Oncology Overview – Flashcards
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Most common incidence of cancer in men
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1. prostate 2. Lung 3. Colorectal
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Most Common incidence of cancer in women
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1. Breast 2. Lung 3. Colorectal
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Men/Women cancer incidence: general
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1/2 men 1/3 women
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Neoplasm
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any new growth of tissue (benign or malignant)
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Tumor
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abnormal tissue (benign or malignant)
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Benign
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typically not recurrent, progressive or invasive. Slow, long process
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Malignant
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growth uncontrollably that are locally invasive or spread to other sites
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Classification of Neoplasms
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1. Rate of growth 2. invading of surrounding tissue 3. local area spread 4. metastic spread
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Carcinoma
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malignant growth derived from epithelial tissue
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Adenocarcinoma
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malignant epithelial carcinoma arising from glandular structures
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Sarcoma
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cancer arising from connective tissue (bone, cartilage, fat, muscle)
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Adenoma
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benign epithelial tumor with secretory structures
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Neuroendocrine tumors (NET)
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tumors arising from endocrine or neural tissues
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Dysplasia
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tissue with abnormal size, shape, organization of mature cells (precursor to cancer cells forming)
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Cachexia
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state of extreme loss of muscle and body mass (mostly end stage cancer)
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Neoplasia
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cell growth is uncoordinated and lacks normal regulatory control over the normal events of mitosis
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Proliferation control, differentiation, and apoptosis
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cancer cells lose these abilities. they grow out of control, look different from the cells in the are and do not have programmed cell death
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angiogenisis
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acquiring or developing new blood supplies
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Telomerase
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enzyme that prevents or repairs the shortening of telomeres --> without adequate length, DNA can get lost or fused. what is found in cancer
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Oncogene
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gene with the ability to cause autonomous cell growth and differentiation. In cancer this part acquires mutation which results in the lost of regulation
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proto-oncogene
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normal gene which becomes an onocogene due to mutation
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tumor-suppressor genes
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suppresses over growth --> tells cells when to start replicating and when to stop
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Caretaker gene
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provide genome stability by preventing the accumulation of mutations
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Gate Keeper gene
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encode a system of checks and balances that monitor cell division and death`
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Landscaper genes
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fostering stromal environments
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What oncogenes are associated with breast and ovarian cancer
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BRCA-1 and BRCA-2 (maybe PALB2)
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What are some examples of environmental hazards that are canerous
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-Benzene -Asbestos -Ionizing radiation -Ultraviolet light -Polycyclic hydrocarbons -Industrial agents
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What are some infectious agents that are cancerous
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-Chronic viral Hep B/C: hepatocellular carcinoma -Human Papilloma Virus (HPV): cervical, anal, penis, tonsils, tongue -Human Herpes Virus: Epstein Barr --> Burkett's lymphoma -HIV: immunocompromised
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Food and drugs linked to cancer
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-Diethylstilbestrol (DES): synthetic estrogen, 40-70s, gave daughters breast and clear cell carcinoma of vagina -smoked foods - nitrates -alcohol and cigarrettes combined
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What are examples of clinical manifestations of cancer
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1. Pain 2. Abnormal masses 3. Unintended weight loss 4. Bleeding 5. Painless Jaundice 6. Paraneoplastic syndrome 7. abnormalities on routine screening
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Pain
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-will be worse at night -result of tissue compression or tissue in vasion
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Abnormal Masses
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-primarily the tumor itself or -enlarged lymph node -a 1cm mass in a typical tumor theoretically takes 5 to 8 years to reach that size
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Unintended Weight loss
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-tumor takes energy 24/7 -tumor increases daily caloric requirement -various cytokines suppress appetite
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Bleeding
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seen or unseen (may be in poop!)
