1
Q
77% of all cancers are diagnosed in patients over age ___. __% of cancers are hereditary. Who has a greater risk of developing it (men or women?) ___% deaths is cancer related making it the 2nd leading cause of death
A
55, 5-10%, men, 25%
2
Q
What are the top 6 most common cancers
A
- lung
- breast
- colorectal
- prostate
- skin (non melanoma)
- stomach
3
Q
What 5 main types of cancer affect a woman’s reproductive organs?
A
Cervical (preventable HPV vaccine) Ovarian (causes most deaths) Uterine (mostly endometrium) vaginal vulvar (on the labia)
4
Q
Common childhood cancers (5)
A
- leukemia
- brain
- neuroblastoma
- wilms tumor (kidney)
- lymphoma
5
Q
carcinoma definition
A
Any cancerous tumor that starts with the cells that cover the inner and outer body surfaces (epithelium), invade surrounding tissue and spread to far regions of the body, other tissue types can also be cancerous (sarcoma, lymphoma, blastoma, etc)
6
Q
Direct spread vs metastasis
A
Direct spread is invasion/infiltration into surrounding tissue, metastasis is vascular or lymphatic spread
7
Q
How do cancer cells kill?
A
- compete with normal cells for nutrients
- immunologic factors or deficiency there of resulting in secondary dz states
- tumor mass distorts normal anatomy and phys
8
Q
Oncogenes
A
Altered forms of genes known as proto oncogenes that can promote tumor formation or growth
9
Q
Proto-oncogenes
A
Responsible for promoting cell growth
10
Q
Tumor suppressor genes
A
Control process of cell growth when functioning correctly promoting apoptosis that when not functioning can lead to tumor formation and growth
11
Q
DNA repair genes
A
Correct naturally occurring errors in DNA and if mutated fail to correct mistakes potentially leading to tumor suppressor gene or proto-oncogene alteration and tumor growth
12
Q
Oncovirus
A
Family of viruses linked to certain cancers in animals and humans (HPV, epstein barr, hep C)
13
Q
Warning signs for cancer (4)
A
- nonhealing sore
- unusual bleeding
- lump
- weight loss
14
Q
Cancer grading: differentiation grade
A
Grade 1 - well differentiated
2 - moderatly differentiated
3 - poorly differentiated
4 - undifferentiated’
15
Q
TNM staging of cancer
A
T- tumor size (T1 in situ T5 extension beyond adjacent organs)
N- nodes (N0 none, N1 ipsalateral or regional involvement, N2 - more extensive, N3 contralateral or distant nodal metastasis)
M- metastasis (M0 - neg, M1 - pos)
16
Q
Radiation therapy definition
A
Cancer treatment that uses high doses of radiation to kill cancer cells and stop them from spreading, up to 1/2 of cancer patients receive it at some point, can be used alone or alongside surgery or chemo
17
Q
Photons energy rating scale
A
- Gamma rays
- x rays
- uv
- visible
- infared
- radio
18
Q
Radiation therapy mech of action
A
Damages DNA directly or creates free radicals in cell that damage DNA of both cancer cells resulting in their death as well as host cells
19
Q
Preoperative radiation is known as ___, during surgery is ____, and post op therapy is ____
A
neoadjuvant, intraoperative, adjuvant
20
Q
Measure of radiation energy absorbed by 1kg of human tissue is a…
A
…gray (Gy)
21
Q
Brachytherapy
A
Internal radiation where radioactive material is placed in the body near cancer cells typically in seeds
22
Q
Systemic radiation
A
A radioactive substance is given by mouth or vein and travels into the blood to tissues thru the body
23
Q
3D conformational radiation therapy (3D-CRT)
A
Most common type of external radiation therapy, computer software allows delivery at precisely shaped areas
24
Q
Intensity modulated radiation therapy (IMRT)
A
A type of external radiation therapy that allows for different areas of a tumor or space nearby to receive varying doses of radiation allowing for less side effects than 3D-CRT
25
Gamma knife/stereotactic radiosurgery
A device for external radiation therapy for small tumors of the brain with well defined edges
26
Cyberknife/sterotactic body radiation therapy
A device for external radiation therapy of small tumors outside the brain and spinal cord
27
Total body irradation
Most commonly used for hematopoietic cell transplantation for leukemias and lymphomas, used as part of cytoreductive regimen
28
Proton therapy vs Electron therapy
Proton deposited energy is mostly delivered at the end of the path and less along the way (go thru tissue and not effect it until hitting the target tissue)
Electron beams can be used on superficial tumors (skin or surface of breast) that cannot travel very far thru tissue
29
During permanent brachytherapy, it is advised to limit contact with children and pregnant women because...
