Test 3 Flashcards
Adenocarcinomas, lymphomas, and leiomyosarcomas
2017: 28000 new cases, 17750 males and 10250 females; 10960 deaths
US has lowest mortality rate
Usually have advanced disease when symptoms start, not easily detected early
Adjuvant therapy doubles median survival but doesn’t affect 5 year survival
Stomach/gastric cancer
9 risk factors for gastric cancers
Lower socioeconomic status: eating, drinking, lifestyle, etc.
Diets low in fruits and vegetables
Ingestion of salt-preserved or smoked foods
Smoking
Chronic atrophic gastritis
Gastric adenomatous polyps
Hereditary
Pernicious anemia
Barrett’s esophagus and peptic ulcers of lower esophagus often with stricture
Inflammation of stomach lining
Gastritis
Premalignant gastric disease
Gastric adenomatous polyps
Body can’t absorb enough vitamin B-12, which is needed to make healthy red blood cells (RBCs)
Severe blood disease decreases RBCs
2-3 times higher risk of gastric cancer
Pernicious anemia
8 symptoms for gastric cancer
Anorexia Early satiety Weight loss Palpable abdominal mass Dysphagia Severe anemia Weakness Nausea and vomiting (N&V), hemoptysis
Coughing up of blood
Hemoptysis
5 tests for gastric cancer
Upper GI Flexible endoscopic gastroscopy Tumor markers: carcinoembryonic antigen (CEA) PET for staging MRI & CT
Highly vascular layer of connective tissue under the basement membrane lining of a layer of epithelium, nourishes the mucosal epithelium and its associated mucosal glands
Lamina propria
4 treatments for gastric cancer
Complete surgical resection for cure, early stage; relapse within about 2 years
Radiation for palliation of pain and obstruction
Chemo and radiation show improved survival
Chemo is treatment of choice with metastatic gastric
90-95% of gastric cancers
Adenocarcinomas
Gastric cancer occurs most often from ___-___ years old, older patients; rare at less than ___ years old
55-90 years old
30 years old
Chemo and radiation for gastric cancer drug, dose, and survival
Drug: 5FU
Dose: 40-50 Gy
Survival: 5.9-12 months
Stomach empties too soon and can’t digest food properly leading to profuse sweating, nausea, dizziness, and weakness
Dumping syndome
Stage 1, 2, and 4 survival for gastric cancer and 5 year survival with and without LN involvement
1 = 67% 2 = 31% 4 = 5% With = 10-25% Without = 75%
More common in males; more common and higher mortality rate in African Americans
2017: 53670 new cases, 27070 males and 25700 females; 43000 deaths
Pancreatic cancer/silent killer
Pancreatic cancer median and 5 year survival
Median: 9-12 months
5 year: 6%
Peak age of pancreatic cancer is ___-___ years old and is rare before ___ years old
60-80
45
8 risk factor of pancreatic cancers
Cigarette smoking and over 4 drinks a day
Diet high in fat and low in fruits and vegetables
Previous partial gastrectomy
Diabetes mellitus type 2 and obesity for over 5 years
Occupational exposure: petroleum compounds, beta naphthylamine (cigarettes), and benzene
Lower socioeconomic status
Hereditary pancreatitis
Coffee drinkers
95% if pancreatic cancer occurs in the _______ portion and 90-95% are ____________
Majority arise in proximal _______ and _______ of pancreas on right side
Exocrine, adenocarcinomas
Head and neck
Digestive system
Exocrine
8 symptoms of pancreatic cancer
Abdominal pain: main Anorexia, weight loss, and early satiety Sleep problems and fatigue Jaundice Nausea and vomiting Diarrhea or constipation Ascitis Courvoisier's sign
5 tests for diagnosis of pancreatic cancer
Abdominal ultrasound CT Endoscopic retrograde cholangiopancreatography (ERCP) Increased CA 19-9 Biopsy for histology
Palpably enlarged gallbladder
Courvoisier’s sign
3 treatments for pancreatic cancer
Whipple procedure
Chemo
Radiation after surgery or inoperable
6 organs removed and 1 nerve block during whipple procedure
Head of pancreas Duodenum Distal stomach Common bile duct Gallbladder Vagotomy sometimes Celiac plexus block
Remove part of the vagus nerve, 50% alcohol at vagus nerve
Vagotomy
Injection of local anesthetic (50% alcohol) into or around celiac plexus bundle of nerves at xiphoid
