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
characteristics of high grade tumours
fast growing, poor prognosis
19
what is the TNM system
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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TNM - What does T mean
size/ extent/ depth of primary tumour
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TNM - What does Tx mean
cannot be assessed
20
TNM - What does Tis mean
carcinoma in situ
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TNM - What does T0 mean
no evidence of tumour
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TNM - What does T1, T2, T3, T4 mean
depend on increasing size, extent or depth of the primary tumour
23
TNM - What does N mean
degree of involvement of regional lymph nodes
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TNM - What does Nx mean
cannot be assessed
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TNM - What does N0 mean
no evidence of tumour in nodes
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TNM - What does N1 mean
spread to limited number of regional nodes
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TNM - What does N2 mean
midway between 1/2
28
TNM - What does N3 mean
greater number of regional nodes or distant nodes
29
TNM - What does M mean
distant metastases
30
3 most common places for tumours to metastasize to
lung, liver and bone
31
TNM - What does M0 mean
no distant metastases
31
TNM - What does M1 mean
deposits in distant organs
32
TNM - T staging of colon cancer, T1
invades submucosa
32
TNM - T staging of colon cancer, T2
invades muscularis proproa
32
TNM - T staging of breast cancer. Size in cm for T1
<2cm
32
TNM - T staging of breast cancer. Size in cm for T2
>2cm but <5cm
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TNM - T staging of breast cancer. Size in cm for T3
>5cm
33
TNM - T staging of breast cancer. Size in cm for T4
involvement of chest wall, skin or inflammatory breast cancer
34
TNM - T staging of colon cancer, T3
invades through the muscularis propria into the subserosa
34
TNM - T staging of colon cancer, T4
invades other organs or structures and /or perforates visceral peritoneum
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TNM - N staging of breast cancer, N1
involved lymph nodes in the armpit but the nodes are not stuck to surrounding tissues
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TNM - N staging of breast cancer - levels
1st level: Axillary, 2nd level: internal mammary, 3rd level: clavicular
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TNM - N staging of breast cancer, N2
stuck LNs in armpit/ involves LNs behind breast bone but not both
38
TNM - N staging of breast cancer, N3
involved LNs above and below the clavicle or armpit and breast bone LNs both involved
39
TNM - N staging of colon cancer
depends on the number of nodes involved
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TNM - M staging of breast cancer, M0
no metastatic disease
41
TNM - M staging of breast cancer, M1
distant metastatic disease
42
TNM - M staging of colon cancer, subclassifiers - M1a
metastasis confined to one organ without peritoneal metastases
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TNM - M staging of colon cancer, subclassifiers - M1b
metastases in more than 1 organ
44
TNM - M staging of colon cancer, subclassifiers - M1c
metastases to the peritoneum with or without other organ involvement
45
what is the NPI
Nottingham Prognostic Index, prognostic decision making system for breast cancer which incorporates size, grade and lymph node stage.
46
NPI equation
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
what is pTNM
pathological TNM
48
what is yTNM
TNM after neo-adjuvant chemoradiation
49
what is lymphovascular invasion parameters [V0-V2]
when the tumour has invaded vascular structures
50
what is surgical resection status shown as
R0-R2
51
what are the serum tumour markers
proteins in the blood when a tumour is present [S0-S3]
52
what is V0
no vascular invasion
53
what is V1
microscopic vascular invasion
54
what is V2
macroscopic vascular invasion
55
what is R0
resection margin clear
56
what is R1
microscopic involvement of margin
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what is R2
macroscopic involvement of margin, surgery cannot get all of it out
58
what are tumour markers released in
Cerebral spinal fluid, urine and blood
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what are tumour markers used for
aiding diagnosis and following up after treatment
60
what is SX
serum markers not available or not performed
61
what is S0
serum markers are in normal limits
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what are S1-3
progressively increased level of serum markers
63
what are serum makers commonly used for
prognosticating testicular cancer
64
inclusion of biomarkers for prognostic staging
tumour grade, hormone receptors (estrogen and progesterone) and HER2
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inclusion of multigene panels for prognostic staging
oncotype DX
66
how are lymphomas staged
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
what does the addition of b to the stages of lymphoma mean (e.g. stage 1b)
there are symptoms of fever, night sweats and weight loss
68
what is performance status
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
what is the ECOG
Easter Cooperative Oncology Group, tells us what category the patient is in for their performance status
70
what does ECOG 0 mean
fully active, can carry out all pre-disease performance without restriction
71
what does ECOG 4 mean
completely disabled, cannot carry out self care, totally confined to bed or chair
72
who decided treatment plan
MDT -> oncologists, surgeons, nurses, pathologists, radiologists