Week 5: Oncology - FOR 362 NOT 363 Flashcards
Cancer Epidemiology
study of distributions and determinants of cancer in population groups
What 3 things does cancer epidemiology include
incidence
mortality
disparity
Cancer Mortality
defined as death rates pertaining to cancer within a specific time frame
What is the overall trend of cancer mortality
overall trend downward
Cancer is #__ on the U.S. mortality annually
2
What is the most common cancer type of cancer mortality
lung
What are the top 4 types of cancer that cause death
- Lung
- Prostate and Breast
- Colon (Colorectal)
- Pancreatic
What are the 1st and 2nd biggest cause of US mortality
- Heart Disease
2. CANCER
Which gender is more likely to die from cancer
Males
What race/ethnicity is most likely to die from cancer
African Americans` (especially males)
Cancer Incidence
defined as: # of NEW cancer cases in a specific time frame
The highest cancer type for males in incidence is ___; for females it is ___
prostate; breast
The highest cancer type incidence between both sexes is what
lung and bronchus cancer
Cancer Incidence has done what over the years
slightly decreased but generally plateaud
Cancer Disparity
Defined as : Differences in cancer measures such as incidence, mortality, screenings, survivorship between population groups
How does cancer dispairty change with the following: Age, Gender, Geograhy, Low SES, High SES
Age - risk increases with age
Gender - males > females
Geography: Cancer is clustered in certain areas
Low SES - increased risk of lung, cervical, stomach, head/neck - increased smoking
High SES - increased breast, prostate, colon cancer
Cancer Mortality differs by ___
race
What groups have higher rates of cervical cancer in females than other groups and which one of them has the highest mortality rate from the disease
hispanic/latino and black/AA women
AA/Black women have the highest rates
____ have higher death rates than all other racial/ethnic groups for many, although not all, cancer types
Black/African Americans
Despite having similar rates of rbeast cancer who is more likely to die from it than white women
African american women
The incidence of what cancer is higher in rural appalachia than in urban areas?
colorectal, lung, and cervical cancers
People with more education are less likely to do what regarding colorectal cancer
less likely to die prematurely (before 65) from colorectal cancer than those with less education REGARDLESS of race or ethnicity
Primary Prevention
measures to make sure cancer does not develop
Factors we can control regarding cancer
tobacco use
diet
lifestyle choices
occupational exposures
environmental exposures
vaccines and medications
Secondary Prevention
screening guidelines for certain kinds of cancer
What is the pattern of breast cancer screening like in those 55+
mammograms every 2 years or continue annual screening
Screening for breast cancer should continue as long as what
the woman is in good health and expected to live 10 years or longer
The American Cancer Society recommends yearly lung cancer screenings with what if you are at higher risk for lung cancer
low dose CT Scan (LDCT)
What are some factors of higher lung cancer risk that indicate need for lung cancer screening
55-74 and in fairly good health
AND
currently smoke or have quit smoking in the last 15 years
AND
have at least a 30 pack year smoking hx (a pack year is 1 pack of cigs per day per year. one pack per day for 30 years or 2 packs per day for 15 years would both be 30 pack years)
When should those over 65 not be tested for cervical cancer
those who had regular cervical testing in the past 10 years with normal results
Who else should not be tested for cervical cancer
people whose cervix has been removed by surgery for reasons not related to cervical cancer or serious pre cancer
Should those vaccinated against HPV still follow cervical cancer screening recommendations?
Yes
If you choose to be screened by something other than colonoscopy…
any abnormal test results need to be followed up with a colonoscopy
What tests are done for prostate cancer
PSA blood test with or without a rectal exam
Tertiary Prevention
reduction of disease and symptoms in cancer survivors
efforts focus on monitoring for and preventing recurrence of primary cancer as well as screening for development of second malignancies in cancer survivors)
Ways Cancer Diagnoses are Made
- Hx and Physical Exam
- Diagnostic Work Up - Radiology study, MRI, Ultrasound, nuclear med scan, endoscopy, lab study, tumor markers
- Pathology testing - surgical biopsy
Carcinogenesis
Cause of Cancer
- Initiation (Initiated cells)
- Promotion (preneoplastic)
- Progression (neoplastic)
- Metastasis (malignant)
Causes of Carcinogenesis
Environmental
hormonal
chemical
viral
radiation
immunosuppression
hereditary
Important Aspects of Benign Tumors
usually encapsulated
partially differentiated
absent metastasis
rare recurrence
slight vascularity
expansive mode of growth
fairly normal cells SIMILAR to parent cell
Important aspects of malignant tumors
rarely encapsulated
poorly differentiated
metastasis usually present
frequent recurrence
moderate to marked vascularity
infiltrative and expansive
cells abnormal and unlike parent cells
Benign (not cancer) tumor cells grow how compared to malignant (cancer) tumor cells?
