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38 Cards in this Set

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True or False:

Colon cancer with affected messentary nodes is metastatic
False - spread just to local lymph nodes is not metastatic
True or False:

Colon cancer with affected subclavian nodes is metastatic
True - metastasis is distant spread
What is prognosis in terms of time.

Or in other words, if the prognosis is 2 years, what does that mean?
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.
What is morbidity?
symptoms, side effects, toxicity;

things that come along with the disease or with the treatment
What is the TNM method of staging? What do the letters stand for?
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
True or False:

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

More radical surgery does not cure more cancer,
because cancer does not spread contiguously.
Clinical trials in the 1970's tried the following treatments:

-mastectomy
-lumpectomy
-lumpectomy + radiation

Which did they find was the best?
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.
Through which route is a cancer more likely to spread:

lymphatic system or blood vessels?
No difference in rates.

Similar biology between lymph system and blood vessels.

Cancer does not have to go through lymph nodes to spread.
Read this card about the likelihood of
breast cancer recurrence given lymph node involvement:
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
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.
True

having lymph nodes involved lets you know about the biology of cancer
Explain the idea of a sentinel node.
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.
How is the sentinel lymph node identified?
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.
What might the surgeon do if the frozen sections
on the sentinal nodes are positive for cancer?
take more nodes
When is radiation helpful?
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.
What kinds of systemic hormonal therapy are used for prostate cancer?
BnRH agonists
Anti-androgens
What are Phase I clinical trials used for?
These are the earliest human trials. They are used to define safety, toxicity and dose.
How do you define phase II?
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.
What is a phase III clinical trial?
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.
How do we define cure in a cancer patient?
The time at which survival is parallel to those without a cancer diagnosis.

The time is site-dependent.
What is palliative care?
relieve symptoms and help the patient live as long and well as possible, without expectation of cure.
True or False:

Local therapy alone can be curative.
True.

If staging shows no sign of systemic disease
AND prognostic indicators are favorable,
local therapy alone is often curative.
How many cancer cells (or what size of cancer) is needed for it to be detected with physical exam, lab tests, or radiographic scans?
a billion cancer cells

about a cm
What kind of tumor gene in colon cancer
predicts response to cetuximab (EGFR inhibitor)
K-ras
What does having HER2/neu gene expression tell you about breast cancer
more likely to respond to trastuzumab (herceptin)
and also higher likelihood of recurrence
What is adjuvant therapy?
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.
What is the goal of adjuvant therapy?
To eradicate microscopic disease and increase the likelihood of cure.
When is chemotherapy indicated in breast cancer?
-positive nodes
-tumor over 2 cm
-tumor 1-2 cm and high grade, ER-, HER2+
Is tamoxifen for pre- or post- menopausal women with ER positive tumors?
Both pre- and post-
Are Aromatase Inhibitors for pre- or post-menopausal women with ER positive tumors?
Post-menopausal only
What is the duration of treatment with tamoxifen or aromatase inhibitors
5 years
Hormonal adjuvant therapy in ER positive tumors (tamoxifen or aromatase inhibitors) reduces the risk of recurrance by what percent?
Reduces the risk of recurrence by about 30%
and the risk of contralateral cancer by about 50%
What are the disadvantages of Herceptin treatment for HER2 positive tumors
cardiac toxicity
expense
What are the major toxicities of chemotherapy?
hair loss, nausea, neutropenia & infection, fatigue,

Rarely: heart failure, leukemia
How often & how long is chemotherapy typically given
IV every 2-3 weeks for 3-4 months
What amount of benefit is sufficient to justify adjuvant chemotherapy?
3% absolute benefit

For example, if it will reduce relapse from 10% to 7%
For which stage of breast cancer do we suggest palliative therapy
Stage IV
True or False:

Pallative therapy can include chemotherapy and radiation
True
The goal of palliative therapy is QTWST. What is this?
Quality time without symptoms or toxicity.

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