Quiz 1 Flashcards
Abnormal growth of tissue resulting from uncontrolled progressive multiplication of cells that serves no function
Tumor
Spread of cancer beyond the primary site; tumor moves
Metastases
Depth at which electronic equilibrium occurs for photon beams; depth of maximum absorbed dose and ionizations for photons from a single treatment field, falls off after
As energy goes up, this goes further down; higher energy = lower
D-max
Region between the skin surface and the depth of D-max
In this region, dose increases with depth until it reaches a maximum at the depth of D-max
The higher the x-ray energy, the greater this
Build-up region
Dose delivered at the depth of D-max through a single treatment field; where we can calculate what is given at D-max
Given dose (GD) Applied dose D-max dose
Unit of time; unit of output measure for linacs
Accelerators are calibrated so that 1 delivers 1 cGy for a standard, reference field size at a standard reference depth at a standard source-to-calibration point
Monitor unit (MU)
1 MU = ? cGy
1 cGy
Average daily dose
180-280 cGy
Point of intersection of the three axes of rotation of the treatment unit; gantry, couch and collimator rotate around this point in space, usually tumor
Isocenter
Central portion of beam emanating from the target, only part of the beam that doesn’t diverge
Central axis (CA)
Distance from the source to the patient’s skin; disadvantage: have to move patient to make up for difference in thickness of patient
Source-skin distance (SSD) set-up
Distance from source to the axis of rotation of the treatment unit (isocenter)
Source-axis distance (SAD) set-up
Unblocked or open field size projected at the reference distance, usually the isocenter (100 cm)
Collimator field size
Equivalent rectangular field dimension of the open treatment area within the collimated field
Ex: MLCs, aperture block
Blocked (effective) field size
Small packet of electromagnetic energy (ex: x-rays, gamma rays, etc.)
Photon energy
Negatively charged subatomic energy that can be accelerated by a variety of machines or emitted from decaying isotopes
Electron energy
Tool that modifies the isodose distribution of a beam to correct for tissue inhomogeneities by progressively decreasing beam intensity across the field irradiated
Wedge
Correct for tissue inhomogeneities
Compensating filter
Used to form/shape treatment field made of 50% bismuth, 26.7% lead, 13.3% tin and 10% cadmium; low melting point but toxic
Cerrobend block
Distinct part of a linac that allows treatment field shaping and blocking through the use of motorized leaves and the head of the machine
Multi-leaf collimators (MLCs)
Extended metal structure used to restrict the useful beam to the required size
Electron application (cone)
Extension cone
Cylinder
Tissue equivalent material placed on the skin to increase skin dose and even out irregular contours on the patient (similar Z to tissue)
Bolus
Allows part of the beam to pass through while reflecting the other part of the beam; prevents beam from diverging into other part of field
Beamsplit
Immobilization devices created from styrofoam shell and foaming agents
Alpha cradle
Immobilization device that consists of a cushion and a vacuum compression pump (“beanbag”)
Vac-Lok
Thermoplastic immobilization device; facemask
Aquaplast
Used to help immobilize and position tongue
Bite block
Lasers that project a small red or green beam of light toward the patient to set up the patient for right treatment
5: right, left, ceiling, floor, back
Positioning lasers
Treat patient with one field
Single field
Pair of fields directed along the same axis from opposite sides (ex: AP and PA)
Parallel opposed fields
Two oblique fields which are similar to a breast bridge, skim the field
Tangential field
Distance from midline to side
Breast bridge
Isocentric technique where the beam moves continuously about the patient
Rotation/arc therapy
Treatment at a short distance; uses radioactive material to deliver dose administered directly into the tumor
Used in early stage disease or as a boost (ex: prostate seeds)
Brachytherapy
Shows distribution of absorbed dose and points of equal dose
Isodoses
Organs that limit the dose or dose that can be tolerated by critical structures
Critical organ dose
Normal tissue or vital organs whose radiation tolerance limits the deliverable dose
Critical structures
Normal tissues (critical structures) in which sensitivity to radiation damage may influence treatment planning and/or delivery of a prescribed dose of radiation
Organ at rise (OAR)
Distance between the borders of two adjacent fields, usually measured on the patient’s skin; used to measure and verify the depth at which two adjacent fields abut
Gap
The use of imaging to compare the position of external set-up marks and internal anatomy to the treatment plan; ex: CT, portal imager (mV and/or kV), etc.
