Oncology Flashcards
(106 cards)
1
Q
What is the oncology care program in Edmonton called?
A
Regional Palliative Care Program
2
Q
What is the Pain and Symptom Team in CCI?
A
Multidisciplinary team for people who are actively receiving treatment from CCI and have complex/extreme symptoms
3
Q
What is the Regional Palliative Care Team?
A
The community equivalent of the Pain and Symptom Team in CCI
For people who are not receiving treatment from CCI
4
Q
What is the Palliative Home Care?
A
Multidisciplinary community-based care for patients at home with ongoing symptom management needs
5
Q
What is the Tertiary Palliative Care Unit, Station 43 in the Grey Nun Hospital?
A
For people whose symptoms cannot be stabilized at another hospital or at home.
Main purpose is to stabilize the patient so that they can return to home or hospice care.
Admission through referral from the Regional Palliative Care Team or Pain and Symptom Team.
6
Q
What is hospice care?
A
End-of-life care for people with life expectancy of 2 months or less and with stable symptoms but needing consistent care
7
Q
Which cancers cause the most cancer deaths every year?
A
Lung, stomach, liver, colon, breast
8
Q
What percentage of cancer deaths can be prevented?
A
~30%
9
Q
What is the single most important risk factor for cancer?
A
Tobacco use
10
Q
Death from cancer worldwide is projected to [increase/decrease].
A
Increase
11
Q
What is cancer?
A
The common term for a complex group of malignant neoplasms
12
Q
What is the overall mechanism of cancer?
A
The normal mechanism for controlling cell growth and proliferation is disturbed, allowing cell growth to continue beyond normal boundaries.
13
Q
What is neoplasm?
A
New growth
14
Q
What is malignancy?
A
The tendency of a medical condition (esp. a tumor) to become progressively worse and potentially result in death.
15
Q
What are the 2 characteristics of malignancy?
A
- Anaplasia – Reverse in differentiation of cells
2. Metastasis – Spread of anaplasia
16
Q
Compare growth control in normal vs. cancer cells?
A
Normal cells: New cell growth = Cell death. Damaged cells self-destruct.
Cancer cells: Damaged cells do not self-destruct, and there is uncontrolled growth.
17
Q
What is carcinogenesis?
A
A series of events that transform a normal healthy cell into a cancer cell
18
Q
What are some causes of carcinogenesis?
A
Spontaneous errors in gene replication and recombination
Genetic predisposition
Carcinogenic exposure
Viruses
19
Q
What are some internal factors that cause cancer?
A
Hereditary
Diet
Hormones
20
Q
What are some external factors that cause cancer and their mechanisms?
A
Chemicals – Damage DNA
Radiation – Damage DNA
Viruses or bacteria – Introduce their own genes into cells
21
Q
Which substances are commonly considered to be carcinogens?
A
Chemicals and radiation
22
Q
What are the 3 prime suspects in gene mutation that lead to cancer?
A
Oncogenes
Tumor suppressor genes
DNA repair genes
23
Q
What are the two types of growth regulatory genes?
A
Proto-oncogenes
Oncogenes
24
Q
What are proto-oncogenes?
A
Growth regulatory gene that promotes cellular proliferation during normal growth and development.
25
What are oncogenes?
Mutated proto-oncogenes that remain in the "on" mode, allowing indefinite cellular proliferation.
26
What are tumor suppressor genes?
Genes that regulate growth during normal development by blocking growth promoting proteins.
27
How do mutated tumor suppressor genes contribute to uncontrolled cell growth in cancer?
They are unable to turn off the cellular proliferation because their function has been inactivated
28
What are the 7 warning signs of cancer?
1. Unusual bleeding or discharge
2. A sore that doesn't heal
3. Lump
4. Nagging cough
5. Obvious change in a mole
6. Difficulty swallowing
7. Changes to bowel or bladder routine
29
What are the ABCDE of mole changes?
```
A: Asymmetry
B: Border irregularity
C: Colour
D: Diameter
E: Evolving
```
30
What are the characteristics of cancer cells?
```
Uncontrolled cellular proliferation
Reduced cell death
Invasiveness -- Migration
Destruction of normal tissue
Atypical tissue structure -- Anaplasia
Variable cellular shape and size
Abnormal chromosome number
Metastases -- Spreading to other areas in the body
```
31
What is metastasis?
Spread of cancer cells from a primary tumor to organs and distant sites in the body
32
What percentage of people have a metastatic disease when diagnosed with cancer?
~60%
33
What are the two mechanisms by which cancer spreads throughout the body?
1. Invasion: Local penetration in neighbouring cells. A necessary characteristic of cancer.
2. Metastasis: Penetration through the blood and lymphatic vessels and systemic circulation. Usually seen in advanced cancer.
34
What are the necessary factors for metastases?
