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Specific Cancer Facts Flashcards

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1
Q

Breast Cancer:
What NEW number of cases (female only) in 2021?

How many deaths?

A

In 2021:

281,550 new cases of female only breast cancer

43,600 deaths

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2
Q

Breast Cancer:
What are four different structures of the breast and corresponding cancers called?

A

Lobules (glands that make breast milk) = lobular cancers

Ducts (small canals that come out from the lobules and carry the milk to the nipple) = ductal cancers

Nipple (opening in the skin of the breast where the ducts come together so the milk can leave the breast) and Areola (darker thicker skin surrounding the nipple) = Paget disease

Stroma (the fat and connective tissue surrounding the ducts and lobules) = phyllodes tumor

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3
Q

Name two cancers that can originate in the breast though are generally NOT considered breast cancers

A

Sarcomas (ie angiosarcoma)

Lymphomas

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4
Q

What are 12 risk factors of Breast Cancer?

A

1.Early menarche (before 12)
2. Late menopause (after 55)
3. First live birth after age 30
4. Nulliparous
5. Recent hormonal contraceptive use
6. BP (Biopsy Proven) proliferative disease
7. BP proliferative disease with atypical hyperplasia
8. Alcohol intake 2+ drinks/day
9. Obesity
10. 1st degree relative w/ post-menopausal breast cancer
11. 1st degree relative w/ pre-menopausal breast cancer
12. Prior Hx of invasive breast cancer
13. Current hormone replacement therapy use with estrogen and progesterone (5+ years)
14. Inherited gene mutation (ie. BRCA1, BRCA2)
15. High breast density

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5
Q

What are two Primary Prevention methods for Breast Cancer?

A
  1. Lifestyle changes (ie. health weight, regular exercise, limit alcohol intake)
  2. Chemoprevention - high risk individuals increasingly are taking Tamoxifen and Raloxifene to decrease risk
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6
Q

What is one Secondary prevention method for Breast Cancer? What are 3 related controversies?

A

Screening! is a Secondary prevention method for Breast Cancer

Screening controversies:
1. Variable screening accuracy, access disparity, recommended intervals, methods.

  1. Though self-breast examination has shown NO benefit in reducing breast cancer mortality, individuals should be aware of any breast changes and promptly seek evaluation if concerned
  2. Mammography advancements have significantly improved accuracy and breast cancer survival for women 60-69 y/o (and likely for 50-59 y/o)
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7
Q

What are 6 Mammogram accuracy variables?

A
  1. Breast tissue (dense vs. fatty)
  2. tumor characteristics
  3. facility/imaging device
  4. technician
  5. Radiologist
  6. use of digital mammography or tomosynthesis (3D)
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8
Q

What are 4 Tertiary prevention method for Breast Cancer?

A
  1. Ongoing surveillance (of secondary cancers and/or treatment-related complications)
  2. Chemoprevention (ie if ER(+) SERD/SERM/AI)

If VERY high risk:

  1. Prophylactic mastectomy
  2. Prophylactic BSO
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9
Q

Name 3 Early Breast Cancer Signs/Symptoms

A
  1. Painless lump
  2. Thickening
  3. Peau d’orange (orange peel appearance) caused by lymphedema of the pores
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10
Q

Name 8 Late Breast Cancer Signs/Symptoms

A
  1. Nipple retraction
  2. Nipple discharge
  3. Nipple elevation (may indicate fixed tumor)
  4. Change in breast symmetry or contour
  5. Change in breast color
  6. Breast dimpling or puckering
  7. Heat or erythema
  8. Skin ulceration
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11
Q

What are 7 typical diagnostic and staging exams/procedures for Breast Cancer?

A
  1. Mammogram
  2. US
  3. biopsy

More likely completed if stage III or IV suspected:
4. CT
5. MRI
6. PET
7. Bone scan

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12
Q

Breast Cancer Staging includes what 7 key pieces of information?