....the patient is slightly radioactive despite the amount reaching the skin is minimal
30
Zevalin definition
A monoclonal antibiody with radioactive substance bound to it used in treatment of B cell non hodgkin lymphoma to bind a protein found on surface of B lymphocytes
31
Often radiation therapy is given multiple times a week 2 treatments a day. Why?
Smaller doses minimize damage to normal tissue and by varying the time we increase chances the cells are being exposed at critical time of cell cycle when they are vulnerable to DNA damage
32
What stage of cell cylce are cells most radiosensitive? What is least?
G2 and M are most, S is least
33
Radiation acute side effects (5, one important one to note)
- diarrhea
- hair loss
- sexual changes
- fatigue
- VERY DEPENDENT on location of the treatment
34
Radiation chronic side effects (5)
- fibrosis and limited movement
- memory loss
- infertility
- mouth problems
- 2ndary cancers in children or adolescents
35
Radiation pneumonitis
A condition occurring 4-12 weeks after chest radiation (lung, breast, mediastinal) that presents with cough, dyspnea, chest pain, low grade fever that can be treated with steroids but can cause lung fibrosis
36
2 big locations of 97% of breast cancers
Ductal or lobal carcinoma
37
2 most common presentations of breast cancer
- mammographic abnormality on screening
- palpable mass discovered by provider or patient
38
2 types of tissue composing breast
Glandular and stromal
39
Risk factors for breast cancer (4)
- personal and family history
- genetics
- Age (increases with)
- reproductive factors (early menarche, age of first birth over 30 years, nulliparity, later onset of menopause)
40
Risk prediction model of breast cancer
Determines risk category to determine average, moderate, or high risk based on history, family history, genetic predisposition, or radiotherapy
41
Average lifetime risk of being diagnosed with breast cancer with no significant risk factor
12.4% or 1/8
42
Women age 40-44 mammogram, 45-54, 55 and older, how long should it continue?
40-44: should have choice to start annual screenings
45-54: get mammogram every year
55+: mammograms every 2 years with choice to continue yearly
Screening should continue as long as woman is in good health and expected to live 10+ years
43
Screening vs diagnostic mammograms
- Screening is 2 views and a radiologist doesn't review prior to patient leaving facility (covered by insurance)
- Diagnostic examines patient and reviews previous sscreens, additional studies are ordered as needed such as ultrasound or additional mammographic views (often not covered and very expensive)
44
Women with breast implants are still susceptible to breast cancer, however need to receive a ___ instead of a mammogram
MRI
45
BRCA1 and 2
Breast cancer genes, every human has and do not cause cancer but are tumor suppressor genes, mutation in them prevents ability to repair broken DNA, those with BCRA1 mutation almost 60% will develop breast cancer before age 70, BCRA2 50% will
46
Pagets disease of the breast
A rare cancer that begins with change of skin cells at the nipple (often normal in those breast feeding) scaling then eventually becoming red lesion, almost 100% are associated with ductal carcinoma in situ, symptoms include sensitivity, burning, pain, bloody discharge
47
Inflammatory breast cancer
A rare type of cancer that blocks lymph vessels causing severe swelling and redness, edema of the breast can present as "peau d'orange", seen in younger women and is much more aggressive
48
Most common sites of breast cancer metastasis (5)
- bone
- brain
- pleura
- skin
- liver
49
3 big chemotherapeutic drugs
Cyclophosamide
Methotrexate
5-FU
50
Breast cancer treatment options (6)
- chemotherapy
- radiation
- masectomy
- lumpectomy (breast sparing)
- hormonal (tamoxifen and estrogen receptor down regulators)
- Complementary treatments used with conventional medicine (different from alternative which is used instead of conventional)
51
Recall the anatomy of the prostate
Situated beneath the bladder and perforated by a portion of the urethra, up against the anterior wall of the rectum, has muscular function to seal off bladder during ejaculation and glandular function to produce alkaline fluid (adds to semen volume) and release PSA
52
PSA
Prostate specific antigen, used as a screening tool to detect BPH, prostatitis, and prostate cancer
53
The prostate's secretion is ___ dependent
DHT (androgen)
54
The majority of prostate cancer occurs in what zone? What are 95% of cell types?
