Oncology 2 Flashcards
(93 cards)
1
Q
clinical manifestations in the earliest stages of cancer
A
most cancers are asymptomatic but treatable if found early
2
Q
clinical manifestations as cancer progresses
A
- nausea, vomiting, and retching (NVR)
- anorexia and subsequent weight loss
3
Q
contributors of anorexia/cachexia
A
- metabolic abnormalities, pro-inflammatory cytokines produced by the host immune system
- circulating tumor-derived catabolic factors
- decreased food intake
4
Q
clinical manifestations in later stages of cancer
A
rapid growth of the tumor encroaches on healthy tissue –> causing destruction, necrosis, ulceration, and hemorrhage, resulting in many local and systemic effects
5
Q
clinical manifestations in advanced or stage IV cancer
A
the host presents systematically w/ muscular weakness, anemia, and coagulation disorders, such as granulocyte and platelet abnormalities
6
Q
clinical manifestations of pyrexia or fever in cancer
A
may be seen w/o infection and is produced either by WBCs inducing a pyrogen (an agent that causes fever) by direct tumor production of a pyrogen
7
Q
what happens with the continued spread of cancer
A
- lead to GI, pulmonary, or vascular obstruction
- decrease host’s immunity –> secondary infections –> death
8
Q
example of how other vital organs may be affected by cancer
A
brain –> increased intracranial pressure by tumor cells can cause stroke-like sx
9
Q
cancer produces __________ signs and sx that aren’t direct effects of either the ________ or its __________
A
systemic; tumor; mestases
10
Q
cancer pain occurs in approximately _______ of adults w/ newly dx malignancies
A
1/4
11
Q
cancer pain occurs in approximately _______ of individuals undergoing tx
A
1/3
12
Q
cancer pain occurs in approximately _____ of all people w/ advanced disease
A
3/4
13
Q
depression and anxiety may increase the person’s ____________ or may be the result of cancer pain
A
perception of pain
14
Q
some cancer pain is caused by pressure on ________ or by the displacement of ________
A
nerves; nerves
15
Q
what happens when microscopic infiltration of nerves by tumor cells occurs?
A
continuous, sharp, stabbing pain generally following the pattern of nerve distribution
16
Q
what does ischemic pain (throbbing) result from
A
interference w/ blood supply or from blockage w/in hollow organs
17
Q
a common cause of cancer pain is metastasis of cancer to _________
A
bone
18
Q
what is the pain referral site for a lesion in C7, T1-5 vertebrae?
A
inter scapular area, posterior shoulder
19
Q
what is the pain referral site for a lesion in the shoulder?
A
neck, upper back
20
Q
what is the pain referral site for a lesion in L1, L2 vertebrae?
A
SI joint and hip
21
Q
what is the pain referral site for a lesion in the hip joint?
A
SI and knee
22
Q
what is the pain referral site for a lesion in the pharynx?
A
ipsilateral ear
23
Q
what is the pain referral site for a lesion in the TMJ?
A
head, neck, heart
24
Q
what is the pain referral site for a lesion in diaphragmatic irritation?
A
shoulder, l-spine
25
what is the pain referral site for a lesion in the heart?
shoulder, neck, upper back, TMJ
26
what is the pain referral site for a lesion in the urothelial track?
back, inguinal region, anterior thigh, and genitalia
27
what is the pain referral site for a lesion in the pancreas, liver, spleen, gallbladder?
shoulder, mid thoracic, or low back
28
what is the pain referral site for a lesion in the peritoneal/abdominal cavity (inflammatory/infectious process)?
hip pain from abscess of psoas or obturator muscle
29
what is the pain referral site for a lesion in a nerve or plexus?
anywhere in distribution of a peripheral nerve
30
what is the pain referral site for a lesion in a nerve root?
anywhere in corresponding dermatome
31
signs and sx accompanying mild-to-moderate superficial pain
sympathetic nervous system response --> hypertension, tachycardia, and tachypnea (rapid, shallow breathing)
32
signs and sx accompanying severe/visceral pain
parasympathetic nervous system response --> hypotension, bradycardia, nausea, vomiting, tachypnea, weakness, fainting
33
signs and sx accompanying spinal cord compression from metastases
radicular back pain, leg weakness, and change/loss of bowel or bladder control
34
___________ and __________ can also lead to pain
immobility; inflammation
35
pain should be _________, _________, and __________ according to clinical practice guidelines (CPGs)
screened, assessed, and managed
36
pain management depends on:
1. the underlying etiology
2. whether the individual is experiencing acute/chronic pain
37
pain control for cancer
- steroids, opioid and nonopijoid analgesics, radiation, chemo, surgical intervention, neurosurgery nerve blocks, intraspinal, rhizotomy, or cordotomy
- other modalities including integrative, psychologic, or rehabilitative strategies
38
what are the commonly used opioids for pain control in cancer?
