Quiz 3 Flashcards
(168 cards)
1
Q
Most common cancer in women, 1 in 8 women will get this
29-30% of new cancers in women
2017: 255,180 new cases (over 252,000 females, 24-2,500 males)
African American women more likely to present with regional/distant disease than white women
Family member with bilateral disease or diagnosed premenopause increases risk
Left most common
Treated with tangents, IMRT, or hybrid of both; usually chemo first
Stop using birth control
Rare to other breast (mets 0.5-1%) but 1-2 times more likely to develop new tumor in contralateral breast
Ovaries, spleen, and stomach
TNM staging
A
Breast cancer
2
Q
10 risk factors of breast cancer
A
Gender: female increases risk
Early menarche
Increased age of birth of first child
Late menopause over 50-55 years old
Use of exogenous hormones: birth control increases risk with prolonged use over 5 years
History of atypical hyperplasia
Family history
Radiation exposure: avoid wedge because of scatter
Increasing age and history of breast cancer
Obesity/high fatty diets: fat cells produce estrogen
3
Q
Menarche
A
Menstration
4
Q
Benign breast disease proliferates and turn malignant
A
Atypical hyperplasia
5
Q
___-___% of breast cancer occurs from altered genes
BRCA 1 & 2 mutations account for ___-___% of breast cancer
1 first degree relative with disease increases risk, 2 _______ risk
A
5-10%
5-6%
Triples
6
Q
Protein promotes growth of breast cancer, 1 in 5 cancers have this more aggressive mutation
A
Human epidermal growth factor receptor 2 (HER2)
7
Q
6 signs and symptoms of breast cancer
A
Most common sign of early benign disease: non-painful, mobile mass; malignant: firm, nontender, irregular, non-movable and fixed mass
Skin dimpling
Nipple retraction
Erythema coincides with peau d’orange
Nipple discharge
Enlarged axillary/supraclavicular (scv) LN
8
Q
Dimpling on the skin commonly mistaken as infection, 50% have lump or mass
Clinical/pathological diagnosis, can be lymphatic
A
Peau d’orange/inflammatory
9
Q
Upper outer breast cancer = \_\_\_% Upper inner = \_\_\_% Central = \_\_\_% Lower outer = \_\_\_% Lower inner = \_\_\_%
A
Upper outer breast cancer = 50% Upper inner = 15% Central = 17% Lower outer = 11% Lower inner = 6%
10
Q
7 diagnostic methods for breast cancer
A
Mammogram Biopsy: fine needle; guided biopsy (mammotome/stereotactic biopsy) for deep tumor Breast self examinations (BSE) Clinical self exam (CBE) Digital radiography MRI defines extent of disease PET for staging
11
Q
When is it recommended for patients 40-44 years old, 45-54 years old, and 55 or older to get a mammogram?
A
40-44: patient’s choice
45-54: yearly
55: every 2 years
12
Q
Excision of tumor with small margin of normal tissue around it; with LN dissection and RT, gets as good a result as mastectomy
Excisional, remove mass in breast
A
Lumpectomy
13
Q
Median age of diagnosis of breast cancer
A
61
14
Q
8 histologic types of breast cancers
A
Invasive/infiltrating ductal Infiltrating lobular Medullary: 5-7% Tubular Mucinous Comedo Paget's disease Inflammatory/peau d'orange
15
Q
70-80% of breast cancers; in ducts
Squamous, angiosarcoma, etc.
