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Acute Care II - Summer 2017 > Weeks 5 & 6: Oncology Overview > Flashcards

Weeks 5 & 6: Oncology Overview Flashcards

1
Q

definition of cancer?

A

group of disease characterized by uncontrolled growth & spread of abnormal cells

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2
Q

definition of proto-oncogenes

A

genetic portion of DNA that regulates normal cell growth & repair

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3
Q

definition of tumor suppressor genes

A

genetic portion of DNA that stops, inhibits or suppresses cell division.

may also inhibit formation of cancers

mutation and loss of this function may allow cells to proliferate beyond normal body needs

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4
Q

most common mutated tumor suppressor gene?

A

p53

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5
Q

oncogenes?

A

altered forms of normal proto-oncogenes

interfere with normal cell growth, differentiation, apoptosis

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6
Q

risk factor for cancer

A

tobacco
alcohol
diet high in fat
UV radiation (dependent on latitude, altitude, humidity & personal behaviors)
ionizing radiation (miners & Hiroshima)
chemicals & other substances - asbestos
close relatives with certain types of cancer genetic predisposition
hormone replacement therapy
age (length of time exposed to cancer inducing agents & natural decline in immune system)
virus: HPV, Hep B

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7
Q

modifiable risk factors for cancer

A 
tobacco
alcohol
overweight/obesity
physical inactivity
low fruit/vegetable consumption
unsafe sex
urban air pollution
indoor smoke from household fuels
contaminated injections in health care setting
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8
Q

signs & symptoms of cancer

A

local symptoms: unusual lumps/swelling; hemorrhage; pain and/or ulcerations; compression of surrounding tissues or obstruction (jaundice)

systemic symptoms: weight loss; poor appetite; cachexia; excessive sweating (night sweats); paraneoplastic phenomena

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9
Q

7 warning signals for cancer

A
  1. change in bowel/bladder habits
  2. unusual bleeding/discharge
  3. sore that doesn’t heal
  4. obvious change in a wart/mole
  5. thickening/lump in breast or elsewhere
  6. nagging cough or hoarseness
  7. indigestion/difficulty swallowing
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10
Q

definition of angiogenesis

A

the proliferation of a network of blood vessels that penetrates into cancerous growths, supplying nutrients, oxygen and removing waste products. this process is necessary for tumor growth & spread

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11
Q

carcinogenesis?

A

multi-step process by which a normal cell is transformed into a malignancy

INITIATION: a carcinogen causes a genetic change or damage to the DNA in a normal cell

PROMOTION: an initiated cell is exposed to an agent that enhances its growth into a larger mass

PROGRESSION: metastatic spread via circulatory and lymphatic systems.

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12
Q

metastasis?

A

spread of cancer cells from a primary tumor to a distant site in the body

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13
Q

how can cancer cells spread?

A

direct invasion
seeding throughout a body cavity
dissemination via lymphatic system
dissemination via circulatory system

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14
Q

incisional biopsy?

A

aspiration, fine needle, core sentinel lymph node

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15
Q

what is a sentinel lymph node?

A

where the injected tracer goes first after injection

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16
Q

excision biopsy?

A

removal of tissue

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17
Q

cytology biopsy?

A

exam of fluid containing cells

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18
Q

prostate cancer tumor marker

A

PSA

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19
Q

ovarian cancer tumor marker

A

CA 125

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20
Q

colorectal cancer tumor marker

A

CEA

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21
Q

primary liver/germ cell tumor marker

A

alpha fetoprotein

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22
Q

choriocarcinoma/pancreas cancer tumor marker

A

HCG

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23
Q

pancreas/stomach cancer tumor marker

A

CA 19-9

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24
Q

most cancers tumor marker

A

LDH

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25
Q

small cell lung cancer tumor marker

A

neuron specific enolase

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26
Q

what is TNM staging?

A

most common way to stage cancer

T-tumor
N-nodes
M-metastasis

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27
Q

T in TNM staging

A

Tx: primary tumor cannot be evaluated

To: no evidence of primary tumor

Tis: carcinoma in situ (early cancer that has not spread to the neighboring tissue)

T1, T2, T3, T4: size and/or extent of the primary tumor

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28
Q

N in TNM staging

A

regional lymph node

Nx: regional lymph nodes cannot be evaluated

N0: no regional lymph node involvement (no cancer found in the lymph nodes)

N1, N2, N3: involvement of regional lymph nodes (number and/or extent of spread)

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29
Q

M in TNM staging

A

distant metastasis

Mx: distant metastasis cannot be evaluated

M0: no distant metastasis (cancer has not spread to other parts of the body)

M1: distant metastasis (cancer has spread distant parts of the body)

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30
Q

stage 0 definition

A

carcinoma in situ

early cancer that is present only in the layer of cells in which it began

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31
Q

stage I, II, III definition

A

higher numbers indicate more extensive disease: greater tumor size and/or spread of the cancer to nearby lymph nodes and/or organs adjacent to the primary tumor

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32
Q

stage IV definition

A

the cancer has spread to another organ

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33
Q

primary treatment?