Image guided radiation therapy (IGRT)
Therapy that delivers non-uniform exposure across the beam’s eye view (BEV) using a variety of techniques and equipment
Changes dose distribution between each field; static field
Inversed planned type treatment
Intensity modulated radiation therapy (IMRT)
Visualization perspective that is “end-on” or positioned as if looking at a volume from the source or radiation; made possible from collected CT data, this perspective is essential in three-dimensional planning
Beam’s eye views (BEVs)
Type of specialized IMRT where it delivers radiation by rotating the radiation machine through one or more arcs while radiation is continuously delivered
Volumetric modulated arc therapy (VMAT)
Type of radiation therapy in which the radiation is delivered slice by slice; 6x energy
Treatment unit where the linac rotates continuously while the treatment couch moves through the gantry bore producing a spiral treatment beam
Tomotherapy
Radiation therapy unit that accelerates electrons and produces x-rays or electron treatments
Linear accelerator (linac)
About 1 in ____ women will develop cancer (____ out of 100)
3; 33
About 1 in ____ men will develop cancer (____ out of 100)
2; 41
Cancer contributes to 1 out of every ____ deaths
4
Cancer is ________ to heart disease as the most common cause of death
2nd
______ deaths a day from cancer in the US
1650
Preventative treatment (ex: treat brain for small cell lung cancer)
Profolactic
Uncontrollable growth of irregular cells; will grow as long as it can
Poor cell differentiation
Invades other tissues (altered surface enzymes allow tumor to grow into other tissues)
Grow at new sites (lymph, blood, etc.)
Avoid immune system (immunotherapy)
Autonomy
Cancer cell
Increased growth
-plasia
Abnormal
Dys-
Disorganized growth
Dysplasia
Increased, excessive
Hyper-
Quality or state of being self-governing; self-directing freedom, especially moral independence
No limitations of growth
Autonomy
Tumors that often invade and destroy normal surrounding tissue and, if left untreated, can cause the death of the host
Have no purpose and immortal
Malignant
Increased cellularity (number of cells increase)
Hyperplasia
After
Meta-
Abnormal appearing of cells, start seeing different cells in an area; not counted as malignant (ex: Barrett’s esophagus)
Metaplasia
More
Pleo-
Variance in size and shape of cells
Pleomorphism
Cell looks the same as the cell it originated from
Well differentiation
Cell looks unlike cell it originated from; more sensitive to radiation
Poor differentiation/anaplastic
2 types of exposure to carcinogens
Incomplete
Complete
Requires same cell to be affected by promoter, can’t cause cancer on its own (ex: UV light, hormones, etc.)
Incomplete exposure
Directly causes cancer (ex: chemicals, viruses, environment)
Complete exposure
3 stage theory of carcinogens
Initiation
Promotion
Progression
4 stages of cell growth
Initiation
Promotion
Progression
Metastasis
Altered DNA cell leads to mutation
Initiation
Promoting agent enhances faulty DNA (preneoplastic to neoplastic)
Promotion
New growth of tumor cell (neoplasm)
Progression
Cell growth, spreads from one point to another
Metastasis
Study of the causes of disease
Etiology
Controls cellular division of normal calls; can become oncogen
Protooncogenes
Gene that regulates the development and growth of cancerous tissues; on/off switch of cancer cells
Oncogene
Gene whose presence and proper function produces normal cellular growth and division; absence or inactivation of such a gene lease to uncontrolled growth
Arrest the damaged DNA to give it time to repair itself
Tumor-suppressor gene
New growth
Neoplasia
Provides information about its biological aggressiveness and is based on the degree of cell differentiation
Grade
Cancers grow by reproducing cells; completes cell cycle by loses restriction at ________
G0 (resting phase)
Time it takes for tumor to double in size (can be hours to months)
Doubling time
Earliest cancer can be detected on x-ray
30 doublings will reach 1 cm in size (about size of a marble)
_____ more doublings past 30 can lead to death
10
Change in ________ can help detect cancer early
WBC count
Greatest risk of developing cancer
Age
Multiple types of cells in tumor volume with a different response to radiation
Tumors are not just one type of cell
Tumor heterogeneity
5 ways cancers metastasize
Enter blood and lymph vessels (most common)
Invasion of adjacent tissues, continuously growing
Invasion/evasion of immune system
Reentrance into distant tissue
Implantation of malignant cells in new tissue
Implantation of malignant cells in new tissue
The spillage of tumor cell clusters and their subsequent growth as malignant implants at a site adjacent to an original tumor
Can happen during surgery (tumor removed and part left or falls off somewhere else and grows)
Seeding
Cancer cells break away from tumor and disseminate in blood
Intravasation
Certain cancer cells go to certain sites (ex: prostate to bone)
Homing
Process by which vascular networks (blood supply) are created to sustain malignant tumors
Angiogenesis/neovascularization
Metastasis = stage ?