A
Invasive/infiltrating ductal
16
Q
10-15% of breast cancers, second most common in glands that secrete milk
A
Infiltrating lobular
17
Q
Uncommon disease of nipple
A
Paget’s disease
18
Q
Average doubling time of breast cancer
A
60-90 days, but can be as fast as 15 days or up to 600 days
19
Q
LN involvement in ___-___% of breast cancers
A
40-60%
20
Q
Lateral lesions usually go to _______ or _______ LNs
Medial lesions usually go to _______, _______, or _______ LNs
A
Lateral lesions usually go to axillary or supraclavicular LNs
Medial lesions usually go to internal mammary, mediastinal, or supraclavicular LNs
21
Q
Biopsy first LNs that receive drainage from tumor; if disease present, complete biopsy
A
Sentinel node biopsy
22
Q
5 year survival of stage 1, 2, 3, and 4 breast cancer
A
1: 99%
2: 84%
3: 65%
4: less than 26%
23
Q
60% estrogen receptor (ER) status; slower-growing, better prognosis
Usually postmenopausal
Use tamoxifen
A
ER positive
24
Q
Anti-estrogen therapy, 60% response rate for ER positive
Standard adjuvant therapy for ER positive patients
A
Tamoxifen
25
More aggressive, postmenopausal women
ER negative
26
More aggressive and dividing breast cancer
Elevated S phase
27
Malignant cellular proliferation has not extended through basement membrane into surrounding tissue
Carcinoma in situ for breast cancer
28
Examine DNA count/microscopic particles to see amount of DNA
Flow cytometry
29
Unusual number of chromosomes, more aggressive
Aneuploid
30
3 surgical options for breast cancer
Lumpectomy
Axillary node dissection
Modified radical mastectomy
31
Removes all breast tissue and axillary node dissection; remove breast, LNs, and sentinel node biopsy
Modified radical mastectomy
32
4 things post-mastectomy radiation is recommended for
Patients with tumors over 5 cm
Skin or chest involvement
Positive surgical margins
Over 4 positive LNs
33
Intact breast and removed breast typical dose
Intact: 4680 cGy and 1400 cGy boost = 6080 cGy
Removed: 5040 cGy and 1000 cGy = 6040 cGy (initial dose higher because we don't have to worry about cosmesis)
34
Chemo given to patients before surgery, have locally advanced or inflammatory breast cancer
Get tumor shrinkage, node negative less than 1 cm
Neoadjuvant
35
Chemo given after primary treatment, recommended for all with positive LNs
Adjuvant
36
3 side effects of tamoxifen
Increase calcium bone uptake (decrease osteoporosis)
Decrease cholesterol and heart disease
Increase risk of uterine tumors
37
7 common chemo drugs for breast cancer
```
Doxorubicin
Epirubicin
Paclitaxal
Docetaxal
5FU
Cyclophosphamide
Methotrexate
```
38
2 factors for breast cancer patients to receive bone marrow transplant (BMT), have shown prolonged survival but still investigational
No mets
| 4 or less positive LNs
39
8 common sites of breast cancer mets (most to least common)
```
LN 40-76%
Bone 71%
Lung 69%
Liver 65%
Pleura 51%
Adrenals 49%
Skin 30%
Brain
```
40
5 labs for breast cancer
```
CAAD
Elevated CA 15-3
Serum liver function studies
Bone scans
Chest x-ray
```
41
5 things patients and families can suffer from
```
Depression
Impaired marital relationships
Lowered self-esteem
Developmental delays in children
Behavioral problems with adolescents
```
42
6% of all cancers, 8% of all cancer deaths
Third most common cancer for both genders, second leading cause of cancer deaths
Rate 50 times higher for people over 60-79 years old, environmental
Higher incidence in African Americans
Equal in men and women, rectal higher in men
Lower in people who have a lot of vegetables in diet, high fiber; 5 servings of fruit and vegetables a day
Direct extension most common, LN and blood, and implantation and seeding
Neoadjuvant chemo before surgery, 5FU radiosensitizes and enhances leucovorin
Colorectal cancer (CRC)
43
Median age of diagnosis of CRC
60-65 years old
44
Most common histology of CRC
Adenocarcinoma (90%) arises from constantly-secreting
45
65%, 25%, less than 10%, and less than 5% of anal cancers
65%: squamous
25%: transitional
Less than 10%: adenocarcinoma
Less than 5%: miscellaneous
46
9 contributing factors to CRC
```
Alcohol, especially beer
Tobacco
History of colon cancer
Sedentary employment: inactive
GYN radiation
Inflammatory bowel disease (ex: Crohn's, etc.)