Peripheral zone, adenocarcinomas
55
Definitive diagnosis for prostate cancer is through...
...biopsy
56
Prostate cancer epdiemiological factors (4)
-Most common cancer in males excluding melanoma, majority found in patients over age 65, rates twice as high in African Americans, BCRA1 and 2 genes
57
Prostate cancer signs and symptoms (4)
- Weak and interrupted urine flow
- burning urine
- low back, hip, or thigh pain (metastasis for bone)
- difficulty getting or maintaining erection
58
Most common site for prostate cancer to metastasize to
Bone
59
Gleason score (prostate cancer)
Grading system of 2 most predominant tumor patterns graded on scale of 1-5 then added to score either 2-6 well differentiated, 7 moderated (need bone scan), 8-10 poorly differentiated (aggressive cancer)
60
Overwhelming majority of patients with prostate cancer in local or regional stages have a 5 year survival of almost __%
100
61
Prostate cancer treatment options (4)
- active surveillance
- radical prostatectomy (will cause dysfunctions like ED)
- brachytherapy (radiation)
- hormonal therapy (orchiectomy, GNRH analogues, estrogens)
62
Induction chemo vs consolidation chemo
Chemo therapy used to reduce tumor load without intention of cure vs used to induce a remission
63
Remission definition
Disease free but not necessarily a cure
64
Zubrod scale
A scale from 0 (normal), 1 (symptomatic and ambulatory), 2 (ambulatory 50% of time and need occasional assistance), 3 (ambulatory less than 50% of time nursing care needed), or 4 (bedridden) to analyze performance status of cancer patient
65
Flow cytometry
Lab test of peripheral blood or bone marrow aspirate that can identify circulating myeloblasts in the majority of patients by characteristic patterns of surface antigen expression, used in most hematological malignancies to make diagnosis
66
Gold standard for diagnosis of leukemias
Bone marrow biopsy and aspiration of marrow
67
Drug choices to alleviate nausea and vomiting as a side effect of chemo (3)
- Dexamethasone
- lorazapam/ativan
- haldol
68
Drug choices to alleviate pancytopenia as a side effect of chemo (2)
- Neupogen (filgastrim)
- epogen (procrit)
69
Drug choices to alleviate diarrhea as a side effect of chemo (4)
- Imodium
- Octreotide
- Questran
- lomotil
70
Febrile neutropenia
A patient that has completed chemo or is still undergoing chemo that develops a fever (has ANC <1500) and are thus very susceptible to infections from various sources
71
Evaluation (3) and treatment (3) of febrile neutropenia
- Good physical exam (look at skin sites and catheters)
- culture
- CXR
- Cefepime (tx pseudomonas), antifungal (diflucan), antiviral (acyclovir)
72
Tumor lysis definition
A treatment complicationn of cancer where tumor cells being lysed by chemotherapeutic agents results in large release of K+, pohsphate, and nucleic acids into systemic circulation, occurs in rapidly dividing cancers and patients with large tumor load and can have severe effects such as NVD, lethargy, heart failure, renal failure, DIC, and sudden death
73
Prevention of tumor lysis (3)
- pre chemo hydration
- allopurinol/zyloprim
- careful monitoring
74
Acute vs chronic leukemia
- Acute usually means hospitalization and immediate treatment (IV chemo and transfusions), fast growing, post chemo complications more frequent and severe in acute dz
- Chronic usually means outpatient treatments and many treatment options use pills opposed to IV, slow growing,
75
Acute myelogenic leukemia (AML)
-80% of all acute leukemias, most frequent in neonates, result of proliferation of leukemic cells in myeloid line interfering with production of normal blood cells causing weakness, infecttion, and bleeding. Generally rapidly lethal unless treatment with intensive chemo or other targeted therapy
