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222 Cards in this Set
- Front
- Back
The estimated number of cancer survivors between the ages of 14-45 years old is 1 in _____ , but it is estimated that in 2010 it will be 1 in ______
|
900
250 |
|
Late effects are a result of (5)
|
1. surgery
2. radiation therapy 3. chemo 4. effects of infections 5. supportive care ( ex. aminoglycosides admin or immunesuppression) |
|
Four factors associated with development of late effects:
|
1. initial dx: location and extent of the primary disease
2. age and developmental stage 3. type and intensity of treatment 4. genetic and familial predisposition |
|
Categories of Late effects are: (5)
|
1. physical
2. psychological 3. cognitive 4. economic 5. social/emotional |
|
_______ therapy is the tx most commonly associated with late CNS toxicity.
|
Radiation
|
|
What are the structural changes associated with irradiation of the whole brain? (3)
|
1. dystrophic calcification
2. mineralizing microangiopathy 3. cerebral atrophy |
|
At what age is associated with increase risk from CNS related toxicity?
|
6 year olds
<2 years old are most vulnerable |
|
After 1,8000 centrigrays to the whole brain is associated with the following:
|
Leukoencephalopathy
|
|
T/F
There is synergistic relationship between Methotrexate and radiation. |
True
radiation disrupts the BBB > increased methotrexate in the CNS > increases chances of leukoencephalopathy |
|
T/F
Hyperfractionated radiotherapy is more damaging to normal CNS |
False
|
|
Neuropsychological deficits are effects by which factors:
|
- type and location of disease
- age - tx implemented: surgery, chemo, corticosteriods - starting IQ / academic performance |
|
Factors which influence cognitive performance:
|
- integrity of visual and motor fxn
- memory - attention - processing speed - motor skills |
|
The two most common long term neurological abnormalities are:
|
1. atrophy
2. decrease subcortical white matter |
|
Platinum based chemo is associated with which CNS symptoms:
|
hearing loss
|
|
HD MTX is associated with which CNS symptoms:
|
neuroanatomic pathology and neurocognitive deficits
|
|
What chemotherapies are associated with peripheral neuropathy?
|
Vinca alkaloids, cinblastine, etoposide, cisplatin
|
|
What chemotherapies are associated with leukoencephalopathy?
|
IV methotrexate
IV cytarabine |
|
What are the s/s of leukoencephalopathy?
|
dementia, dysarthria, dysphagia, ataxia, spasticity, seizures, or coma
rare (blindness) |
|
What are the s/s of peripheral neuropathy?
|
foot drop, paranthesis, or numbness of hands and feet
|
|
How to work up long term CNS findings?
|
CT scan of head for calcification
Possible MRI Neuropsych testing @ baseline then periodically as indicated |
|
Behavioral and neurocognitive rehabilitation includes:
|
- appr. school placement
- counseling - training in behavioral management - psych drugs if needed |
|
Abnormalities of the HPA are commonly seen after radiation to the ____, ____, and _____
|
head
neck face |
|
Injury to the HPA axis can cause alterations in the following hormones:
|
Growth hormones
throtropin gonadotropin adrenocorticotropin (ACTH) prolactin antidiuretic (ADH) vasopressin |
|
Injuries from radiation therapy can happen between _____ to ______ cGy
|
1800
5000 |
|
Growth abnormalities can occur between :________ cGy
|
1800-2000
|
|
Precious Puberty can occur between :________ cGy
|
1800-2000
|
|
Gonadotropin can occur between :________ cGy
|
3000-4000
|
|
TSH deficiency can occur between :________ cGy
|
> 3000 cGy
|
|
ACTH deficiency can occur between :________ cGy
|
> 3000 - 4000 cGy
|
|
hyperprolactinemia can occur between :________ cGy
|
> 4000 - 5000 cGy
|
|
T/F
Children with tumors in the HPA region have a 50% chance of developing an ADH deficiency before surgery and 25% chance after surgery. |
False
actually 30 % and 16 % |
|
what is the most common abnormality of the HPA axis?
