Week 5- Oncology (pt 2) Flashcards
Most cancers are ___________ but treatable if found early
asymptomatic
True or false: As cancer progresses, there may be cases of nausea/vomiting/retching and anorexia/subsequent weight loss
True
Contributors of anorexia/cachexia
-Metabolic abnormalities
-Pro inflammatory cytokines
-Circulating tumor derived catabolic factors
-Decreased food intake
-Other unknown factors
When does the rapid growth of the tumor encroach on healthy tissue?
Later stage
What can rapid growth of a tumor cause?
-Destruction
-Necrosis
-Ulceration
-Hemmorrhage
Stage in which the host presents systemically with muscular weakness, anemia, and coagulation disorders, such as granulocyte and platelet abnormalities
Advanced or stage IV cancer
This clinical manifestation may be seen without infection and is produced either by WBCs inducing a pyrogen or by direct tumor production of a pyrogen
Pyrexia/fever
True or false: Continuation spread of a cancer does not lead to GI, pulmonary, or vascular obstruction
False
(it does… lol)
True or false: Continuation spread of cancer decreases the host’s immunity
True
True or false: Clinical manifestations may produce systemic signs and symptoms that are not direct effects of either the tumor or its metastases
True
Cancer pain occurs in about _____ of adults with newly diagnosed malignancies
1/4
Cancer pain occurs in about _____ of individuals undergoing treatment
1/3
Cancer pain occurs in about _____ of all people with advanced disease
3/4
True or false: Depression and anxiety does not increase the person’s perception of pain or may be the result of the cancer pain
False
(can increase)
Some pain is caused by pressure on _________ or by the displacement of _________.
Nerves
Nerves
Microscopic infiltration of nerves by tumor cells can result in _______________ generally following the pattern of nerve distribution
Continuous, sharp, stabbing pain
Ischemic pain (throbbing) may result from interference with _____________ or from blockage within hollow organs
Blood supply
A common cause of cancer pain is metastasis of cancer to __________.
Bone
Signs and symptoms accompanying mild-to-moderate superficial pain
-Hypertension
-Tachycardia
-Tachypnea
(result of a sympathetic nervous system response)
True or false: Sympathetic nervous system responses is more characteristic in severe or visceral pain
False
(Parasympathetic)
True or false: Cancer pain can manifest as spinal cord compression from metastases
True
Types of pain regarding spinal cord compression from metastases
-Radicular back pain
-Leg weakness
-Change/loss of bowel or bladder control
True or false: Immobility and inflammation can also lead to pain
True
Pain should be screened, assessed, and managed according to ________.
Clinical practice guidelines (CPGs)
What does pain management depend on?
-The underlying etiology
-Whether the individual is experiencing acute or chronic pain
Methods of pain control
-Steroids
-Opioids
-Radiation
-Chemotherapy
-Surgical intervention
-Neurosurgery nerve blocks
-Intraspinal
-Rhizotomy
-Cordotomy
True or false: Integrative, psychologic, or rehabilitative strategies do not help pain control
False
(they do help)
Most common drugs used for pain control
-Morphine
-Hydromorphone
-Fentanyl
-Oxycodone
A balance between analgesia and side effects might be achieved by changing to an equivalent dose of an alternative opioid
Opioid rotation
Methods of continuous infusion
-Around the clock
-As needed
-Patient controlled analgesia (PCA)
Examples of complementary therapies
-Massage
-Simple touch
-Acupuncture
-Imagery/hypnosis
-Reflexology
-Relaxation training
Technique that reduces stress and anxiety but is debatable about its safety in individuals with lymphedema or who are at risk for developing lymphedema
Massage
True or false: There is no evidence that shows massage can spread cancer, although direct pressure over a tumor is usually discouraged
True
True or false: Biophysical agents do not relieve symptoms associated with cancer
False
(They have the potential to relieve some symptoms but not intended to treat the cancer)
How do biophysical agents work?
They alter cell membrane permeability and alter transmembrane potentials, potentially triggering tissue growth and development increase circulation, promote cell function, growth, and replication
The use in individuals with cancer or a history of cancer is controversial with the exception of ____________.