4 (highest, poor prognosis)
4 common metastatic sites (most to least common) of lung cancer
Liver
Adrenal glands
Bone
Brain
4 common metastatic sites (most to least common) of breast cancer
Lymph
Bone
Lung
Liver
Common metastatic site of stomach cancer
Liver
2 common metastatic sites (most to least common) of anus cancer
Liver
Lungs
3 common metastatic sites (most to least common) of bladder cancer
Lungs
Bone
Liver
3 common metastatic sites (most to least common) of prostate cancer
Bone
Liver
Lungs
3 common metastatic sites (most to least common) of uterine cervix cancer
Lungs
Bone
Liver
Common metastatic site of colon cancer
Liver (direct hepatic drainage)
Common metastatic site of sarcomas
Lungs
3 patterns of cancer occurrence
Sporadic
Inherited
Familial cancer
Most cancers arise spontaneously (most common pattern of occurrence; no history or exposure to carcinogens
Occurs later in life (greater than 50 years)
Sporadic
Family has pattern of cancer, patient inherited faulty repair gene
Rare (less than 10% of all cancer)
Typically occur at younger age/earlier in life
Requires promoter, bilateral
Ex: breast cancer about 5%
Inherited
Certain cancers happen enough that it can’t be related to chance but is not genetic
Families share certain risk factors (ex: smoke, diet) and environment
Occurs later in life
Familial cancer
Between ____% to _____% of all cancers are associated with lifestyle (ex: smoking and diet)
60% to 70%
Most preventable cause of cancer
Cigarette smoking
3 patterns of cancer occurance
Sporadic
Inherited
Familial cancer
Most cancers arise spontaneously, no history or exposure to carcinogens; occurs later in life (greater than 50 years)
Sporadic
Family has pattern of cancer, patient inherited faulty repair gene; two or more generations diagnosed with the same or related forms of cancer
Rare, less than 10% of all cancers
Typically occurs at younger age/earlier in life
Requires promotor
Usually bilateral, multifocal, or multiple primary tumors in one or more family members
Ex: about 5% of breast cancer
Inherited
Certain cancers happen enough that it can’t be related to chance but it’s not genetic
Families share certain risk factors (ex: smoke, diet) and environment
Occurs later in life
Familial cancer
Between ____% to ____% of all cancers are associated with lifestyle (ex: smoking, diet)
60% to 70%
Most preventable cause of cancer; ____% of lung cancer in men, ____% in women
Cigarette smoking; 90%, 70%
Occurance of cancer in the general population
Absolute risk
Statistical estimate that compares the likelihood of development of a cancer in a person who has a specific risk factor with the likelihood in a person who doesn’t have the specific risk factor
Risk of someone developing disease with a risk factor compared to someone without the risk factor
Relative risk
Number of cases of cancer that could be prevented with the manipulation of known risk factors
Amount of disease caused by a specific risk factor and its prevention if changed within the population
Attributable risk
7 cancers smoking is associated with
Head and neck Stomach Bladder Kidney Pancreas Liver Cervix
___% to ___% of all hereditary cancers diagnosed
5% to 10%
Cancer on both sides of the body (ex: kidneys, breasts)
Bilateral
Cancer in different spots, more aggressive
Multifocal
Noma
Tumor
Leio
Smooth
Myo
Muscle
Sarcoma
Connective tissue
Hemato
Blood
Neuro
Nervous system (brain)
Adeno
Glandular
Carcinoma
Epithelium
Classification of benign and malignant tumors of glandular epithelium
Benign: adenoma
Malignant: adenocarcinoma
Classification of benign and malignant tumors of squamous epithelium
Benign: papilloma
Malignant: squamous cell carcinoma
The thin tissue forming the outer layer of a body’s surface and lining the alimentary canal and other hollow structures
Epithelium
Relating to, consisting of, or denoting a layer of epithelium that consists of very thin flattened cells
Squamous