76
Environmental factors of acute myelogenic leukemia (AML) (3)
- exposure to high dose radiation
- retroviruses
- Tobacco use
77
Presenting symptoms of AML (4)
- fatigue (most common)
- fever (from infection)
- extramedullary disease
- leukemia cutis on skin
78
Auer rods seen with what condition
Lab abnormalities of AML present in 50% of cases, can also occur in myelodysplastic disease
79
AML treatment standard
7+ 3 regimen, (7 days of cytabine and 3 days of daunorubicin)
80
Chemo is not used in patients over age of __ regardless of health status as it will worsen patient outcome
..80
81
Acute promyelocytic leukemia (APL) definition
A form of AML that is an emergency, occurs with presence of atypical promyelocytes in bone marrow and peripheral blood (have creased fold or dumbell nuclei), worrisome to avoid hemorrhage from characteristic coagulopathy (pulmonary or cerebrovascular hemorrhage) (mean survival <1 month if left untreated)
82
CNS leukemia
Occurs rarely as side effect of AML, diagnosed via LP, cranial nerves III and VI affected most commonly
83
Leukopheresis definition
Removal of excessive WBC from peripheral blood in AML treatment
84
Differentiation syndrome (cytokine storm)
Occurs in 25% of APL patients within days of starting ATRA + chemo regimen characterized by fever, peripheral edema, pulmonary infiltrates, hypoxemia, respiratory distress, hypotension, etc.
85
Differentiation syndrome (cytokine storm) treatment (1)
-Dexamethasone for 3 or more days
86
Chronic myelgenous leukemia (CML) def
Dysregulated production and uncontrolled proliferation of mature and maturing myeloid cells with fairly normal differentiation, presents with fatigue, malaise, hallmark is absolute basophilia (basophils >20% on diff), has a triphasic course
87
Triphasic course of untreated CML
1) Chronic phase - usually asymptomatic, 3.5-5 years before transforming into aggressive phase
2) accelerated phase - B symptoms appear (fever, sweats, weight loss 10% in 6 months), sometimes skipped
3) Blastic phase - morphologically resembles acute leukemia, usually die within 6 months without treatment
88
Philadelphia chromosome
BCR-ABL fusion gene, occurs in 95% of CML diagnoses and diagnostic for CML
89
CML treatment (2)
- Allogenic hematopoietic cell transplant (curative, used if genetics unfavorable for TKI treatment)
- tyrosine kinase inhibitors (TKI) (control)
90
Imatinib/gleevec
A tyrosine kinase inhibitor that is NOT curative but helps push remission that targets specific abnormal tyroosine kinase made from cancer causing gene used to treat CML, does not attack normal cells and can be used orally with minimal side effects such as fluid retention
91
Acute lymphoblastic leukemia/lymphoblastic lymphoma (ALL/LBL)
A group of hematopoietic neoplasms most common childhood malignancy (25% of all child cancers) involving the cells that form the lymphoid lineage, can occur with or without the philadelphia chromosome, divided into T cell and B cell versions, called leukemia if >25% bone marrow blasts, called lymphoma if <25% bone marrow blasts, is frequently missed due to non-distinct symptoms
92
Bloom syndrome definition
Rare recessive genetic disorder characterized by short stature, predisposition to cancer development, and general genomic instability
93
Hyper CVAD
A chemotherapeutic regimen of cytoxan, vincristine, daunorubicin, and dexamethasone used for ALL/LBL without philadelphia chromosome
94
ALL/LBL treatment options (3)
- Hyper CVAD
- TKI if philadelphia chromosome pos
- prophylactic CNS treatment (Neupogen granulocyte colony stimulating factor)
95
Most common leukemia in western world and what is unique to it?