morphine, hydromorphone, fentanyl, and oxycode
39
opioid rotation
a balance btwn analgesia and side effects might be achieved by changing to an equivalent dose of an alternative opioid
40
methods of continuous infusion of opioids for pain control in cancer
- around the clock
- as needed
- patient-controlled analgesia (PCA)
41
nonpharmacologic modalities for cancer pain
complementary therapies --> massage, simple touch, acupuncture, imagery/hypnosis, reflexology, and relaxation training etc
42
nonpharmacologic modalities for cancer pain - massage
- reduce of stress/anxiety
- some debate about its safety in individuals w/ lymphedema/who are at risk for developing lymphedema
- no evidence shows massage can spread cancer, although direct pressure over a tumor is usually discouraged (Cochrane)
43
cancer pain - biophysical agents
- have potential to relieve some of the sx associated w/ cancer
- alters cell membrane permeability and alter transmembrane potentials, potentially triggering tissue growth and development increase circulation, promote cell function, growth, and replication
- the use in individuals w/ cancer or a history of cancer is controversial w/ the exception of hospice or palliative care
- PT needs to conduct risk-benefit assessment and have an open dialogue w/ patients
44
cancer neuropathic pain
directly caused by tumor invasion or indirectly as a side effect of cytotoxic drug therapy
45
cancer neuropathic pain recommended tx
infrared light therapy, anti-depressant drugs, anti-epileptics, and steroids
46
cancer-related fatigue (CRF)
- a distressing, persistent, and subjective sense of tiredness or exhaustion related to cancer or cancer tx (unknown mechanisms)
- may be the result of pain, anemia, sleep disturbance, nutritional deficits, deconditioning, comorbidities, the presence of certain cytokines, or psychosocial factors such as emotional distress, anxiety, and depression
47
what is the nearly universal sx in all cancer survivors?
cancer-related fatigue (CRF)
- imposes limitations on normal daily activities
- more distressing than pain/nausea and vomiting on many people's perception
48
paraneoplastic syndrome
- when tumors produce signs and sx (not direct effects of either the tumor or its metastases) at a site distant from the tumor/its metastasized sites
- involve ectopic hormone production by tumor cells or the secretion of biochemically active substances that cause metabolic abnormalities
- may accompany relatively limited neoplastic growth and provide an early clue to the presence of certain types of cancer
49
healthy people 2030
focuses on promoting evidence-based cancer screening and prevention strategies -- and on improving care and survivorship for people w/ cancer
50
primary prevention - epigenetics
screening to identify high-risk people and subsequent reduction/elimination of modifiable risk factors
51
primary prevention - nutrigenomics
prevent cancer through the impact of nutrition on gene structure and stability
52
primary prevention - chemoprevention
the use of agents to inhibit and reverse cancer, has focused on diet-derived agents
53
secondary prevention
aimed at preventing morbidity and mortality uses screening, early detection, and prompt tx
**need to keep up to date on recs
54
tertiary prevention
focuses on managing sx, limiting complications, and preventing disability associated w/ cancer or its tx
55
dx - tissue biopsy
- curettage (Pap smear)
- fluid aspiration (pleural effusion, lumbar puncture, spinal tap)
- fine-needle aspiration (breast/thyroid)
- dermal punch (skin/mouth)
- endoscopy (rectal polyps)
- open surgical excision (visceral tumors and nodes)
- incisional biopsy (open biopsy)
- excision biopsy (lumpectomy)
- core needle biopsy (Tru-Cut needle biopsy)
- stereotactic (mammotome) biopsy
- sentinel lymph node (SLN) biopsy
56
dx - biologic tumor markers
- substances produces and secreted by tumor cells
- may be found in blood serum
- tumor marker is not diagnostic itself bu can signal malignancies
57
examples of biologic tumor markers
- CEA (carcinoembryonic antigen)
- PSA (prostate-specific antigen)
58
CEA
carcinoembryonic antigen --> may indicate large bowel, stomach, pancreas, lungs, and breasts malignancy
59
PSA
prostate-specific antigen --> helps evaluate prostatic cancer
60
dx - molecular profiling
by using specific cancer biomarkers, it provides additional info for the oncologist in determining aggressiveness of the tumor, potential response to tx, and prediction of risk for cancer dx w/ a family
61
examples of molecular profiling
- immunohistochemistry
- gene expression by microarray
- fluorescence in situ hybridization
- DNA sequencing via PCR
62
anti-neoplastic tx
- the medical management of cancer may be curative (i.e. w the intent to cure) or palliative (i.e., provides sx relief but doesn't cure)
- begins w/ surgery to remove primary tumor burden --> adjuvant therapies (chemo & radiation) to obtain local regional or systemic control --> possibly finally long-term (5+) hormonal tx
- neoadjuvant (before definitive surgical intervention) tx w/ chemo or radiotherapy to shrink the primary tumor/provide local or systemic control
63
the decision to initiate neoadjuvant vs adjuvant therapies is based on:
the size, extent of involved tissue, and often the stage/grade of the tumor
64
major therapies of curative cancer
- surgery
- irradiation therapy
- chemotherapy
- immunotherapy
- antiangiogenic therapy
- hormonal therapy
- complementary and alternative (integrative) medicine
65
what is most often used in combo with other therapies to treat cancer?