```
Tumor angiogenesis
Mechanical pressure
Cell motility
Loss of cellular adhesion
Proteolytic enzymes -- Helps degrade cellular adhesion
Immunogenicity
```
35
When a tumor's size is ≥ __ mm, it needs its own blood vessel.
2 mm
36
True or False: A highly vascularized tumor has a higher risk of metastasis.
True
37
What is immunogenicity?
Ability for cancer cells to move through blood vessels and invade the immune system without detection by the immune system
38
What is the difference between benign and malignant tumors?
Benign: Cannot spread by invasion or metastasis
Malignant: Spreads by invasion or metastasis
39
True or False: Cancer includes both benign and malignant tumours.
False. Cancer only includes malignant tumours.
40
How are metastases named, and why?
Metastases always share the name of the primary tumor, so that the name indicates the cell type that was originally mutated, as well as the metastatic state and advancedness of the cancer.
41
What are the signs and symptoms of metastases?
```
Bone pain or movement pain
Constant unrelenting pain
Nocturnal pain
Severe spasm
Expanding pain
Empty end feels in ROM
Shortness of breath
Lack of appetite and weight loss
Neurological symptoms (weakness, vomiting, ataxia, seizure, drowsiness, headache, dizziness, confusion)
```
42
What is a new pain in cancer patients always presumed to be?
Metastases
43
In which cancers are bone metastases more common?
BLT on Rye with a Pickle:
| Breat, Lung, Thyroid, Renal, Prostate
44
What are carcinoma?
Solid tumors originating from epithelial tissues
45
What percentage of all cancers is carcinoma?
~80%
46
What is sarcoma?
Cancers of the bone or connective tissue
47
What percentage of all cancers is sarcoma?
~10%
48
What is lymphoma?
Cancer developing in the lymphatic system
49
What is leukemia?
Cancer of the blood cells
50
What is myeloma?
Cancer that develops from antibody-producing cells in the bone marrow
51
What would a prostate cancer spreading into bone be documented as?
Prostate carcinoma metastasized to bone
52
What is tumor staging?
Classifying cancer based on the apparent anatomic extent of the malignancy
53
Describe the TNM system of staging.
T - Tumor. Size and extent of the primary tumor.
N - Node. Lymph node involvement.
M - Metastases. Presence or absence of distant metastases.
54
What are the 3 goals of cancer treatment?
Cure, control, palliation
55
What are the types of cancer treatment?
Surgery
Radiation therapy
Chemotherapy
Biotherapy
56
What are the two main goals of surgery in cancer?
Diagnosis or staging (i.e. biopsy)
| Primary treatment with cure as the goal
57
What percentage of cancer patients have surgery for diagnostic or staging purposes?
~90%
58
What percentage of cancer patients have surgery as their primary treatment?
> 50%
59
What are the goals of radiation therapy in cancer?
Cure, control, palliation, anticipatory
60
Which device is used in radiation therapy of cancer?
Linear accelerator
61
What are the 2 types of radiation therapy?
1. Direct hit: Direct damage to cellular DNA.
| 2. Indirect hit: Damage to the environment by targeting the cell exterior leading to formation of free radicals.
62
Contrast direct vs. indirect radiation therapy?
Direct hit: Most effective but least used.
| Indirect hit: Less effective but most used.
63
What is fractionation of radiation?
Delivering radiation in fractions over time
64
Why is fractionation of radiation done?
To allow normal cells to repair
| To catch cells at different stages of the cell cycle
65
What are the roles of OT in regards to radiation therapy?
Skin care -- Protection of skin during and after treatment. Lymphedema control.
Nutrition/Hydration -- Swallow assessment, xerostomia, referral to dietician
Fatigue -- Education, equipment
66
What are the goals of chemotherapy?
Cure
Control
Palliation
Chemoprevention (only if high genetic risk)
67
What is chemotherapy?
Therapy using pharmacologic agents that inhibit tumour growth by interfering with cellular function and reproduction
68
What is myelosuppression?
Bone marrow suppression
69
What is hematopoietic nadir?
The few (~7) days after chemotherapy when blood cell counts are at the lowest, i.e. immunocompromised and at high risk of fever
70
What are the adverse effects of chemotherapy?
```
Hematopoietic nadir
Gastrointestinal effects
Integument/skin effects
Reproductive cells or gonads
Hair follicles
Neurotoxicity
```
71
Why does hematopoietic nadir happen?
The bone marrow cannot make enough cells to replace cells that are dying due to chemotherapy. Neutrophils are 50% of the white blood cell population, and they are at their lowest after chemotherapy.
72
What are conditions that can be caused by the neurotoxicity of chemotherapy?
Peripheral neuropathy
Cerebellar dysfunction
Personality changes
73
What is the OT role after chemotherapy?
Hand-foot syndromes
Falls risk Ax and prevention -- walking aids and shoe fillers
Supportive resources for personality and memory changes
74
Where in neurons does chemotherapy tend to deposit toxins?