Hospice or palliative care
PTs need to conduct _________ and have an open dialogue with patients
Risk-benefit assessment
Cancer neuropathic pain is directly caused by _______ or indirectly as a side effect of _________
Tumor invasion
Cytotoxic drug therapy
Recommended treatment for this pain includes infrared light therapy, anti-depressant drugs, anti-epileptics, and steroids
Cancer neuropathic pain
A distressing, persistent, and subjective sense of tiredness or exhaustion related to cancer or cancer treatment (unknown mechanisms)
CRF (cancer-related fatigue)
True or false: CRF is not a universal symptom for cancer survivors
False
(it is)
True or false: It is important to reassure the patient that CRF is not necessarily an indicator of disease progression
True
CRF may be the result of…
-Pain
-Anemia
-Sleep disturbance
-Nutritional deficits
-Deconditioning
-Comorbidities
-Presence of certain cytokines
-Psychological factors (ex: emotional distress, anxiety, depression)
Condition when tumors produce signs and symptoms (not direct effects of either the tumor or its metastases) at a site distant from the tumor or its metastasized sites
Paraneoplastic syndrome
Many of the paraneoplastic syndrome involve…
-Ectopic hormone production by tumor cells
-The secretion of biochemically active substances that cause metabolic abnormalities
Paraneoplastic syndrome may accompany relatively limited ___________ and provide an early clue to the presence of certain types of cancers
Neoplastic growth
Examples of primary prevention
-Epigenetics
-Nutrigenomics
-Chemoprevention
-Cancer vaccine
Prevent cancer through the impact of nutrition on gene structure and stability
Nutrigenomics
The use of agents to inhibit and reverse cancer, has focused on diet-derived agents
Chemoprevention
Applies screening to identify high-risk people and subsequent reduction or elimination of modifiable risk factors
Epigenetics
Aimed at preventing morbidity and mortality uses screening, early detection, and prompt treatment
Secondary prevention
Focuses on managing symptoms, limiting complications, and preventing disability associated with cancer or its treatment
Tertiary prevention
Substances that may be found in the blood serum and are produced/secreted by tumor cells. This is not a diagnostic itself but can signal malignancies.
Biologic tumor markers
By using specific cancer biomarkers, it provides additional information for the oncologist in determining aggressiveness of the tumor; potential response to treatment and prediction of risk for cancer diagnosis with a family
Molecular profiling
The medical management of cancer may be _______ or ________
Curative (intent to cure)
Palliative (provides symptomatic relief but does not cure)
Treatment that uses this order:
Surgery to remove primary tumor –> therapies (chemotherapy/radiation therapy) to obtain local regional/systemic control –> possibly finding long term hormonal treatment
Anti-neoplastic treatment
Adjuvant therapies
Chemotherapy/radiation therapy
This means before definitive surgical intervention
Neoadjuvant
The decision to initiate neoadjuvant vs adjuvant therapies is based on the _________, _________, and often the __________
Size
Extent of involved tissue
Stage/grade of the tumor
True or false: Major therapies may be used alone or in combination, depending on the type, stage, localization, and responsiveness of the tumor and on limitations imposed by the person’s clinical status
True
Major therapies of curative cancer (list them)
-Surgery
-Irradiation Therapy
-Chemotherapy
-Immunotherapy
-Antiangiogenic Therapy
-Hormonal Therapy
-Complementary and Alternative (Integrative) Medicine
This is used most often in combination with other therapies. May be used curatively for localized cancer; tumor biopsy and tumor removal or palliatively to relieve pain, correct obstruction, or alleviate pressure
Surgery
____ phase represents the resting phase of cell proliferation
G0
_____ phase is the growth and preparation of the chromosomes for replication
G1
_____ phase is the synthesis of DNA
S1
____ phase is the preparation of the cell for division
G2
____ phase represents cell division
M
The final result of the cell cycle is the production of two ____________.