Polyposis
Family history
Irritation of anal canal
```
47
3 irritations of anal canal
Condyloma
Rectal intercourse
Fistulas, tears/fissures, abscesses, hemorrhoids, etc.
48
Anal warts
Condyloma
49
Grade identifies adenocarcinoma: ___% of disease is well-differentiated, ___% moderately differentiated, and ___% poorly differentiated
10% of disease is well-differentiated
70% moderately differentiated
20% poorly differentiated
50
5 year survival for stage I, II, IIIA-C, and IV CRC
I: 93%
II: 85%
IIIA-C: 83-44%
IV: 8%
51
6 signs and symptoms of right/ascending colon disease
```
Abdominal pain
Melena
Weakness due to anemia, common
Obstruction uncommon
Palpable abdominal mass
Anorexia
```
52
Bleeding dark or mahogany red
Melena
53
3 signs and symptoms of transverse colon disease
Blood in stool
Change in bowel pattern
Potential bowel obstruction
54
12 signs and symptoms of left/descending colon disease
```
Colicky pain
Bleeding red mixed with stool
Obstruction common
Weakness due to anemia, uncommon
Nausea and vomiting
Constipation alternating with diarrhea
Decreased caliber of stool
Tenesmus
Fatigue
Anorexia
Failure to thrive
Right upper quadrant (RUQ) pain (common hepatic duct leads to liver mets)
```
55
Caliber
Size
56
Feeling you have to go to the bathroom due to narrowing, ineffective and painful straining during a bowel movement (BM)
Tenesmus
57
9 signs and symptoms of rectal disease
```
Steady pain
Bleeding bright red, coating stool
Change in bowel movements
Pencil stools
Rectal urgency
Fecal incontinence
Spasmodic contractions
Peineal and buttock pain
Tenesmus
```
58
4 signs and symptoms of anal disease
Bleeding
Pain
Sensation of a mass
Severe anal itching
59
6 signs and symptoms of CRC
```
Change in bowel habitus
Blood in stool
Abdominal pain
Anorexia
Flatulence
Indigestion
```
60
3 late signs and symptoms of CRC
Weight loss
Fatigue
Decline in general health
61
CRC percent in descending and sigmoid, ascending, and transverse colon
Descending and sigmoid: 52%
Ascending: 32%
Transverse: 16%
62
Glycoprotein elevates with CRC
Carcinoembryonic antigen (CEA)
63
3 common sites of mets for colon
Liver: venous drainage through colon
Lungs
Peritoneum
64
Colon cancer goes through bowel wall and sheds into bowel cavity
Peritoneal seeding
65
Common mets site of rectal disease
Lung: venous drainage through hemorrhoidal veins
66
3 common sites of mets for anus
Liver
Lungs
Inguinal nodes
67
4 complications due to CRC
Bowel perforation
Obstruction of surrounding genitourinary organs
Hemorrhage
Liver failure
68
Start screening for CRC at ___ years old, high risk at ___-___ years
50
| 40-45
69
6 ways CRC is diagnosed with no symptoms
```
Fecal occult blood test (FOBT)
Fecal immunochemical test (FIT)
Flex sigmoidoscopy
Double contrast barium enema (BE)
Colonoscopy
Digital rectal examination (DRE)
```
70
Sample for blood in stool at home in clean container and spread on card
False positives with red meat, iron, tomatoes, etc.; false negatives with low fiber diet 72 hours before test
Fecal occult blood test (FOBT)
71
Sample for blood in stool at home with long-handled brush smeared on card, no dietary restrictions
Fecal immunochemical test (FIT)
72
How often should FOBT and FIT, flex sigmoidoscopy, BE, and virtual CT, colonoscopy, and DRE be done?
