1
Q
What is the 6th most common cancer
A
Bladder cancer
It is relatively common and has a peak incidence in the 7th decade of life.
2
Q
At what age does the incidence of bladder cancer peak?
A
73 years old
This disease is uncommon in patients younger than 40.
3
Q
Bladder cancer is more common in which gender?
A
Men (4:1 ratio)
In men, it is the 4th most prevalent malignancy.
4
Q
Which race is predominantly affected by bladder cancer?
A
Whites
The disease is more common in urban settings than in rural ones.
5
Q
List some environmental factors that contribute to bladder cancer.
A
- Ionizing Radiation
- Arsenic in water
- Occupational exposure to chemicals
- Cyclophosphamide
These factors increase the risk of developing bladder cancer.
6
Q
What lifestyle factor is associated with 45% of bladder cancer cases**?
A
Smoking
Smoking cigarettes is more strongly associated with bladder cancer than cigars or pipes.
7
Q
What is the most common sign of bladder cancer?
A
Blood in urine (hematuria)
This occurs in 75-80% of cases and may change urine color.
8
Q
What are some other signs and symptoms of bladder cancer?
A
- Frequent urination
- Urgent urination
- Burning or pain during urination
- Difficulty urinating
- Low back pain or pelvic pain
Symptoms often appear as the tumor grows larger or deeper.
9
Q
True or false: Chronic bladder infections can contribute to bladder cancer.
A
TRUE
Other factors include exposure to radiation and bladder stones.
10
Q
What is the histopathological origin of most bladder cancers?
A
Epithelial tissue (98%)
Approximately 92% of epithelial tumors are transitional cell carcinoma.
11
Q
What are the staging categories for bladder cancer according to the AJCC 7th Edition?
A
- T1: Invades subepithelial connective tissue
- T2: Invades muscularis propria
- T3: Invades perivesical tissue
- T4: Invades surrounding structures
Staging is crucial for determining treatment options.
12
Q
What is the 5-year survival rate for non-invasive bladder cancer?
A
95%
Survival rates decrease significantly with deeper invasion.
13
Q
What is the first treatment for early-stage bladder cancer?
A
Surgery (TURBT)
Transurethral resection of bladder tumor is standard for early-stage cases.
14
Q
What is the role of intravesical therapy in bladder cancer management?
A
Adjuvant treatment post-TURBT
It helps prevent further recurrence or manage residual disease.
15
Q
What are the prognostic factors affecting bladder cancer outcomes?
A
- Tumor extent
- Depth of muscle invasion
- Tumor morphology
Papillary tumors are usually low grade and have a favorable prognosis.
16
Q
What is the expected outcome for bladder cancer that has spread to nearby lymph nodes?
A
35% 5-year survival rate
Survival rates drop significantly for metastatic disease.
17
Q
What is the induction therapy duration for high-risk patients receiving intravesical BCG?
A
6 weeks
This treatment improves the risk of recurrence and progression compared to chemotherapy.
18
Q
Name the intravesical agents commonly used for bladder cancer treatment.
A
- BCG
- Mitomycin C
- Anthracyclins (epirubicin, doxorubicin, valrubicin)
- Gemcitabine
- Docetaxel
- Thiotepa
These agents are used for intravesical chemotherapy.
19
Q
What is indicated for earlier stage disease in high-risk patients to prevent progression to T2 disease?
A
Cystectomy
This is necessary for patients with multiple tumors, frequent recurrences, or involvement of the prostatic urethra.
20
Q
What are the common chemotherapy combinations used for neoadjuvant treatment of bladder cancer?
A
- GC (Gemcitabine/Cisplatin)
- CMV (Cisplatin/Methotrexate/Vinblastine)
- MVAC (Methotrexate/Vinblastine/Doxorubicin/Cisplatin)
Neoadjuvant cisplatin-based chemotherapy improves overall survival and lowers recurrence risk.
21
Q
True or false: Preoperative XRT has a significant impact on survival compared to cystectomy alone.
A
FALSE
Preoperative XRT can improve local control but does not affect survival.
22
Q
What is the complete response rate for TURBT plus chemotherapy compared to chemotherapy alone?
A
51% for TURBT + chemo
27% for chemo alone
This indicates the effectiveness of combining TURBT with chemotherapy.
23
Q
What is the 5-year overall survival (OS) estimate with Chemoradiation regimens for bladder cancer?
A
50-60%
This includes patients treated with bladder-preserving approaches.
24
Q
What is the standard treatment for stage 2 and stage 3 bladder cancer?
A
Combination of chemotherapy drugs including cisplatin
Chemotherapy is often used as part of chemoradiation.