A
  1. T
  2. N
  3. M
  4. ER (Estrogen Refceptor) status
  5. PR (Progesterone Receptor) staus
  6. HER2 (human epidermal growth factor receptor 2)
  7. Grade
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13
Q

What are 5 factors that influence Breast Cancer treatment choices?

A
  1. Menopausal status
  2. Stage
  3. Grade
  4. ER/PR status
  5. HER2 status
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14
Q

What is the leading Histologic type of breast cancer?

What % of all breast cancers does this histologic type account for?

A

Ductal

70-80%

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15
Q

What are 9 Histologic Types of Breast Cancer?

A
  1. Ductal
  2. Lobular
  3. Medullary
  4. Tubular
  5. Mucinous
  6. Inflammatoriy (clinical diagnosis)
  7. Metaplastic
  8. Paget disease
  9. Malignant phyllodes
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16
Q

What are 3 grades of Breast Cancer?

A
  1. Grade 1 = well differentiated
  2. Grade 2 = moderately differentiated
  3. Grade 3 = poorly differentiated
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17
Q

What are the most common 3 Molecular markers in Breast cancer?

A
  1. ER (Estrogen Receptor) status
  2. PR (Progesterone Receptor) staus
  3. HER2 (human epidermal growth factor receptor 2)
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18
Q

What are 2 common Breast Cancer gene profiling assays used?

What treatment decisions do these assays help to determine?

A
  1. Oncotype DX 21
  2. MammaPrint

Help to determine if Chemotherapy will provide an additional survival benefit to endocrine therapy

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19
Q

Name 5 Treatment Modalities used to treat Breast Cancer

A
  1. Chemotherapy: neoadjuvant (prior to surgery) & adjuvant (post-surgery)
  2. Radiation Therapy (local control of disease)
  3. Surgery
  4. Hormonal
  5. Targeted therapies (ie. HER2, EGFR, CDK4/6)
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20
Q

What are 4 most common Breast Cancer Metastatic sites?

A
  1. Bone & Bone Marrow (spine/ribs/proximal long bones)
  2. Liver
  3. Lung
  4. Brain
  5. Chest wall
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21
Q

What is the Second leading Cancer Diagnosis in the US with the highest Mortality rate in both Men and Women?

A

Lung Cancer

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22
Q

In 2021 what were the new cases and deaths caused by Lung Cancer?

A

235,760 new cases (about 13% of all cancers)

131,880 deaths (Leading cause of cancer death in M & F, 22% of all cancer deaths)

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23
Q

Name Lung Cancer types

A

Small cell lung cancer (SCLC)
Non-small cell lung cancer (NSCLC)

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24
Q

What percentage of all lung cancers does Small cell lung cancer (SCLC) comprise?

A

Small cell lung cancer (SCLC) makes up about 13% of all lung cancers.