|
GH deficiency
|
|
Deficiency of growth hormone presents clinical with:
|
- reduced growth velocity
- decrease in muscle mass - increased adipose tissue - high cholesterol levels - hypertension - early onset arthrosclerosis |
|
Precious puberty presents clinical with:
|
- early breast development ( girls < 8 y/o)
- early genital development (boys < 9 y/o ) - accelerated bone maturation - premature epiphyseal fusion - reduced final height |
|
Deficiency of gonadotropin presents clinical with:
|
- failure to progress through puberty
- arrested puberty - amenorrhea - if public and axillary hair develop w/o breast development |
|
Deficiency of ACTH presents clinical with:
|
- decreased stamina
- lethargy - fasting - hypoglycemia - dilutional hyponatremia |
|
Hyperprolactinemia presents clinical with:
|
- failure to proceed through puberty
- arrested puberty - galactorrhea - amenorrhea - decreased libido - impotence |
|
What is the diagnostic work up for GHD?
|
- assess growth velocity, tanner stage, bone age
- thyroid fxn - Insulin growth factors (IGF1, IGFBP3) - Formal GH stimulation testing - frequent serum sampling of GH over a 12-24 hour period |
|
What is the diagnostic work up for Gonadotropin Def?
|
- LH
- FSH - Testerone - Estradiol - GnRh |
|
What is the diagnostic work up for precious puberty?
|
- Tanner stage
- bone age - testing for GnRh - GH testing |
|
What is the diagnostic work up for TSH deficiency?
|
- basla conc of thyroxine and TSH
|
|
What is the diagnostic work up for ACTH deficiency?
|
- random serum cortisol level (first thing in the am)
- if abnormal then do a 1 hour ACTH stimulation test |
|
What is the diagnostic work up for hyperprolactinemia?
|
- random samples of serum plasma prolactin
- should be referred to an endocrinologist |
|
What is the diagnostic work up for diabetes insipidus?
|
- ADH def
- UA - serum electrolytes and |
|
What is the medical treatment for GHD?
|
- GH therapy should not be done until at least a year after cancer treatment
- GH therapy |
|
What is the medical treatment for precocious puberty?
|
- gonadotropin releasing hormone analog is used to suppress puberty
- GH with gonadotropin releasing hormone increased overall height in studies |
|
What is the medical treatment for gonadotropin deficiency ?
|
- replace hormone - estrogen (female) and testerone (males)
- should be overseen by an endocrinologist |
|
What is the medical treatment for TSH deficiency?
|
- thryroxine replacement therapy (levothyroxine/ Synthroid)
-- should be overseen by an endocrinologist |
|
What is the medical treatment for Adenocorticotropin Deficiency?
|
- hydrocortisone
- stress dose during times of stress - mineralocorticoids may also need to be replaced -- should be overseen by an endocrinologist |
|
What is the medical treatment for hyperprolactinemia?
|
- bromocriptine or related dopaminergic agents
- endocrinologist |
|
What is the medical treatment for dibetes insipidus?
|
- demopressin (to treat antidiuretic hormone deficiency)
- endocrinologist |
|
Nursing Assessment or HPA axis:
|
- height and weight ( including sitting height)
- s/s of hormone def - tanner stages of development |
|
The most common thyroid dysfunction related to late effects is :
|
hypothyroidism
|
|
The peak incidence of thyroid abnormalities is ____ - _____ years s/p treatment.
|
2-5
|
|
What are the risk factors for thyroid complications as late effects of treatment?
|
- radiation > 1000 cGY to the head, neck, chest, or spinal axis
- single dose or total body irradiation > 750 cGy - use of busulfan/cyclophosphamide - treated in puberty increase chance of problems - lymphangiograms done at time of dx have been associated with late effects - thyriodectomy - radiolabeled antibodies used in dx and tx of neuroblastoma - allogeneic bone marrow transplant |
|
what are the clinical presentations of hypothyroidism ?
|
- intolerance to temperature
- constipation - weight gain - dry skin - generalized weakness - muscle and joint aches - hoarseness - bradycardia - hypotension - puffy and round face - brittle nails and hair - periorbital edema - amenorrhea and arrested pubertal development - problems concentrating and depression - high cholesterol level - elevated TSH and decreased T4 |
|
what are the clinical presentations of compensated hypothyroidism ?
