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Oncology Midterm > Diagnosis and Staging > Flashcards

Diagnosis and Staging Flashcards

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1
Q

Medical History

A 
Essential part of a ca. diagnosis
-differential diagnosis
-drives workup
-family hx
-known risk factor
not all cancers present with symptoms
suspicious signs and symptoms that warrant further work-up
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2
Q

Red Flag symptoms?

A 
unexplained fatigue
wt loss >10lbs
night sweats
bleeding/bruising
unexplained fever
poor healing
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3
Q

general guide for suspicious symptoms

A

cancer is not usually the cause of these symptoms
abnormal signs and symptoms lasting several weeks: seek care
early stage cancer usually not painful
do not wait to feel pain before seeking care
symptoms not caused by cancer cells themselves

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4
Q

symptoms usually caused by:

A

increasing tumor burden
organ dysfunction related to tumor
cutaneous changes related to tumor
(cancer affecting other organs)

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5
Q

Suspicious symptoms ROS General

A 
fatigue and/or weakness without cause
night sweats (NOT sweating at night, soaked)
prolonged fever > 1 week, without etiology, low grade
generalized pruritis (bee symtoms)
weight changes: gain or loss without cause or purpose
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6
Q

Suspicious symptoms ROS HEENT

A

hoarseness that does not resolve (thyroid, throat, lung, lymph)
difficulty swallowing
prolonged non-tender, enlarged lymph nodes (axilla or groin)
expistaxis - prolonged (leukemia/bone marrow)

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7
Q

Suspicious symptoms ROS respiratory

A

non-resolving cough

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8
Q

Suspicious symptoms ROS chest/breast

A

change in size or shape of breast or nipple
change in texture or skin
edema of all or part of a breast (even if no distinct lump)
breast skin irritation or dimpling
breast or nipple pain
nipple retraction
erythema, scaling, or thickening of nipple or skin
nipple discharge

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9
Q

Suspicious symptoms ROS GI

A

early satiety
pain or discomfort after eating (normal with gallblader probl)
changes in appetite (usually anorexia)
hematochezia (blood in stool - bright)
abdominal pain
change in bowel movements: diarrhea or constipation

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10
Q

Suspicious symptoms ROS Genitourinary

A

dysuria
hematuria
abnormal vaginal bleeding or discharge

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11
Q

Suspicious symptoms ROS integumentary

A

new or changing mole (thin ABCDs of skin ca.)
non-healing lesion
thickening or new lump on or under skin (lymph node)
petechiae/purpura

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12
Q

Suspicious symptoms ROS Neurologic

A

headaches - especially with N/V or vision changes
new onset weakness
acute onset seizures

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13
Q

Pt education: symptoms

A

7 warning signs spell CAUTION

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14
Q

CAUTION

A

C - change in bowel or bladder habits
A - a sore that doe snot heal in a normal amount of time
U - unusual bleeding or discharge
T - thickening of breast tissue or a lump
I - indigestion and/or difficulty swallowing
O - obvious changes to moles or warts
N - nagging cough

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15
Q

Physical Exam

A

head to to

Performance status - use to assist in determining patients’ ability to tolerate treatment options

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16
Q

Performance status

A

-use to assist in determining patients’ ability to tolerate treatment options
-used in clinical trials to determine eligibility
–most use ECOG status
–phase I vs phase III or IV, earlier trial inc PS needed
several different scales:

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17
Q

2 Performance scales

A

ECOG * eastern cooperative oncology group: 0-5 dead

Karnofsky - 0%-100%

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18
Q

Lab studies

A

Evaluate baseline information prior to developing treatment plan
Universal stand of care labs

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19
Q

baseline information

A

marrow function
hepatic function
renal function
tumor lysis

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20
Q

Universal standard of care labs

A

CBC with differential
basic metabolic panel
hepatic function

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21
Q

Common labs

A

coagulation panel
pancreatic enzymes
lactate dehydrogenase (LDH)

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22
Q

Imaging studies

A

confirms tumor existence and location
confirms extent of spread of tumor if metastasized
anatomical Vs functional status (CT vs PET)

*information for biopsy/surgery

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23
Q

Anatomical studies

A

image the anatomy to help detect abnormalities

  • xrays
  • computed tomogaphy (CT)
  • mammography (type of xray)
  • magnetic resonance imaging (MRI)
  • nuclear sans (bone scan..)
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24
Q