surgery --> large % of clients have evidence of micrometastases at the time of dx
66
surgery in cancer
may be used curatively for localized cancer, tumor biopsy, and tumor removal or palliatively to relieve pain, correct obstruction, or alleviate pressure
67
Cell cycle - G0
resting or quiet phase
68
cell cycle - G1
cycle begins: post mitotic or presynthesis phase
69
cell cycle - S
DNA syntheses phase (DNA is doubled)
70
cell cycle - G2
Premitotic or postsynthesis phase
71
cell cycle - M
mitosis or cell division --> new daughter cell
72
when stimulated by growth factors and/or hormones, _____ cells move into the ____
G0 --> G1
73
_____ is a checkpoint to stop the cell cycle if the DNA is damaged
G1 - cell can either repair the DNA or undergo apoptosis
74
____ is another checkpoint when the cell cycle can be stopped if DNA is damaged or unreplicated, in which case repair/apoptosis occurs
G2
75
Most organ cells that are hormonally linked take approximately ___ to ___ days to complete one full cycle
19 to 33 days
76
chemotherapy is most effective during ___________ and __________
DNA synthesis; mitosis
77
cells are most sensitive to radiation therapy in the ____ phase
G2
78
stem cells in the _____ phase are resistant to chemo and radiation therapy
G0
79
the repeated or cyclic chemo/radiotherapy is designed to capture cells at ______
each stage of the cell cycle
80
irradiation therapy (radiotherapy)
- used preoperatively to shrink a tumor, making it operable, while preventing further spread of the disease during surgery
- after surgical wound heals, postoperative doses prevent residual cancer cells from multiplying/metastasizing
81
mechanisms of irradiation therapy (radiotherapy)
destroy the dividing cancer cells by destroying hydrogen bonds btwn DNA strands w/in the cancer cells
82
two types of irradiation therapy (radiotherapy)
ionizing radiation and particle radiation
83
depending on the type and extent of the tumor, radiotherapy may be delivered externally or internally by:
1. external beam (teletherapy)
2. sealed source (brachytherapy): X-rays and gamma rays
3. unsealed source (systemic therapy)
84
newer technologies of irradiation therapy (radiotherapy)
brachytherapy, accelerated partial breast irradiation, radiofrequency ablation, radiopharmaceutical therapy CyberKnife, and Proton therapy
85
radiation injuries
- used in approximately 50% of all cases of cancer in the local control phase of tx, but it has both direct and indirect toxicities associated w/ its use
- harmful effects (acute, delayed, or chronic) to body tissues through exposure to ionizing radiation
86
chemotherapy
- particularly useful in the tx of widespread or metastatic disease --> systemic drugs travel throughout the body rather than remain confined to a specific area
- combo therapies often used bc some drugs work better during different cell cycles --> designed to capture cell cycles (interfering w/ cellular fxn and division) at different phases for optimum cell death
87
primary mechanism of chemotherapy
affects or interferes w/ the synthesis or fxn of nucleic acid (DNA) targeting cells in the growth phase and therefore doesn't kill all cells
88
how is chemotherapy administered
- orally, subcutaneously, intramuscularly, intravenously, intracavitarily, intrathecally, and by arterial infusion
- usually intermittent to allow for bone marrow recovery btwn doses
89
cytotoxic strategy of chemo
- limit cell proliferation by killing or attenuating the growth of the cancerous cells
- inhibit DNA/RNA synthesis and fxn or directly inhibit cell division (mitosis)
- affect cancerous cells to a greater extent than normal cells --> cancerous cells have a greater need to replicate their genetic material and thus undergo mitosis at a much higher rate than most noncancerous cells
90
growth fraction of chemo
- the % of proliferating cells relative to total neoplastic cell population
- it typically decreases as a tumor gets larger
- the % of cells that are actively dividing starts to decline as the tumor gets larger bc blood flow and nutrient supply to the tumor can't sustain extremely rapid tumor growth
91
cell kill hypothesis
- each round of chemo will kill a certain % of cancerous cells (e.g., 90% were killed w/ 10% survive)
- chemo can never completely eliminate tumor
- if chemo can reduce the tumor to a certain size (typically <10,000 cells), the body's endogenous defense mechanisms (i.e. cytoxic immune responses) can deal w/ the remaining cancerous tissues, and the disease is considered to be in remission
92
what do growth fraction and cell kill hypothesis mean to us?
chemo works the best when the tumor is small and a large proportion of the cells are actively dividing
93
major chemotherapeutic agents
1. alkylating agents
2. antimetabolites
3. antibiotics
4. antimicrotubule (microtubule-targeting) agents
5. topoisomerase inhibitors
6. anticancer hormones
7. platinum coordination complexes
8. agents that target cell surface glycoproteins, growth factor receptors, and ligands
9. other biologic agents
