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Unit 6-Intro Exam
Cancer Management: Surgery & Chemo
| Question | Answer |
|---|---|
| Many people still feel that a diagnosis of cancer is a death sentence; however, it is important to remember that cancer is a ___________ disease. | chronic |
| Definition of cure | the removal of the risk of death associated with some disease |
| How long do you have to be cancer free to be considered cured? | 5 years |
| Local control in reference to tumor | the tumor has not returned to the area where it originally was |
| Response in reference to tumor | the tumor has shown some decrease in size |
| Complete response | the tumor is no longer detectable |
| Partial response | the tumor has reduced in size by atleast 50% |
| T or F. While tumor response may provide great benefit in the relief of symptoms, it may have little or no effect on long term survival. | True |
| What are the factors that influence the treatment decision? | -diagnosis -biology of the disease -personal factors -treatment goal -location of tumor -state of the art alternatives |
| What is the most critical factor when choosing a treatment option? | diagnosis |
| What does diagnosis include? | stage and grade of the tumor and the evaluation of mets |
| Each cancer has a typical pattern of __________. | spread |
| Since each cancer has a typical pattern of spread what does this mean for treatment? | The area that the cancer would spread to would also be included in the treatment plan |
| T or F. Metastatic cells will closely resemble the tissue of the primary site. | Yes, most of the time. (this will guide the diagnosing team to the primary site) |
| Biology of the disease gives some indication of what? | -the tumor's associated prognosis -the tumor's anticipated behavior -the tumor's response to different treatment techniques |
| What are some personal factors that would influence treatment options? | -general overall health -age, other medical conditions, ability to tolerate the tx and side effects |
| What are some treatment goals associated with choosing a treatment option? | -primary/curative -palliative -prophylactic (before disease is visibly present) -adjuvant (at the same time) |
| What are some factors with the location of the tumor that would play a role in choosing a treatment? | -is the tumor invasive around critical structures? -is the tumor indwelling or outdwelling? -can clear margins be obtained with surgery? -metastatic surgery |
| What are 2 state of the art alternatives associated with treatment options? | -identifying all possible traditional treatment options -investigating "other/alternative" treatment techniques available |
| Ultimately, it must be the ____________ who makes the decision of what treatment is best. | patient |
| What are clinical trials? | research studies in which researchers assign participants to get one or more interventions (such as a drug, behavior, or medical device) to test what happens in people |
| What are the potential risks associated with participating in a clinical trial? | -side effects/health problem during a study (also called an adverse event) -may get the standard treatment or no treatment at all -intervention being tested may not work or may not work better than the standard treatment -may require multiple visits |
| What are the potential benefits associated with participating in a clinical trial? | |
| How and why are clinical trials/protocols monitored? | |
| What is a protocol? | |
| What is a control group? | |
| What types (categories) of clinical trials are currently available? | |
| What are the four phases associated with a clinical trial? | |
| What impact, if any, does a clinical trial/protocol have on cancer treatments? | |
| What are the factors that play a role in the recommendation of surgery? | -prevention -diagnosis or staging -resection of primary tumor -resection of other tumors -palliation -prevention -reconstruction/rehabilitation -support for chemo |
| In prevention, a surgeon can remove tissue that is not yet ________________ but it has the potential to be. | cancerous |
| What are some examples of prevention surgeries? | -removal of precancerous polyps -genetic cancer -prophylactic surgery |
| Prevention surgeries are done to prevent (or lower) the risk of ___________ conditions developing into cancer. | benign |
| Ulcerative colitis is a benign condition of the bowel; however, _______% of the patients will develop colon cancer within ______ years. | 40%;20 years |
| Women who test positive for HPV are at an increased risk of _______________ cancer. | cervical |
| Diagnosing and staging is used as a diagnostic tool in ______% of all cancer patients. | 90% |
| Diagnosis/staging is often performed through a _________. | biopsy |