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25
What is the largest risk factor for development of Small cell lung cancers (SCLC)?
Smoking tobacco
26
Is the TNM staging system generally used for Small cell lung cancer (SCLC)?
Perhaps the Veteran's Administration Lung Cancer Study Group staging (limited vs. extensive) disease is used for SCLC instead of the TNM staging since SCLC is typically centrally located, diagnosed at an advanced stage (fast growing, diffuse, and aggressive), often with metastasis.
27
What % of Small Cell Lung Cancer (SCLC) present with Limited disease? What are some disease characteristics of Small Cell Lung Cancer (SCLC) Limited disease?
SCLC Limited disease makes up ~1/3 of new case SCLC Limited disease is defined as: 1. Disease confined to one lung 2. Below supraclavicular area 3. disease can be included in one radiation treatment field 4. Median survival = 16-24 months 5. 14% 5-year survival rate
28
What % of Small Cell Lung Cancer (SCLC) present with Extensive disease? What are some disease characteristics of Small Cell Lung Cancer (SCLC) Extensive disease?
Small Cell Lung Cancer (SCLC) Limited disease makes up ~2/3 of new case Extensive disease SCLC is defined as: 1. Often involving both lungs 2. Metastasis outside the lungs (brain, bone, liver, and adrenals) 3. Median survival = 6-12 months 4. Long-term survival = rare
29
What are the typical treatments for Small Cell Lung Cancer (SCLC)?
SCLC treatment usually includes Chemotherapy + thoracic and disease usually responds readily to chemotherapy; however, SCLC most often recurs rapidly. RT may also be used for: Prophylaxis and treatment of brain metastases.
30
What percentage of Lung cancers are Non-small cell lung cancer (NSCLC)?
84% of all Lung cancers are Non-small cell lung cancer (NSCLC).
31
What are 3 types Non-small cell lung cancer (NSCLC)?
1. Squamous cell (often central & vascular = hemoptysis) 2. Large cell 3. Adenocarcinoma (MOST common, typically peripheral lesions, though can be both)
32
How are Non-Small Cell Lung Cancer (NSCLC) and Small Cell Lung Cancer (SCLC) staged?
NSCLC = staged with TNM system SCLC = staged with Veteran's Administration Lung Cancer Study Group staging (limited vs. extensive) disease
33
What are 5 Risk Factors for Lung Cancer?
1. Cigarette smoking (leading cause) and other combustible tobacco products (cigars, pipes, waterpipes) 2. Radon gas (2nd leading cause & #1 leading cause among non-smokers) A direct by-product of radioactive decay of radium-226 present naturally in rocks and soil. 3. Second hand smoke (3rd leading cause) 20-30% risk 4. Other environmental exposures. * Occupational (ie asbestos, soot, coal-tar pitch, nickel, chromium, aluminum production plants) * Air pollution (accounts for 1-2% of lung cancer deaths) 5. Personal or Family history
34
In 2023 what 2 populations have the highest smoking rates?
American Indian and Alaska Natives (AIAN) * Northern Plains (42% adult smoking rate) * Southwest (19% Men, 15% Women smoking rates) Fewer quit attempts and slower cessation compared to other racial groups Native Hawaiians (19.6% smoking rates reported in 2018-2020)
35
How are education and income linked to smoking rates and Lung Cancer risk?
Higher smoking rates are linked to lower education and lower income levels
36
What are other factors influence Lung Cancer risk associated with cigarette smoking?
1. Quality healthcare access 2. Targeted deceptive tobacco product advertising 3. Lack of tailored smoking-cessation programs
37
What two populations have higher smoking-related lung cancer risk?
1. Native Hawaiians 2. Blacks (as compared to White, Japanese American, or Hispanic)
38
What 5 US states have the highest levels of Radon (the 2nd leading cause of Lung Cancer)?
1. Alaska 2. South Dakota 3. Pennsylvania 4. Ohio 5. Washington
39
What are 8 Lung Cancer Signs and Symptoms?