A

major modality used to treat a cancer

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34
Q

adjuvant therapy

A

therapy given after the primary treatment to control potential or known sites of metastasis

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35
Q

me-adjuvant treatment

A

therapy given before the primary treatment to control potential or known sits of metastasis

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36
Q

goal of therapy: cure

A

eradication of tumor cels

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37
Q

goal of therapy: control

A

containment of the growth of cancer cells without complete eradication

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38
Q

goal of therapy: palliation

A

comfort and relief of symptoms when cure is no longer possible

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39
Q

goal of therapy: reconstruction

A

to return an individual to his/her optimum functional status

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40
Q

types of cancer treatment modalities

A 
surgery
radiotherapy
chemotherapy
hormone therapy
immunotherapy
biotherapy
molecular targeted therapy
gene therapy
nanobiotherapy
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41
Q

eco performance status?

A

eastern cooperative oncology group

0: fully active, able to carry on all pre-disease performance without restriction
1: restricted in physically strenuous activity by ambulatory and able to carry out work of a light or sedentary nature (light house work, office work)
2: ambulatory and capable of all self care but unable to carry out any work activities. up and about more than 50% of waking hours
3. capable of only limited self care, confined to bed or chair more than 50% of waking hours
4. completely disabled. cannot carry on any self care. totally confined to bed or chair
5. dead

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42
Q

karnofsky performance status score

A

100: normal: no complaints, no evidence of disease
90: able to carry on normal activity; minor symptoms
80: normal activity with effort; some symptoms
70: cares for self; unable to carry on normal activities
60: requires occasional assistance; cares for most needs
50: requires considerable assistance and frequent care
40: disabled: requires special care and assistance
30: severely disabled: hospitalized but death not imminent
20: very sick: active supportive care needed
10: moribund: fatal processes are progressing rapidly
0: dead

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43
Q

lung cancer facts

A

3rd most common cancer

most common cause of death

44
Q

is there effective screening program?

A

no - 3D CT scan is now recommended for high risk persons

45
Q

are people with lung cancer symptomatic at diagnosis?

A

not generally, on 6% are

46
Q

how many lung cancers are related to smoking?

A

more than 85% of all lung cancers are related to smoking

47
Q

major histologies of lung cancer?

A

small cell lung cancer (25% of all lung cancers) - a norendocrine tumor - harder treat

non small cell lung cancer -

48
Q

risk factors for colorectal cancer

A
  • men & women > 50 years old
  • personal/family h/o colorectal cancer or benign colorectal polyps
  • personal family h/o inflammatory bowel disease/ulcerative colitis or Crohn’s disease
  • family h/o inherited colorectal cancer
  • tobacco, obesity, sedentary lifestyle
49
Q

common symptoms of colorectal cancer

A
  • change in bowel habits
  • diarrhea, constipation or feeling that bowel does not empty completely) tensenums
  • blood (bright red, very dark) in the stool
  • stools that are narrower than usual
  • general abdominal discomfort (frequent gas pains, bloating, fullness and/or cramps)
  • unexplained weight loss
  • abdominal / pelvic pain
50
Q

ACS screening guidelines for average risk patients

A

-fecal occult blood test or fecal immunochemical test every year
-flexible sigmoidoscopy every 5 years
fecal occult blood test or fecal immnochemical test every year plus flexible sigmoidoscopy every 5 years
-double contrast barium enema every 5 years
-colonoscopy every 10 years

recommendations are for persons 50+ y/o with average risk

51
Q

early detection of colorectal cancer for people at average risk

A
  • regular screening at age 50
  • fecal occult blood test annually
  • flexible sigmoidoscopy every 5 years, alone or in combination with FOBT
  • barium enema or colonoscopy every 10 years when the last test was normal

people at greater risk need to begin colorectal cancer screening at an earlier age