| What 3 cancers use exploratory surgery for staging? | Hodgkin's disease, ovarian, and certain lymphomas |
| What is often the best form of treatment? | resection of primary tumors |
| With resection of primary tumors, in some cases this would provide a _________. | cure |
| What is removed when the primary tumor is resected? | -the tumor -any involved adjacent tissue -an adjacent area of "normal looking" tissue (margin) -any lymph nodes that may be involved or suspicious looking |
| If the primary tumor is removed in one piece then this is referred to as... | en block |
| Resection of the primary tumor is often referred to as ____________ or ___________ treatment. | radical or curative |
| With the resection of "other" tumors, __________ tumors are left following treatment with chemo or radiation. | residual |
| With the resection of "other" tumors, they are considered metastatic when? | only if it is a solitary lesion |
| With the resection of "other" tumors, ___________ is the second removal of the tumor. | recurrent |
| With palliation, what problems could be caused by the tumor growth that would need treatment? | -obstruction -invasion of surrounding tissue that results in pain -control blood loss from a tumor |
| Reconstruction/rehabilitation is done to... | -repair anatomical defects -improve functioning (improving the quality of life) -improve cosmetic appearance |
| When might reconstructive surgery be indicated? | -breasts, face, and neck |
| Support for chemotherapy is essentially for ______________ access. | vascular |
| Where is the vascular access located and where does it enter? | just below the clavicle and into the subclavian vein |
| What are 2 types of ports? | Hickman and port-a-cath |
| What are 5 types of surgery that can be performed? | - de-bulking surgery - second look surgery - cryosurgery - laser surgery -biopsy |
| What is de-bulking surgery? | removal of a portion of the tumor prior to chemo or radiation |
| Why is de-bulking surgery done? | to facilitate the administration of the prescribed treatment |
| Second look surgery is re-opening the patient for what 2 reasons? | -evaluating the success of the treatment -searching for recurrent disease |
| Is second look surgery still done today? | No, bc imaging is able to show this now |
| What is cryosurgery? | use of subfreezing (-160 degrees celcius) temp to kill tissue |
| What agent is often used in cryosurgery? | liquid nitrogen |
| What is cryosurgery often used in conjunction with? | -tumors occurring in the oral cavity or on the skin -tx of Parkinson's disease (destroys the nerve cells of the thalamus) |
| What kind of radiation dose laser surgery use to destroy tissue? | intense radiation from the visible, ultraviolet, or infrared portions of the spectrum |
| Laser surgery results in less ______________ or ______________. | bleeding or scarring |
| What is laser surgery used for? | -laryngeal tumors -cervical dysplasia -eyes |
| What 4 types of biopsies are there? | -needle aspiration -needle biopsy -incisional -excisional |
| Needle aspiration | thin/fine needle, cellular fluid sample (cytological dx) |
| Needle biopsy | core/wide needle, tissue sample (histological dx) |
| Incisional | portion of the tumor |
| Excisional | the entire tumor |
| What 3 types of anesthesia are used? | -local -regional -general |
| Local anesthesia | direct administration of an agent to the tissue that will induce an absence of sensation (affects only a small portion of the body) |
| What kind of drugs are used for local anesthetics? | -caine drugs |
| When is local anesthesia used? | for brief surgical procedures and dental procedures |
| Regional anesthesia agents are used to block a group of _____________ ______________. | sensory nerves |
| What is an example of a regional anesthetic? | epidural |
| General anesthesia | agents are used to cause a loss of sensation and consciousness |
| General anesthesia is administered via ______________ or ________ injection. | inhalation; IV injection |
| T or F. The degree of general anesthesia depends on the severity of the surgical procedure. | True |
| List the advantages of surgery. | -tumors have no biological resistance -has no potential carcinogenic effects -can cure un-disseminated tumors -provides most accurate evidence of disease (dx/prognosis) -quicker |
| List the disadvantages of surgery. | -normal and malignant tissue are destroyed equally -may result in deformity or loss of function -cannot effectively remove disseminated tumors -seeding may occur -formation of scar tissue is possible |
| Chemotherapy is the use of ____________ drugs in the treatment of cancer. | cytotoxic |
| _________% of all cancer patients will have chemotherapy. | 50% |
| What is the primary focus of chemotherapy? | to prevent cancer cells from multiplying and invading adjacent or distant tissues |