FOBT and FIT: annually
Flex sigmoidoscopy, BE, and virtual CT: every 5 years
Colonoscopy: every 10 years
DRE: not recommended as only test
73
6 diagnostic workups for CRC
H&P: palpate abdomen, breast, and rectum
CBC, liver function test, coagulation profile, CEA, etc.
Endoscopic examination: flex-sig, colonoscopy, biopsy
Transrectal ultrasound for staging
Double contrast BE (noninvasive)
Diagnostic studies: CT chest, abdomen, and pelvis; MRI for soft tissue of abdomen and pelvis
74
4 ways high fiber diet protects colon
Decreasing transient time in intestine
Diluting carcinogens in stool
Altering pH in colon
Decreasing ammonia concentrations in intestine
75
_______ is primary treatment of CRC, over _______ of patients can be cured with surgical resection
Surgery, half
76
Treatment of choice for anal disease because of sphincter
Chemo and RT
77
5 ways colostomy is managed
Clean the peristomal skin with soap and water, don't submerge self down to stoma
Apply disposable pouch over the stoma
Empty the pouch when it's 1/3 full of stool and/or flatus
Change the pouch every 4-7 days if there's no leakage
Adequate fluids, no nuts or seeds, avoid beans, cabbage, and brussel sprouts (flatulence), avoid heavy lifting and pulling, etc.
78
3 pre-op RT indications for CRC
Reduce bulky rectal cancers
Improve rate of resectability
Eradicate microscopic disease
79
Advantage of pre-op RT for CRC
Better blood flow
80
4 post-op RT indications for CRC
Prevent local recurrence in stage B or C rectal cancers
Remove remaining disease if positive surgical margins
Disease invades other organs
Palliatively to decrease painful mets or control bleeding
81
About ___% of CRC patients require surgical colostomy, every patient after this surgery require colostomy to rest area
15%
82
8 CRC related complications from RT
```
Skin irritation: erythema, dry or moist desquamation, and hyperpigmentation
Proctitis
Nausea/vomiting
Diarrhea
Bone changes: obstruction, fibrosis, adhesions, and fistulas
Sexual dysfunction
Myelosuppression
Fatigue
```
83
Inflammation of rectal lining
Proctitis
84
Inflammation of bladder
Cystitis
85
About ___% of CRC patients die of mets due to left behind disease, chemo important
50%
86
2 CRC chemo regimens
FOLFOX
| FOLFIRI
87
FOLFOX
5FU, leucovorin, and oxaliplatin
88
FOLFIRI
5FU, leucovorin, and irinotecan
89
Secrete/produce hormones directly into the bloodstream for transport throughout the body
Endocrine glands
90
Excessive secretion of hormones directly into the bloodstream for transport throughout the body
2017: 59250 new cases, 3010 deaths
Endocrine neoplasms
91
6 common endocrine tumors
```
Pituitary/master gland
Thyroid
Parathyroid
Adrenal glands: benign or malignant
Pancreatic/silent killer
Carcinoid: slow-growing, surgery is treatment of choice
```
92
Four posterior to thyroid, controls calcium
Parathyroid
93
Secretes large amounts of hormones but not endocrine gland, 90% in intestines
Slower growing but have mets potential
Arises from cells
Most common site: appendix
Carcinoid tumors
94
7 hormones secreted by pituitary gland
```
Growth
Prolactin
Thyroid stimulating
Follicle stimulating
Luteinizing
Melanocyte stimulating
Adrenocorticotropic
```
95
Controls body growth
Growth hormone
96
Initiates milk production
Prolactin
97
Controls thyroid gland
Thyroid stimulating hormone
98
Stimulates egg and sperm production
Follicle stimulating hormone
99
Stimulates other sexual and reproductive activity
Luteinizing hormone
100
Hormone that relates to skin pigmentation
Melanocyte stimulating hormone