benigng - grow only locally and cannot spread by invasion or metastasis
malignant - invade neighboring tissues, enter blood vessels, and metastasize to different sites
Malignant tumors are:
A usually encapsulated
B have marked vascularity
C often migrate via lymph nodes
D - are similar to parent cells
E - remain in one area
B and C
What types of cancer often metastasize to the brain
skin melanoma
lung cancer
breast cancer
Where does lung cancer often metastasize to
bone
brain
adrenal gland
Where does breast cancer often metastasize
brain
bone
lung
liver
Where does pancreatic cancer often metastasize
lung
liver
Where does colorectal cancer often metastasize
liver
where does ovarian cancer often metastasize
pleura
liver
6 Major Categories of Cancer Nomenclature
Carcinoma
Sarcoma
Myeloma
Leukemia
Lymphoma
Mixed Types
Histologically, how many different cancers are there
hundreds (but they are grouped into 6 major types with primary and location standpoints)
what are the main primary/location standpoints of cancer types
skin
lungs
female breasts
prostates
colon rectum
cervix and uterus
Carcinoma
epithelial tissue cancer
Sarcoma
supportive connective tissue cancer
Myeloma
plasma cells of bone marrow cancer
Leukemia
blood cancer
Lymphoma
lymphatic tissue cancer
Cancer Grade
the degree of abnormality of cancer cells compared to normal cells under a microscope
Cancer grade is an indicator of what
how quickly the tumor will grow or spread
How does cancer grading work
increasing abnormality increases the grade from 1-4 (the higher the grade, the more aggressive the tumor)
Cancer Differentiation
based on HOW CLOSELY TUMOR CELLS RESEMBLE NORMAL CELLS in their structure and maturity
is the process of becoming mature and functional
There can be what in a single tumor
different stages of differentiation (1-4)
What does G X mean
cancer grading that cannot be determined
What does G I mean
Well differentiated, low grade of malignant change, slow growing, look like normal (parent) cells
What does G II mean
moderately differentiated, more malignant characteristics, slightly more abnormal
What does G III mean
poorly differentiated and very abnormal
What does G IV mean
poorly differentiated, immature, cant determine tissue of origin
METASTATIC DISEASE
____ decreases as grade increases
prognosis
What is Cancer Staging
different from grade/differentiation
determines the sizeof the tumor, the existence of local invasion, lymph node involvement, and distant metastases
What does T mean in cancer staging
extent of the primary TUMOR
the size - small or large
What does N mean in cancer staging
the absence or presence and extent of regional lymph node involvement
the higher the n level the more migration
What does M mean in cancer staging
absence or presence of distant metastasis
the higher the level of metastasis, the more metastasis sites seen
What does Tx mean
primary tumor cannot be measured
What does T0 mean
no evidence of primary tumor
What does Tis mean
carcinoma in situ
What occurs as you move up from T 1 to T 4
increasing size or local extent of the tumor
What does Nx mean
regional lymph nodes cannot be measured
What does N0 mean
no regional lymph node metastasis
What does N1, 2, and 3 mean
Increasing involvement of lymph nodes
N1 - to same side, still movable
N2 - to same size, fixed to one another or structure
N3 - to more distant nodes
What does Mx mean
cannot be measured
What does M0 mean
no evidence of distant metastasis
What does M1 to M4 mean
M1 to M4 is increasing evidence of distant # metastasis
GI, T1, N0, M0 stage malignancy means the patient:
A - has a small tumor with neg lymph nodes and no mets
B- has a large tumor and status of lymph nodes and mets is unknown
C- has a small tumor with multiple lymph nodes involved and widespread mets.
D- has a large tumor with fixed nodes and mets.
A
The patient’s tumor has been staged as G4, T2, N1, M1. Select the correct description.
Large tumor, not invasive, positive nodes, some mets
Small tumor, very invasive, negative nodes, some mets
Large tumor, very invasive, one lymph node, one area of mets
Small tumor, very invasive, positive nodes, mets
C
SEER
Surveillance, Epidemiology and End Results (Another staging method)
Used by NCI for all types of cancer
SEER groups cancer into what 5 main categories
in situ
localized
regional
distant
unknown
Cell Cycle
interval between each cell division
4 Phases of the Cell Cycle
G1 - Gap 1 Phase
S Phase
G2 Phase
M Phase
G0 Phase
G1 Phase
Variable
gap 1
postmitotic phase - DNA synthesis ceases; RNA and protein synthesis and cell growth takes place
S Phase
10-20 hours
DNA synthesis occurs; gives rise to 2 separate sets of chromosomes (one for each daughter cell)
G2 Phase
gap 2
2-10 hours
Premitotic phase - DNA synthesis ceases; RNA and protein synthesis continues
M Phase
0.5-1 hour
phase of cellular division or mitosis
G0 Phase
variable
resting phase - phase in which cells are not actively dividing and are quiescent
Length of cell cycle can range from < ___ hours to …
<8 hours to > 1 year
Why is the cell cycle important to cancer treatment
plan chemo cycles, radiation therapy treatments to interrupt “bad” cells before they continue to replicate
The goal of cancer treatment is
interrupt cellular growth
Each time a tumor is exposed to chemotherapy
a % of tumor cells (20-99% depending on dosage and agent). Repeated doses of chemo are eneded over a prolonged period of time to achieve regression of the tumor
3 Major types of cancer treatment
Surgery
Radiation
Chemo/Immunotherapy
Goals of Cancer Treament - 3 Main Types of Goals
- Cure
- Control
- Palliative
* think how surgery, chemo, radiation fit into these treatment goals*
___ is the ideal cancer treatment
Surgery
Surgery can be used to…
diagnose - biopsy OR as a primary treatment
Surgeyr can be what types for cancer
Prophylactic
Palliative (promote comfort)
Reconstructive (improve function or cosmetic results)
Debulking
surgical removal of as much tumor as possible
Important Areas of Nursing Management for a Cancer Surgery Patient
Physiological
Self concept and body image issues
education and emotional support
referral to support services
If having undergone recent chemotherapy or radiation therapy what should you watch for
increased risk for infection
increased risk for bleeding
poor wound healing
anemia
increased s=risk of DVT
poor nutritional status