1. Cough (most common, wet or dry) 2. Dyspnea 3. Hemoptysis (most commonly seen with SCLC, Squamous cell NSCLC, and centrally located tumors) 4. Chest pain 5. Pleural effusions (associated with nagging dry cough & DOE) 6. SVC syndrome = an oncologic emergency, occurs when the SVC is compressed (~60-90% of SVC syndrome cases are caused by Cancer, ~65% of the cases by Lung Cancers) 7. Hoarseness 8. Pericardial effusion, tamponade, dysphagia, and bronchorrhea
40
What are 5 Metastatic Lung Cancer Signs and Symptoms?
1. Fatigue 2. Pain (especially due to bone mets) 3. Brain Mets S&S (Seizures, HA, AMS, N/V) 4. Anorexia and Weight loss (5%(+) weight loss at diagnsis = poor prognostic indicator) 5. GI obstruction due to mets (liver, adrenal glands, abdominal LN)
41
Paraneoplastic Syndromes: 1. Occur when? 2. Affect what % of Lung Cancer patients? 3. Are more common in what type of lung cancer? 4. Affect prognosis how?
Paraneoplastic Syndromes 1. Occur when the immune system has a reaction to a cancerous tumor (hormones, growth factors, cytokines or antibodies secreted by the tumor) 2. Occur in approximately 10% of lung cancer patients 3. More common in SCLC 4. Often correlated with a poor prognosis
42
Name 7 Paraneoplastic Syndromes
1. Humoral hypercalcemia of malignancy 2. Ectopic adrenocorticotropic hormone syndrome 3. Syndrome of inappropriate antidiuretic hormone 4. Lambert-Eaton myasthenic syndrome 5. Paraneoplastic Cerebellar degeneration 6. Trousseau syndrome 7. Hypertrophic pulmonary osteoarthropathy, clubbing
43
For Lung Cancer, define 1 pack year
1 pack year = smoking 1 pack/day for one year If 2 packs/day for 25 years = 50 pack years
44
What 4 criteria indicate screening for Lung Cancer?
1. Current or former heavy smoker (within 15 years) 2. 30 pack-year history 3. Age 55-74 4. Asymptomatic
45
What are the most common Lung Cancer metastatic sites?
1. Brain 2. Liver 3. Bone (including spine)
46
What are common Molecular tests associated with Lung Cancer?
1. EGFR (Epidermal Growth Factor Receptor) - Mutations occur in 50% of patients with Adenocarcinoma (more common in Asians, women, and never-smokers) * Sensitivity to TKI (Tyrosine Kinase Inhibitors) 2. ALK (anaplastic lymphoma kinase) variants. ALK was originally described in lymphoma, but most ALK-positive cancers are in NSCLC non-small cell lung cancer) * Several targeted therapies 3. KRAS (Kirsten RAt Sarcoma - viral oncogene homolog) is an oncogene that encodes a small GTPase transductor protein called KRAS = a signal transduction protein) * Resistant to TKI (Tyrosine Kinase Inhibitors) * Poorer prognosis
47
What are treatment modalities for Lung Cancer?
1. Surgery 2. Chemotherapy 3. Targeted therapy 4. RT
48
What are 5 different targeted therapies for NSCLC?
1. EGFR variants (Afatinib, Erlotinib, Geftinib, Osimertinib) 2. ALK rearrangement (Alectinib, Certinib, Crizotinib, Brigatinib) 3. ROS1 rearrangement (Certinib, Crizotinib) 4. BRAF variants (Dabrafenib) 5. PD-L1 expression (Atezolizumab, Nivolumab, Pembrolizumab)
49
What are NSCLC Survival Statistics for: 1. Overall survival 2. Limited or local disease 3. Distant
1. Overall survival = 18% 2. Limited or local disease survival = 56% 3. Distant disease survival = 5%
50
Name 4 Positive Prognostic Factors for NSCLC?
1. Early stage 2. Good ECOG 3. Less than 5% weight loss 4. Female
51
What % of Lung cancer patients experience Dyspnea? Name 5 strategies to manage Dyspnea
65% of lung cancer patients will experience Dyspnea Manage Dyspnea: 1. If acute, rule out PE 2. Supplemental O2 3. Pharmocologic (i. e., opioids, bronchodilators, diuretics, benzodiazepines) 4. Raising the head of the bed 5. If Pleural Effusions: * Thoracentesis, * talc pleurodesis
52
Name 3 strategies to manage Cough and Hemoptysis in Lung Cancer patients.