25
What is the **cumulative dose** for radiation therapy in bladder cancer treatment?
64-66Gy
## Footnote
This dose is adjusted based on normal tissue tolerances.
26
What are the **acute gastrointestinal effects** of radiation therapy?
* Diarrhea
* Abdominal cramping
* Rectal discomfort
* Rectal bleeding
## Footnote
These effects may occur during radiation treatment.
27
What is the **highest incidence** of breast cancer observed in terms of geographic location?
High-income, developed countries
## Footnote
This includes countries like Canada, the United States, and some European nations.
28
What are some **environmental factors** that contribute to breast cancer risk?
* Alcohol
* Diet (high fat, high BMI)
* Previous radiation
* Smoking
## Footnote
These factors are associated with an increased risk of developing breast cancer.
29
What is the **recommended age** for women to start having mammograms?
Over 50 or younger if family history
## Footnote
Mammograms are not ideal for younger women due to breast density.
30
What is the **sensitivity** of mammograms in detecting breast cancer?
90-95%
## Footnote
This indicates the probability that a test will be negative when no disease is present.
31
What is the **average age** of breast cancer diagnosis?
60
## Footnote
Breast cancer mostly occurs in women between 50 and 69 years of age.
32
What is the **false negative rate** for mammograms?
5-10%
## Footnote
This indicates the percentage of cases where the test fails to detect the disease.
33
What is the **recommended age** for women to undergo screening mammography?
Over 50 or younger if family history
## Footnote
Younger women may have dense breast tissue, making mammograms less ideal.
34
What is the **false negative rate** for screening mammography?
5-10%
## Footnote
This means that 5-10% of cases may not be detected when no disease is present.
35
What are the **important features** of screening and detection?
* Cost effectiveness
* Accuracy
* Specificity
* Safety
* Availability
## Footnote
These features are crucial for evaluating screening methods.
36
Define **screening**.
Checking for a disease in a group of people who don't show any symptoms
## Footnote
Screening tests help find breast cancer before symptoms develop.
37
What is a **mammography**?
A low-dose x-ray of the breast
## Footnote
It is the most reliable way to find breast cancer early in women.
38
What should women aged **40 to 49** do regarding breast cancer risk?
Talk to their doctor about risk and mammogram benefits
## Footnote
This discussion helps in making informed decisions about screening.
39
What is the **anatomical origin** of the breast?
Evolves from sudoriferous (sweat) gland tissue
## Footnote
The mammary gland is a modified sweat gland.
40
What are the **components** of the breast anatomy?
* Lobes
* Lobules
* Alveoli
* Areola
* Suspensory ligaments
## Footnote
These structures are essential for breast function and support.
41
What is the **major arterial supply** to the breast?
Branches of the IM artery and Axillary artery
## Footnote
The Lateral Thoracic Artery primarily supplies the lateral aspect of the breast.
42
What is the **most common clinical presentation** of breast cancer?
Painless mass
## Footnote
Other symptoms may include nipple discharge and skin changes.
43
What does **Paget’s disease** involve?
Psoriasis around the nipple extending into the alveolar region
## Footnote
In its pure form, it is classified as DCIS and is not aggressive.
44
What is the **5-year relative survival rate** for stage 2 breast cancer?
93%
## Footnote
Survival rates vary significantly by stage.
45
What are the **types of biopsies** used in breast cancer diagnosis?
* Fine-Needle
* Core-Needle
* Incisional
* Excisional/Lumpectomy
## Footnote
Each type has specific indications based on the size and nature of the mass.
46
What is the purpose of a **sentinel lymph node biopsy**?
To identify and remove the first lymph node that receives lymph fluid from around a tumor
## Footnote
This helps determine if cancer has spread to the lymph nodes.
47
What is the **TNM staging system** used for?
To classify the size and spread of cancer
## Footnote
T = size, N = number and position of lymph nodes.
48
What does **invasive** mean in the context of breast cancer?
Cancer cells have started to spread into surrounding tissue
## Footnote
This contrasts with non-invasive cancers, which have not spread beyond their origin.
49
What are the **routes of spread** for breast cancer?
* Direct invasion
* Extension via the duct system
* Lymphatic channels
* Blood borne metastases
## Footnote
Understanding these routes is crucial for treatment planning.
50
What is the **development of distant metastasis** linked to?
* Size of primary tumor
* Histology of primary tumor
* Extent of lymph node involvement
## Footnote
These factors influence the likelihood of cancer spreading to distant sites.
51
Which lymph nodes are the most likely sites of **regional involvement**?
