Test 4 (H&N, RCC, and Testicular) Flashcards by Courtney W

3% of all new cancers
Includes all areas of the head and neck: lips, oral cavity, etc.
17: 49670 new cases, 9700 deaths
Treatment depends on disease site
Sarcomas rare; carotid rupture rare but can be caused by RT or chemo and can be fixed by surgery and pressure

Head and neck (H&N) cancers

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Occurs in younger age group more than other H&N disease, 20% under 30 years old
More common in Chinese than caucasians

Nasopharynx disease

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3 parts of the pharynx

Nasopharynx
Oropharynx
Hypopharynx

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Upper part of pharynx connecting with nasal cavity above soft palate

Nasopharynx

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Part of pharynx between soft palate and hyoid bone

Oropharynx

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Laryngeal part of pharynx extending from hyoid to lower margin of cricoid cartilage

Hypopharynx

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5 risk factors of H&N cancer depending on site

Tobacco use and alcohol most important risk factor for disease site, smokeless tobacco
Advancing age over 50, older people
Epstein-Barr virus (EBV)
Occupational: asbestos, wood dust, leather, and metal breathed in nasal conchae turbinates, and sun exposure
Males, about 3:1 ratio

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___% of lip cancer patients have outdoor occupation

31%

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No known cause of salivary or thyroid, but risk factor for thyroid

Radiation exposure

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Histology that makes up the majority of all H&N cancers, comes in direct contact with carcinogen

Squamous cell carcinomas

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4 early symptoms of H&N cancers

Changes in facial appearance
Sight and smell
Swallowing and speech
Ulceration and pain at primary site

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5 H&N diagnostic tests

History and physical (H&P)
CT, MRI, and PET (recurrence and unknown primary): diagnostic information, lymph node (LN) involvement, etc.
Thyroid scans for thyroid cancer: thyroid tissue swelling and growth versus (vs) nodules
Lab studies
Biopsy for diagnosis, histology to determine treatment method

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5 types of H&N skin cancer

Basal cell: common
Squamous: common
Merkel: more lethal than melanoma, consider LN involvement
Skin appendage: consider LN involvement
Melanoma: consider LN involvement

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H&N skin cancer treatment

Mohs wide excision surgery

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7 indications for thyroid cancer

History of low dose radiation exposure
New nodule in patients over 40 years old
Nodule fixation if thyroiditis is excluded
Rapid growth
Onset of hoarseness
Palpable LN in neck
Solitary nodule in any age male

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Must have thyroid diagnosis before _______ or _______ done

Thyroidectomy or Iodine-131 (I-131)

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Thyroid cancer treatment and treatment for advanced disease/mets

Radical surgery (thyroidectomy) and RT
Chemo for advanced disease/mets

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3 lips cancers and sites

Squamous cell most common on lower lip because sun directly hits it
Basal cell most common on upper lip and overall
Minor salivary gland cancers usually advanced or high grade

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Treatment of squamous and basal cell cancer of lip and minor salivary gland cancer

Squamous and basal cell: surgery or RT, most concerned with cosmesis
Minor salivary gland: wide exision

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3 major glands and number of minor glands

Parotids
Submandibular
Sublinguals
About 600 minor glands

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2 types of oral and pharyngeal cancers

95% squamous cell if on mucosal surfaces

Minor salivary glands remainder

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Treatment and treatment of advanced cases of oral and pharyngeal cancers

Tx: RT or surgery have same cure rate
Advanced: combination of surgery, RT, and chemo

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H&N cancer mets usually by way of what and why?

LNs because 1/2 of body’s LNs in H&N area

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Most common mets site of H&N cancer

Lungs

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3 treatments for speech production affected by a laryngectomy

Artificial larynx Esophageal speech Tracheoesophageal puncture (TEP)

Learn to burp sounds, can take up to 6 months

Esophageal speech

Surgically created hole between esophagus and trachea with voice prosthesis inserted

Tracheoesophageal puncture (TEP)

6 H&N radiation side effects

Watch for malnutrition: sore throat, hardest treatment for patients to tolerate Radionecrosis and mandibular bone loss if in treated site Mucositis Redness of skin Dysphagia Xerostomia: watch parotids

Inflammation and ulceration of mucous membranes, smoking and drinking make it worse Softer toothbrush, swish and swallow, antiseptic mouthwash, etc.