Celiac plexus block
En-bloc resection doubles median survival of pancreatic cancer
Whipple procedure
Median survival of pancreatic cancer
15-19 months
Chemo for pancreatic cancer mets after surgery or for inoperable disease
Gemcitabine
10-20% of pancreatic cancers are resectable: stage 1 (T___-T___, no ___ or ___)
T1-T2, no N or M
Liver and bile duct cancer
High fatality rate
2017: 40710 new cases, 29200 males and 11510 females; 28920 deaths
Diagnosis: US, MRI, and CT
Hepatocellular carcinoma (HCC)
Most primary liver cancers in adults are __________ and are ___________
Hepatocellular, adenocarcinomas
Arise from hepatocytes
Hepatocellular
7 HCC risk factors
Chronic infection with hepatitis B, C with or without cirrhosis
Preexisting cirrhosis, almost always associated with cirrhosis: heavy drinker, infections, etc.
Aflatoxin
Hormones: oral contraceptives over 8 years or long-term use of androgen
Being male: 3/4 cases
Obesity and diabetes
Heavy alcohol use and tobacco
Steroid-type hormone like testosterone
Androgen
8 symptoms of HCC
RUQ pain most common Fatigue Abdominal swelling Weight loss Unexplained fever Jaundice Elevated alpha-fetoprotein (AFP) tumor marker, 70% of patients
Mutated P53 tumor suppressor gene
Aflatoxin
5 treatments of HCC
Surgery is only cure/main treatment, only 15% are resectable
Hepatic intra-arterial infusion of chemo
Liver transplant
Radiation not curative
Single agent chemo: doxorubicin, 5FU, and cisplatin
5 year survival and 2 year recurrence for HCC with resected tumor
5 year: 33-47%
2 year: 55%
5 year and median survival for HCC with unresected tumor
5 year: less than 10 months
Median: 3-6 months
4 conditions gallbladder cancer is associated with
Cholecystitis and cholelithiasis associated with a majority of cases because irritation causes proliferation of cells
Ulcerative colitis
Age 60-70, older; rare before age 40
More common in females
2017: 11740 new cases, 5320 males and 6420 females; 3830 deaths
RT controversial; chemo for resected tumors to increase survival and unresected tumors show response but no evidence of increased quality of life (QOL) or cure
Gallbladder cancer
Cause of gallbladder cancer
Unknown
Gallbladder cancer is usually _________ and _________ disease when found
Asymptomatic, advanced
5 year survival of gallbladder cancer based on ______
Stage
Gallbladder cancer spreads by ______________ to local areas like liver, stomach, duodenum, etc. and becomes unresectable
Direct extension
Treatment of choice of gallbladder cancer
Surgery
Most common type of gallbladder cancer
Adenocarcinoma
5 year survival of stage 0, 1, 2, 3, and 4 gallbladder cancer
0: 80%
1: 50%
2: 28%
3: 7%
4: 2%
Chemo regimen for gallbladder cancer
FAM
FAM
5FU
Doxorubicin
Mitomycin
3 chemo drugs that have shown some benefits of survival for advanced gallbladder disease
Gemcitabine
Fluoropyrimidine
Platinum-based agents
7 common sites of gynecological (GYN) cancers
Endometrial Ovarian Cervical Fallopian tubes Vagina Vulva Gestational neoplasms
Epithelial surface, lining of uterus
Endometrium
Average/median age of endometrial, ovarian, and cervical cancer
Endometrial: 55-70+ (postmenopausal)
Ovarian: 63, 50-70
Cervical: 48, 30-39 and 60-69
Neoplasms related to pregnancy
Gestational neoplasms
Staging for cervical cancer accepted by International Federation of Gynecology and Obstetrics (FIGO)
TNM
Spaces between cervix past fornices in bony structure of pelvis
Parametrium
Treatment for early stage 1 cervical disease, tissue removed by scalpels, etc. in cone-shape; lower morbidity and easier recovery
Cone biopsy
2 types of cone biopsies
Endocervical
Exocervical
Cervical disease higher up in surface, longer wedge piece removed
Endocervical cone biopsy
Cervical disease in cervical oss, wider portion removed
Exocervical cone biopsy
One of the only preventable cancer because of its long malignant/invasive state that can be detected on pap smears
External RT gives good survival rates for early disease; hysterectomy depends on stage of disease, patient’s health and age, etc.