* Axillary nodes
* Internal mammary nodes
## Footnote
These nodes are critical in the lymphatic drainage of the breast.
52
The lymphatic drainage of the breast can be segmented into **two anatomic regions**: drainage of the medial quadrants and drainage of the __________.
lateral quadrants
## Footnote
This segmentation is important for understanding the spread of breast cancer.
53
Name the **five groups** defined in the axillary lymph node group.
* Anterior (pectoral) nodes
* Posterior (subscapular) nodes
* Lateral (brachial) nodes
* Central nodes
* Apical (infraclavicular/deltopectoral/subclavian) nodes
## Footnote
These groups are crucial for understanding lymphatic drainage patterns.
54
The **anterior and posterior nodes** drain to which nodes?
Central nodes
## Footnote
This drainage pathway is essential for understanding lymphatic spread.
55
The **medial quadrants** of the breast can also drain to the __________.
internal mammary nodes
## Footnote
These nodes are located along the internal surface of the chest wall.
56
True or false: **Supraclavicular nodes** are commonly involved in breast cancer metastasis.
FALSE
## Footnote
Supraclavicular nodes are rare and correlated with extensive axillary metastasis.
57
What are the **prognostic factors** for breast cancer?
* Age
* HER2-neu status
* ER/PR status
* Presence of axillary lymph node involvement
* Tumor size
* Histologic type
* Histological grade
* LVI
* Positive margins
## Footnote
These factors help predict patient outcomes.
58
What is the rationale for **surgery** in breast cancer treatment?
* Primary treatment
* Removal of breast and surrounding tissues
* High complication rates led to modified approaches
## Footnote
Surgical options include radical mastectomy and modified radical mastectomy.
59
What does a **modified radical mastectomy** involve?
* Removal of the breast
* Some or all axillary nodes
* Preservation of pectoralis major muscle
## Footnote
This approach aims to improve cosmetic results and reduce complications.
60
What is the main goal of **breast conserving surgery**?
Total gross removal of the tumor with surrounding tissue
## Footnote
This approach aims to maintain good cosmesis.
61
What is **lumpectomy**?
Removal of the tumor with a margin of normal-appearing tissue
## Footnote
This is a type of breast conserving surgery.
62
What is the purpose of **axillary dissection**?
Removal of a sample of axillary nodes for staging information
## Footnote
This procedure can also provide local control if nodes are positive.
63
What is the purpose of **sentinel node biopsy**?
Identifies the first draining node and nodal status
## Footnote
This technique uses limited dissection of the axilla.
64
What is the rationale for **radiation therapy (XRT)** following surgery?
* Administered adjuvantly to surgery
* Can be delivered as a boost
* Used if patients refuse surgery
## Footnote
Radiation helps to target remaining cancer cells.
65
What does **IMRT** stand for?
Intensity-Modulated Radiation Therapy
## Footnote
This technique is used for patients needing satisfactory distribution with radiation.
66
What are the **indications for chemotherapy** in breast cancer?
* High grade
* Large tumor
* Young patient (premenopausal)
* Positive nodes
* HER2-neu status
## Footnote
These factors help determine the need for systemic therapy.
67
What is the goal of **hormone therapy** in breast cancer treatment?
To deprive cancer cells of hormones needed for growth
## Footnote
This is particularly relevant for ER/PR positive tumors.
68
What is **Tamoxifen** used for?
To bind to estrogen receptors and block estrogen production
## Footnote
Most women are on Tamoxifen for about 5 years.
69
What is the rationale for **partial breast treatment**?
Allows for a shorter treatment regimen
## Footnote
This can involve permanent or temporary implants.
70
What are the **indications for a boost** in radiation therapy?
* Close/positive margins
* High grade tumor
* Young patient
## Footnote
Boosts are used to target specific areas of concern.
71
What is the **treatment sequence** for early-stage breast cancer?
* Surgery
* Chemotherapy
* Radiation
## Footnote
This sequence is crucial for effective management.
72
What is the **primary treatment** for **Stage IIIA breast cancer**?
* Combination of small T, N2 or bigger T, and N1/N2
* Neoadjuvant: Chemotherapy and Herceptin if receptor positive
* Primary Surgery: Mastectomy + ALND
* Adjuvant RT: Chest wall + superclav +/- Herceptin
## Footnote
Stage IIIA involves a combination of tumor size and lymph node involvement.
73
What does **adjuvant chemotherapy** involve for **receptor positive** cases?
* Tamoxifen or an aromatase inhibitor if ER/PR+
* Tamoxifen if ER/PR+ premenopausal
## Footnote
Adjuvant chemotherapy is used to reduce the risk of cancer recurrence.