Mucositis

Difficulty swallowing

Dysphagia

3 xerostomia treatments

Sodium bicarbonate/baking soda helps fight infection and moistens mouth Artificial saliva Water bottle

Go to treatment for H&N cancer and mets treatment

Go-to: surgery and RT | Mets: chemo

4 factors of H&N cancer prognosis

Stage Histology Extent of LN involvement Future lifestyle: quit smoking and drinking

5 year disease free survival of H&N cancer

60%

Ratio of males to females for renal cell carcinoma (RCC)/kidney cancer

Males 2 to 1 over females

Median age of RCC

64 (older)

7 risk factors for RCC

Smoking Exposure to asbestos: main filtration Von Hippel-Lindau syndrome (VHL) Renal cystic disease while on hemodialysis Genetic predisposition Increasing age, rare under 45 years old Obesity, cadmium and uranium exposure, and use of prescription diuretics (association)

Compared to non-smokers, risk of RCC increases ___% in males and ___% in female smokers

50% | 20%

Angiomatosis in retina leads to angiomas in blood and lymph vessels

Von Hippel-Lindau syndrome (VHL)

Obesity especially in women accounts for ___% of kidney cancer in general

30%

6 RCC histopathology subtypes and percentages

``` Clear cell: 75-80% Papillary: 10-15% Chromophobe: 5-10% Medullary: less than 1% Collecting duct: less than 1% Oncocytoma: uncommon ```

90% of RCCs arise from _______

Renal parenchyma

Where ureter enters kidney and expands, about 10% of kidney disease here

Renal pelvis

90% of renal pelvis disease are _______ and about 8% are _______

Transitional, squamous

Kidney cancer in 1 of 200-250,000 kids Peak age of 3, rare after 8 90% cure rate for localized tumor

Wilms tumor

3 signs and symptoms of RCC

Hematuria most common Flank pain and mass Hypertension, anemia, cachexia, weight loss, fever, and other symptoms

Triad of symptoms that are a sign of advanced renal disease in about 10% of patients

Hematuria Flank pain Flank mass

Side of person's body between ribs and hips

Flank

Buildup of protein in body

Amyloidosis

Increased RBCs

Erychrocytosis

Intestinal disease

Enteropathy

Disease of nerves and associated muscle tissue

Neuromyopathy

Fever

Pyrexia

Excessive or inappropriate production of milk

Galactorrhea

Mets affects about ___% (__/__) of all RCC cases

33% (1/3)

7 sites and percentages of RCC mets

``` Lung most common: 50-60% Liver: 30-40% Bones: 30-40% LN: 30-40% Adrenal glands: 20% Opposite kidney: 10% CNS system: 5% ```

8 RCC workups

``` H&P CBC and chemical profile Ultrasound (US) CT of pelvis abdomen Abdominal (IVC involvement) or brain (mets) MRI KUB/IVP Cystoscopy for hematuria Biopsy ```

Layer of connective tissue encapsulating the kidneys and adrenal glands

Gerota's fascia

5 factors RCC prognosis is dependent on

``` Grade: important predictor for mets especially for groin and even more powerful with depth of tumor invasion Stage Size Histologic type Mets ```

5 year survival of stage I, II, III, and IV RCC

I: 81% II: 74% III: 53% IV: 8%

5 RCC treatments

Surgery for early stage, only cure Immunotherapy for relapsed patients or patients who have inoperable stage 4 clear cell disease Targeted therapy: tyrosine-kinase inhibitor (TKI) and antibodies Radiation for palliation, recurrence, and brain mets Chemo used when immuno- or targeted therapy has failed; no real benefit for survival and uncommon

RCC immunotherapy that forces immune system to fight cell

Interleukin 2 (Il-2)

Why is RCC considered a radioresistant disease?