52
Q

what are stool based screening tests for colorectal cancer

A

fecal occult blood test

fecal immunochemical test

53
Q

what are direct visualization tests for screening for colorectal cancer

A 
colonoscopy - every 10 years
flexible sigmoidoscopy - 5 years
ct colonography (virtual colonoscopy) - 5 years
54
Q

risk factors for breast cancer

A
  • older age
  • family age
  • increased breast density
  • long menstrual history
  • obesity after menopause
  • recent use of oral contraceptives or post menopausal estrogens/progestin
  • having no children or having first child late in life
  • consume alcoholic beverages
  • biopsy confirmed atypical hyperplasia
55
Q

clinical manifestations of breast cancer

A
  • breast lump or thickening
  • swelling
  • distortion
  • tenderness
  • skin irritation
  • dimpling
  • nipple pain
  • scaliness
  • ulceration
  • retraction
56
Q

ways to decrease risk of breast cancer

A
  • physical activity
  • maintain healthy body weight
  • certain medications (tamoxifen)
  • screening high risk populations for BRCA/BRCA2 to assess for mutations associated w breast and ovarian cancer
57
Q

risk factors for prostate cancer

A
  • cause is unknown
  • associated w/ increased testosterone level
  • family history
  • high fat diet
  • increased age
  • most common in African American males
  • incidence continues to rise
58
Q

clinical manifestations of prostate cancer

A
  • usually asymptomatic
  • often discovered by DRE or PSA
  • frequent urination as an early symptom
  • difficulty starting urinary stream or holding back urine
  • weak flow of urine
  • painful urination
  • difficulty having an erection/painful erection
  • blood in urine
  • frequent pain/stiffness in lower back/hips/upper thighs
59
Q

types of lymphoma

A

Hodgkin lymphoma

non-Hodgkin lymphoma

60
Q

hematologic malignancies

A
  1. lymphoma
  2. multiple myeloma
  3. leukemia
61
Q

types of leukemia

A 
acute lymphocytic leukemia (ALL)
chronic lymphocytic leukemia (CLL)
acute myeloid leukemia (AML)
chronic myeloid leukemia (CML)
other leukemias
62
Q

definition of hodgkins lymphoma

A

-malignant disease of the lymphatic system

63
Q

characterization of hodgkins lymphoma

A

painless, enlargement of lymph nodes, the spleen, other lymphatic tissue

other symptoms: fever, weight loss, fatigue, night sweats

64
Q

types of non-hodgkin lymphoma

A 
B cell lymphoma
Burkitt's lymphoma
diffuse cell lymphoma
follicular lymphoma
immunoblastic large cell lymphoma
lymphoblastic lymphoma
mantle cell lymphoma
mycosis fungoides
post transplantation lymphoproliferative disordder
small non-cleaved cell lymphoma
t-cell lymphoma
65
Q

staging for non-hodgkin lymphoma

A

Stage 1: limited to one lymph node group (neck, axilla, groin, etc) above or below the diaphragm, or in an organ or site other than the lymph nodes (extra nodal) but has not spread to the other organs or lymph nodes

Stage 22: limited to 2 lymph node groups on the same side of the diaphragm, or limited to one extra nodal organ and has spread to one or more lymph node groups on the same side of the diaphragm

Stage 3: two lymph node groups, with/without partial involvement of an extra nodal organ or site above and below the diaphragm

Stage 4: extensive involvement of one organ or site with/without disease in distant lymph nodes

66
Q

grades of lymphoma

A

low grade or indolent: slow growing lymphomas that can go for many years without treatment

intermediate grade or aggressive: faster growing lymphomas

high grade or highly aggressive: very fast growing lymphomas

67
Q

definition of leukemia

A

malignant disease of the bone marrow and blooed

68
Q

how is leukemia characterized

A

uncontrolled accumulation of blood cells

69
Q

most common types of leukemias in adults

A

AML, CLL

70
Q

how do you diagnose leukemia

A

heme 8 w/ differential

bone marrow aspiration/biopsy

cytogenetics/chromosomal analysis
-flow cytometry measures and identifies DNA characters and cell surface markers

71
Q

treatment modalities hematologic malignancies

A 
surgery (remove spleen)
chemotherapy
radiation therapy
biotherapy
bone marrow transplant
72
Q

how do you assess response to treatment

A

complete response: complete disappearance of signs and symptoms of cancer lasting at least 1 month

partial response: a >50% reduction lasting at least 1 month without developing any new lesions

progression: > 25% increase

stable disease: non of the above

73
Q

oncologic emergencies:

A

spinal cord compression

74
Q

definition of spinal cord compression

A

pressure on the spinal cord by tumor or collapsed vertebrae

75
Q

etiology of spinal cord compression

A

malignant neoplasm compresses spinal cord

most common metastatic tumors are lung/breast/prostate

less frequently: lymphoma, myeloma, renal cell cancer, previous radiation to spine