74
What is the **role of IMRT** in breast cancer treatment?
* Improve target volume coverage
* Produce a more homogenous plan
* Decrease dose to normal tissue
* Minimize dose to the heart and lungs
* Ability to treat two volumes simultaneously
## Footnote
IMRT stands for Intensity-Modulated Radiation Therapy.
75
What are the **acute side effects** of radiation therapy?
* Fatigue
* Pruritus
* Erythema/Dry desquamation
* Moist Desquamation
## Footnote
These side effects typically begin within the first few weeks of treatment.
76
What is the **normal PSA level** for men aged **50-59**?
0-3.5 (ug/L)
## Footnote
PSA stands for Prostate-Specific Antigen, and levels vary by age.
77
True or false: **Lymphedema** in the arm can lead to swelling and inflammation.
TRUE
## Footnote
Lymphedema is caused by impaired lymphatic drainage.
78
What are the **field borders** for tangents in breast cancer treatment?
* Sup: SSN (1.5-2.0cm sup of breast tissue)
* Inf: 2cm inf of infra-mammary fold
* Med: Midline
* Lat: Mid-axillary line
## Footnote
These borders help define the treatment area for radiation.
79
What is the **dose** for **4-field** breast treatment?
* Dose: 50/25
## Footnote
This refers to the total dose delivered in fractions.
80
What is the **incidence** of prostate cancer in men aged **65 and older**?
>65% of prostate carcinomas occur in men 65 years and older
## Footnote
Prostate cancer is the most common malignancy in males.
81
What are the **interventions** for managing **lymphedema**?
* Perform tests on the other arm
* Avoid carrying heavy objects
* Wash and clean cuts
* Observe for signs of infection
* Keep arm elevated above head when possible
* Perform arm exercises
## Footnote
These interventions help manage symptoms and prevent complications.
82
What is the **treatment** for **moist desquamation**?
* Wash gently with mild soap
* Expose area to air
* Use Glaxal base cream initially
* Protect area from sun
* Wear loose fitting cotton clothing
## Footnote
Moist desquamation is a common side effect of radiation therapy.
83
What are the **normal PSA levels** for men older than 50 years?
* 50-59 years: 0-3.5 (ug/L)
* 60-69 years: 0-4.5 (ug/L)
* 70 and older: 0-6.0 (ug/L)
## Footnote
PSA levels vary with age, with higher levels acceptable in older men.
84
What are the **sites of origin** for prostate cancer?
* Peripheral zone (70%)
* Central zone (20%)
* Transitional zone (5-10%)
## Footnote
The majority of prostate cancers originate in the peripheral zone.
85
True or false: Prostate cancer tends to be **multifocal**.
TRUE
## Footnote
Multifocality means that multiple cancerous areas can exist within the prostate.
86
What does **extracapsular extension** indicate in prostate cancer?
Tumor growth extending through the prostate capsule into surrounding tissues
## Footnote
This is classified as T3 in the TNM staging system.
87
What is the most common site for **distant metastasis** in prostate cancer?
Bone
## Footnote
Prostate cancer often leads to osteoblastic metastatic lesions in the bones.
88
What are the **early clinical presentations** of prostate cancer?
* Usually asymptomatic
* Prostate hypertrophy
* Urethral obstruction
* Frequent urination
* Narrow stream urination
* Nocturia
* Painful urinations
* Blood in urine or semen
## Footnote
Symptoms may vary, but many patients are asymptomatic in early stages.
89
What does the **Gleason score** indicate?
Histologic grading system based on tumor characteristics
## Footnote
The Gleason score ranges from 2 to 10, indicating the aggressiveness of the cancer.
90
What are the **risk categories** based on Gleason score and PSA level?
* Low Risk: Gleason 2-6, PSA <10
* Intermediate Risk: Gleason 7, PSA 10-20
* High Risk: Gleason 8-10, PSA >20
## Footnote
These categories help determine treatment options and prognosis.
91
What are the **diagnostic procedures** for prostate cancer?
* Physical examination
* DRE (digital rectal exam)
* TRUS (trans-rectal ultrasound) and biopsy
* PSA test
* CBC (complete blood count)
* CT scan
## Footnote
These procedures help in diagnosing and staging prostate cancer.
92
What is the **TNM staging** for prostate cancer?
* T1: Non-palpable
* T2: Palpable nodule
* T3: Nodule with extra-capsular extension
* T4: Invasion of neighboring structures
## Footnote
The TNM system classifies tumors based on size and spread.
93
What is the **treatment of choice** for low-risk prostate cancer?