Encourage patients to report symptoms immediately 1. Bleeding: Evaluation and a bronchoscopy to cauterize bleeding vessels, or RT 2. Pharmacologic: * Opioids provide the best relief, especially when added to a syrup. * Benzonatate (capsule) numbs the throat and lungs, which minimizes chronic irritation and cough. 3. r/o underlying infection (especially with a productive cough) or interstitial pneumonitis (if patient is being treated with a TKI).
53
Name 3 causes of Fatigue (in Lung Cancer and all Cancer)
Fatigue is caused by: 1. Disease 2. Treatment 3. Dehydration 4. Anorexia 5. Depression
54
Name 5 strategies to manage Fatigue in Lung Cancer patients.
1. Teach energy conservation techniques (such as dividing ADLs into smaller steps) 2. discuss sleep habits and hygiene 3. Request a referral to rehabilitation services 4. Encourage exercise as tolerated. 5. Encourage participation in support groups and/or cognitive behavioral therapy.
55
What are 3 causes of Pain in Lung Cancer patients?
Pain can occur from: 1. Tumor location - especially Pancoast tumors, located in the lung apex (supraclavicular area), which can press on adjacent nerves 2. Metastatic location including bone and/or vertebrae 3. Spinal cord compression (an oncologic emergency)
56
How can Lung Cancer Pain be treated?
1. Pain medications * narcotics * neuromodulators 2. palliative radiation 3. Bisphosphonates (combined with radiation) for lytic bone lesions 4. Surgery to stabilize weak bones that are at risk for fracture
57
What is the treatment of choice for Stage I and Stage II NSCLC?
Surgery
58
What are common metastatic site(s) for Bladder?
Bone, liver, lung
59
What are common metastatic site(s) for Breast?
Bone, brain, liver, lung
60
What are common metastatic site(s) for Colon?
Liver, lung, peritoneum
61
What are common metastatic site(s) for Kidney?
Adrenal gland, bone, brain, liver, lung
62
What are common metastatic site(s) for Lung?
Adrenal gland, bone, brain, liver, other lung
63
What are common metastatic site(s) for Melanoma?
Bone, brain, liver, lung, skin, muscle
64
What are common metastatic site(s) for Ovary?
Liver, lung, peritoneum
65
What are common metastatic site(s) for Pancreas?
Liver, lung, peritoneum
66
What are common metastatic site(s) for Prostate?
Adrenal gland, bone, liver, lung
67
What are common metastatic site(s) for Rectal?
Liver, lung, peritoneum
68
What are common metastatic site(s) for Stomach?
Liver, lung, peritoneum
69
What are common metastatic site(s) for Thyroid?
Bone, liver, lung
70
What are common metastatic site(s) for Uterus?
Bone, liver, lung, peritoneum, vagina
71
2021 What are gastric cancer: New cases and Deaths in US? What percentage are adenocarcinomas?
Gastric cancer New cases: 26,560 Deaths: 11,180 95% are adenocarcinomas
72
Name 15 Gastric Cancer risks.
1. Infection (Helicobacter pylori or Epstein-Barr) 2. Age 3. Male 4. Ethnicity: Hispanic, African, Asian Pacific Islander, Native American 5. Diet: low in fruits/veg and high in salted/smoked 6. Chronic GI conditions (gastritis, polyps, hypertrophic gastropathy and intestinal metaplasia) 7. Tobacco 8. Pernicious anemia 9. family Hx (Gastric, adenomatous polyposis, heriitary nonpolyposis colon ca syndome (Lynch syndrome)) 10. Overweight 11. Prior stomach surgery 12. Type A blood 13. Occupation: coal/metal/rubber 14. Stomach lymphoma 15. Alcohol use
73
Gastric cancer prevention strategies
1. Smoking cessation 2. Diet: Increase fruits/veg, Decrease salted/smoked processed 3. Infection: Treat H. pylori 4. Decrease Aspirin/NSAIDS
74
True or False There is standard routine screening tests for Gastric Cancer.
False. Several screening tests (e.g., upper endoscopy, serum pepsinogen levels, barium-meal gastric photofuorography) have been used; however, studies did not show decreased death rates with gastric cancer. More research is needed on screening those with high risk factors. Endoscopic surveillance is appropriate for those with significant risk factors.
75
Name 13 S&s of Gastric Cancer