There's a high level of differentiation in cell

Radiosensitive disease, 1% of all cancers in men Most common age is 20-39 Rising in US and Europe, less common in African Americans and Africans 4-5% mortality rate Most curable solid tumor in adults, over 90% cure rate for stages I and II and even late stages can be cured Unknown cause

Testicular cancer

5 risk factors of testicular cancer

``` History of cryptorchid testis Klinefelter's syndrome History of previous testis tumor HIV and HPV Family history of first degree relative (dad or brother) ```

Testicle doesn't drop into scrotum

Cryptorchid testis

Suture testicle into scrotum; before age 6 decreases risk of testicular cancer, after 13 increases risk

Orchiopexy

Congenital endocrine disease where primary testicular function doesn't take place, not secreting hormones, etc.

Klinefelter's syndrome

2 histologies and percentages of testicular cancer

Germ cell tumors: 95% | Non germ cell type: 5%

Reproductive cells

Germ cells

___-___% of germ cell tumors are bilateral (in both testes) which leads to infertility

1-2%

2 types and percentages of germ cell tumors, 50% mixed

Seminoma: 50% Nonseminoma: 50%

5 subcategories of nonseminomas

``` Embryonal Teratomas Teratocarcinoma: one of the least aggressive non seminomas Yolk sac in kids Choriocarcinoma ```

Tumor composed of tissues not normally present at site, one of the least aggressive nonseminomas

Teratomas

Rare seminoma but most aggressive

Choriocarcinoma

2 types of non germ cell tumors

Sertoli | Leydig

8 symptoms of testicular cancer

``` Mass with or without swelling in scrotum, most common presenting symptom Swelling Varicocele Hydrocele Spermatocele Torsion Epididymitis Gynecomastia and lower back pain less common ```

Vein engorgement within scrotum

Varicocele

Accumulation of scrotal fluid

Hydrocele

Irregular grapelike sac, cystic distension of the epididymis to testicle

Spermatocele

Spermatic cord twists, cutting of testicle's blood supply; swelling

Torsion

Inflammation of empididymis

Epididymitis

4 symptoms of advanced testicular cancer

Cough Dyspnea Headache Seizure

Combination of 3 symptoms that are a sure sign of testicular disease

Gynecomastia Swollen left supraclavicular LN Testicular mass

5 diagnostic tests for testicular cancer

Testicular examination with physician: evaluate testicles and inguinal nodes US Orchiectomy/orchidectomy Tumor markers: AFP for seminomas and lactate dehydrogenase (LDH [spread because it identifies tissue damage within organs]) Chest x-ray (CXR), chest, abdomen, and pelvis CT to evaluate LNs

Testicular cancer staging system

TNM with serum tumor markers

3 serum tumor markers for testicular disease

AFP LDH HCG: pregnancy

LDH 1, 2, and 5

1: heart tissue 2: lung 3: liver

2 routes of spread of seminoma (more orderly)

Retroperitoneal LNs usually first | Rarely and late it can spread to lung, bone, liver or brain via blood (hematogenous)

3 sites of spread of nonseminomas

LNs Lungs Liver

Choriocarcinomas usually mets to this early in disease process

Brain

3 treatments of testicular cancer

Observation following orchiectomy with retroperitoneal LN dissection (RPLD) which can limit ejaculate/ability to have offspring Radiation: seminomas radiosensitive Chemo for bulky/systemic disease: nonseminomas more sensitive to chemo

Stage I and II and III treatment after inguinal orchiectomy

I and II: RT | III: commonly cisplatin-based chemo or RT to abdominal and pelvic LNs

Overall cure rate and survival of testicular cancer

95%

80% of testicular cancer patients with mets/stage 4 disease have a ___% survival rate

95%

About ___% of testicular cancer patients are able to father kids

33%

Deficiency of sperm about one year after chemo

Oligospermia

Absence of sperm about one year after chemo

Azoospermia

Chemo regimen for stage III and bulky stage II testicular cancer

3-4 cycles BEP, surgery if BEP fails

BEP

Bleomycin Etoposide Cisplatin

3 acute toxicities associated with chemo for testicular cancer

Gastrointestinal effects: nausea and vomiting Renal effects: decreased ceatinine clearance and tubular loss of sodium, potassium, and magnesium Bone marrow depression

5 long-term toxicities associated with chemo for testicular cancer

Bleomycin pneumonitis (rarely fatal if under 400 U are given) Peripheral neuropathies Cisplatin-induced hearing loss Sterility Secondary acute myelogenous leukemia (AML) related to etoposide (typically shows 11q23 translocation, under 5% incidence at 5 years)

Sperm not maturing

Spermatogenesis deficiency

Test 4 (H&N, RCC, and Testicular) Flashcards

(103 cards)