Chronic lymphocytic leukemia (CLL), it is the only leukemia NOT associated with exposure to radiation
96
CLL/SLL presentation (3)
- Waxing and waning painless lmphadenopathy often in cervical area walders's ring
- acquired immunodeficiency disorder
- B symptoms
97
Diagnosis of CLL
- Absolute lymphocyte count in peripheral blood >5000
| - demonstration of clonality of the circulating B lymphocytes by flow cytometry
98
Lymphoma definition
Group of cancers in lymphoid tissues derived from B or T cell progenitors or mature that undergo malignant change and begins to multiply crowding out healthy cells creating tumors which enlarge nodes, either non hodgkin (more common) or hodgkin
99
Presentation of nonhodgkin lymphoma (NHL)
-Aggressive lymphomas that present acutely or subacutely with B symptoms, often insidious
100
Hairy cell leukemia (HCL)
A B cell lymphoproliferative disorder, accumulation of small mature B cells with abundant cytoplasm hairy projections in peripheral blood, bone marrow, and splenic red pulp, unknown pathogenesis but can be familial,very insidious
101
Hairy cell leukemia symptoms (HCL) (3)
- fatigue, weakness (NO FEVER or NIGHT SWEATS)
- bruising or bleeding
- asymptomatic
102
Treatment of HCL (2) and prognosis
- Usually observation
- no curative treatment
- many undergo remission without issue
103
Diffuse large B cell (DLBCL)
An AIDS defining malignancy of nonhodgkin lymphoma
104
Burkitt lymphoma definition
Highly aggressive B cell tumor with 3 forms (endemic africa big mass on jaw bone, non endemic in US with abdominal presentation, AIDS), rapidly growing tumor with evidence of tumor lysis (doubling time 24 hrs)
105
R-CHOP regimen and what is it used to treat
Chemotherapy group of agents used in treatment of NHL
106
Rituximab (rituxan) use raises concern for reactivation of what pathogen if previously infected?
Hep B/C
107
Hodgkin lymphoma risk factors (4)
- standard of living
- infectious mononucleosis
- HIV
- lack of breastfeeding
108
Reed sternberg cells
Indicative of some types of hodgkin lymphoma and have an owl appearance
109
Hodgkin lymphoma presentation (3)
- asymptomatic lymphadenopathy
- mediastinal mass on x ray
- generalized pruritis
- rubbery lymph nodes***
110
Test for multiple myeloma (3)
- S-PEP (serum protein electrophoresis)
- CT cross sectional imaging
- bone marrow biopsy
111
Myeloma definition
Malignancy of plasma*** cell which produce immunoglobins, when too much proliferation in the bone marrow occurs it can cause skeletal destruction and other pathological fractures
112
MM treatment (3)
- Initial treatment is needed immediately, patients will die within 6 months
- bone marrow autologous transplant
- chemo 3 drug regimen (bortezomib/velcade + lenalidomide/revlimid + dexamethasone/decadron)
113
Signs of multiple myeloma (4)
- Pallor
- anemia
- bone pain
- hypercalcemia
114
S-PEP and M spike
Serum protein electrophoresis - a technique that measures specific proteins in the blood, results see a "church steeple" of a significant proteins levels indicative of multiple myeloma (M spike)
115
S-PEP and M spike
Serum protein electrophoresis - a technique that measures specific proteins in the blood, results see a "church steeple" of a significant proteins levels indicative of multiple myeloma (M spike)
116
Multiple myeloma CRAB criteria
```
One of the following that must accompany clonal bone marrow plasma cells >10%
hyperCalcemia
Renal insufficiency
Anemia
Bone lesions
```
117
"punched out lesions" on radiograph are indicative of...