1. Epigastric discomfort 2. Abdominal discomfort 3. Nausea and vomiting 5. Weight loss 6. Dysphagia 7. Anorexia 8. Heartburn or indigestion 9. Anemia 10. Early satiety 11. Blood in stool 12. Ascites 13. Jaundice
76
True or False Endosocopic ultrasound (EUS) is highly accurate to detect Gastric Cancer depth of tumor invasion and involvement of regional nodes.
True. Endosocopic ultrasound (EUS) is highly accurate to detect Gastric Cancer depth of tumor invasion and local involvement of regional nodes. EUS is NOT useful for determining the involvement of distant LN.
77
What staging system is used for Gastric Cancer?
TNM staging
78
What 3 genetic tests should be done with a Gastric Cancer diagnosis?
1. MSI 2. HER2/neu 3. PDL-1
79
Name typical Gastric Cancer treatments
1. Surgery 2. RT 3. Chemo 4. Targeted / Immunotherapy
80
Name 6 Targeted/Immunotherpies for Gastric Cancer.
1. Ramucirumab: anti-VEGFR2 antibody 2. Fam-trastuzumab deruxtecan-nxki: humanized monoclonal antibody (targets HER2, attached to topoisomerase I inhibitor DXd) 3. Trastuzumab: targets HER2 overexpression 4. Entrectinib and larotrectinib (TRK inhibitors used for NTRK gene fusion-positive tumors) 5. Nivolumab: targets PD-L1 6. Pembrolizumab: targets PD-1; MSI-H/dMMR or high tumor variant burden (TMB-H))
81
True or False: Colon cancer is in most cases preventable and curable.
True
82
What percent of the time do both colon and rectal cancers occur in individuals over age 50 years?
90%
83
True of False: Combined, CRCs (colorectal cancers) are one of the leading causes of cancer deaths in the Western world.
True
84
2024 United States Colon and Rectal Cancer Estimates * New cases of colon cancer? * New cases of rectal cancer? * Combined deaths?
2024 United States Colon and Rectal Cancer Estimates * New cases of colon cancer: 106,590 * New cases of rectal cancer: 46,220 * Combined deaths: 53,010
85
Name 3 Non-Modifiable Risks for CRCs (Colorectal cancers)
1. Age = most important risk factor 2. History - Personal history of colorectal adenomas, colorectal cancer, or ovarian cancer - Hereditary conditions, including familial adenomatous polyposis (FAP) and Lynch syndrome (hereditary nonpolyposis colorectal cancer [HNPCC]) - Personal history of long-standing chronic ulcerative colitis or Crohn colitis. 3. Race -HIGHEST in US = American Indian/Alaska Native -African American - Ashkenazi Jews: (Several gene mutations)
86
What is the most common hereditary colorectal syndrome? Most likely in what age? What is lifetime risk?
Lynch Syndrome or hereditary nonpolyposis colorectal cancer (HPNCC) is the most common hereditary colorectal syndrome. * Common in YOUNG colorectal patients * Lifetime risk up to 50% * FAP = Familial adenomatosous polyposis
87
What 3 Races/Ethnic backgrounds are at hightest risk for CRCs
1. American Indian/Alaska Native (highest rates in U.S.) 2. African American 3. Ashkenazi Jews
88
What % of CRC (coleorectal cancer) cases are due to modifiable causes?
55% of CRC cases are due to modifiable causes
89
What are 6 modifable causes of CRCs (colorectal cancers)?
1. Diet (high in red or processed meat and low in fruits/veg) 2. Obesity 3. Physical inactivity 4. Heavy alcohol consumption 5. Long-term smoking 6. Low calcium intake 7. DMII (insulin = increased risk, Metform = decreased risk)
90
List 3 Prognostic factors for CRCs (colorectal cancers) List two two other prognostic factors assoc. with poorer prognosis
1. Degree of penetration of the tumor through the bowel wall. 2. If nodal involvement 3. If distant metastases 1. Bowel obstruction 2. High CEA (carcinoembryonic antigen)
91
List 4 main Histological types of colon cancer:
1. Adenocarcinoma (most colon cancers). 2. Mucinous (colloid) adenocarcinoma. 3. Signet ring adenocarcinoma. Scirrhous tumors. 4. Neuroendocrine - tumors with neuroendocrine differentiation typically have a poorer prognosis than pure adenocarcinoma variants.

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