Classification of benign and malignant tumors of connective tissue smooth muscle
Benign: leiomyoma
Malignant: leiomyosarcoma
Classification of malignant tumors of the hematopoietic system
Leukemia (WBC)
Classification of malignant tumors of the lymphoreticular system
Lymphoma
Classification of benign and malignant tumors of the neural system
Benign: neuroma
Malignant: blastoma
Most common histology associated with the oral cavity, pharynx, lung, anus, and cervix (tissue comes in direct contact with carcinogen)
Squamous cell carcinoma
Most common histology associated with the breast
Infiltrating ductal carcinoma
Most common histology associated with the colon and rectum, endometrium, and prostate (gland)
Adenocarcinoma
Most common histology associated with the brain
Astrocytoma
3 levels of cancer prevention
Primary
Secondary
Tertiary
Evading disease by methods such as immunization, avoiding tobacco, and reducing exposure to UV light
Primary cancer prevention
Early detection and treatment of subclinical, asymptomatic, or early disease in persons without signs or symptoms of cancer
Screenings should be sensitive (disease present) and specific (no disease) and take into account false positives and negatives
Secondary cancer prevention
Management of an illness to prevent progression, recurrence, or other complications (ex: blood test)
Tertiary cancer prevention
5 dietary recommendations to reduce cancer risk
Avoid overeating, maintain ideal body weight (ex: fat cells produce estrogen associated with breast cancer)
Reduce fat intake to less than 30% of total caloric intake
Eat fruits and vegetables that provide fiber (5 servings a day); decreases transfer time of fecal material, provides antioxidants
Minimize the intake of foods that are salt-cured, smoked (associated with stomach and esophageal cancer), and nitirite-cured (ex: lunch meat, bacon); food preservatives (nitrates and nitrites) associated with increased risk of cancer
Limit consumption of alcoholic beverages/don’t drink excessively (oral cavity, larynx, esophagus, breast, and liver cancer)
Number of new cases per 100,000 people per year
Incidence rate
Number of deaths per 100,000 people per year
Mortality rate
Proportion of patients alive at some point after their diagnosis
Survival rate
The number of cancers that exist in a defined population at a given point in time
Measures proportion of the population who have cancer at a specified point or during an interval of time; how common it is seen in population
Prevalence
Include fatality rates only for those who have the disease
Case-fatality rate
Most common cancer in both men and women
Skin cancer (basal, squamous, malignant melanomas
3 most common cancers in men (account for 41% of all cancers in men)
Prostate
Lung and bronchus
Colon and rectum
3 incidence rates of cancer in men
Black men have the highest incidence
White men are next
American Indians/Alaska Natives had the lowest rates
3 most common cancers in women (account for 50% of all cancers in women)
Breast (30%)
Lung and bronchus
Colon and rectum
How long you can stay in the sun without getting burned x SPF number
Sun protection factor (SPF)
Second leading cause of death in the US
Lung cancer
5 incidence rates of cancer in women
White women have the highest rates Blacks Hispanics Asian/Pacific Islander American Indian/Alaska Native women have the lowest rates
5 tests recommended for colorectal screenings by the American Cancer Society (ACS) and how often they should be done
Fecal occult blood test (FOBT)- look for blood in feces by getting a stool sample on a test card coated with a plant based substance called guaiac; annual
Flexible sigmoidoscopy (flex sig) every 5 years
Double contrast BE every 5 years
Colonoscopy every 10 years or virtual CT colonoscopy every 5 years (can’t biopsy)
Combination of FOBT and flex sig every 5 years
When does the ACS recommend people should begin colorectal screenings?
