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Clin Med2- Hematology > Hem/Onc - waldron > Flashcards

Hem/Onc - waldron Flashcards

1
Q

What is cancer

A

a group of related diseases characterized by: unregulated growth, invasion of neighboring tissues or spaces, and sitand spread

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2
Q

what are the characteristics of malignant cells

A

unchecked growth
immortality (loss of apoptosis and senescence)
sustained angiogenesis (ability to grow new BV)
ability to invade neighboring tissues and build metastases at distant sites
ability to evade the immune system

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3
Q

What are proto-oncogenes and oncogenes

A

dominant- only one gene copy needs to be mutated

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4
Q

what are tumor suppressor genes

A

both gene copies need to be mutated to lose function

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5
Q

what are DNA repair genes

A

mismatch pair

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6
Q

What type of cancer is the most common cancer diagnosis

A

breast cancer

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7
Q

what is the second most common cancer diagnosis

A

lung and bronchus cancer

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8
Q

what is the leading cancer diagnosis among men

A

prostate cancer

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9
Q

what are the most common kinds of children cancers (ages 0-14)

A

acute lymphocytic leukemia
Brain and CNS
neuroblastoma
non-hodgkin lymphoma

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10
Q

what are the most common kinds of adolescent cancers (15-19)

A

Hodgkin lymphoma
thyroid carcinoma
brain and CNS
Testicular germ cell tumors
Non-hodgkin lymphoma

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11
Q

what are the risk factors for cancer

A

Age
childhood cancers

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12
Q

what are modifiable risk factors of cancer

A

Tobacco
Obesity
Sun Exposure
Alcohol
Infections
Physical activity
Diet

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13
Q

why is cancer more common in older pateints

A

takes time to develop - increased number of exposures to carcinogens, more prolonged exposures to carcinogens, accumulate DNA damage
immune system weakness with age
aging cells are less effective at repair

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14
Q

what is the leading cause of death in children in the US

A

Accidents

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15
Q

what is the leading cause of death due to disease in children in the US

A

cancer

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16
Q

What is the median age of cancer diagnosis in the US

A

66 years old

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17
Q

what is the median age of death due to cancer in the US

A

72 years old

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18
Q

What are the 3 things to evaluation with Oncology

A

Confirm diagnosis
determine the extent - staging
determine how healthy is the patient

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19
Q

What is the TNM system of staging cancer

A

Tumor: size (or depth) of the primary tumor
Nodes: number and size of regional lymph nodes
Metastases: presence of metastases

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20
Q

What are the different types of tumor

A

TX: primary tumor cannot be evalutated
T0: No evidency of a primary
Tis: carcinoma in situ - cancer cells have not invaded into surrounding tissues have not broken through the basement membrane
T1-T4: depending upon size and/or depth of invasion higher number means bigger or deeper tumor

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21
Q

What are the different Nodes staging

A

NX: nodes cannot be evaluated
X0: no regional lymph nodes involved
N1-N3: size and number of nodes involved

