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19 Cards in this Set
- Front
- Back
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How does the TNM staging system work?
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Clinical staging (physical exam, imaging), then pathological staging on surgery specimen (doesn't replace the clinical stage).
T: tumor size, 0 (none) to 4 (invasive), is: in situ N: lymph nodes, 1 to 3 M: metastases, 0 or 1, distant spread, by organ system. |
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How are recurrences staged?
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Separately from the initial staging of the tumor, listed as relapses.
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What are metachronous and synchronous tumors?
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Synchronous is another primary tumor, metachronous is more than six months after the inital tumor.
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What do you look for in the clinical evaluation for cancer?
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look for wt loss of more than 10% of baseline, fever, sweats, chills.
Karnofsky scale (0-100% activity) and Zubrod/ECOG scale (0-4 activity): take other metabolic abn, uncontrolled infections and other severe pain into consideration. Look at comorbid conditions that affect response to treatment. Some patients won't benefit from vigorous therapies. |
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What's the Zubrod/ECOG scale?
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0: fully active
1: restricted in strenuous activity 2: ambulatory, capable of self-care, up >50% of day 3: limited self-care, confined to bed/chair >50 % of day 4: totally bed/chair confined |
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What's meant by the concept of multidisciplinary care?
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lots of different treatment modalities that work together: surgical, radiation, chemotherapy, immunotherapy, hormone manipulation.
non-overlapping toxicity is exploited to dissolve the tumor. eg lumpectomy and radiation, then chemo for breast cancer w/ lymph nodes. |
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What's the difference between curative and palliative intent?
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palliative means you can't cure it but you can prolong and improve the patient's life. Surgical palliation (eg of intestinal obstruction), medial palliation (chemo to decrease tumor size and pain), radiation palliation (to relieve bone pain or bronchial obstruction)
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What's neoadjuvant therapy?
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pretherapy, drugs or radiation before surgery
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What's adjuvant therapy?
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treatment after surgery or radiation has removed most of the tumor
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What's concurrent/concomittant therapy?
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radiation and chemo therapy given at the same time
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What's supportive care?
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not directed at the cancer but to improve survival and quality of life.
includes: cytokines for RBC, WBC, platelets; Abx; rehab (avoid bone breaks); analgesics, neurosurgical anesthesia procedures; control of dysphoria/depression. |
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What's palliative care?
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hospice care, end of life care, control of symptoms.
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What are the critera for complete response to therapy?
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complete disappearance, normalization of markers.
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What about partial response to therapy?
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a decrease of 50 % from the baseline (WHO) or 30 % decline from baseline (RECIST) sustained and confirmed at 4 wks.
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How is progressive disease defined?
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increase of more than 20% from the smallest sum or appearance of new lesions.
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What's stable disease?
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Neither progressive nor partial response to treatment
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What are the four phases of clinical trials?
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Phase I: to define a safe dose and pharmacokinetic characteristics. Find maximum tolerated dose (below toxic dose).
Phase II: estimate response in a tumor/target. randomized trials. Phase III: compare vs. standard, larger sample number. Phase IV: evaluate use with a new indication. |
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What clinical trials have been famously ethically wrong in the past?
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Willowbrook study (testing fluid transmission of hep on mentally retarded kids)
Tuskegee Syphilis study WWII torture for science |
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What's the difference between censored and uncensored cases in case studies?
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Uncensored cases are followed to death, censored cases are followed to an endpoint or until lost to follow-up.
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