Quiz 2 (wk 3) Flashcards Preview

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Flashcards in Quiz 2 (wk 3) Deck (34)
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1
Q

Diagnosis and staging:

  • Diagnosis
  • STAGING
  • How is Lymphoma dx’d?
A

• Needle Bx sufficient for dx
• FOR STAGING => excisional biopsy is required to maintain tissue architecture
o M/C=> Lymphoma dx’d excisional biopsy

2
Q

Laparoscopic staging is becoming standard for what?

A

Laparoscopic staging is becoming standard for GI and pelvic cancers

3
Q

Lymph node biopsy is often important for staging, why?

A

helps to establish local spread

-lymph node excision is only a diagnostic procedure, and not considered therapeutic

4
Q

Sentinal node biopsy does what?

A
  • Removes a single lymph node closest to the original lesion.
  • preserves local architecture in a better way therefore reduces risk of lymphedema later.
5
Q

Most likely procedure to be curative in a cancer diagnosis

A

-Complete resection of a local cancer

6
Q

Clear surgical margins are crucial to treatment efficacy to which Cancer?

A

-Common skin cancers can approach 100% cure rate

  • Upper GI and lung cancers tend to have disappointing cure rates
  • higher cure rates in certain cancers (e.g., gynecologic surgeons)
7
Q

Important rule of thumb for breast cancer:

Mastectomy vs lumpectomy

A

-Mastectomy is equivalent to lumpectomy followed by radiation with respect to cure rate

8
Q

PALLIATIVE SURGERY uses?

A
  • Opening bowel obstruction
  • Placing stent to allow for bile or urine flow (Common)
  • Relieving pressure from ascites (paracentesis procedure)
  • Nerve blocks or debulking for pain control
9
Q

In patients with cancer, risks associated with surgery?

A

Infection,
clotting,
poor wound recovery

10
Q

The most common reconstructive surgery is after what?

Most common reconstruction uses a what?

A
  • after lumpectomy or mastectomy for breast cancer

- Most common reconstruction uses a saline implant

11
Q

Radiation Therapy Acute effects last up to how long?

A

• Acute effects: up to 8 weeks after treatment,

Later=>will be late effects beyond this

12
Q

What is ‘Apoptosis’?

A

-Damage that leads to cell kill within 24 hrs of treatment-> ‘Quick’

13
Q

What is ‘Disruption of cell division’:

A

-Damage that leads to cell kill years post-treatment

14
Q

RELATIVE TISSUE SENSITIVITY:

Highly sensitive vs Low sensitivity

A
  • Highly sensitive: Susceptible to damage to tx. (Less resistant)
  • Less (low) sensitive: More resistant
15
Q

RELATIVE TISSUE SENSITIVITY:

Highly sensitive cell types:

A

Highly sensitive => Susceptible to damage to tx.

 Germ cells
 Lymphatic tissue
 Salivary glands

16
Q

RELATIVE TISSUE SENSITIVITY:

Less sensitive / More resistant cell types:

Key tx for which Cancer type?

A

More resistant cell types/Less sensitive cell types:

Nerve cells
Connective tissue

  • Key tx for Sarcoma!!!
17
Q

Curative / adjuvant treatment

-Tx types?

A

(Post surgery) Specific # of Grays that generally will be delivered in this setting- tumor is already gone d/t surgery.

o Treatments are frequent and small exposures over long period of time

18
Q

Curative tx dose?

A

Highest tolerable dose given for cure

19
Q

Adjuvant treatment dose (post-surgery)

A

lower doses for adjuvant vs Curative

20
Q

Curative / adjuvant treatment side effects types?

A

o Expect considerable acute effects

21
Q

Palliative treatment dose & # of tx’s?

A

-Lowest dose & number of tx’s to achieve desired effects

22
Q

Palliative treatment side effects

A
  • This strategy should minimize acute effects
  • Late effects are not likely to be relevant for most pts

o Fewer tx’s, higher doses = less acute affects

23
Q

Ex: Palliative treatment for Spinal metastasis for pain

o Fewer tx’s, higher doses = less acute affects

A

Hit it really hard for 3 days to control pain.

24
Q

BRACHYTHERAPY:

Will only be used for what type of tumors?
Treatment allows for what type of doses?
Duration of tx?
Type of Gleason score?

A
  • Used for small tumors of well-defined reach
  • Treatment allows for delivery of high doses in small areas (Close to area)-> Prostate
  • Duration of radiation emission is short – 2 to 7 days
  • Low Gleason score
25
Q

ACUTE EFFECTS OF RADIATION:

3 types of tissue

The degree of permanent damage will be related to the amount of damage to local stem cells.

A
  • Skin
  • GI Mucosa
  • Hematopoetic precursors (Stem/Blood cells)
  • ->(Anemias that persist for years.)

The degree of permanent damage will be related to the amount of damage to local stem cells

26
Q

• Fractionation of therapy does what?

A

Fractionation of therapy makes permanent tissue damage more rare than previous delivery methods

-For this reason, you’ll generally expect full recovery from acute effects

Fatigue as an acute effect, but it is a very likely symptom. Should resolve w/in 3 mos of end of treatment occult dx may be present

27
Q

LATE EFFECTS OF RADIATION:

Organ systems affected (5)

A
Lung
Kidney
Heart
CNS
Hematopoetic precursors
28
Q

LATE EFFECTS OF RADIATION:
Late effects are likely to be persistent

Organ systems affected
• Lung

A

o In 2-6 mos, can see radiation pneumonitis
o May respond to nebulized or p.o. steroid tx
o After 6 mos, may see irreversible fibrosis occur

29
Q

LATE EFFECTS OF RADIATION:
Late effects are likely to be persistent

Organ systems affected:

 CNS

A
  • In 2-6 mos, can see demyelination

* In 1-2 yrs, can see radiation necrosis

30
Q

LATE EFFECTS OF RADIATION:
Late effects are likely to be persistent

Organ systems affected:

 Hematopoetic precursors

A

• You may see a persistent (macrocytic) anemia post-irradiation of hip/low back

31
Q

LONG-TERM OUTCOMES:

Once a tissue is irradiated once, can it be tx w/radiation a second time?

A

-No, once a tissue is irradiated once, it cannot be treated with radiation a second time.

o You can radiate an area after surgery but not vice-versa.

**Once you radiate, can’t radiate again or do surgery ;(

32
Q

LONG-TERM OUTCOMES:

Are surgical procedures possible post-radiation treatment?

A

-No, surgical procedures are generally not possible post-radiation treatment.

(Exceptions include CNS tumors!!!)

33
Q

DNA damage increases the chances of what occurring?

A

Increased risk of secondary malignancy

34
Q

Possible secondary malignancy from these cancer occur when?

(about 14% will develop a second malignancy. The number of these due to radiation)

  • Leukemias
  • Solid tumors
A
  • Leukemias can emerge with a peak at 6-8 yrs post-tx
  • Solid tumors have a peak incidence at 10-30 yrs post-tx

(About 14% will develop a second malignancy. The number of these due to radiation)