Test 4 (H&N, RCC, and Testicular) Flashcards
3% of all new cancers
Includes all areas of the head and neck: lips, oral cavity, etc.
17: 49670 new cases, 9700 deaths
Treatment depends on disease site
Sarcomas rare; carotid rupture rare but can be caused by RT or chemo and can be fixed by surgery and pressure
Head and neck (H&N) cancers
Occurs in younger age group more than other H&N disease, 20% under 30 years old
More common in Chinese than caucasians
Nasopharynx disease
3 parts of the pharynx
Nasopharynx
Oropharynx
Hypopharynx
Upper part of pharynx connecting with nasal cavity above soft palate
Nasopharynx
Part of pharynx between soft palate and hyoid bone
Oropharynx
Laryngeal part of pharynx extending from hyoid to lower margin of cricoid cartilage
Hypopharynx
5 risk factors of H&N cancer depending on site
Tobacco use and alcohol most important risk factor for disease site, smokeless tobacco
Advancing age over 50, older people
Epstein-Barr virus (EBV)
Occupational: asbestos, wood dust, leather, and metal breathed in nasal conchae turbinates, and sun exposure
Males, about 3:1 ratio
___% of lip cancer patients have outdoor occupation
31%
No known cause of salivary or thyroid, but risk factor for thyroid
Radiation exposure
Histology that makes up the majority of all H&N cancers, comes in direct contact with carcinogen
Squamous cell carcinomas
4 early symptoms of H&N cancers
Changes in facial appearance
Sight and smell
Swallowing and speech
Ulceration and pain at primary site
5 H&N diagnostic tests
History and physical (H&P)
CT, MRI, and PET (recurrence and unknown primary): diagnostic information, lymph node (LN) involvement, etc.
Thyroid scans for thyroid cancer: thyroid tissue swelling and growth versus (vs) nodules
Lab studies
Biopsy for diagnosis, histology to determine treatment method
5 types of H&N skin cancer
Basal cell: common Squamous: common Merkel: more lethal than melanoma, consider LN involvement Skin appendage: consider LN involvement Melanoma: consider LN involvement
H&N skin cancer treatment
Mohs wide excision surgery
7 indications for thyroid cancer
History of low dose radiation exposure New nodule in patients over 40 years old Nodule fixation if thyroiditis is excluded Rapid growth Onset of hoarseness Palpable LN in neck Solitary nodule in any age male
Must have thyroid diagnosis before _______ or _______ done
Thyroidectomy or Iodine-131 (I-131)
Thyroid cancer treatment and treatment for advanced disease/mets
Radical surgery (thyroidectomy) and RT Chemo for advanced disease/mets
3 lips cancers and sites
Squamous cell most common on lower lip because sun directly hits it
Basal cell most common on upper lip and overall
Minor salivary gland cancers usually advanced or high grade
Treatment of squamous and basal cell cancer of lip and minor salivary gland cancer
Squamous and basal cell: surgery or RT, most concerned with cosmesis
Minor salivary gland: wide exision
3 major glands and number of minor glands
Parotids
Submandibular
Sublinguals
About 600 minor glands
2 types of oral and pharyngeal cancers
95% squamous cell if on mucosal surfaces
Minor salivary glands remainder
Treatment and treatment of advanced cases of oral and pharyngeal cancers
Tx: RT or surgery have same cure rate
Advanced: combination of surgery, RT, and chemo
H&N cancer mets usually by way of what and why?
LNs because 1/2 of body’s LNs in H&N area
Most common mets site of H&N cancer
Lungs
3 treatments for speech production affected by a laryngectomy
Artificial larynx
Esophageal speech
Tracheoesophageal puncture (TEP)
Learn to burp sounds, can take up to 6 months
Esophageal speech
Surgically created hole between esophagus and trachea with voice prosthesis inserted
Tracheoesophageal puncture (TEP)
6 H&N radiation side effects
Watch for malnutrition: sore throat, hardest treatment for patients to tolerate
Radionecrosis and mandibular bone loss if in treated site
Mucositis
Redness of skin
Dysphagia
Xerostomia: watch parotids
Inflammation and ulceration of mucous membranes, smoking and drinking make it worse
Softer toothbrush, swish and swallow, antiseptic mouthwash, etc.