|
- asymptomatic
- labs elevate TSH with normal T4 |
|
what are the clinical presentations of Graves disease?
|
- tachycardia
- excitability, anxiety, nervousness - heat intolerance - increased sweating - wt loss - increased appetite - muscle weakness - fatigue - diarrhea - moist skin - tremors of the hands - irregular menstrual period - exophthalmos - decreased TSH and elevate T4 |
|
what are the clinical presentations of thyroiditis?
|
- s/s of hypothyroidism
- elevated serum thyroid antibodies |
|
what are the clinical presentations of benign or malignant tumor?
|
- palpable nodules or enlargement of the thyroid
- endocrinologist |
|
what are the clinical presentations of mixed hypothyroidism?
|
- s/s of central hypothyroidism
- mildly elevated TSH level |
|
What is the diagnostic workup for thyroid complications?
|
- palpation of the pt thyroid
- Thyroid panel |
|
T/F
Pt who received craniospinal radiation and/ or taking birth control should be evaluated for thyroid function based on free T4 rather than T4. |
True
|
|
What is the medical treatment of hypothyroidism?
|
Synthroid
|
|
What is the medical treatment of compensatory hypothyroidism?
|
Synthroid
|
|
What is the medical treatment of Graves Disease?
|
- surgical removal of part or all
thyroid - thyroid ablation with radioactive iodine - antithyroid drugs |
|
What is the medical treatment of thyroiditis?
|
- can be self limiting
- monitor serum thyroid studies - may involved hormone replacement |
|
What is the medical treatment of benign or malignant tumor?
|
- tumors are surgically resected
- see endocrinologist |
|
High dose radiation + the following factors effect hearing s/p treatment:
|
- younger age
- otosclerosis - tympanosclerosis - conductive hearing loss - eustachian tube dysfunction |
|
What type of chemotherapy is known for causing ototoxicity?
|
platinum
|
|
At what cumulative dose of cisplatin is correlated with hearing problems?
|
360 mg/m2
|
|
Ocular complications are associated with:
|
- direct orbital/ eye radiation
- higher dose cranial radiation |
|
Reduced visual acuity and orbital hypoplasia is caused by doses greater than:
|
30 Gy
also @ 30 Gy : lacrimal duct atrophy and xerophthalmia, retinopathy |
|
Cataracts can occur at doses greater than
|
10 Gy
|
|
Radiation combined with _____ and _____ increase the risk for cataract development.
|
- steroids
- busulfan |
|
Keratitis and keratoconjunctivitis are cause by doses greater than
|
50 Gy
|
|
Optic chiasm neuropathy can be caused at 30-65 Gy, and are exacerbated by the following comorbid conditions?
|
- diabetes mellitus
- hypertension |
|
How does glaucoma present?
|
- eye pain
- headache - nausea/ vomiting - decreased peripheral vision |
|
Radiation can lead to vascular injury that leads to ______ in the vessel wall and perivascular interstitial spaces.
|
fibrosis
|
|
Cranial radiation puts people at risk for ( @ 30cGy)
|
- vasculopathies in the larger vessels of the brain
- TIA, strokes, focal seizures - accelerated arthrosclerosis -- rare: hemorrhage |
|
True or False
Currently there is little evidence that links chemotherapy exposure to vasculature changes in the head and neck. |
True
|
|
What effects can radiation have on mucosal linings long term?
|
- chronic sinusitis
- altered sinus drainage |
|
What effects can radiation have on skin long term?
|
- telangiectasia
- atrophy - hyperpigmentation - alopecia - accelerated aging - 2ndary cancers |
|
What effects can chemotherapy have on skin long term?
|
- bleomycin : increase size of melanocytes
- busulfasn: permanent alopecia |
|
What effects can radiation have on bones long term greater than 3000 cGy?
|
- hypoplasia
- craniofacial abnormalities - fractures - necrosis |
|
T/F
Children older than 5 years at time of radiation are at higher risk for bone and connective tissue damage. |
False
|
|
What effects can radiation have on connective tissue long term?
|
- fibrosis
- hypoplasia |
|
Atrophy of salivary glands resulting in decreased salivation may occur with doses greater than ______ . cGY. This may also leads to altered _______ _______.