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22
Q

What are the different Metastases staging

A

M0: no evidence of metastatic disease
M1: presence of metastatic disease

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23
Q

what is cTNM

A

clinical staging
based on physical exam, imaging studies; no tissue biopsy

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24
Q

what is pTNM

A

pathologic staging
based on results of surgery and biopsies

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25
what are the different two types of staging
clinical staging (cTNM) and Pathologic staging (pTNM)
26
What is stage 1
small amount of local disease, usually no lymph node involvement
27
what is stage 2-3
locally advanced (regional)
28
what is stage 4
metastatic disease
29
what is the standard blood work with the presumption of cancer
CBC (blood counts, bone marrow function) CMP (liver and kidney function, electrolytes)
30
when are cancer marker labs taken
after biopsy confirmation
31
what are the cancer markers - dependent on type of cancer
Prostate-specific antigen (PSA) - prostate cancer Cancer antigen 125 (CA125) - ovarian cancer Calcitonin - medullary thyroid cancer Alpha-fetoprotein (AFP) - liver cancer Human Chorionic gonadotropin (HCG) - germ cell tumors
32
what are patient issues regarding the treatment of cancer
patient preferences physiologic age life expectancy comorbidities
33
what are tumor issues regarding the treatment of cancer
aggressiveness and type of cancer stage of cancer curative vs palliative likelihood that the cancer will cause symptoms, disability and death how much benefit to treatment side effects of treatment
34
What is Adjuvant therapy
therapy given after primary tumor has been removed
35
what is neo-adjuvant therapy
therapy given before primary tumor has been removed
36
what is localized therapy
surgery radiation therapy
37
what is systemic therapy
chemotherapy and biologic therapy
38
what are the benefits of surgical therapy for cancer
prophylactic - removing premalignant polyps diagnostic staging treatment - 40% of cancer pts cured with surgery Palliation need to weigh risks and benefits
39
what are the three main kinds of radiation therapy
External beam: beams of radiation aimed at a tumor within a pt Brachytherapy: encapsulated source of radiation implanted into a tumor "seeds" Systemic: inject radio-nucleotides that are targeted to a tumor
40
what is IMRT
Intensity Modulated Radiotherapy
41
what is the benefits of IMRT
form of high precision radiotherapy that can deliver extremely controlled doses of radiation to malignant tumors. radiation bean is shaped and intensity varied to target the tumor and protect vital organs
42
What is Photon and Proton radiotherapy
targets tumor with a beam of energy which damages DNA and kills cancer cells
43
What is Gama Knife
gamma rays are emitted to the tumor from different angles, affecting only the tumor with a 0.15mm accuracy
44
what are the short term side effects of radiation
fatigue, nausea, vomiting Burns Mucositis bone marrow toxicity
45
what are the chronic side effects of radiation
cataracts thyroid failure MI Pulmonary fibrosis
46
what is included with chemotherapy
includes hormonal therapies - most common breast and prostate cancer used both cure and pallitation often given as combinations: "alphabet soup" ABVD, CHOP, CMF,AC, then T, FOLFOX
47
what are the side effects of chemotherapy
side effects depend on drugs and dosages bone marrow suppression N/V Neuropathy Cardiac toxicity cold intolerance mucositis hair loss decreased fertility/premature menopause development of secondary malignancies
48
what is neutropenic fever
MEDICAL EMERGENCY increased risk of death if neutropenic in the presence of fever fever: greater than 100.4 for an hour, single temp over 101 Neutropenia: ANC <500, <1,000 and expected to fall to <100 pts are often admitted to the hospital for broad spectrum antibiotics
49
what is biologic therapy
antibodies that are directed towards specific target on tumor cells: Trastuzumab (herceptin) for breast cancer, Rituximab targets CD-20, used in lymphoma Cytokines - interferon Immune system activators: Keytruda et al - use may be limited by "itis's"
50
What is hospice care
end of life care
51
What is Palliative care
can benefit any patient with illness-related suffering, should be considered in all patients regardless of prognosis
52
What is the palliative care framework
goals of care directed by pts values and preferences involves a great deal of communication need coordination of providers, skilled nursing and family
53
what are the major domains of palliative care
physical symptoms psychological/psychiatric/cognitive symptoms illness understanding and preferences for care social and economic concerns religious/spiritual issues
54
what are the common cancer symptoms/complaints
pain SOB fatigue dry mouth lack of appetite weight loss nausea sadness, grief and depression anxiety loss of autonomy/independence/identity
55
what are the benefits of hospice care
significantly better quality of life for patients and families significantly reduced risk of PTSD and prolonged grief disorder among bereaved family members
56
how do you break the bad news
preparation, setting, who should be there assess pts perception and understanding inform: direct, simple language, no jargon, allow for silence address the emotions summary and planning (pts goals and needs)
57
how do you respond to the emotions
use their name show understanding, empathy respect offer support explore what their thinking; guilt, abandonment/loneliness, anxiety/depression
58
what are the advanced directives
Living will durable power of attorney for health care physician orders for life-sustaining treatment (POLST) DNR orders
59
what is a living will
specifics vary from state to state document that describes treatments that the patient does or does not want in the events of a terminal illness or permanent vegetative state - statement of wishes not effective unless pt cant communicate can be a statutory form, but many courts have recognized unofficial documents
60
what is the durable power of attorney for Health care
proxy decision maker with authority to terminate life-sustaining treatments provider "substituted judgement" if no one is designated, ask families and next of kin living wills and DPOAs for HC are often used together
61
what is POLST
physician orders for life-sustaining treatment form that accompanies patient to different sites of care orders regarding treatment who signs depends upon the state

Clin Med2- Hematology (8 decks)

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