101
Influences the action of the adrenal cortex
Adrenocorticotropic hormone
102
Cell that produces growth hormone and prolactin
Acidophils
103
Cell that produces thyroid stimulating, follicle stimulating, luteinizing, melanocyte stimulating and adrenocorticotropic hormones
Basophils
104
4 pituitary tumors
Growth hormone
Prolactinomas
Corticotropin (ACTH)-producing tumors
Gonadotropin-producing tumors
105
2 syndromes with growth hormone tumors
Gigantism is kids
| Acromegaly in adults
106
Enlarged extremities and organs
Acromegaly
107
3 syndromes with prolactinomas
Galactorrhea
Amenorrhea
Impotence
108
Abnormal milk discharge, men and infants can develop milk
Galactorrhea
109
Cessation of menstration
Amenorrhea
110
Inability to get erection
Impotence
111
Syndrome with corticotropin (ACTH)-producing tumors
Cushings disease
112
10 clinical features of cushings disease
```
Central obesity
Facial plethora
Moon face
Buffalo hump
Purple striae
Easy bruising
Muscle weakness
Emotional lability
Hypertension
Diabetes mellitus
```
113
Oversecretion of cortisol
Corticotropin (ACTH)-producing tumors
114
Stress hormone
Cortisol
115
Excessive abdominal fat around center of body/stomach area
Central obesity
116
Excess of blood in face
Facial plethora
117
Face develops rounded appearance due to fat deposits on side of face
Moon face
118
Excess deposit of fat localized on the back of the neck
Buffalo hump
119
"Stretch marks"
Purple striae
120
Rapidly changing mood
Emotional lability
121
High blood pressure (BP)
Hypertension
122
Body's ability to produce or respond to insulin reduced
Diabetes mellitus
123
Syndrome with gonadotropin-producing tumors
Reduction of absence of hormone secretion or other physiological activity of the gonads (testes or ovaries), don't have enough sex hormone to testes or ovaries
Hypogonadism
124
Usually benign histologically and rarely metastasize
Can invade local structures such as optic nerves, cavernous sinus, CNS, cervical LNs, liver, and bone
Severe headaches, visual defects, vascular thrombosis, and hydrocephalus
Surgery treatment of choice, incision through nose/sphenoid bone; large invasive tumors: surgery and radiation (SRS)
Prolactinomas: medications
Pituitary tumor
125
7 primary tumors that metastasize to pituitary
```
Breast
Lung
Kidney
Prostate
Liver
Pancreas
Nasopharynx
```
126
2 types of thyroid cancers
Follicular cells
| Parafollicular cells
127
Synthesize thyroid hormones
Follicular cells
128
3 histologies of follicular cell tumors
Papillary 70%
Follicular 15%
Anaplastic 0.5-1.5%
129
Produce calcitonin for calcium and bone metabolism
| Medullary carcinomas develop from these cells, 5-8%
Parafollicular cells
130
Painless thyroid mass
Diagnosis: fine-needle aspiration biopsy
Good prognosis
2017: 56870 new cases, 2010 deaths
Thyroid cancers
131
4 symptoms that suggest thyroid tumor is malignant
Size greater than 3 cm
Rock-hard consistency
Lymphadenopathy
Hoarseness due to vocal cord paralysis
132
Papillary and follicular cure rate and 10 year survival and medullary 10 year survival
Papillary: cure rate over 90%, 95% 10 year survival
Follicular: cure rate over 90%, 90% 10 year survival
Medullary: 75% 10 year survival
133
More invasive follicular disease, loss of differentiation
| Patients die within 6 months-1 year of diagnosis
Anaplastic
134
Treatment for papillary and follicular thyroid disease
Near total thyroidectomy and daily suppression therapy; I131 treatment, stop L-thyroxine (LT4) 4-6 weeks before
LT4
135
Thyroid hormone replacement
