, 3rd level: clavicular

37
Q

TNM - N staging of breast cancer, N2

A

stuck LNs in armpit/ involves LNs behind breast bone but not both

38
Q

TNM - N staging of breast cancer, N3

A

involved LNs above and below the clavicle or armpit and breast bone LNs both involved

39
Q

TNM - N staging of colon cancer

A

depends on the number of nodes involved

40
Q

TNM - M staging of breast cancer, M0

A

no metastatic disease

41
Q

TNM - M staging of breast cancer, M1

A

distant metastatic disease

42
Q

TNM - M staging of colon cancer, subclassifiers - M1a

A

metastasis confined to one organ without peritoneal metastases

43
Q

TNM - M staging of colon cancer, subclassifiers - M1b

A

metastases in more than 1 organ

44
Q

TNM - M staging of colon cancer, subclassifiers - M1c

A

metastases to the peritoneum with or without other organ involvement

45
Q

what is the NPI

A

Nottingham Prognostic Index, prognostic decision making system for breast cancer which incorporates size, grade and lymph node stage.

46
Q

NPI equation

A

tumour size (cm) x 0.2 + histological grade (1-3) + number of +ve lymph nodes [1= 0 nodes, 2= 1-3 nodes, 3 = >3 nodes]

47
Q

what is pTNM

A

pathological TNM

48
Q

what is yTNM

A

TNM after neo-adjuvant chemoradiation

49
Q

what is lymphovascular invasion parameters [V0-V2]

A

when the tumour has invaded vascular structures

50
Q

what is surgical resection status shown as

51
Q

what are the serum tumour markers

A

proteins in the blood when a tumour is present [S0-S3]

52
Q

what is V0

A

no vascular invasion

53
Q

what is V1

A

microscopic vascular invasion

54
Q

what is V2

A

macroscopic vascular invasion

55
Q

what is R0

A

resection margin clear

56
Q

what is R1

A

microscopic involvement of margin

57
Q

what is R2

A

macroscopic involvement of margin, surgery cannot get all of it out

58
Q

what are tumour markers released in

A

Cerebral spinal fluid, urine and blood

59
Q

what are tumour markers used for

A

aiding diagnosis and following up after treatment

60
Q

what is SX

A

serum markers not available or not performed

61
Q

what is S0

A

serum markers are in normal limits

62
Q

what are S1-3

A

progressively increased level of serum markers

63
Q

what are serum makers commonly used for

A

prognosticating testicular cancer

64
Q

inclusion of biomarkers for prognostic staging

A

tumour grade, hormone receptors (estrogen and progesterone) and HER2

65
Q

inclusion of multigene panels for prognostic staging

A

oncotype DX

66
Q

how are lymphomas staged

A

according to the number of sites they have. Stage 1 = 1 above diaphragm, stage 2 = 2 above diaphragm, stage 3 = above and below diaphragm, stage 4 = involvement of spleen/liver etc

67
Q

what does the addition of b to the stages of lymphoma mean (e.g. stage 1b)

A

there are symptoms of fever, night sweats and weight loss

68
Q

what is performance status

A

measure of how well a person is able to carry on ordinary daily activities while living with cancer and provides an estimate of what treatments the patient may tolerate

69
Q

what is the ECOG

A

Easter Cooperative Oncology Group, tells us what category the patient is in for their performance status

70
Q

what does ECOG 0 mean

A

fully active, can carry out all pre-disease performance without restriction

71
Q

what does ECOG 4 mean

A

completely disabled, cannot carry out self care, totally confined to bed or chair

72
Q

who decided treatment plan

A

MDT -> oncologists, surgeons, nurses, pathologists, radiologists

causes and consequences (15 decks)

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