Quiz 2 (wk 3) Flashcards Preview

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

Diagnosis and staging:

- Diagnosis
- STAGING
- How is Lymphoma dx'd?

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

2

Laparoscopic staging is becoming standard for what?

Laparoscopic staging is becoming standard for GI and pelvic cancers

3

Lymph node biopsy is often important for staging, why?

helps to establish local spread

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

4

Sentinal node biopsy does what?

-Removes a single lymph node closest to the original lesion.

-preserves local architecture in a better way therefore reduces risk of lymphedema later.

5

Most likely procedure to be curative in a cancer diagnosis

-Complete resection of a local cancer

6

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

-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

Important rule of thumb for breast cancer:

Mastectomy vs lumpectomy

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

8

PALLIATIVE SURGERY uses?

-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

In patients with cancer, risks associated with surgery?

Infection,
clotting,
poor wound recovery

10

The most common reconstructive surgery is after what?

Most common reconstruction uses a what?

-after lumpectomy or mastectomy for breast cancer

-Most common reconstruction uses a saline implant

11

Radiation Therapy Acute effects last up to how long?

• Acute effects: up to 8 weeks after treatment,

Later=>will be late effects beyond this

12

What is 'Apoptosis'?

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

13

What is 'Disruption of cell division':

-Damage that leads to cell kill years post-treatment

14

RELATIVE TISSUE SENSITIVITY:

Highly sensitive vs Low sensitivity

-Highly sensitive: Susceptible to damage to tx. (Less resistant)

-Less (low) sensitive: More resistant

15

RELATIVE TISSUE SENSITIVITY:

Highly sensitive cell types:

Highly sensitive => Susceptible to damage to tx.

 Germ cells
 Lymphatic tissue
 Salivary glands

16

RELATIVE TISSUE SENSITIVITY:

Less sensitive / More resistant cell types:

Key tx for which Cancer type?

More resistant cell types/Less sensitive cell types:

Nerve cells
Connective tissue

- Key tx for Sarcoma!!!

17

Curative / adjuvant treatment

-Tx types?

(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

Curative tx dose?

Highest tolerable dose given for cure

19

Adjuvant treatment dose (post-surgery)

lower doses for adjuvant vs Curative

20

Curative / adjuvant treatment side effects types?

o Expect considerable acute effects

21

Palliative treatment dose & # of tx's?

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

22

Palliative treatment side effects

• 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

Ex: Palliative treatment for Spinal metastasis for pain

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

Hit it really hard for 3 days to control pain.

24

BRACHYTHERAPY:

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

-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

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.

-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

• Fractionation of therapy does what?

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

LATE EFFECTS OF RADIATION:

Organ systems affected (5)

Lung
Kidney
Heart
CNS
Hematopoetic precursors

28

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

Organ systems affected
• Lung

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

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

Organ systems affected:

 CNS

• In 2-6 mos, can see demyelination
• In 1-2 yrs, can see radiation necrosis

30

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

Organ systems affected:

 Hematopoetic precursors

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

31

LONG-TERM OUTCOMES:

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

-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

LONG-TERM OUTCOMES:

Are surgical procedures possible post-radiation treatment?

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

(Exceptions include CNS tumors!!!)

33

DNA damage increases the chances of what occurring?

Increased risk of secondary malignancy

34

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

•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)