Test 3 Flashcards
(112 cards)
1
Q
Adenocarcinomas, lymphomas, and leiomyosarcomas
2017: 28000 new cases, 17750 males and 10250 females; 10960 deaths
US has lowest mortality rate
Usually have advanced disease when symptoms start, not easily detected early
Adjuvant therapy doubles median survival but doesn’t affect 5 year survival
A
Stomach/gastric cancer
2
Q
9 risk factors for gastric cancers
A
Lower socioeconomic status: eating, drinking, lifestyle, etc.
Diets low in fruits and vegetables
Ingestion of salt-preserved or smoked foods
Smoking
Chronic atrophic gastritis
Gastric adenomatous polyps
Hereditary
Pernicious anemia
Barrett’s esophagus and peptic ulcers of lower esophagus often with stricture
3
Q
Inflammation of stomach lining
A
Gastritis
4
Q
Premalignant gastric disease
A
Gastric adenomatous polyps
5
Q
Body can’t absorb enough vitamin B-12, which is needed to make healthy red blood cells (RBCs)
Severe blood disease decreases RBCs
2-3 times higher risk of gastric cancer
A
Pernicious anemia
6
Q
8 symptoms for gastric cancer
A
Anorexia Early satiety Weight loss Palpable abdominal mass Dysphagia Severe anemia Weakness Nausea and vomiting (N&V), hemoptysis
7
Q
Coughing up of blood
A
Hemoptysis
8
Q
5 tests for gastric cancer
A
Upper GI Flexible endoscopic gastroscopy Tumor markers: carcinoembryonic antigen (CEA) PET for staging MRI & CT
9
Q
Highly vascular layer of connective tissue under the basement membrane lining of a layer of epithelium, nourishes the mucosal epithelium and its associated mucosal glands
A
Lamina propria
10
Q
4 treatments for gastric cancer
A
Complete surgical resection for cure, early stage; relapse within about 2 years
Radiation for palliation of pain and obstruction
Chemo and radiation show improved survival
Chemo is treatment of choice with metastatic gastric
11
Q
90-95% of gastric cancers
A
Adenocarcinomas
12
Q
Gastric cancer occurs most often from ___-___ years old, older patients; rare at less than ___ years old
A
55-90 years old
30 years old
13
Q
Chemo and radiation for gastric cancer drug, dose, and survival
A
Drug: 5FU
Dose: 40-50 Gy
Survival: 5.9-12 months
14
Q
Stomach empties too soon and can’t digest food properly leading to profuse sweating, nausea, dizziness, and weakness
A
Dumping syndome
15
Q
Stage 1, 2, and 4 survival for gastric cancer and 5 year survival with and without LN involvement
A
1 = 67% 2 = 31% 4 = 5% With = 10-25% Without = 75%
16
Q
More common in males; more common and higher mortality rate in African Americans
2017: 53670 new cases, 27070 males and 25700 females; 43000 deaths
A
Pancreatic cancer/silent killer
17
Q
Pancreatic cancer median and 5 year survival
A
Median: 9-12 months
5 year: 6%
18
Q
Peak age of pancreatic cancer is ___-___ years old and is rare before ___ years old
A
60-80
45
19
Q
8 risk factor of pancreatic cancers
A
Cigarette smoking and over 4 drinks a day
Diet high in fat and low in fruits and vegetables
Previous partial gastrectomy
Diabetes mellitus type 2 and obesity for over 5 years
Occupational exposure: petroleum compounds, beta naphthylamine (cigarettes), and benzene
Lower socioeconomic status
Hereditary pancreatitis
Coffee drinkers
20
Q
95% if pancreatic cancer occurs in the _______ portion and 90-95% are ____________
Majority arise in proximal _______ and _______ of pancreas on right side
A
Exocrine, adenocarcinomas
Head and neck
21
Q
Digestive system
A
Exocrine
22
Q
8 symptoms of pancreatic cancer
A
Abdominal pain: main Anorexia, weight loss, and early satiety Sleep problems and fatigue Jaundice Nausea and vomiting Diarrhea or constipation Ascitis Courvoisier's sign
23
Q
5 tests for diagnosis of pancreatic cancer
A
Abdominal ultrasound CT Endoscopic retrograde cholangiopancreatography (ERCP) Increased CA 19-9 Biopsy for histology
24
Q
Palpably enlarged gallbladder
A
Courvoisier’s sign
25
3 treatments for pancreatic cancer
Whipple procedure
Chemo
Radiation after surgery or inoperable
26
6 organs removed and 1 nerve block during whipple procedure
```
Head of pancreas
Duodenum
Distal stomach
Common bile duct
Gallbladder
Vagotomy sometimes
Celiac plexus block
```
27
Remove part of the vagus nerve, 50% alcohol at vagus nerve
Vagotomy
28