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Painless jaundice
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-grim sign, sign of pancreatic cancer -(if have jaundice from another cause, mostly other signs are associated with it, N/V, etc)
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Paraneoplastic syndrome
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-symptoms that occur as a result of the body's immune response to a tumor, or substances secreted by the tumor EX: -fever, anorexia, fatigue -hypertrophic osteoarthropathy (periosteum thickened and inflamed) -hypokalemia, hyponatremia or hyper, hyperphosphatemia -*SIADH* -hypercalcemia -carcinoid syndrome -thrombocytosis, polycythemia -*cushing syndrome* -*Lamber-Eaton myasthetic syndrome* (looks like myasthenia gravis
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Tumor Markers: general, what are they
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-substances that are produced by cancer or by other cells of the body in response to cancer or certain benign conditions -presence that is normally there may be elevated or presense of it that is not normally there -tumor markers are proteins
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Tumor Markers: Examples
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-Alphafetoprotein (AFP): heptaocellular cancer -Carcinoembryonic antigen (CEA): bowel and breast cancer -CA-125: ovarian cancer -Prostate specific antigen (PSA): prostate cancer -Estrogen receptor (ER): on breast tissue in certain breast cancers, differs in treatment) -HER2/neu: breast, gastric cancer
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Tumor Markers: what are they used for
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-assessment of likelihood of presence of cancer -assess the response of a tumor to treatment -recurrence of tumor -prognostic purposes -to direct the type of chemotherapy -*CANT MAKE DIAGNOSIS OFF MARKER, NEED A BIOPSY*
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Staging of cancer: Roman Numeral System
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Stage 0: carcinoma in situ Stage 1: cancers are small and localized to one part of the body Stage 2: cancers are locally advanced Stage 3: cancers are also locally advanced but to a greater degree Stage 4: cancers have metastasized or spread to other organs or throughout body
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Staging of cancer: TNM
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T: relates to tumor size N: lymph node involvement M: metastatic spread
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Staging of cancer: TMN --> T
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T - primary tumor TX: primary tumor cannot be evaluated T0: no evidence of primary tumor Tis: carcinoma in situ CIS (abnormal cells present) T1, T2, T3, T4: size and/or extent of primary tumor
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Staging of cancer: TNM --> N
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N - lymph node involement NX: regional lymph nodes cannot be evaluated N0: no regional lymph node involvement N1, N2, N3: involvement of regional lymph nodes and/or extent of spread
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Staging of cancer: TNM --> M
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M - distant metastasis MX: distant metastasis cannot be evaluated M0: no distant metastasis M1: Distant metastasis present
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Staging of Cancer: Ann Arbor staging system
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used for cancers that do not have an anatomical sight -leukemia, myeloma, lymphoma
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Staging of cancer: histologic grade
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-looks at microscopic appearance and the TNM score -the more antaplastic the cells look, the worst off the diagnosis -gleason score: for prostate cancer
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Oncologic emergencies: general
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1. Structural obstructive 2. Metabolic emergencies 3. Treatment-related emergencies 4. Hematologic emergencies
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Oncologic emergencies: Structural obstructives
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1. *Superior Vena Cava*: obstruction doesn't allow blood flow -presentation: neck/facial swelling, dilated neck veins, edema on upper body 2. *Intestinal obstruction*: in colon or ovarian cancer -presentation: pain (colicky), something obstruction bowel movement 3. *Malignant spinal cord compression*: obstruction via blood supply leading to ischemia or by direct compression of nerve cord (Cauda equine syndrome: saddle sign, rectal/bladder disfunction) 4. *Pericardial effusion/tamponade: metastatic in pericardium (hard for heart to pump) 5. *urinary obstruction* 6. *malignant biliary obstruction* 7. *increased intracranial pressure*
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Oncologic emergencies: Metabolic emergencies
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1. Hypercalcemia: most common metabolic paraneoplastic syndrome -overproduction of PTH: results in rapid boney invasion 2. SIADH: hyponatremia -comes to attention of routine lab
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Oncologic emergencies: Treatment-related
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*Tumor Lysis Syndrome*: *hyperuricemia, hyperkalemia, hyperphosphateemia, and hypocalcemia* --occurs as a massive destruction of a large number of rapidly proliferating neoplastic cells --usually right after chemo for lymphomas and leukemia
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Oncologic emergencies: Hematologic emergencies
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1. febrile neutropenia: chemo associated --> bacterial or fungal infections (b/c of low WBC count) 2. Hyperviscosity syndrome: waldenstrom's macroglobulinemia --> makes lots of messed up antibodies and fills up blood, blood becomes slushy
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Cancer modalities: 3 treatment categories
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1. *Curative*: cure the patient of their cancer 2. *Control*: recognizing cure not possible treatment designed to control malignancy and provide quality of life 3. *Palliative*: treatment designed to relieve suffering without efforts to prolong life
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Cancer modalities: 3 ways to treat
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1. surgery 2. radiation 3. chemotherapy
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Cancer modalities: Surgery
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-used for diagnosis and staging with curative intent -1st line treatment for solid tumors -can help debulk tumor
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Cancer modalities: Radiation
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-used for curative intent, control and palliative intent -over 50% cancer patient undergo radiation -doesn't distinguish between good and bad cells
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Cancer modalities: complications of radiation
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-myelosuppression (BM suppression) -mucositis (inflammation of mucous membranes) -xerostomia (dry mouth) -N/V -changes in taste/smell -hair loss -RT induces some degrees of tissue scarring which continues to evolve over years (problems after 10-20 yrs)
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Cancer modalities: Chemo
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-interrupts cell growth/mitosis by disrupting protein synthesis, DNA and RNA production -helps for tumors you can't see/didn't know were there -more effective in rapidly growing tumors
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Cancer modalities: Complications of Chemo
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-myelosupression: THE LIMITATION OF CANCER -N/V -GI issues: Diarrhea, malabsorption -obstipation: so wound up you can't poop! -
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Cancer modalities: Hormone therapy
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-*Tamoxifen*: hormone modifier -useful in treatment of cancers which are responsive to hormonal manipulation (breast cancer)
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Cancer modalities: Bone Marrow and Stem Cell transplantation
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-leukemia and lymphomas -the patients native bone marrow is destroyed by chemo/radiation and replaced with either allogenic marrow or autologous marrow which has been treated to remove cancer celss
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Cancer preventing: Primary prevention
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Lifestyle modification and Chemoprevention -limit: tobacco, alcohol, sun, obesity chemoprevention: ASA, NSAIDS, VIT E, etc
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Cancer preventing: Secondary prevention
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EARLY DETECTION -PE: observation and palpation -Labs/procedures: pap smear, colonoscopy, mammography