|
4000
Taste buds |
|
Dental abnormalities related to radiation (greater than 1000 cGY) are:
|
- tooth and root agenesis
- enamel dysplasia - caries - malocclusion - microdontia - arrested/ altered root development - periodontal disease |
|
Who is at greatest risk in developing dental complications long term?
|
- children under 5
- Total Body Irradiation - greater than 1000 cGY |
|
What three chemo agents are known for disrupting dental development?
|
- cyclophosphamide
- vincristine - vinblastine |
|
What complications are associated with chemotherapy in dental development?
|
- malocclusion
- enamel hypoplasia - opacities -hypodontia - microdontia - supernumerary teeth - enlarged pulp chamber - altered root development - marked shortening of premolar root - thickening and constricting of roots |
|
What are the common dental finding in patient who undergo BMT?
|
- v shaped roots
- premature apical closure - microdontia - enamel disturbances - aplasia |
|
What are the kind of cerebrovascular complications you can see as late effects?
|
stroke, premature carotid artery disease, Moyamoya disease, occlusive cerebral vasculopathy.
|
|
What are the kind of presenting symptoms accompany cerebrovascular complications late effects?
|
change in mental status, headaches, weakness, hemiparesis, numbness, or tingling, aphasia
|
|
What are the kind of subclavian-artery disease you can see as late effects?
|
diminished brachial and radial pulses, pallor of upper extremities, coolness of the skin or unequal blood pressure measurements
|
|
What are the late effects on skin?
|
pale, thinning, loss of pliability, submucosal induration, chronic ulcerations
|
|
What are the late effects on nasal mucosa?
|
intranasal scarring, changes in normal production of mucus and sinus drainage, possible chronic sinusitis, chronic nasal discharge, postnasal drip, nasal obstruction, facial pain, and headache
|
|
Late effects as skin can appear as:
|
hyper or hypo pigmentation, telangiectasias, atrophy, dryness, lockjaw, xerostomia.
|
|
Hair loss occurs at what dose cGY?
|
4,500 - 5,000 cGy
also hair color and texture changes |
|
Late effects on the bones and connective tissue appear as:
|
deformities, muscle hypoplasia, loss of elasticity, constricting fibrosis, osteoradionecrosis, and necrosis or ulcers of the soft tissue
|
|
Late effects on salivary glands and taste buds appear as:
|
xerostomia, dental caries, and decay
|
|
Dental late effects appear as:
|
root and crown abnormalities, root agenesis, premature apical closure, enamel hypoplasia, and microdontia, gingival hyperplasia
|
|
What is the potential medical treatment of vasculature changes?
|
stroke- revascularization surgery
hyperlipidemia - diet, lipid lowering agent, antiplatelet agents |
|
What is the potential medical treatment of skin and mucous membranes?
|
removal of suspicious moles and dysplastic nevi
Chronic sinusitis- aggressive for infections, re: to ENT |
|
ABCD is assessing moles:
|
a- ASYMMETRY
b- BORDERS c- COLOR d- DIAMETER |
|
Cardiotoxicity in long term effects most commonly takes form of:
|
cardiomyopathy
pericarditis valvular or coronary artery disease |
|
T/F
Males and young children have a higher incidence of late cardiovascular effects. |
False
females and younger children |
|
T/F
Myocardial impairment increases as the survivor ages. |
True
|
|
Cardiomyopathy increase with _____ chemotherapy agents at the following dose _____ m2.
|
anthracycline
>300m2 |
|
Other chemotherapies responsible for cardiomyopathy are:
|
cytoxan, dactinomycin, mitomycin, decarbazine, vincristine, bleomycin, methotrexate
|
|
T/F
Mediastinal radiation enhance anthracycline toxicities. |
True
|
|
What are factors that enhance the possibility of myocardial toxicity?
|
underlying cardiac abnormalities
primary tumor of the chest pregnancy recreational drug use health behaviors uncontrolled HTN |
|
What are the clinical s/s of pericarditis?
|
fatigue, cyanosis, ascites, peripheral edema, hypotension, chest pain, dyspnea, fever, venous distention, pulsus paradoxus, muffled heart sounds, effusion, and friction rub.