Start around 50 years old or 40-45 if high risk
3 ACS recommendations for breast cancer screenings
Breast self-examinations (BSE)
Clinical breast examinations
Mammography (40 years and older)
When does the ACS recommend people should do BSEs?
Start at age 20 and perform monthly 5-7 days after period; lead to a lot of false positives so now recommend be familiar with breast
When does the ACS recommend people should get clinical breast exams?
Start at 20 years old every 4 years until annually at 40 years old
When does the ACS recommend people should get mammograms at 40-44 years old, 45-54, and older than 55?
40-44: up to patient
45-54: annually
Older than 55: every 2 years
Mammography benefits older women ___ to ___ years old; reduce mortality by ____% to ____% at this age
50-69 years old
20% to 35%
5 risk factors of breast cancer
Mother or sister had premenopausal or bilateral disease Had period before age 12 Reached menopause after age 55 First birth after 30 years old Nulliparity
Never given birth
Nulliparity
3 components of BSEs
Visual examination in mirror (scaling or dimpling, change in nipple, discharge)
Palpation in the shower
Palpation in the supine position on the bed
Blood test, indicators that increase or come about because person has cancer
Serum tumor markers
Cancer protein/molecule immune system recognizes
Cancer antigen (CA)
7 serum tumor markers
Alpha-fetoprotein (AFP) Carcinoembryonic antigen (CEA) CA-125 CA-15-3 CA 19-9 Human chorionic gonadotropin Prostate-specific antigen (PSA)
4 cancers associated with AFP
Hepatocellular carcinoma
Choriocarcinoma (uterus)
Teratoma
Tumors of testes and ovaries
7 cancers associated with CEA
Colon Rectum Pancreas Stomach Lung Breast Ovary
3 cancers associated with CA-125
Ovarian
Breast
Colorectal
Cancer associated with CA-15-3
Breast
4 cancers associated with CA 19-9
Colorectal
Pancreas
Stomach
Liver
4 cancers associated with HCG
Choriocarcinomas
Germ cell tumors
Testicular disease
Hydidiform moles (cysts) - hormonal reproductive system
Structure, shape, etc.
Morphology
Cell type
Histology
Surgical procedure that involves removing all or part of the tissue suspected of being cancerous
Biopsy
4 biopsies from smallest to largest
Needle
Incisional
Excisional
Open
2 types of needle biopsies
Aspiration
Core
Smallest biopsy, cytological sample
Aspiration
Insert needle and remove tumor cells
Core
Act of cutting into tissue to remove part of the tumor so that a diagnosis can be made, larger than needle
Incisional
Removal of the entire tumor by cutting it out so that a diagnosis can be made
Excisional
Under direct vision or by laser remove part or whole tumor, most invasive
Open biopsy
Why is pathology important?
A clinical diagnosis is just a guess without a pathology report
3 things neede to identify the histopathology
Tumor type
Classification
Grade
Tumor type
Origin
Subtype of malignancy (ex: adenosquamous)
Classification
Provides information about a tumor’s biologic aggressiveness and is based on the degree of cell differentiation (what cell looks like)
Grade
Few features of cell tumor originated from = high grade tumor
Poorly undifferentiated
Higher grade tumor = _____ aggressive
More aggressive
5 grades (G) for malignancy
X I (1) II (2) III (3) IV (4)
Grade cannot be determined, not enough information
GX
Cells are well differentiated, closely resembling the tissue from which they arose; considered a low-grade tumor
Mature cells
GI (1)
Cells are moderately differentiated; still resemble normal cells somewhat, but exhibit more malignant characteristics
Cells have some immaturity and vary from normal tissue
GII (2)
Cells are poorly differentiated; few normal cellular characteristics are retained, but the tissue of origin may still be established
Immature cells, do not look like normal cells
GIII (3)
Cells are undifferentiated, no normal cellular characteristics can be found and determining the origin is very difficult
GIV (4)
3 steps in which cancer is staged
Start with history and physical (H&P) - background (ex: smoker, drinker), family history, when signs and symptoms started if any
Order radiographic procedures, diagnostic tests (radiation oncologist = administers RT; medical oncologist = chemotherapy doctor)
Order with some labs (easy way to get a lot of information from patient)
Step-by-step process to determine the size and location of a tumor and the degree to which it has spread
Staging
The movement of charged particles in a fluid or gel under the influence of an electric field
Electrophoresis
Staging system from the American Joint Committee on Cancer (AJCC) used on solid tumors (breast, lung, colon, etc.)