Can be squamous, adenocarcinoma, adenosquamous, small, or glassy cell carcinomas
EBRT and implant due to the dose limits of surrounding structures
1.5% of new cancers in women and cancer deaths
2017: 12820 new cases, 4210 deaths
Cervical cancer
Most common cervical cancer because it’s in direct contain with carcinogens
Squamous cell carcinomas
6 risk factors of cervical cancers
Early coitus and more than 5 partners
Human papillomavirus (HPV) and warts
HIV
Low socioeconomic status: don’t have resources/screenings
Smoking causes precancerous changes in cervix
Oral contraceptives for over 5 years
HPV responsible for ___% of cervical cancer patients
99%
Intercourse before age of 18
Early coitus
7 symptoms of cervical cancer
Abnormal vaginal bleeding most common Thin, watery vaginal discharge Heavier menses Post-coital spotting Spontaneous, intermittent uterine bleeding Back, flank, and leg pain Lower extremity edema
6 symptoms of late cervical disease
Dysuria Hematuria Pelvic pressure Rectal bleeding Flank and leg pain Cough (advanced moving disease)
Foul-smelling fluid
Malodorous serosanguinous
Pain during sex
Dyspareunia
Tumors during pregnancy
Gestational trophoblastic disease (GTD)
4 terms with a pap smear
Atypia
Dysplasia
Cervical intraepithelial neoplasia (CIN)
Squamous intraepithelial lesion (SIL)
Structural abnormality in cell, not typical/atypical and doesn’t give much information
Atypia
Distinct abnormality of cellular development, premalignant disease; rated mild, moderate, or severe based on deviation from normal appearance of cell
Dysplasia
Identifies dysplastic category 1, 2, or 3; dysplasia increases with level
Cervical intraepithelial neoplasia (CIN)
CIN when HPV is present in patient
Squamous intraepithelial lesion (SIL)
Treatment of early cancer confined to cervix smaller than 4 cm, 4 cm and confined to cervix, and cancer beyond cervix into the parametria
Early cancer confined to cervix smaller than 4 cm: radical hysterectomy and LN dissection
4 cm and confined to cervix: radiation then simple hysterectomy
Cancer beyond cervix into the parametria: radiation and/or chemo
2 ways to avoid hysterectomies in younger cervical cancer patients because of fertility
Trachelectomy/cervicectomy
Intracavitary treatment: tandem, ovoid, heyman’s capsules, etc.
