Cancer Diagnosis And Treatment - Saundra Buys

Front 1

True or False:

Colon cancer with affected messentary nodes is metastatic

Back 1

False - spread just to local lymph nodes is not metastatic

Front 2

True or False:

Colon cancer with affected subclavian nodes is metastatic

Back 2

True - metastasis is distant spread

Front 3

What is prognosis in terms of time.

Or in other words, if the prognosis is 2 years, what does that mean?

Back 3

If the prognosis is 2 years it means that the average person would live 2 years.

So, by 2 years 50% of all patients with similar characteristics would have died already and 50% will still be alive.

Front 4

What is morbidity?

Back 4

symptoms, side effects, toxicity;

things that come along with the disease or with the treatment

Front 5

What is the TNM method of staging? What do the letters stand for?

Back 5

T = tumor (size and amount of invasion) stage depends on the organ. Melanomas are staged by depth, colon cancer are rated by if they penetrate the colon wall.
N = Nodes (how many are involved N0= no nodes N1 = 1-3 nodes
M = metastasis

Front 6

True or False:

When removing cancer surgically it is better to take more tissue
(well beyond the affected margins)
to improve cure rates.

Back 6

False

More radical surgery does not cure more cancer,
because cancer does not spread contiguously.

Front 7

Clinical trials in the 1970's tried the following treatments:

-mastectomy
-lumpectomy
-lumpectomy + radiation

Which did they find was the best?

Back 7

No difference in survival.

If patients did have locoregional recurrence it may be that their disease was one that is not susceptible to radiation, or that it is one especially prone to metastasis.

Front 8

Through which route is a cancer more likely to spread:

lymphatic system or blood vessels?

Back 8

No difference in rates.

Similar biology between lymph system and blood vessels.

Cancer does not have to go through lymph nodes to spread.

Front 9

Read this card about the likelihood of
breast cancer recurrence given lymph node involvement:

Back 9

0 nodes involved = 10-30% likelihood of recurrence
1-3 nodes involved = 30-50% likelihood of recurrence
4-9 nodes involved = 60-80% risk of recurrence
>= 10 nodes involved = 80-95% risk of recurrence

Front 10

True or False:

If a cancer can grow in a lymph node ( a foreign environment) then cancer is more likely to be able to grow in another tissue like brain or bone.

Back 10

True

having lymph nodes involved lets you know about the biology of cancer

Front 11

Explain the idea of a sentinel node.

Back 11

The sentinel lymph node (SLN) is the regional node that is most likely to be involved. If the SLN is not involved it eliminates the need for extensive surgery.

The sentinel node is the first draining node from the affected organ. It is the node with the highest likelihood of having cancer in it.

Front 12

How is the sentinel lymph node identified?

Back 12

Radioisotope and blue dye is injected into the primary tumor. Lymph nodes that are blue and "hot" (identified via external gamma probe) are the sentinel nodes.

Front 13

What might the surgeon do if the frozen sections
on the sentinal nodes are positive for cancer?

Back 13

take more nodes

Front 14

When is radiation helpful?

Back 14

After a tumor has been removed surgically radiation would be helpful if:

some tumor had to be left to spare an organ,
if tumor was large,
if the margins were close.

Front 15

What kinds of systemic hormonal therapy are used for prostate cancer?

Back 15

BnRH agonists
Anti-androgens

Front 16

What are Phase I clinical trials used for?

Back 16

These are the earliest human trials. They are used to define safety, toxicity and dose.

Front 17

How do you define phase II?

Back 17

Now the right dose is known. We look at a group of people for whom we think the drug might work. If we see ANY response at all we will treat more people. We will only take cancers that don't have other good treatments.

Front 18

What is a phase III clinical trial?

Back 18

The new treatment is compared to the standard of care.

We only move to phase III if it looks like the drug might be better than the standard.

Front 19

How do we define cure in a cancer patient?

Back 19

The time at which survival is parallel to those without a cancer diagnosis.

The time is site-dependent.

Front 20

What is palliative care?

Back 20

relieve symptoms and help the patient live as long and well as possible, without expectation of cure.

Front 21

True or False:

Local therapy alone can be curative.

Back 21

True.

If staging shows no sign of systemic disease
AND prognostic indicators are favorable,
local therapy alone is often curative.

Front 22

How many cancer cells (or what size of cancer) is needed for it to be detected with physical exam, lab tests, or radiographic scans?

Back 22

a billion cancer cells

about a cm

Front 23

What kind of tumor gene in colon cancer
predicts response to cetuximab (EGFR inhibitor)

Back 23

K-ras

Front 24

What does having HER2/neu gene expression tell you about breast cancer

Back 24

more likely to respond to trastuzumab (herceptin)
and also higher likelihood of recurrence

Front 25

What is adjuvant therapy?

Back 25

giving treatment for cancer to someone who has no sign of residual cancer after local therapy and who has a higher risk of cancer recurring based on predictiors.

Front 26

What is the goal of adjuvant therapy?

Back 26

To eradicate microscopic disease and increase the likelihood of cure.

Front 27

When is chemotherapy indicated in breast cancer?

Back 27

-positive nodes
-tumor over 2 cm
-tumor 1-2 cm and high grade, ER-, HER2+

Front 28

Is tamoxifen for pre- or post- menopausal women with ER positive tumors?

Back 28

Both pre- and post-

Front 29

Are Aromatase Inhibitors for pre- or post-menopausal women with ER positive tumors?

Back 29

Post-menopausal only

Front 30

What is the duration of treatment with tamoxifen or aromatase inhibitors

Back 30

5 years

Front 31

Hormonal adjuvant therapy in ER positive tumors (tamoxifen or aromatase inhibitors) reduces the risk of recurrance by what percent?

Back 31

Reduces the risk of recurrence by about 30%
and the risk of contralateral cancer by about 50%

Front 32

What are the disadvantages of Herceptin treatment for HER2 positive tumors

Back 32

cardiac toxicity
expense

Front 33

What are the major toxicities of chemotherapy?

Back 33

hair loss, nausea, neutropenia & infection, fatigue,

Rarely: heart failure, leukemia

Front 34

How often & how long is chemotherapy typically given

Back 34

IV every 2-3 weeks for 3-4 months

Front 35

What amount of benefit is sufficient to justify adjuvant chemotherapy?

Back 35

3% absolute benefit

For example, if it will reduce relapse from 10% to 7%

Front 36

For which stage of breast cancer do we suggest palliative therapy

Back 36

Stage IV

Front 37

True or False:

Pallative therapy can include chemotherapy and radiation

Back 37

True

Front 38

The goal of palliative therapy is QTWST. What is this?

Back 38

Quality time without symptoms or toxicity.

Symptoms= what the cancer does
Toxicity = what the treatment does