Tumor-node-metastasis (TNM) staging
Characteristics of a given tumor (size, depth of invasion, involvement of surrounding structures)
Tumor (T)
Presence or absence of involved nodes and size or number of involved nodes
Node (N)
Presence or absence of metastasis
Metastasis (M)
4 stages of the primary tumor (T)
TX
T0
Tis
T1, T2, T3, T4
Primary tumor cannot be assesed
TX
No evidence of primary tumor
T0
Carcinoma in situ
Tis
An early form of cancer defined by the absence of invasion
In situ
Increasing size and/or local extent of the primary tumor specific to every disease
T1, T2, T3, T4
3 stages of regional lymph nodes (N)
NX
N0
N1, N2, N3
Regional lymph nodes cannot be assessed
NX
No regional lymph node metastasis
N0
Increasing involvement of regional lymph nodes
N1, N2, N3
3 stages of distant metastasis
MX
M0
M1
Distant metastasis cannot be assesd
MX
No distant metastasis
M0
Distant metastasis
M1 (automatically stage 4)
3 reasons staging is important
Gives prognosis values
Determines treatment based on disease within the patient
Data collection gives protocols for type of disease and what treatment works best for it; tumor registry
Database tracking mechanism for cancer incidence, characteristics, management, and results in cancer treatment facilities for patients diagnosed with cancer; carry diagnosis, stage, and treatment
Follow patient for life through followup examinations
Tumor registry
4 stages of the Ann Arbor classification of lymphoma staging (Hodgkin’s) (spreads in a pattern)
Stage I
Stage II
Stage III
Stage IV
Lymphoma confined to nodal group
Stage I
More than one group of lymphoma on the same side of the diaphragm
Stage II
Lymphoma on both sides of the diagram
Stage III
Disseminated disease, spread of lymphoma
Stage IV
Fevers, night sweats, and weight loss from lymphoma
B-symptoms
Extra lymphatic disease (extra nodal site with disease)
E
5 stages of leukemia using the Rai system
Stage 0 Stage I Stage II Stage III Stage IV
The Rai staging system works well with what leukemia?
Chronic lymphocytic leukemia (CLL)
Rai stage of leukemia where patient has more than 10,000 lymphocytes
Stage 0
Rai stage of leukemia where patient has enlarged lymph nodes
Stage I
Rai stage of leukemia where patient has enlarged liver and/or spleen
Stage II
Rai stage of leukemia where patient has anemia
Stage III
Rai stage of leukemia where patient has thrombocytopenia
Stage IV
Decrease in the peripheral red cell count, low RBCs
Anemia
Abnormal decrease in the number of platelets
Thrombocytopenia
About ___% to ___% of all acute lymphoblastic leukemia (ALL) will achieve complete remission and ____% to ____% will be cured; ____% to ____% cure rate for kids
About 80% to 90% of all acute lymphoblastic leukemia (ALL) will achieve complete remission and 30% to 40% will be cured; 60% to 80% cure rate for kids
Most common childhood leukemia
ALL
3 stages of the Binet classification of leukemia
Clinical stage A
Clinical stage B
Clinical stage C
Binet stage of leukemia where patient has no anemia or thrombocytopenia and less than three areas of lymphoid involvement
Clinical stage A
Binet stage of leukemia where patient has no anemia or thrombocytopenia with greater than or equal to three areas of lymphoid involvement
Clinical stage B
Binet stage of leukemia where patient has anemia and/or thrombocytopenia regardless of the number of lymphoid enlargement
Clinical stage C
4 stages of colon cancer according to Dukes staging system
A
B
C
D
Colon cancer confined to muscular lining of bowel wall
A
Colon cancer grown beyond muscular layer of bowel wall
B
Colon cancer spread to involved lymph nodes
C
Distant metastasis of colon cancer
D
Staging system for how deeply penetrating a melanoma is
Clark and Breslow
7 other tests for cancer
CT: general anatomic information MRI: soft tissue (ex: brains) Nuclear medicine: bone scans, physiological PET: changed lung disease treatment PET/CT Bone marrow biopsy: through iliac crest Multiple gated acquisition (MUGA) scan
Scan that determines heart function using a gamma camera; restrictions to who can be around patient (ex: pregnant, kids)
Multiple gated acquisition (MUGA) scan
5 advantages of PET/CT
Concise calibration Patient in same position Good for lymphomas Check response to chemotherapy Check for recurrent disease
Patients that have mets
Tests show no obvious origin (undifferentiated cells)
Prognosis around 3-4 months
Unknown primary
Unknown primaries account for what percent of all cancers?