Mucositis
Difficulty swallowing
Dysphagia
3 xerostomia treatments
Sodium bicarbonate/baking soda helps fight infection and moistens mouth
Artificial saliva
Water bottle
Go to treatment for H&N cancer and mets treatment
Go-to: surgery and RT
Mets: chemo
4 factors of H&N cancer prognosis
Stage
Histology
Extent of LN involvement
Future lifestyle: quit smoking and drinking
5 year disease free survival of H&N cancer
60%
Ratio of males to females for renal cell carcinoma (RCC)/kidney cancer
Males 2 to 1 over females
Median age of RCC
64 (older)
7 risk factors for RCC
Smoking
Exposure to asbestos: main filtration
Von Hippel-Lindau syndrome (VHL)
Renal cystic disease while on hemodialysis
Genetic predisposition
Increasing age, rare under 45 years old
Obesity, cadmium and uranium exposure, and use of prescription diuretics (association)
Compared to non-smokers, risk of RCC increases ___% in males and ___% in female smokers
50%
20%
Angiomatosis in retina leads to angiomas in blood and lymph vessels
Von Hippel-Lindau syndrome (VHL)
Obesity especially in women accounts for ___% of kidney cancer in general
30%
6 RCC histopathology subtypes and percentages
Clear cell: 75-80% Papillary: 10-15% Chromophobe: 5-10% Medullary: less than 1% Collecting duct: less than 1% Oncocytoma: uncommon
90% of RCCs arise from _______
Renal parenchyma
Where ureter enters kidney and expands, about 10% of kidney disease here
Renal pelvis
90% of renal pelvis disease are _______ and about 8% are _______
Transitional, squamous
Kidney cancer in 1 of 200-250,000 kids
Peak age of 3, rare after 8
90% cure rate for localized tumor
Wilms tumor
3 signs and symptoms of RCC
Hematuria most common
Flank pain and mass
Hypertension, anemia, cachexia, weight loss, fever, and other symptoms
Triad of symptoms that are a sign of advanced renal disease in about 10% of patients
Hematuria
Flank pain
Flank mass
Side of person’s body between ribs and hips
Flank
Buildup of protein in body
Amyloidosis
Increased RBCs
Erychrocytosis
Intestinal disease
Enteropathy
Disease of nerves and associated muscle tissue
Neuromyopathy
Fever
Pyrexia
Excessive or inappropriate production of milk
Galactorrhea
Mets affects about ___% (__/__) of all RCC cases
33% (1/3)
7 sites and percentages of RCC mets
Lung most common: 50-60% Liver: 30-40% Bones: 30-40% LN: 30-40% Adrenal glands: 20% Opposite kidney: 10% CNS system: 5%
8 RCC workups
H&P CBC and chemical profile Ultrasound (US) CT of pelvis abdomen Abdominal (IVC involvement) or brain (mets) MRI KUB/IVP Cystoscopy for hematuria Biopsy
Layer of connective tissue encapsulating the kidneys and adrenal glands
Gerota’s fascia
5 factors RCC prognosis is dependent on
Grade: important predictor for mets especially for groin and even more powerful with depth of tumor invasion Stage Size Histologic type Mets
5 year survival of stage I, II, III, and IV RCC
I: 81%
II: 74%
III: 53%
IV: 8%
5 RCC treatments
Surgery for early stage, only cure
Immunotherapy for relapsed patients or patients who have inoperable stage 4 clear cell disease
Targeted therapy: tyrosine-kinase inhibitor (TKI) and antibodies
Radiation for palliation, recurrence, and brain mets
Chemo used when immuno- or targeted therapy has failed; no real benefit for survival and uncommon
RCC immunotherapy that forces immune system to fight cell
Interleukin 2 (Il-2)
Why is RCC considered a radioresistant disease?
There’s a high level of differentiation in cell
Radiosensitive disease, 1% of all cancers in men
Most common age is 20-39
Rising in US and Europe, less common in African Americans and Africans
4-5% mortality rate
Most curable solid tumor in adults, over 90% cure rate for stages I and II and even late stages can be cured
Unknown cause
Testicular cancer
5 risk factors of testicular cancer
History of cryptorchid testis Klinefelter's syndrome History of previous testis tumor HIV and HPV Family history of first degree relative (dad or brother)
Testicle doesn’t drop into scrotum
Cryptorchid testis
Suture testicle into scrotum; before age 6 decreases risk of testicular cancer, after 13 increases risk
Orchiopexy
Congenital endocrine disease where primary testicular function doesn’t take place, not secreting hormones, etc.