Identical daughter cells
When stimulated by growth factors and/or hormones, ____ cells move into the ____
G0
G1
____ is a checkpoint to stop the cell cycle if DNA is damaged
G1
____ is another checkpoint when the cell cycle can be stopped if DNA is damaged or unreplicated, in which case repair or apoptosis occurs
G2
Chemotherapy is most effective during the ____ and ____ phases
S
M
Cells are more sensitive to radiation therapy in the ____ phase
G2
Stem cells in the ____ phase are resistant to chemotherapy and radiation therapy
G0
The repeated or cyclic chemo or radio therapy is designed to capture cells at _______.
Each stage of the cell cycle
May be used preoperatively to shrink a tumor, making it operable, while preventing further spread of the disease during surgery
Radiotherapy
True or false: After the surgical wound heals, postoperative doses of radiotherapy do not prevent residual cancer cells from multiplying or metastasizing
False
(they do prevent lol)
Radiotherapy destroys the dividing cancer cells by destroying _______ between DNA strands within the cancer cells
Hydrogen bonds
Two types of radiotherapy
Ionizing radiation
Particle radiation
Depending on the type and extent of the tumor, radiotherapy may be delivered externally or internally by…
External beam (teletherapy)
Sealed source (x rays/gamma rays)
Unsealed source (systemic therapy)
Radiotherapy is used in approximately ____ of all cases of cancer in the local control phase of treatment, but it has both direct and indirect toxicities associated with its use
50%
True or false: Radiation reactions and injuries are the harmful effects (acute, delayed, or chronic) to body tissues through exposure to ionizing radiation
True
Method to treat cancer with systemic drugs traveling throughout the body rather than remain confined to a specific area
Chemotherapy
True or false: Chemotherapy affects or interferes with the synthesis or function of nucleic acid (DNA) targeting cells in the growth plates and kills all cells
False
(it does not kill all cells)
True or false: Combination therapies are often used because some drugs work better during different cell cycles
True
The process of chemotherapy is usually intermittent to allow for ________ recovery between doses
Bone marrow
Chemotherapy limits cell proliferation by __________.
Killing/attenuating the growth of the cancerous cells
True or false: Chemotherapy inhibits DNA/RNA synthesis and function or directly inhibit cell division
True
True or false: Chemotherapy affects cancerous cells to a lesser extent than normal cells
False
(greater extent)
__________________ have a greater need to replicate their genetic material and thus undergo mitosis at a much higher rate than most _____________ cells
Cancerous cells
Noncancerous cells
True or false: The growth fraction typically decreases as a tumor gets larger
True
The % of proliferating cells relative to neoplastic cell population
Growth fraction
True or false: Blood flow and nutrient supply to the tumor can sustain extremely rapid tumor growth
False
(cannot sustain)
Each round of chemo will kill a certain _____ of cancerous cells
%
True or false: The chemo can never completely eliminate the tumor
True
True or false: If chemo can reduce the tumor to a certain size (typically < 10,000 cells), the body’s endogenous defense mechanisms (i.e., cytotoxic immune responses) can deal with the remaining cancerous tissues, and the disease is considered to be in remission
True
Chemo works the best when the tumor is ______, and a ______ proportion of the cells are actively dividing
Small
Large
True or false: Early detection and aggressive chemotherapy are not essential in successfully treating cancer
False
(they are essential)
If a patient has a tumor in the pancreas, what would be the most common site of pain referral for this tumor?
-Inguinal region, anterior thigh, and genitalia
-Shoulder, midthoracic, or low back
-Sacroiliac joint and hip
-Anywhere in corresponding dermatome
Shoulder, midthoracic, or low back
Cells are most sensitive to radiation therapy in the ____ phase
-S
-M
-G1
-G2
G2
What is the last step in the mitotic cycle before cell division?
-G0
-G1
-G2
-G3
G2
Which of the following concepts describe the theory that each round of chemotherapy will affect a certain percentage of cancerous cells and the chemotherapeutic regimen can never completely eliminate the tumor?
-Growth fraction
-Cell kill hypothesis
-Cytotoxic strategy
-Molecular profiling
Cell kill hypothesis