|
|
What are the clinical s/s of cardiomyopathy?
|
tachycardia, tachypnea, SOB, dyspnea, edema, heptomegaly, fatigue, cough, HTN, suncope, arrhythmias, cardiomegaly, gallop rhythms, palpitations, congestive heart failure, pleural effusion
|
|
What are the clinical s/s of valvular damage?
|
weakness, cough, dyspnea, new murmur, pulsating liver
|
|
What are the clinical s/s of coronary artery disease?
|
chest pain, pain on exertion, dyspnuea, diaphoresis, pallor, hypotension, arrhythmias
|
|
What is the medical tx of pericarditis?
|
if tamponade> pericardiocentesis
Effusion 1-10 months usually resolves if chronic then pericardiectomy |
|
What is the medical tx for cardiomyopathy?
|
afterloading reducing agents
digoxin diuretics possible cardiac transplant |
|
What is the medical tx for valvular damage?
|
penicillin proph before surgery or dental procedures
surgical replacement of damaged valves |
|
What is the medical tx for coronary artery disease?
|
diuretics
cardiac medications dietary restrictions balloon dilatations angioplasty or bypass surgery |
|
What are the general considerations for long term effects on the respiratory system?
|
combination of therapies, younger age at exposure, higher cumulative doses, concurrent infection and baseline dysfunction
|
|
Ankylosing spondylitis
clinical findings |
Chronic inflammatory disease of spine and sacroiliac joints → ankylosis (stiff spine), uveitis, and
aortic regurgitation. Bamboo spine. |
|
what chemo agent most commonly associated with pulmonary toxicity?
|
Bleomycin
Increased @ > 400 m2 but seen @ 60- 100 units/m2 |
|
Busulfan and Nitrosureas (carmustine, lomustine) are linked to what late effects ?
|
fibrosis
pneumonitis Bulsulfan > 500 mg/m2 increase risk |
|
Cumulative doses to lung tissue greater than ____ Gy, TBI greater than ____ Gy in a single fraction, or fractioned TBI greater than ___ Gy present the highest risk.
|
10-15
6 12 |
|
Indirect effects of radiation of the lungs are:
|
impair normal growth
development of the thoracic cage, airways, and lung parenchyma |
|
What is the pathophysiology of treatment induced long term lung damage?
|
DNA damage
free radical formation allergic and inflammatory response to chemo or radiation |
|
Long term effects possible with cytosine arabinoside or interleukin 2:
|
non cardiac pulmonary edema involving endothelial inflammation and vascular leak
|
|
Tx of pulmonary edema is:
|
1. oxygen therapy
2. diuresis |
|
What is the clinical presentation of pneumonitis?
|
1-3 months after radiation therapy or chemotherapy
low grade fever, congestion, cough, fullness of chest, dyspnea, dry cough, pinkish sputum, pleuritic chest pain, can lead to gradual development of pulmonary fibrosis |
|
What is the clinical presentation of fibrosis?
|
months or years after tx
changes occur over 1-2 years then stabilize chronic respiratory failure: dyspnea on exertion, fatigue, cough, decreased exercise tolerance, orthopnea, cyanosis, oxygen dependence, chronic cor pulmonale. |
|
What are the preventive measures for respiratory long term effects?
|
Monitor PFTs, CXR
Early detection of changes Pneumococcal Vaccine/ FLU Prevent infections Cessation of smoking |
|
TX of long term respiratory issues:
|
corticosteroids
bronchodilators expectorants antibiotics oxygen bed rest |
|
What are the most common pathological abnormalities of the GI tract in long term survivors?
|
- fibrosis
- enteritis from esophagus to rectum |
|
Long term complications of the GI tract include:
|
- structures
- adhesions - obstruction - ulcers - malabsorption |
|
What are the most common pathological abnormalities of the liver in long term survivors?
|
- fibrosis
- cirrhosis |
|
T/F
Parts of the small intestine appear to be more sensitive to radiation than the esophagus or colon. |
True
|
|
T/F
Bowel obstruction is rarely seen in those who have had abdominal radiation but not abdominal surgery. |
True
|
|
Radiation greater than 25 Gy puts pts at risk for :
|
secondary GI malignancies
> screening should beging @ age 35 then every 10 years |
|
What chemo can increase acute radiation related toxicities of the GI tract?