L-thyroxine (LT4)
136
Treatment for medullary thyroid carcinoma
Total thyroidectomy and suppression therapy
137
Treatment for anaplastic thyroid carcinoma
Total thyroidectomy, suppression therapy, and sometimes EBRT and doxorubicin chemo
138
Neck mass with lymphadenopathy, hypercalcemia
Elevated levels of parathyroid hormone (PTH), need tissue sample to confirm
Treat with aggressive neck dissection, chemo and RT rarely help
Parathyroid carcinoma
139
5 and 10 year survival of parathyroid carcinoma
5: 88%
10: 49%
140
2 parts of adrenal gland
Adrenal cortex
| Adrenal medulla
141
Outer part of adrenal gland that produces steroid hormones
| Tumors produce excessive cortisol, testosterone, and aldosterone; large amounts of cortisol leads to cushings
Adrenal cortex
142
Inner part of adrenal gland that makes catecholamines
Adrenal medulla
143
Controls potassium and sodium in blood
Aldosterone
144
Manifestations of adrenal tumors if producing aldosterone (2), androgen (2), pheochromocytomas (4), and nonsecreting tumors (2)
Aldosterone: hypertension and hypokalemia
Androgen: virilization in women, asymptomatic in men
Pheochromocytomas: hypertension, sweating, palpitations, and irregular heartbeat
Nonsecreting: pain or weight loss
145
Deficiency of potassium in blood
Hypokalemia
146
Masculine secondary sex; changes: deep voice, balding, facial hair, etc.
Virilization
147
2 treatments of adrenal tumors
Surgery for nearly all hormone secreted tumors and nonsecreting tumors over 6 cm; good prognosis for benign tumors, better in younger patients and smaller localized disease: complete resection and nonfunctioning/nonsecreting
Chemo with mitotane (adrenal hormone) in malignant tumors, RT not effective
148
5 year survival for stage 1 & 2, 3, and 4 adrenal tumors
1 & 2: 65%
3: 40%
4: 10%
149
Endocrine system cells
Islet
150
Digestive enzymes
Exocrine
151
3 hormones produced by pancreas
Insulin
Glucagon
Somatostatin
152
Causes body to take up glucose/sugar
Insulin
153
Liver converts glycogen to glucose
Glucagon
154
Controls release of insulin/glucagon
Somatostatin
155
3 common types of pancreatic islet tumors
Gastrinoma
Insulinoma
Glucagonoma
156
Islet tumor that produces gastrin
Gastrinoma
157
Gastric acid usually created in stomach
Gastrin
158
Produce excessive amounts of insulin
Insulinoma
159
Produce excessive amounts of glucagon
Glucagonoma
160
2 symptoms of pancreatic tumors caused by excessive amounts of gastrin
Multiple or recurrent peptic ulcers
| Zollinger-Ellison syndrome
161
Chronic watery diarrhea
Zollinger-Ellison syndrome
162
4 symptoms of pancreatic tumors caused by excessive amounts of insulin
Hypoglycemia
Confusion
Convulsions
Coma
163
___% of gastrinomas are malignant and ___% benign; true for all other pancreatic tumors except for insulinomas where ___% are malignant and ___% are benign
80%, 20%
| 20%, 80%
164
Can palpate gallbladder due to obstruction of pancreas
Courvoisier's sign
165
4 treatments of islet cell tumors
Surgical resection treatment of choice: whipple procedure
Small meals help with hypoglycemia
Administration of some medications, ex: for ulcers
Chemo: doxorubicin or 5FU and other agents
166
Remove head of pancreas, distal stomach, duodenum, common bile duct, and gallbladder, and vagotomy
Whipple procedure
167
Remove vagus nerve for pain
Vagotomy
168
Symptoms of cutaneous flushing, diarrhea, and wheezing
May develop fibrosis of right heart valves, endocardium, pleura, peritoneum, and retroperitoneum
Advanced carcinoid tumors, mets
Carcinoid syndrome