76
Q

pathophysiology of spinal cord compression

A

mechanisms of malignant invasion: direct tumor invasion, lymph node growth into epidural space, hematogenous seeding of tumor cells along brain and spinal cord

mechanisms of compression causing neurologic deficits: direct tumor encroachment of spinal cord, interruption of vascular supply, compression from collapsed vertebrae

77
Q

clinical manifestations of spinal cord compression

A

pain->motor weakness ->sensory loss->autonomic nervous system dysfunction

pain, present on movement->spinal instability

pain in 90% of patients

localized: over area of tumor, increased when supine
radicular: nerve root compression, radiates along dermatome of the affected nerve roots
- increase when lying down, more common in lumosacral lesions

78
Q

what does thoracic area spinal cord compression feel like?

A

tight band across chest

79
Q

physical examination of spinal cord compression

A

motor weakness 60-86% of patients: stiffness, heaviness of extremity; ataxic gait (especially w/ back pain), loss of coordination

sensory weakness: numbness, tingling, paresthesias, coldness

autonomic nervous system dysfunction: bowel-lack of urge to defecate; bladder-retention, incontinenece hesitancy; sexual-impotence

80
Q

diagnostic studies for spinal cord compression

A

MRI-procedure of choice, distinguishes extra vs. intramural and extra vs. intramedullary lesions, no contrast required

pyelography - replaced by MRI

CT of spine/plain spine x-rays

lumbar puncture: CSF sampling can detect meningeal carcinomatosis, but not specifically spinal cord compression

81
Q

management of spinal cord compression

A

goals: pain control, avoid complications-local disease progression; preservation/improvement of neurologic function

pain management: narcotic analgesics

corticosteroids: initial treatment

surgery/radical + RT; vertebropasty & kyphoplasty + RT

stereotactic radiotherapy over external beam radiotherapy

82
Q

principles of treatment for spinal cord compression

A

pain management
bed rest
anticoagulation
prevention of constipation

83
Q

definition of superior vena cava syndrmoe

A

mechanical obstruction occludes superior vena cava

could be tumor, lymph node, thrmobosis

84
Q

compression or obstruction of superior vena cava causes

A

blocked venous drainage
edema of face, arm, trachea
pleural effusions

85
Q

severe superior vena cava causes

A

cerebral edema and impaired cardiac filling

86
Q

etiology of superior vena cava syndrome

A
  • males 50-70 y/o
  • malignant disease most common cause-tumors of mediastinum; advanced lung cancer (75% of cases); breast cancer with metastases to mediastinum

iatrogenic causes: venous thrombosis in ventral venous catheters; fibrosis d/t radiation therapy

tumors that are rapidly proliferating and have high growth rate: lymphoma, acute leukemia, small cell lung cancer

large tumor burden: non small cell lung cancer, breast cancer

history of renal disease: renal insufficiency, acute renal failure, increased creatinine, oliguria, anuria

87
Q

pathophysiology of superior vena cava syndrome

A

located in right anterior superior medistinum

collects venous drainage from head, neck, upper extremities and upper thorax,

transports blood to right atrium

superior vena cava is vulnerable to compression: it’s a thin walled vessel in a tight compartment

development depends on: growth rate of tumor, extent and location of blockage, ability to develop collateral circulation - bypass the obstruction, redirects blood flow from the upper thoracic venous system and the obstructed superior vena cava to the inferior vena cava to the right atrium

88
Q

what causes impaired venous drainage of the superior vena cava

A

congestion of the veins draining into the superior vena cava

  • head, neck, upper extremities and upper thorax
  • venous hypertension
  • veous stasis
  • decreased cardiac output
89
Q

what does untreated superior vena cava syndrome lead to?

A

stupor, coma, death

90
Q

clinical manifestations of superior vena cava syndrome

A

depends on the onset
Gradual onset: subtle symptoms due to venous engorgement
Rapid onset: life threatening presentation, absence of collateral circulation