Injection of local anesthetic (50% alcohol) into or around celiac plexus bundle of nerves at xiphoid
Celiac plexus block
29
En-bloc resection doubles median survival of pancreatic cancer
Whipple procedure
30
Median survival of pancreatic cancer
15-19 months
31
Chemo for pancreatic cancer mets after surgery or for inoperable disease
Gemcitabine
32
10-20% of pancreatic cancers are resectable: stage 1 (T___-T___, no ___ or ___)
T1-T2, no N or M
33
Liver and bile duct cancer
High fatality rate
2017: 40710 new cases, 29200 males and 11510 females; 28920 deaths
Diagnosis: US, MRI, and CT
Hepatocellular carcinoma (HCC)
34
Most primary liver cancers in adults are __________ and are ___________
Hepatocellular, adenocarcinomas
35
Arise from hepatocytes
Hepatocellular
36
7 HCC risk factors
Chronic infection with hepatitis B, C with or without cirrhosis
Preexisting cirrhosis, almost always associated with cirrhosis: heavy drinker, infections, etc.
Aflatoxin
Hormones: oral contraceptives over 8 years or long-term use of androgen
Being male: 3/4 cases
Obesity and diabetes
Heavy alcohol use and tobacco
37
Steroid-type hormone like testosterone
Androgen
38
8 symptoms of HCC
```
RUQ pain most common
Fatigue
Abdominal swelling
Weight loss
Unexplained fever
Jaundice
Elevated alpha-fetoprotein (AFP) tumor marker, 70% of patients
```
39
Mutated P53 tumor suppressor gene
Aflatoxin
40
5 treatments of HCC
Surgery is only cure/main treatment, only 15% are resectable
Hepatic intra-arterial infusion of chemo
Liver transplant
Radiation not curative
Single agent chemo: doxorubicin, 5FU, and cisplatin
41
5 year survival and 2 year recurrence for HCC with resected tumor
5 year: 33-47%
| 2 year: 55%
42
5 year and median survival for HCC with unresected tumor
5 year: less than 10 months
| Median: 3-6 months
43
4 conditions gallbladder cancer is associated with
Cholecystitis and cholelithiasis associated with a majority of cases because irritation causes proliferation of cells
Ulcerative colitis
Age 60-70, older; rare before age 40
More common in females
44
2017: 11740 new cases, 5320 males and 6420 females; 3830 deaths
RT controversial; chemo for resected tumors to increase survival and unresected tumors show response but no evidence of increased quality of life (QOL) or cure
Gallbladder cancer
45
Cause of gallbladder cancer
Unknown
46
Gallbladder cancer is usually _________ and _________ disease when found
Asymptomatic, advanced
47
5 year survival of gallbladder cancer based on ______
Stage
48
Gallbladder cancer spreads by ______________ to local areas like liver, stomach, duodenum, etc. and becomes unresectable
Direct extension
49
Treatment of choice of gallbladder cancer
Surgery
50
Most common type of gallbladder cancer
Adenocarcinoma
51
5 year survival of stage 0, 1, 2, 3, and 4 gallbladder cancer
0: 80%
1: 50%
2: 28%
3: 7%
4: 2%
52
Chemo regimen for gallbladder cancer
FAM
53
FAM
5FU
Doxorubicin
Mitomycin
54
3 chemo drugs that have shown some benefits of survival for advanced gallbladder disease
Gemcitabine
Fluoropyrimidine
Platinum-based agents
55
7 common sites of gynecological (GYN) cancers
```
Endometrial
Ovarian
Cervical
Fallopian tubes
Vagina
Vulva
Gestational neoplasms
```
56
Epithelial surface, lining of uterus
Endometrium
57
Average/median age of endometrial, ovarian, and cervical cancer
Endometrial: 55-70+ (postmenopausal)
Ovarian: 63, 50-70
Cervical: 48, 30-39 and 60-69
58
Neoplasms related to pregnancy
Gestational neoplasms
59
Staging for cervical cancer accepted by International Federation of Gynecology and Obstetrics (FIGO)
TNM
60
Spaces between cervix past fornices in bony structure of pelvis
Parametrium
61
Treatment for early stage 1 cervical disease, tissue removed by scalpels, etc. in cone-shape; lower morbidity and easier recovery
Cone biopsy
62
2 types of cone biopsies
Endocervical
| Exocervical
63
Cervical disease higher up in surface, longer wedge piece removed
Endocervical cone biopsy
64
Cervical disease in cervical oss, wider portion removed
Exocervical cone biopsy
65
One of the only preventable cancer because of its long malignant/invasive state that can be detected on pap smears
External RT gives good survival rates for early disease; hysterectomy depends on stage of disease, patient's health and age, etc.