* Active surveillance
* Prostatectomy
* Brachytherapy
* External beam radiation
## Footnote
Treatment options vary based on risk assessment.
94
What is **androgen deprivation therapy**?
Removal of testosterone production or blocking its action
## Footnote
This therapy is crucial in managing prostate cancer.
95
What are the **post-prostatectomy** situations that arise?
* PSA does not decrease
* PSA is undetectable but tumor margins contain tumor
* PSA is undetectable but begins to rise
## Footnote
These situations require careful monitoring and potential further treatment.
96
What is the role of **cryosurgery** in prostate cancer treatment?
Used to treat early-stage prostate cancer using extreme cold
## Footnote
Cryotherapy destroys abnormal tissues and is guided by ultrasound or MRI.
97
What are the **common symptoms** of late-stage prostate cancer?
* Anemia
* Fatigue
* Weight loss
* Loss of bowel control
## Footnote
These symptoms indicate advanced disease and may require palliative care.
98
What is the purpose of **deprivation therapy** in cancer treatment?
To remove circulating testosterone which can aid in tumour growth
## Footnote
This therapy is often used in the context of prostate cancer treatment.
99
Name two **gonadotropin-releasing hormone agonists** mentioned.
* Goserelin (Zoladex)
* Leuprolide acetate (Lupron)
## Footnote
These medications initially cause a rise in gonadotropin levels, followed by a sharp decline.
100
What are the two types of **radiation therapy** mentioned?
* External Beam (2-phase, IMRT)
* Brachytherapy
## Footnote
Radiation can be used as primary treatment or adjuvant to surgery.
101
What are the **Four Field Borders** in radiation therapy?
* Upper: mid sacral level
* Lower: most inferior aspect of the prostate
* LATS: 1.5-2 cm from lateral pelvic brim
* ANT: 1 cm post to the projection of the anterior cortex of the pubis symphysis
* POST: at the posterior ischium with shielding the posterior rectal wall
## Footnote
These borders help define the treatment area in radiation therapy.
102
What is the typical **dose** for pelvic lymph nodes in radiation therapy?
45-50Gy
## Footnote
This dose is often combined with higher doses to the prostate.
103
What is the **dose range** for prostate treatment in radiation therapy?
72-80 Gy at 1.8-2.0 Gy per day
## Footnote
This dose is crucial for effective prostate cancer treatment.
104
What does **IMRT** stand for?
Intensity-Modulated Radiation Therapy
## Footnote
IMRT is an advanced technique that specifies the chosen dose to the tumour volume.
105
What is the **Phase 1 dose** in a two-phase radiation treatment?
4500–5000 cGy (180–200 cGy per Tx) to whole pelvis
## Footnote
This is followed by a higher dose in Phase 2.
106
What is the typical dose for **I-125** in interstitial brachytherapy?
145 Gy
## Footnote
This isotope is commonly used in brachytherapy for prostate cancer.
107
What is the **usual dose** with **Pd-103** in interstitial brachytherapy?
15 Gy
## Footnote
Pd-103 is another isotope used in brachytherapy.
108
What is the significance of **D90** values in brachytherapy?
Recurrence rate increases with D90 values less than 140Gy
## Footnote
D90 refers to the dose received by 90% of the prostate volume.
109
What is the **patient position** during interstitial brachytherapy?
Dorsal lithotomy position
## Footnote
This position allows for optimal access during the procedure.
110
What is the **CT scan** used for after interstitial brachytherapy?
To determine the post-implant dosimetry
## Footnote
This scan is taken about 40 days after the procedure.
111
What are the **acute gastrointestinal effects** of radiation?
* Diarrhea
* Abdominal cramping
* Rectal discomfort
* Occasionally rectal bleeding
## Footnote
These effects can occur shortly after radiation treatment.
112
What percentage of formerly potent patients experience **erectile dysfunction** after external radiation?
30-60%
## Footnote
This is a common side effect of radiation therapy for prostate cancer.
113
What is the **TD 5/5** for the whole bladder in radiation therapy?
65 Gy
## Footnote
This dose indicates the tolerance level for the bladder.
114
What is the **TD 5/5** for the whole colon in radiation therapy?
45 Gy
## Footnote
This dose indicates the tolerance level for the colon.
115
What is the **TD 5/5** for the whole rectum in radiation therapy?
60 Gy
## Footnote
This dose indicates the tolerance level for the rectum.
116
What is the **TD 5/5** for the whole small bowel in radiation therapy?
40 Gy
## Footnote
This dose indicates the tolerance level for the small bowel.
CAMRT
flashcards
Decks in class (1)
# Cards