|
1. Anthracyclines
2. Dactinomycin |
|
What chemo agents have been associated with esophageal ulcerations, fibrosis, and strictures?
|
Vinblastine
Dactinomycin Doxorubicin 5- flurorouracil Methotrexate |
|
GVHD can lead to GI tract complications such as:
|
1. strictures
2. perimuscular fibrosis 3. chronic diarrhea 4. impaired absorption |
|
There is an increase risk of hepatic damage with radiation therapy if:
|
- hx of hepatic resection,
- VOD - Chronic hepatitis - Chronic alcohol use |
|
Splenomegaly and thrombocytopenia may develop as a consequence of
|
- portal HTN
- hypersplenism |
|
T/F
Dactinomycin and doxorubicin can enhance the hepatic effects of radiation. |
True
|
|
Methotrexate is associated with the development of:
|
- hepatic dysfunction
- fibrosis - cirrhosis |
|
T/ F
Daily oral methotrexate therapy is associate with a higher incidence of fibrosis and cirrhosis than intermittent parenteral dosing. |
True
|
|
Thioguanine has been associated with :
|
acute hepatotoxicity & VOD
chronic dysfunction including portal hypertension, nodular hyperplasia, fibrosis, and siderosis (iron in liver) |
|
The potential long term clinical s/s of intestinal fibrosis are:
|
abd pain (severe and intermittent), dysphagia, vomiting, diarrhea, constipation, bleeding, weight loss, poor linear growth, fatigue, obstruction, rectal pain
|
|
The potential long term clinical s/s of adhesions and strictures are:
|
abd pain, bilious vomitting, hyperactive bowel sounds, dyphagia, reflux, and aspiration pneumonia
|
|
The potential long term clinical s/s of cholelithiasis:
|
colicky abdominal pain related to increased fatty foods and excessive flatulence
upper right sided abd pain + Murphy's sign on palpation |
|
The potential long term clinical s/s of hepatic fibrosis are:
|
elevated transaminase
elevated bilirubin hepatomegaly icterus jaundice itching bruising portal HTN encephalopathy |
|
T/F
Chronic hepatitis may have no signs or symptoms |
True
|
|
The potential long term clinical s/s of hepatitis are:
|
elevated transaminase, elevated bilirubin
anorexia, malaise, n/v, abd pain, arthralgia, jaundice, hepatomegaly, hepatic fibrosis, + hepatitis screens |
|
What is the medical management of long term effects of intestinal fibrosis?
|
- dilatation of the affected area
- dietary mgmt |
|
What is the medical management of long term effects of enteritis?
|
- dietary mgmt
|
|
What is the medical management of long term effects of bowel obstruction?
|
decompression if needed
contrast studies surgical resection or ballon dilatation |
|
What is the medical management of long term effects of GI strictures?
|
barium test with endoscopy
dilatation of affected area |
|
What is the medical management of long term effects of esophagitis?
|
pharmacological agents
|
|
What is the medical management of long term effects of cholelithiasis?
|
- avoid fatty foods
cholecystectomy |
|
What is the medical management of long term effects of hepatic fibrosis or cirrhosis?
|
diuretics
diet liver transplant |
|
What is the medical management of long term effects of hepatitis?
|
viral (interferon or antivirals)
liver transplant |
|
What are potential long term risk factors with radiation to the kidneys?
|
renal insufficiency
HTN @ > 10 Gy |
|
What are potential long term risk factors with radiation to the bladder?
|
dysfunctional voiding
fibrosis vesicouretral reflux hemorrhagic cystitis hydronephrosis unlikely, but bladder malignancies @ > 30 Gy |
|
Long term bladder effects are greater with radiation + what chemo agents?
|
Cyclophosphamide
ifosfamide |
|
What are potential long term risk factors with radiation to the ureter, urethra ?
|
@ greater than 5000 cGY
Generalized effects |
|
What are potential long term risk factors with radiation to the female pelvis?
|
vaginal stenosis/fibrosis
uterine growth retardation ovarian dysfunction @ > 20 Gy |
|
What are potential long term risk factors with radiation to the male pelvis?