At the ends of neuronal processes
75
What are the differences between biologic therapy or biotherapy, vs. chemotherapy and radiation therapy?
Biotherapy does not affect the DNA, as chemotherapy and radiation therapy do. Biotherapy aims to spare normal cells and only target cancer cells, while chemotherapy and radiation therapy kill both normal and cancer cells.
76
What is the general mechanism of biotherapies?
Boost the body's own immune response to tumours and cancer cells so that they are detected and destroyed.
Disrupt cellular signal transduction and prevent the malignant cells' ability to proliferate, differentiate, and metastasize.
77
What is cellular signal transduction?
Communication between the cell nucleus and the cell membrane
78
True or False: Biologic therapy or biotherapy is a first line treatment because it has a lot of advantages.
False. It is usually a second line treatment because it is less well studied.
79
What is hemotopoietic transplantation?
Treating otherwise fatal disease using high dose chemotherapy, total body radiation, or both, with the use of stem cells.
80
Which cancers is hemotopoietic transplantation usually used for?
Fatal diseases such as leukemia, lymphoma and myeloma
81
What is the usual procedure for hemotopoietic transplantation?
The patient is put onto a high dose chemotherapy or total body radiation which puts their cancer in remission. This is when their stem cells are collected if using autologous transplantation. When the cancer comes back, an otherwise fatal dose of chemotherapy is given, but the patient is "rescued" by stem cells.
82
What are the two approaches to hematopoietic transplantation?
Autologous: Re-infusing patient's own stem cells. The ideal approach.
Allogenic: Infusing marrow/stem cells donated by someone other than the patient. Risk of rejection of the donation.
83
What are factors that are considered when discharge planning for cancer patients?
Self-care
Productivity
Leisure
End-of-life care planning
84
What are common symptoms experienced by cancer patients?
Anorexia/Cachexia
Pain
Dyspnea
Fatigue
85
What is anorexia?
Loss of desire to eat.
86
What is cachexia?
Anorexia with significant loss of tissue or wasting.
87
What is the prevalence of cachexia in advanced cancer?
80%
88
Cachexia is [reversible/irreversible].
Irreversible
89
What are the OT roles in anorexia/cachexia?
Education -- esp. for caretakers
| Energy conservation
90
What are the three general types of pain?
Acute
Chronic
Mixed
91
What are the 3 main causes of pain in cancer patients?
Direct tumour involvement
Treatment related
Unrelated to disease or treatment
92
What are the two classifications of pain in cancer patients?
Nociceptive
| Neuropathic
93
What are the two types of nociceptive pains, and what are their characteristics?
Visceral -- Squeezing, poorly localized.
| Somatic -- Bone and muscle pain, well localized.
94
What are the two types of neuropathic pains, and what are their characteristics?
Neuralgic -- Sharp and shooting
| Dysesthetic -- Constant, heat or electric, radiating
95
What is total pain syndrome?
A phenomenon where pain is caused by different factors of life (physical, social, spiritual, emotional).
96
What are some treatment options for pain?
```
Opioids
Radiation therapy
Orthopedic surgery
Occupational and Physical therapy
Complimentary therapies
Expressive support therapy
Environmental alterations
```
97
What are the OT roles in pain?
```
Comprehensive assessment of patient's experience of pain and its affect on different aspects of life
Prioritizing and goal setting
Custom comfort products
Activity modification
Psychosocial support and (re)engagement
```
98
What is dyspnea?
The subjective feeling of breathing discomfort. Different from hypoxia, a physiological phenomenon.
99
What are the treatment options for dyspnea?
```
Opioids
Supplementary oxygen
Repositioning
Behaviour modification
Chest PT
Counseling for psychological causes
Palliative sedation with refractory dyspnea
```
100
How is cancer-related fatigue different from every day fatigue?
It is more severe and more distressing, and rest does not always relieve it.
101
What is the OT role in fatigue?
```
Education
Energy conservation
Exercise/Activity programming
Psychosocial support
ADL/equipment Ax
Referrals to community resources
Sleep hygiene
```
102
What are the two considerations when helping someone with fatigue?
Pacing of activities
| Delegation of activities
103
True or False: It is better to have a patient with fatigue rest as much as they want, foregoing any activity.
False. It is better to schedule some amount of doing everyday, than resting every day and potentially leading to a deconditioning spiral.
104
What are the criteria for receiving medical assistance in dying (MAID)?
Eligible for health services funded by a government in Canada
At least 18 years of age and capable of making decisions wrt their health
Grievous and irremediable medical condition
Voluntary request for MAID
Informed consent to receive MAID
105
What are the 3 steps of MAID application?
1. Contact 811 or MAID care team
2. Two assessments of medical condition completed by different physicians
3. Formal request completed for MAID with 2 independent witnesses
4. 10 day waiting/reflection period after approval of request
106
True or False: If someone requests MAID for when they are so sick that they lose the ability to consent, then they will receive MAID.
False. MAID requires continuous consent.