91
Q

early symptoms of superior vena cava syndrome

A
  • swelling of face, arms, fingers, neck
  • dyspnea (most common)
  • cough
  • feeling of fullness in head
  • difficulty buttoning shirt collar (Stroke’s sign)
  • breast swelling
  • dysphagia & hoarseness
  • chest pain
92
Q

late symptoms of superior vena cava syndrome

A
  • laryngeal and cerebral edema
  • life threatening respiratory distress
  • orthopnea
  • headache
  • visual disturbances
  • dizziness
  • syncope
  • lethargy, irritability and mental status changes
93
Q

physical examination early signs of superior vena cava syndrome

A
  • edema of face, neck, upper thorax, breasts and upper extremities
  • prominent venous pattern due to dilated veins of face, neck and thorax
  • jugular vein distention
  • peri-orbital edema and erythema and edema of conjunctiva
  • compensatory tachycardia
94
Q

physical examination late signs of superior vena cava syndrome

A
  • cyanosis of face or upper torso
  • engorged conjunctiva
  • mental status changes
  • tachypnea, orthopnea, stridor, respiratory distress
  • stupor, coma, seizures, and death
95
Q

diagnostic studies for superior vena cava syndrome

A
  • need to be able to visualize vessels so need contrast
  • chest CT w/ IV contrast
  • MRI if patient has contrast dye allergy
  • superior vena cavogram
  • histologic diagnosis-least invasive technique
  • sputum for cytology (bronchogenic cancer)
  • biopsy of palpable lymph node
  • bronchoscopy or medistinoscopy
  • throacentesis (pleural effusion)
  • bone marrow biopsy
96
Q

management of superior vena cava syndrome

A

-treatment is based on histologic diagnosis of primary tumor, rate of onset, type of obstruction (intrinsic or extrinsic)
main treatment modalities
-radiation therapy (non-small lung cancer)
-endovascular stent-restores venous return and rapid symptom palliation
-chemotherapy (small cell lung cancer & lymphoma)
-pharmacologic therapy - corticosteroids, diuretics, thrombolytic therapy

97
Q

definition of tumor lysis syndrome

A

abnormal complication of metabolism caused by rapid breakdown (lysis) of large number of tumor cells

  • lysis of tumor cells cause release of contents of the damaged cells into the circulation
  • causes imbalance in circulation and interferes w/ norma metabolism
98
Q

what can cause tumor lysis syndrome?

A

-cell lysis and subsequent necrosis and breakdown of tumor cells is an intended effect of cytotoxic therapy
-cytotoxic chemotherapy or radiation therapy can cause
massive lysis of tumor cells if tumor has a rapid proliferation rate, or if later tumor burden (tumor > 8-10 cm)

99
Q

common malignancies for tumor lysis syndrome

A
  • acute lymphoblastic leukemia-cell ALL, Burkitt
  • Acute myeloid leukemia
  • chronic lymphocytic leukemia
  • chronic myeloid leukemia
  • non-hodgkin’s lymphoma
  • hodgkin’s disease
  • multiple myeloma
  • solid tumor - small cell lung cancer, neuroblastoma, germ cell tumors
100
Q

pathophysiology of tumor lysis syndrome

A

concentration of phosphorous, nucleic acids and potassium increases in blood vessels

  • liver metabolizes the nuclei acids into uric acid
  • hyperphostatema, hyperuricemia and hyperkalemia
  • hypocalcemia occurs w/ tumor lysis syndrome b/c hyperphosphatemia causes excretion of calcium
101
Q

metabolic changes with tumor lysis syndrome

A 
hyperphosphatemia
hyperuricemia
hyperkalemia
hypocalcemia
azotemia & renal failure

increase phosphate
increase uric acid
increase K+
decrease Ca+

102
Q

clinical manifestations of tumor lysis syndrome

A

nausea, vomiting, diarrhea, anorexia, lethargy, hematuria, heart failure, cardiac dysrhythmias, seizures, muscle cramps, tetany, syncope, possible sudden death

103
Q

what can you give for elevated uric acid

A

raspuricase, helps uric acid to be excreted.

104
Q

more clinical manifestations of tumor lysis syndrome

A

may occur 24-48 hours after cytotoxic therapy is initiated

  • may continue for 5-7 days
  • severity & duration of tumor lysis syndrome depends on: status of patient’s renal function, amount of tumor burden, recognition and treatment
105
Q

signs and symptoms of tumor lysis syndrome

A

direction related to metabolic abnormalities

106
Q

diagnostic studies for tumor lysis syndrom

A 
potassium
phosphorus
uric acid
calcium
creatinine
blood urea nitrogen (azotemia)
107
Q

management of tumor lysis syndrome

A
  • prevention of renal failure: aggressive IV hydration (3L/m2), allpurinol to decrease uric acid formation - watch drug/drug interactions; rasburicase rapidly reduces uric and concentration (first screen for G6PD deficiency, if they have the deficiency then rasburicase won’t work); HD may be necessary
  • prevention of electrolyte imbalances: monitor serum electrolytes, BUN, creatinine, phosphorus, magnesium and calcium Q6-12 hours & correct abnormal chemistries

Acute Care II - Summer 2017 (10 decks)

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