|
Leydig cell and germ cell dysfunction
decreased fxn in prostate gland decreased seminal fluid |
|
Radiation + what chemos can cause long term genitorourinary late effects?
|
cytoxan
methotrexate dactinomycin nitrosoureas anthracyclines |
|
What chemo agents cause late term gonadal dysfunction?
|
alkylating agents
cisplatin carboplatin |
|
What factors put one at higher risk for gonadal dysfunction?
|
- being male
- if received MOPP (mechlorethamine, oncovin, prednisone, and procarbazine) - > 3 cycles of busulfan (600mg/m2), cyclphosphamide (7.5 mg/m2) or alkylators with radiation |
|
What are the clinical presentation of renal insufficiency?
|
- tubular dysfunction
- hematuria - fatigue - HTN - hypomagnesemia - Fanconi Syndrome - proteinuria - anemia - growth abnormalities |
|
What are the clinical presentation of bladder dysfunction?
|
mucosal irritation, microscopic (or macro) hematuria, urgency, frequency, dysuria, hemorrhagic cystitis, incontinence, pain, and fibrosis
|
|
What are the clinical presentation of long term effects prostate?
|
inability for erection
diminished ejaculum |
|
What are the clinical presentation of long term effects vagina/uterus?
|
alteration in sexual fxn
uterine vascular insufficiency adverse pregnancy outcomes altered gonadal fxn (delayed or arrest puberty) |
|
What is the medical tx of long term effects of cystitis?
|
hydration, instillation of alum solution, cauterization of bleeding sites, partial or total cystectomy, bladder augmentation
|
|
What is the medical tx of long term effects of kidney dysfunction?
|
re: nephroplogist
antihypertensives electrolyte supplements |
|
What is the medical tx of long term effects of strictures?
|
- placement of stents
- urinary diversion |
|
What is the medical tx of long term effects of reproductive organs?
|
surgical interventions
pharmalogical interventions |
|
T/F
Spermatogenesis can occur 3/5 years after the use of some chemotherapeutic agents has ceased. |
True
|
|
Males are at higher risk for infertility if:
|
- > 3 cycles of nitrogen mustard, vincritine, procarbazine and prednisone
- combo therapy for Hodgkin's - Busulfan and cyclophosphamide - radiation to the testes (200cGy) |
|
If the following lymph node is dissected for staging of ferm cell or testicular tumors, then ejaculation function can be damaged?
|
retroperitoneal lymph node
|
|
Secondary testicular failure is a result of damage to the:
|
HPA axis
|
|
What are the clinical presentations of primary testicular dysfunction?
|
delayed or arrested development
small testicles oligospermia azoospermia elevated fondadotropin level Leydig's cell dysfunction decreased testerosterone increased FSH and LH |
|
What are the typical labs for germinal cell dysfunction ?
|
increased FSH
with normal LH and testosterone |
|
Girls are at risk for premature ovarian failure if they receive what chemotherapy?
|
alkylating agent
combo alkylating with radiation below the diaphragm or TBI |
|
@ what age are you concerned if there is no breast buds in prepubertal females ?
|
12 or no progression past Tanner 2 @ by age 14
|
|
What are the clinical presentation of postpubertal females with ovarian failure?
|
hot flashes, mood swings, headache, vaginal dryness, dyspareunia, low libido, irregular menses or amenorrhea
|
|
What is the medical tx of ovarian failure?
|
oophoropexy
shield ovaries pre radiation preserve ovarian tissue Hormone replacement therapy |
|
Musculoskeletal late effects are:
|
weakness, alteration or loss of function, osteopathy or fractures
occasionally, limb salvage, poor development, and amputation |
|
Complete arrest of he epiphysis occurs at _____ cGY
|
2,000
|
|
Prolonged use of steroids can result in :
|
avascular necrosis of the femoral head, osteopenia, osteoporosis
|
|
Pt are at an increased risk of bone abnormalities when the have the following comorbid conditions:
|
hyperthyriodism
growth hormone deficiency hypogondism Family hx of osteropenia co administration of corticosteroids |
|
Vincristine can cause acute:
|
neuropathy
foot drop abnormal gait |
|
Methotrexate is associate with with bone abnormality:
|
development of osteopathy
|
|
What long term effects can result from radiation to the bones?
