Prognosis_Lecture_Flashcards

Question 1

What does ‘prognosis’ mean in medicine?

Answer 1

The predicted outcome or course of a disease, including chances of recovery, recurrence, or death.

Question 2

What are the main purposes of determining prognosis?

Answer 2

To guide treatment decisions, inform patients, predict survival, and help plan follow-up care.

Question 3

What are prognostic factors?

Answer 3

Disease or patient characteristics that influence outcome independent of treatment.

Question 4

How are prognostic factors different from predictive factors?

Answer 4

Prognostic = overall outcome; Predictive = response to specific treatment.

Question 5

What are the three main categories of prognostic factors?

Answer 5

1) Disease/tumour-related 2) Patient-related 3) Treatment-related.

Question 6

What is the most important prognostic factor in early breast cancer?

Answer 6

Axillary lymph node status.

Question 7

Why is axillary lymph node status important?

Answer 7

Shows regional spread and predicts recurrence and survival.

Question 8

How does tumour size affect prognosis?

Answer 8

Larger tumours have higher recurrence risk and poorer survival.

Question 9

What does histologic type mean in breast cancer?

Answer 9

Microscopic tumour subtype (ductal, lobular, tubular, etc.) influencing aggressiveness.

Question 10

Which breast cancer subtypes have better prognosis?

Answer 10

Tubular, mucinous, and cribriform carcinomas.

Question 11

What is histologic grade?

Answer 11

Degree of differentiation (1–3). High grade = more aggressive, worse prognosis.

Question 12

What does lymphatic or vascular invasion indicate?

Answer 12

Cancer cells have entered lymph/blood vessels → higher metastasis risk.

Question 13

How does metastasis affect prognosis?

Answer 13

Presence of distant metastases = incurable disease, poor survival.

Question 14

What are proliferation markers?

Answer 14

Markers like Ki-67 indicating cell division rate; high = poor prognosis.

Question 15

What is ER/PR status and why is it important?

Answer 15

ER+/PR+ tumours grow slower and respond to hormone therapy (better prognosis).

Question 16

What does HER2 positivity mean?

Answer 16

HER2+ tumours are aggressive but respond well to trastuzumab (Herceptin).

Question 17

How does age affect breast cancer prognosis?

Answer 17

Younger women have fewer cases but more aggressive tumours.

Question 18

Which age group has the highest breast cancer incidence?

Answer 18

Ages 50–70.

Question 19

How does ethnicity influence prognosis?

Answer 19

Black women have lower incidence but higher mortality (triple-negative, healthcare barriers).

Question 20

What are modifiable patient-related prognostic factors?

Answer 20

Diet, weight, exercise, alcohol, smoking.

Question 21

What are semi-modifiable factors?

Answer 21

Socioeconomic status and comorbidities.

Question 22

What are non-modifiable factors?

Answer 22

Age, genetics, ethnicity.

Question 23

What are treatment-related prognostic factors?

Answer 23

Factors related to treatment type, quality, and timing affecting outcome.

Question 24

How does treatment modality affect prognosis?

Answer 24

Combination of surgery, chemo, and radiation improves survival.

Question 25

What is the main difference between mastectomy and lumpectomy?

Answer 25

Mastectomy removes entire breast; lumpectomy removes tumour only (requires radiation).

Question 26

How does radiation treatment volume affect prognosis?

Answer 26

Larger field = better control but more toxicity.

Question 27

What does 'dose and fractionation' mean in radiation therapy?

Answer 27

Total dose and how it’s divided over time.

Question 28

What is the purpose of a 'boost' in breast radiation therapy?

Answer 28

Extra dose to tumour bed to reduce recurrence, especially in young patients.

Question 29

Why is treatment time important in prognosis?

Answer 29

Delays allow tumour regrowth → worse outcomes.

Question 30

What is Oncotype DX used for?

Answer 30

Genomic test predicting recurrence risk and chemo benefit (ER+, HER2−).

Question 31

What does a low recurrence score (<18) in Oncotype DX mean?

Answer 31

Low recurrence risk → hormone therapy only, no chemo.

Question 32

How can local tumour growth cause death?

Answer 32

By compressing or invading vital organs (e.g., brain, airway, liver).

Question 33

What is lymphovascular spread?

Answer 33

Spread through lymph/blood to nodes/organs, worsening prognosis.

Question 34

What is distant metastasis?

Answer 34

Spread to distant organs (lungs, liver, bone, brain) — main cause of death.

Question 35

How can infection cause death in cancer patients?

Answer 35

Due to immunosuppression and neutropenia → sepsis.