Can be squamous, adenocarcinoma, adenosquamous, small, or glassy cell carcinomas
EBRT and implant due to the dose limits of surrounding structures
1.5% of new cancers in women and cancer deaths
2017: 12820 new cases, 4210 deaths
Cervical cancer
66
Most common cervical cancer because it's in direct contain with carcinogens
Squamous cell carcinomas
67
6 risk factors of cervical cancers
Early coitus and more than 5 partners
Human papillomavirus (HPV) and warts
HIV
Low socioeconomic status: don't have resources/screenings
Smoking causes precancerous changes in cervix
Oral contraceptives for over 5 years
68
HPV responsible for ___% of cervical cancer patients
99%
69
Intercourse before age of 18
Early coitus
70
7 symptoms of cervical cancer
```
Abnormal vaginal bleeding most common
Thin, watery vaginal discharge
Heavier menses
Post-coital spotting
Spontaneous, intermittent uterine bleeding
Back, flank, and leg pain
Lower extremity edema
```
71
6 symptoms of late cervical disease
```
Dysuria
Hematuria
Pelvic pressure
Rectal bleeding
Flank and leg pain
Cough (advanced moving disease)
```
72
Foul-smelling fluid
Malodorous serosanguinous
73
Pain during sex
Dyspareunia
74
Tumors during pregnancy
Gestational trophoblastic disease (GTD)
75
4 terms with a pap smear
Atypia
Dysplasia
Cervical intraepithelial neoplasia (CIN)
Squamous intraepithelial lesion (SIL)
76
Structural abnormality in cell, not typical/atypical and doesn't give much information
Atypia
77
Distinct abnormality of cellular development, premalignant disease; rated mild, moderate, or severe based on deviation from normal appearance of cell
Dysplasia
78
Identifies dysplastic category 1, 2, or 3; dysplasia increases with level
Cervical intraepithelial neoplasia (CIN)
79
CIN when HPV is present in patient
Squamous intraepithelial lesion (SIL)
80
Treatment of early cancer confined to cervix smaller than 4 cm, 4 cm and confined to cervix, and cancer beyond cervix into the parametria
Early cancer confined to cervix smaller than 4 cm: radical hysterectomy and LN dissection
4 cm and confined to cervix: radiation then simple hysterectomy
Cancer beyond cervix into the parametria: radiation and/or chemo
81
2 ways to avoid hysterectomies in younger cervical cancer patients because of fertility
Trachelectomy/cervicectomy
| Intracavitary treatment: tandem, ovoid, heyman's capsules, etc.