|
spinal abnormalities, discrepancies in limb length, exostoses, slipped capitofermoral epiphysis, pathologic fracture, poor tooth development
|
|
What long term effects can result from radiation to the muscles?
|
hypoplasia
muscle asymmetry (reduced or uneven growth) |
|
What is the medical management of limb length discrepancies?
|
shoe lift
contranlateral epiphyssiodesis to arrest growth in a nonaffected limb contralateral limb shortening ipslateral lengthening procedures |
|
What is the medical management of slipped capitofemoral epiphysis ?
|
medical emergency requires fixation
|
|
What is the medical management of pathological fractures?
|
internal fixation
immobilization bone grafting amputation |
|
What is the medical management of scoliosis ?
|
> 20 degrees bracing
> 45 degrees (rare) fusion |
|
What is the medical management of osteopenia and osteoporosis?
|
calcium supplementation
biphosphonates tx exacerbating conditions evaluate with scans and bone mineral density |
|
Pt are predisposed to long term myelodysplasia when the following chemo agents are used:
|
- alkylating agents
- topoisomerase II inhibitors |
|
Radiation between 4 - 5K cGY to the Bone can take more than 4-6 weeks up to ___ years
|
2
|
|
T/F
Incomplete T Cell reconstitution has been reported up to 4 years after radiation of 1,000 cGy |
True
|
|
The spleen can become completely compromised after _____ cGY. Therefore putting the patients at risk of sudden and overwhelming infections from encapsulated organisms.
|
4,000
|
|
What labs are used to evaluate long term effects on immune system?
|
Immunoglobins
T cell studies with T4 and T8 subset studies |
|
With long term immune compromise, what medical management should be considered?
|
- pneumococcal conjugate and/or polysaccharide vaccine/ HIB vaccine menengococcal, influenza
- antimicrobial prophylaxis - daily prophylactic dose of penicillin or erythromycin |
|
Secondary Cancers can result from (2)
|
- previous cancer therapy
- genetic determinants |
|
T/F
The cumulative risk of developing a second cancer 20 years after having a childhood cancer is estimated to be 10- 12 % |
False
3-5 % |
|
AML is a risk after receiving what chemotherapy agents?
|
alkaylating agents
epipodophyllotoxins 4-6 years after initial therapy |
|
What secondary cancers are associated with radiation?
|
- carcinomas
- sarcomas - CNS tumors - skin cancer Begins 8-10 years after completion of radiation therapy |
|
What genetic mutations predispose family members to specific cancers?
|
- Von Recklinghausen Neurofibromatosis
- Li-Fraumeni |
|
What are the clinical presentation of secondary leukemia?
|
-fatigue, anemia, thrombocytopenia, granulocytopenia, bone pain, bleeding, fever, and frequent infections
|
|
What are the clinical presentation of secondary solid tumors?
|
fatigue, anorexia, palpable mass, bloody stools, melena, anemia, pain
|
|
What are the clinical presentation of CNS tumors?
|
seizures, headache, altered mental states, visual changes, nausea, and vomiting
|
|
What laws protect cancer survivors from discrimination?
|
American with Disabilities Act of 1990 ( employers can not discriminate based on medical hx)
Family and Medical Leave Act of 1993 ( job security up to 12 weeks) Employee Retirement and Income Security Act ( can not be fired for cancer dx/hx) Military service admission pending no treatment for 5 years. |
|
What organizations are available for advocacy and education for survivors?
|
- Candlelighters Childhood Cancer Foundation (legal)
- National Coalition for Cancer Survivorship - American Cancer Society - Job Accommodation Network - Cancer Legal Resource Center |
|
True/ False
Most states sponsor a comprehensive health insurance plan called a high risk pool. |
True
|
|
What is the Comprehensive Omnibus Budget Reconciliation Act?
|
requires employers to offer group medical coverage to employees to offer group medical coverage to employees and their dependents who otherwise would lose their group coverage due to individual circumstances
|
|
Health Insurance Portability and Accountability Act of 1996
|
allows individuals to change jobs without losing coverage if they have been insured for at least 12 months
|