Remove cervix and leave uterus, still childbearing
Trachelectomy/cervicectomy
3 types of hysterectomies
Extrafascial/simple
Modified radical
Radical
Entire uterus and cervix removed, done vaginally or abdominally
Extrafascial/simple hysterectomy
Remove uterus, cervix, small portion of upper vagina, and inner third of perimetria
Modified radical hysterectomy
Outer serous layer of the uterus
Perimetria
Removed upper 3 cm of vagina, most of perimetria, uterus, cervix, and regional LN dissection and ureters dissected out of urethral sacral ligaments
Radical hysterectomy
Radical surgical procedure that involves the removal of the uterus, vagina, parametria, bladder (anterior), and rectum (posterior) for advanced disease
For recurrent cancer with curative intent leads to a loss of QOL and high rate of morbidity
Pelvic exenteration
Fallopian tubes and ovaries removed
Salpingo-oophorectomy
3 types of pelvic exenterations
Anterior
Posterior
Total
Remove urethra, lower part of ureters, cervix, vagina, and bladder; stoma for urine
Anterior pelvic exenteration
Remove lower part of large bowel, rectum, uterus, cervix, ovaries, fallopian tubes, vagina, and LNs may be removed
Posterior pelvic exenteration
Remove bladder, rectum, and internal reproductive organs; permanent colostomy and urinary diversion
Total pelvic exenteration
Radiation dose for cervical cancer
70-90 cGy with implants
2 chemo drugs that increase radiosensitivity of cervical cancer
5FU
Cisplatin
2.6% of new cancers and 5% of cancer deaths in women
No reliable tests for screening asymptomatic women
Most deadly of GYN diseases
Ovarian cancer
7 ovarian cancer cells
Epithelial carcinoma most common Malignant germ cell tumors most common Endometrioid Clear cell Brenner Undifferentiated diseases Sarcomas
7 risk factors of ovarian cancer
Risk increases until age 70
Family history of ovarian, breast-ovarian, or breast-ovarian-endometrial-colon especially if two or more first degree relatives have disease
Incessant ovulation
Northern European ancestry or line in western industrialized countries
BRCA 1 and 2 accounts for 15% of ovarian diseases
Perineal talc powders
Low risk factors: high dietary fat and excessive coffee and alcohol consumption
Proteins that repair damaged genes/DNA
Breast cancer susceptibility gene 1 and 2 (BRCA 1 and 2)
Birth control _______ risk significantly by as much as 50% but ________ chance of cervical and liver disease
Lowers, increases
8 symptoms of ovarian disease
Abdominal/pelvic pain and abdominal distension most common
Increased flatus
Changes in GI function
Abdominal girth: aggressive
Weight gain: aggressive
Pain: aggressive
Dyspepsia, anorexia, and early seity can be some of the first symptoms seen
Pressure and general discomfort in rectum, bladder, and pelvis
Treatment of early stage 1 and stage 2-4 ovarian cancer
1: removal of one of ovaries with adjuvant chemo, 3-6 cycles of paclitaxal plus platinum based drug
2-4: involved surgical cytoreduction staging which can include hysterectomy, bilateral salpingo-oophorectomy, and omentectomy, and pelvic and paraaortic LN dissection; chemo
7% of new cancers and 3.9% of cancer deaths i women
17: 61380 new cases, 10920 deaths
Endometrial cancer
7 endometrial cancer cell types
Adenocarcinoma/glandular epithelium most common: 75-80% Adenosquamous Squamous Mucinous Serous papillary Clear cell Undifferentiated
7 risk factors for endometrial cancer
Unopposed exogenous estrogen
Nulliparity, infertility, and anovulation
Late menopause over 52 years old
Obesity: fat cells produce estrogen and reduce level of sex hormones
Diabetes mellitus and hypertension
Family history
Complex atypical hyperplasia
Estrogen not combatted by progesterone leads to thickening of uterine lining, women with uterus removed don’t have to worry about progesterone
Unopposed exogenous estrogen
6 symptoms of endometrial cancer
Abnormal uterine bleeding most common: about 80% Pap smear abnormality Urinary changes Yellow, watery vaginal discharge Pyometra and hematometra Hypogastric and lumbosacral pain
Accumulation of pus in uterus
Pyometra
Accumulation of blood in uterus
Hematometra
4 symptoms of advanced endometrial disease
Uterine enlargement
Pelvic pressure
Leg swelling
SOB
Body of womb/uterus
Corpus
Wound ruptures/splits open
Wound dehiscence