Klinefelter’s syndrome
2 histologies and percentages of testicular cancer
Germ cell tumors: 95%
Non germ cell type: 5%
Reproductive cells
Germ cells
___-___% of germ cell tumors are bilateral (in both testes) which leads to infertility
1-2%
2 types and percentages of germ cell tumors, 50% mixed
Seminoma: 50%
Nonseminoma: 50%
5 subcategories of nonseminomas
Embryonal Teratomas Teratocarcinoma: one of the least aggressive non seminomas Yolk sac in kids Choriocarcinoma
Tumor composed of tissues not normally present at site, one of the least aggressive nonseminomas
Teratomas
Rare seminoma but most aggressive
Choriocarcinoma
2 types of non germ cell tumors
Sertoli
Leydig
8 symptoms of testicular cancer
Mass with or without swelling in scrotum, most common presenting symptom Swelling Varicocele Hydrocele Spermatocele Torsion Epididymitis Gynecomastia and lower back pain less common
Vein engorgement within scrotum
Varicocele
Accumulation of scrotal fluid
Hydrocele
Irregular grapelike sac, cystic distension of the epididymis to testicle
Spermatocele
Spermatic cord twists, cutting of testicle’s blood supply; swelling
Torsion
Inflammation of empididymis
Epididymitis
4 symptoms of advanced testicular cancer
Cough
Dyspnea
Headache
Seizure
Combination of 3 symptoms that are a sure sign of testicular disease
Gynecomastia
Swollen left supraclavicular LN
Testicular mass
5 diagnostic tests for testicular cancer
Testicular examination with physician: evaluate testicles and inguinal nodes
US
Orchiectomy/orchidectomy
Tumor markers: AFP for seminomas and lactate dehydrogenase (LDH [spread because it identifies tissue damage within organs])
Chest x-ray (CXR), chest, abdomen, and pelvis CT to evaluate LNs
Testicular cancer staging system
TNM with serum tumor markers
3 serum tumor markers for testicular disease
AFP
LDH
HCG: pregnancy
LDH 1, 2, and 5
1: heart tissue
2: lung
3: liver
2 routes of spread of seminoma (more orderly)
Retroperitoneal LNs usually first
Rarely and late it can spread to lung, bone, liver or brain via blood (hematogenous)
3 sites of spread of nonseminomas
LNs
Lungs
Liver
Choriocarcinomas usually mets to this early in disease process
Brain
3 treatments of testicular cancer
Observation following orchiectomy with retroperitoneal LN dissection (RPLD) which can limit ejaculate/ability to have offspring
Radiation: seminomas radiosensitive
Chemo for bulky/systemic disease: nonseminomas more sensitive to chemo
Stage I and II and III treatment after inguinal orchiectomy
I and II: RT
III: commonly cisplatin-based chemo or RT to abdominal and pelvic LNs
Overall cure rate and survival of testicular cancer
95%
80% of testicular cancer patients with mets/stage 4 disease have a ___% survival rate
95%
About ___% of testicular cancer patients are able to father kids
33%
Deficiency of sperm about one year after chemo
Oligospermia
Absence of sperm about one year after chemo
Azoospermia
Chemo regimen for stage III and bulky stage II testicular cancer
3-4 cycles BEP, surgery if BEP fails
BEP
Bleomycin
Etoposide
Cisplatin
3 acute toxicities associated with chemo for testicular cancer
Gastrointestinal effects: nausea and vomiting
Renal effects: decreased ceatinine clearance and tubular loss of sodium, potassium, and magnesium
Bone marrow depression
5 long-term toxicities associated with chemo for testicular cancer
Bleomycin pneumonitis (rarely fatal if under 400 U are given)
Peripheral neuropathies
Cisplatin-induced hearing loss
Sterility
Secondary acute myelogenous leukemia (AML) related to etoposide (typically shows 11q23 translocation, under 5% incidence at 5 years)
Sperm not maturing
Spermatogenesis deficiency