5-10%
Must have _________________ to determine if someone has cancer
Tissue diagnosis
3 steps needed to complete staging
Diagnosis
Prognosis
Correct treatment
How often should we check a patient’s blood?
Once a week
WBCs less than ______ stops treatment, increased risk of infection
2,000
Platelets less than _______ may stop treatment; below ______ to ______ at risk for severe bleed
Platelets less than 100,000 may stop treatment; below 20,000 to 50,000 at risk for severe bleed
Percent of packed RBC
Hematocrit (HCT)
Normal HCT level, in men, and in women
Normal = 40-45% Men = 38.8-46.4% Women = 35.4-44.4%
What transports oxygen in blood
Iron
Iron level
Hemoglobin (HGB)
Normal HGB level in men, women, and children (g/dL)
Men = 13.3-16.2 g/dL Women = 12-15.8 g/dL Children = 11.5-14.5 g/dL
Normal erythrocyte (RBC) blood counts per cubic millimeter and percentage for men and women
Men per cubic millimeter = 4.3-5.6 x 10^6; percentage = 100
Women per cubic millimeter = 4-5.2 x 10^6; percentage = 100
Normal reticulocyte blood count per cubic millimeter and percentage
Per cubic millimeter = 0.8-2.3% red cells
Percentage = 100
Normal total leukocyte (WBC) blood count per cubic millimeter and percentage
Per cubic millimeter = 3,500-9,050
Percentage = 100
Normal band blood count per cubic millimeter and percentage
Per cubic millimeter = 0-450
Percentage = 0-5
Normal lymphocyte blood count per cubic millimeter and percentage
Per cubic millimeter = 701-4,530
Percentage = 20-50
Normal eosinophil blood count per cubic millimeter and percentage
Per cubic millimeter = 0-540
Percentage = 0-6
Normal basophil blood count per cubic millimeter and percentage
Per cubic millimeter = 0-180
Percentage = 0-2
Normal monocyte blood count per cubic millimeter and percentage
Per cubic millimeter = 140-720
Percentage = 4-8
Normal platelet blood count per cubic millimeter
165,000-415,000 per cubic millimeter (severely low less than 20,000)
Clotting factor
Platelets
Bone marrow aspiration/biopsy detects or assesses
Hematologic abnormalities
Blood chemistries and hepatic function studies detects or assesses
Abnormalities of the liver, kidneys, and bone related to cancer or its therapy
Complete blood count detects or assesses
Bone marrow abnormalities or treatment toxicity
Creatinine clearance detects or assesses
Kidney function, especially important prior to administration for nephrotoxic drugs
Hemoccult test detects or assesses
Presence of blood in stool; screening but not specific for cancer
Pap smear detects or assesses
Cervical cancer or premalignant changes
Serum electrophoresis detects or assesses
Serum protein and immunoglobulin levels (multiple myeloma)
Urine catecholamines detects or assesses
Neuroblastoma, pheochromocytoma (released by adrenals)