Question 36

What are common metabolic disturbances in advanced cancer?

Answer 36

Hypercalcemia, hyponatremia, liver/kidney failure, cachexia.

Question 37

Why are cancer patients hypercoagulable?

Answer 37

Tumour cells activate clotting → DVT, PE, or DIC.

Question 38

What are the six stages of cancer treatment decision-making?

Answer 38

1. Diagnosis 2. Prognostic/predictive review 3. Define goals 4. Review options 5. Assess side effects 6. Choose plan.

Question 39

What are the main goals of cancer treatment?

Answer 39

Cure, control, or palliation.

Question 40

What factors influence treatment choice?

Answer 40

Stage, performance status, tumour biology, patient preference.

Question 41

What does shared decision-making mean?

Answer 41

Clinician and patient collaborate based on evidence and values.

Question 42

What is the therapeutic ratio?

Answer 42

Balance between tumour control and normal tissue complications.

Question 43

What do the two curves on a therapeutic ratio graph represent?

Answer 43

Tumour Control Probability (TCP) and Normal Tissue Complication Probability (NTCP).

Question 44

What does the gap between TCP and NTCP curves show?

Answer 44

The therapeutic window — effective but safe dose range.

Question 45

How can we increase the therapeutic ratio?

Answer 45

Precision targeting, fractionation, radiosensitizers, radioprotectors, and fewer delays.

Question 46

What is performance status (PS)?

Answer 46

Measure of patient’s ability to perform daily activities and tolerate treatment.

Question 47

What are the two main performance status scales?

Answer 47

Karnofsky (0–100) and ECOG (0–5).

Question 48

What does ECOG 0 mean?

Answer 48

Fully active, no restrictions.

Question 49

What does ECOG 3 mean?

Answer 49

Confined to bed/chair >50% of day; limited self-care.

Question 50

What is the treatment threshold for curative therapy?

Answer 50

ECOG ≤2 or Karnofsky ≥70.

Question 51

What are the four main roles of therapeutic intervention?

Answer 51

Neoadjuvant, Radical (Curative), Adjuvant, and Palliative.

Question 52

What is neoadjuvant therapy?

Answer 52

Treatment before main therapy to shrink tumour.

Question 53

What is adjuvant therapy?

Answer 53

Treatment after surgery to kill microscopic disease.

Question 54

What is radical therapy?

Answer 54

Curative-intent treatment to eliminate cancer.

Question 55

What is palliative therapy?

Answer 55

Relieves symptoms and improves quality of life, not curative.

Question 56

Why is radiation therapy fractionated?

Answer 56

To allow normal tissue repair while continuing to kill tumour cells.

Question 57

What does the α/β ratio tell us?

Answer 57

How sensitive a tissue is to fractionation (low = more sensitive).

Question 58

Which tissues are late-responding and more sensitive to large fraction sizes?

Answer 58

Normal tissues with low α/β ratio (spinal cord, kidney).

Question 59

What happens if radiation treatment is delayed or interrupted?

Answer 59

Tumour repopulation → reduced control, poor prognosis.

Question 60

What are the 5 R’s of Radiotherapy?

Answer 60

Repair, Reoxygenation, Redistribution, Repopulation, Radiosensitivity.

Question 61

What does Repair refer to?

Answer 61

Normal tissues repair sublethal DNA damage between fractions.

Question 62

What is Reoxygenation?

Answer 62

Hypoxic tumour cells become oxygenated and more radiosensitive.

Question 63

What is Redistribution?

Answer 63

Cells move into radiosensitive phases (G₂/M).

Question 64

What is Repopulation?

Answer 64

Cell regrowth during therapy — delays worsen prognosis.

Question 65

What is Radiosensitivity?

Answer 65

Inherent cell response to radiation (varies by tumour type).

Question 66

Which tumours are most radiosensitive?

Answer 66

Lymphomas, leukemias, germ cell tumours.

Question 67

Which tumours are radioresistant?

Answer 67

Melanoma, sarcoma, renal cell carcinoma.

Question 68

What is the clinical goal of the 5 R’s?

Answer 68

Maximize tumour kill, minimize normal tissue injury.

Question 69

Which R explains why normal tissue tolerates fractionation?

Answer 69

Repair.

Question 70

Which R explains why hypoxic cells become radiosensitive over time?

Answer 70

Reoxygenation.

Question 71

Which R explains why we use multiple fractions?

Answer 71

Redistribution and Repair.

Question 72

Which R explains why treatment delays are dangerous?

Answer 72

Repopulation.

Question 73

Which R explains tumour-specific differences in radiation response?

Answer 73

Radiosensitivity.