Functional studies

A

image the working processes of the body

  • Tissue metabolism, organ efficiency, neural signaling
  • magnetic resonance spectroscopy
  • Positron emission tomography (PET) - hot spots
  • octreotide scan
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25
X-ray
``` 2 day image quick and efficient inexpensive non-invasive used often in multiple myeloma: quickly see lytic bone lesions limitations: obesity ```
26
Ultasound in cancer diagnosis
non-invasive high frequency sound waves images made from reflection of waves uses: liver, kidney, breast, ovarian, effusions (ascities, peicardial), transvaginal
27
Computed tomography (CT)
most common diagnostic imaging tool in onc combines xrays with sophisticated computers 3D omputer model allows examine of body one slice at a time to pinpoint specific areas caution in use of IV contrast with renal disease pts (check CREAT levels, metformin, shelfish allergy) contrast - helps to highlight
28
Magnetic Resonance imaging MRI
uses a magnetic field and radio waves create detailed images of the organs and tissues magnetic field temporarily realigns hydrogen atoms in your body not exposed to ionizing radiation preferred for bone, musculoskeletal, CNS limitations: metal implants, tolerability (claustrophibia)
29
Positron Emission Tomography (PET)
reveal tissue and organ function uses radioactive drug (tracer), usually glucose tracer collects in areas that have higher level of chemical activity - often correspond to areas of disease, can correspond with normal tissue, bright spots or "hot spots" used mainly for lymphoma and melanoma
30
Bone scan
inject radioactive tracer: F-FDG, sugar metabolically active areas uptake the tracer and light up on images reported uptake as an SUV not all tumors will uptake tracer b/c slow growing (broncho-alveolar) expensive diagnostic for: esophageal, colorectal, melanoma, lymphoma, NSCLC, thyroid, breast, lung nodunes
31
GI series
``` barium studies upper GI series lower GI series limitations: fasting required, bowel prep useful for assessment in colon cancer *must tolerate drinking barium ```
32
Diagnosis
accurate diagnosis needed to determine treatment must have tissue to make diagnosis (biopsy) tissue or cells are examined histologically to determine malignancy from benign microscopic diagnosis
33
Biopsy based on:
symptoms reported by patient physical examination findings incidental findings on xray or any other test done for different reason screening tests
34
Tissue diagnosis
biopsy diagnosis requires tissue histology = microscopic structure of tissue cytology = structure and fn of cells
35
sites most likely to obtain adequate tissue
``` Fine needle aspiration (FNA) Core needle biopsy stereostatic biopsy excisional incisional CT guided bx ```
36
Diagnostic procedures
``` endoscopy colonoscopy laparoscopy bronchoscopy throcaoscopy metiastionoscopy ```
37
Pathology
histologic exam: tissue sliced thinly, viewed under scope | Cytology exam: cells from fluid
38
cytology exam tissue sources
urine, CSF, sputum, peritoneal fluid, pleural fluid, cervical/vaginal smears, blood
39
Benign tumor
slow growth rate grows within a capsule of fibrous tissue no invasion of adjacent tissue = no mets cytology is uniform with well differentiated cells that look like origin cell
40
Malignant tumor
high mitotic rate = rapid growth not encapsulated = invades surrounding tissue cytology poorly differentiated
41
primary tumor
site of origin
42
secondary tumor
used to describe a metastatic tumor or a new primary
43
6 cancer categories
``` Carcinoma Sarcoma Myeloma Mixed type Leukemia Lymphoma ```
44
Carcinoma
epithelial origin or cancer of the internal or external lining of the body account for 80-90% of all cancer cases 2 major subtypes: --1. adenocarcinoma = develops in an organ or gland --2. squamous cell carcinoma = originates in the squamous epithelium
45
Sarcoma
originates in supportive and connective tissues generally occurs in young adults most common sarcoma often develops as a painful bone mass resemble the tissue in which they grow
46
Myeloma
originates in the plasma cells of bone marrow
47
Mixed types
components may be within one category or from different categories ex. adenosquamous carcinoma -need bone marrow transplants, hard to treat: many cells
48
Leukemia
"liquid tumors", blood cancers cancers of the bone marrow *site of WBC production overproduction of immature WBC = blasts blasts immature, do not function properly --> immune suppression RBC affects due to fatigue r/t anemia dec platelets & RBC --> symptoms: bleeding, fatigue, anemia
49
Lymphoma
develops in glands or nodes of lymph system Lymph system: network of vessels, nodes, & organs (spleen, tonsils, thymus), filters body fluids, produces infection fighting WBC (lymphocytes) extra-nodal lymphomas occur in specific organs (stomach, breast, brain)
50
Lymphoma 2 categories
Hodgkin Lymphoma- reed-sternberg cells in hodgkins' diagnostically distinguishes Non-hodgkin lymphoma
51
Immunohistochemical Stains (IHC)
principle of antibodies binding specifically to antigens in biological tissues detect the antigens (proteins) in cells of tissue section used to diagnose some cancers, identifies site of origin cellular activity within cancer highlighted by staining distinguish benign or malignant
52
IHC common markers