....multiple myeloma
118
Monoclonal gammopathy of undetermined significance (MGUS) definition
Noncancerous condition with abnormal M protein that occurs with 1% progression to multiple myeloma, requires waitful watching but does not cause symptoms
119
2 types of cancers that almost never metastasize
Basal cell carcinoma and squamous cell carcinoma on the skin
120
2 serotypes of HPV that are associated with cervix cancer
16 and 18
121
If a breast is too dense for x ray mammography, 2 alternatives are...
...ultrasound and MRI
122
Lynch (hereditary nonpolyposis colon cancer) syndrome
A collection of cancers that are related to the defective tumor suppressor genes MSH2 causing colon cancer without polyps which is unique
123
Signs that would indicate referral for woman with pelvic mass to gynecologic oncologist (4)
- elevated CA 125 level
- ascites
- abdominal or fixed pelvic mass
- evidence of abdominal or distant metastases
124
Superficial spreading melanoma
A very treatable form of melanoma that grows outward opposed to deep and with large excision can be easily detected and treated fully
125
Sentinal lymph node dissection
Proedure where radioactive blue dye is injected into the tumor area, then a geigar counter traces it to the sentinal node then potentially dissects out that and the closest 2 or 3 to ensure that the cancer has not spread
126
Small cell lung cancer
Contains neuro and endocrine components, no surgery will help (treatment is chemo therapy and radiation) that FREQUENTLY metastases to the brain
127
Coin lesions on x ray
Common name for finding on an x ray that is a solid pulmonary lesion that is often asymptomatic. Can be a small or non small cell lung cancer or benign that requires biopsy for further diagnosis
128
Pancoast tumor and treatment options
A rare form high lying tumor in the lung in the upper lobe near the clavicle that can put pressure on the brachial plexus resulting in horner syndrome, treated with wedge resection
129
Mesothelioma
Occupational cancer, pleural based malignancy caused by exposure to asbestos, cannot be dealt with surgically as it is diffuse in the pleura and doesn't respond to any chemotherapy yet devised
130
Superior vena cava syndrome definition
Occurs when blockage due to lump in upper right chest limits blood return to the heart causing facial and upper extremity edema, shortness of breath, distended neck veins, dyspnea, and cough
131
Space OAR definition
a hydrogel that protects the rectum during radiation from prostate cancer lasting approx 3 months done via a needle that inserts between the rectum and prostate
132
Androgen deprivation therapy agents for prostate cancer (2)
- leuprolide
- flutamide
Professional Development
flashcards
Decks in class (62)
# Cards
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Part 1122
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Part 2123
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Part 3120
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Part 4150
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Part 5124
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Part 6125
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Part 7148
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Part 8160
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Part 9198
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Part 10119
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Part 11131
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Part 12119
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Part 13126
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Part 14123
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Part 15133
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Part 16142
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Part 17124
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Part 18135
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Part 19127
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Part 20108
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Part 21160
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Part 22125
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Part 23145
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Part 24160
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Part 25170
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Part 26120
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Part 27130
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Part 28153
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Part 29124
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Part 30144
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Part 31181
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Part 32121
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Part 33165
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Part 34133
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Part 35116
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Part 36175
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Part 37170
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Part 38191
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Part 39222
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Part 40150
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Part 41124
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Part 42154
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Part 43183
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Part 44132
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Part 45103
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Part 46125
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Part 47165
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Part 48126
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Part 49114
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Part 50155
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Part 51151
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Part 52101
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Part 53128
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Part 54151
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Part 55130
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Part 56132
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Part 57149
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Part 58131
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Part 59151
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Part 60151
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Part 61136
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Part 62111