82
Remove cervix and leave uterus, still childbearing
Trachelectomy/cervicectomy
83
3 types of hysterectomies
Extrafascial/simple
Modified radical
Radical
84
Entire uterus and cervix removed, done vaginally or abdominally
Extrafascial/simple hysterectomy
85
Remove uterus, cervix, small portion of upper vagina, and inner third of perimetria
Modified radical hysterectomy
86
Outer serous layer of the uterus
Perimetria
87
Removed upper 3 cm of vagina, most of perimetria, uterus, cervix, and regional LN dissection and ureters dissected out of urethral sacral ligaments
Radical hysterectomy
88
Radical surgical procedure that involves the removal of the uterus, vagina, parametria, bladder (anterior), and rectum (posterior) for advanced disease
For recurrent cancer with curative intent leads to a loss of QOL and high rate of morbidity
Pelvic exenteration
89
Fallopian tubes and ovaries removed
Salpingo-oophorectomy
90
3 types of pelvic exenterations
Anterior
Posterior
Total
91
Remove urethra, lower part of ureters, cervix, vagina, and bladder; stoma for urine
Anterior pelvic exenteration
92
Remove lower part of large bowel, rectum, uterus, cervix, ovaries, fallopian tubes, vagina, and LNs may be removed
Posterior pelvic exenteration
93
Remove bladder, rectum, and internal reproductive organs; permanent colostomy and urinary diversion
Total pelvic exenteration
94
Radiation dose for cervical cancer
70-90 cGy with implants
95
2 chemo drugs that increase radiosensitivity of cervical cancer
5FU
| Cisplatin
96
2.6% of new cancers and 5% of cancer deaths in women
No reliable tests for screening asymptomatic women
Most deadly of GYN diseases
Ovarian cancer
97
7 ovarian cancer cells
```
Epithelial carcinoma most common
Malignant germ cell tumors most common
Endometrioid
Clear cell
Brenner
Undifferentiated diseases
Sarcomas
```
98
7 risk factors of ovarian cancer
Risk increases until age 70
Family history of ovarian, breast-ovarian, or breast-ovarian-endometrial-colon especially if two or more first degree relatives have disease
Incessant ovulation
Northern European ancestry or line in western industrialized countries
BRCA 1 and 2 accounts for 15% of ovarian diseases
Perineal talc powders
Low risk factors: high dietary fat and excessive coffee and alcohol consumption
99
Proteins that repair damaged genes/DNA
Breast cancer susceptibility gene 1 and 2 (BRCA 1 and 2)
100
Birth control _______ risk significantly by as much as 50% but ________ chance of cervical and liver disease
Lowers, increases
101
8 symptoms of ovarian disease
Abdominal/pelvic pain and abdominal distension most common
Increased flatus
Changes in GI function
Abdominal girth: aggressive
Weight gain: aggressive
Pain: aggressive
Dyspepsia, anorexia, and early seity can be some of the first symptoms seen
Pressure and general discomfort in rectum, bladder, and pelvis
102
Treatment of early stage 1 and stage 2-4 ovarian cancer
1: removal of one of ovaries with adjuvant chemo, 3-6 cycles of paclitaxal plus platinum based drug
2-4: involved surgical cytoreduction staging which can include hysterectomy, bilateral salpingo-oophorectomy, and omentectomy, and pelvic and paraaortic LN dissection; chemo
103
7% of new cancers and 3.9% of cancer deaths i women
| 17: 61380 new cases, 10920 deaths
Endometrial cancer
104
7 endometrial cancer cell types
```
Adenocarcinoma/glandular epithelium most common: 75-80%
Adenosquamous
Squamous
Mucinous
Serous papillary
Clear cell
Undifferentiated
```
105
7 risk factors for endometrial cancer
Unopposed exogenous estrogen
Nulliparity, infertility, and anovulation
Late menopause over 52 years old
Obesity: fat cells produce estrogen and reduce level of sex hormones
Diabetes mellitus and hypertension
Family history
Complex atypical hyperplasia
106
Estrogen not combatted by progesterone leads to thickening of uterine lining, women with uterus removed don't have to worry about progesterone
Unopposed exogenous estrogen
107
6 symptoms of endometrial cancer
```
Abnormal uterine bleeding most common: about 80%
Pap smear abnormality
Urinary changes
Yellow, watery vaginal discharge
Pyometra and hematometra
Hypogastric and lumbosacral pain
```
108
Accumulation of pus in uterus
Pyometra
109
Accumulation of blood in uterus
Hematometra
110
4 symptoms of advanced endometrial disease
Uterine enlargement
Pelvic pressure
Leg swelling
SOB
111
Body of womb/uterus
Corpus
112
Wound ruptures/splits open
Wound dehiscence