fluorescent dyes enzymes radioactive elements antigens: ER/PR/Her2/Neu/PSA/Ki67
53
Flow Cytometry
laser based, biophysical testing cell sorting and counting, biomarker detection and protein engineering suspends cells in a stream of fluid and passing them by an electronic detection routinely used in diagnosis of hematologic malignancies, indicative for treatment uses in research, clinical practices and trials used in: lymphomas, leukemias, bladder cancer specimins from biopsy, effusions, bone marrow, bladder cytology
54
Cytogenetics
-concerned with structure and function of the cell, esp chromosomes -FISH: flourescence in situ hybridization PCR: polymerase chain reaction
55
FISH
flourescence in situ hybridization | test that "maps" the genetic material in a person's cells
56
PCR
polymerase chain reaction amplifies the genetic material to a level that can be detected looks at copies of a DNA sequence for relevance to diagnosis (abnormal)
57
Ideal tumor marker
ideal only from 1 tissue/cancer type... but not the case not always correct/accurate/predictive Specific - 1 tumor only Sensitive - present or detectible early Proportional - level reflect tumor mass Predictive - able to foretell disease response and recurrence Feasible - cost effective and commercially available
58
PSA tumor marker (ideal?)
occurs regularly with aging | but if worsening condition, likely progressing with disease
59
Tumor markers
substance that can be found in body when cancer is present -in blood, urine, or other body fluids/ tissues -sometimes by normal cells too -different cancers types have different markers not ideal bc normal cells can produce markers not useful for screening
60
When do we use tumor markers?
used to watch for treatment response never treat a number* not useful for screening
61
Common tumor markers
``` ALK Alpha-fetoprotein Beta 2 microtubulin beta-human chorionic gonadotroping BCR-Able fusion gene BRAF CA15 CA19 CA125 Calcitonin Carcinoembryonic antigen CD20 Chromogranin A Chromosomes 3,7, 17 and 9p21 Cytokeratin ```
62
BCR-ABL fusion gene
Chronic myeloid leukemia from blood and bone marrow to confirm diagnosis and monitor disease
63
BRAF mutation V60E
cutaneous melanoma and colorectal cancer tumor tissue to predice response to targeted therapy
64
CA125
ovarian cancer blood to help in diagnosis, assessment of response to treatment, or evaluation of recurrence
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Estrogen Receptor/Progesterone Receptor ER/PR
breast cancer tumor tissue to determine whether treatment with hormone therapy is apporpriate
66
HER2/neu
breast, gastric and esophageal cancer tumor to determine wheter treatment with Trastuzumab is appropriate
67
21 Gene signature (Oncotype DX)
breast cancer tumor to evaluate risk of recurrence
68
70-Gene signature (mammaprint)
breast tumor to evaluate risk of recurrence
69
Grading
pathologist grades tumor assigns number to characterize how closely a cancer resembles normal tissue grade is guide to aggressiveness of tumor cells determines prognosis guide formulation of the treatment plan
70
Grading
1- low grade or well-differentiated (slow growing) 2 - intermediate/moderate grade or moderately differentiated (faster than normal cells) 3- High grade or poorly differentiated (fast growing) 4- Undifferentiated (do not resemble normal cells at all)
71
Types of staging
Clinical staging | Pathologic staging
72
Clinical staging
based on radiologic imaging and physical exam
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pathologic staging
based on biopsy | not as common with newer scanning techniques
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TNM staging
determines extent of cancer determines prognosis and treatment options comparison stats statify for clinical trials
75
TNM
Used for most solid tumors T- tumor, indicates size, depth of invasion and local extension N- nodes, distinguishes whether there is tumor in regional lymph nodes M- metastasis, present or absent Tumor Nodes Mets
76
AJCC stating guide
based on TNM ratings tumor placed into one stage Stage O - insitu, indicates tumor contained at site of devo. Stage I-IV - varies, based on invasiveness
77
Local Regional Distant
local - in spot regional - few lymph involved distant - mets to lung, brain, bone
78
SEER Staging
``` NCI groups into 5 main categories using summary staging -In situ -Localized -Regional -Distant -Unknown ```
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``` Seer: In situ Localized Regional Distant Unknown ```
In situ - abn cells only in payer where developed Localized - limited to organ of origin Regional - spread from primary site to nearby lymph or organ tissue Distant - spread to distant organs or nodes unknown - not enough info to determine (33%)
80
Ann Arbor staging
``` *for Hodgkin's lymphoma I - single LN region II - One side of diaphragm III - both sides of diaphragm IV - disseminated ``` A no systemic (constitutional) symptoms B fever, night sweats, weight loss E extra lymphatic sites (tissue outside of lymph) S splenic disease
81
Testicular Cancer Risk staging
Good to poor
82
Recurrence and Autopsy
staging indicated -with cancer recurrence -assess the extent of the disease Autopsy allows for a final and most complete staging

Oncology Midterm (4 decks)

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