| List the goals of chemotherapy | -to cure a specific cancer -to serve as the tx of choice for systemic cancers -to control tumor growth where cure is not possible -palliation of symptoms -to shrink tumors prior to sx or rad therapy -to destroy micro-metastases after tumor removed |
| Why is chemo considered a systemic treatment? | because it eliminates malignancies in the blood, bone marrow, and lymphatic system |
| What is complete remission in chemo? | where the tumor disappears completely |
| How long can complete remission last for? | weeks, months, years, or forever |
| What is partial remissions in chemo? | the tumor shrinks by more than half its original size |
| In partial remission, chemotherapy is continued until when? | until the tumor stops shrinking; from here the drug regimen is changed with hopes of stimulating an additional response |
| What is stabilization in chemo? | the tumor neither shrinks nor grows |
| Stabilization in chemo could last how long? | weeks or months before the tumor resumes growth patterns |
| What is progression in chemo? | tumor may continue to grow despite the chemotherapy agents |
| What should be done in the progression stage? | it must be discovered quickly so that another tx alternative may be investigated |
| Like normal cells, cancer cells go through the ___________ cycle. | mitotic |
| What is the first phase of interphase? | G1 |
| G1 is the _____________ _____________phase. | pre-DNA synthesis |
| G1 phase | gap in growth between active cell division and DNA synthesis |
| What is the second phase of interphase? | S |
| S is the _______ ________________ phase. | DNA synthesis |
| Explain how S phase works. | The chromosome is transformed from having 2 chromatids attached to 1 centromere into a structure having 4 chromatids attached to 1 centromere. |
| What is the third phase of interphase? | G2 |
| G2 is the _______________ ____________ and _____________ phase. | post-DNA synthesis;resting |
| What are chemotherapy drugs designed to do? | interrupt the mitotic cycle and stop the cancer cells from growing and multiplying |
| How are chemotherapy drugs classified? | based on how and where they interrupt the mitotic cycle |
| When undergoing chemotherapy, patients need to inform the physician on what things? | -drug allergies -pregnancies or possible pregnancies -breastfeeding -medications -if hx of anemia, chicken pox, kidney disease, liver disease, heart problems, GI problems, and/or lung problems |
| What should be avoided during chemo and why? | Immunizations should be avoided because they are live agents to help build your immune system when introduced, but these patient's are already immunosuppressed so this would cause issues. |
| What was the first chemotherapy category? | Alkylating agents |
| Are alkylating agents cell cycle phase specific? | No, they attack the cell cycle during all phases |
| Alkylating agents form molecular bonds with ____________ acids. | nucleic |
| What do alkylating agents prevent and damage? | prevent DNA synthesis and damage DNA after replication |
| What are alkylating agents toxic to? | proliferating and non-proliferating cells |
| What is the most common alkylating agent used? | cisplatin but other examples include busulfan, cyclophosphamide, melphalan, nitrogen mustard and thiotepa |
| Antimetabolites imitate normal cellular ______________ involved with DNA synthesis. | nutrients |
| When do antimetabolites exhibit maximum activity? | during S phase |
| Antimetabolites are toxic to _______________________ cells. | proliferating |
| Examples of Antimetabolites. | fluorouracil and methotrexate |
| Antitumor Antibiotics insert themselves into the __________ strand and then does what? | DNA; break up the chromosomes and inhibit DNA and/or RNA synthesis |
| When do Antitumor Antibiotics attack the cell's DNA? | during all phases of cell cycle |
| Examples of Antitumor Antibiotics. | bleomycin, dactinomycin, and doxorubicin |
| Doxorubicin is also known as? | the red devil |
| When do nitrosureas attack the cell? | during all phases |
| What chemo agent can cross the blood-brain barrier? | nitrosureas |
| What chemo agent have actions similar to alkylating agents? | nitrosureas |
| What are some examples of nitrosureas? | carmustine and lomustine |
| Vinca Plant Alkaloids are derivatives of the ______________ plant. | periwinkle |
| Vinca Plant Alkaloids attack during the _________________. | metaphase |
| What does Vinca Plant Alkaloids do to the cell? | -causes mitotic arrest -cell loses its ability to divide -cell dies |
| Examples of Vinca Plant Alkaloids. | vincristine and vinblastine |
| What treatment is non-cytotoxic and is used for prevention and not as a curative treatment? | hormones/adrenocorticosteroids |
| T or F. While some tumors thrive on hormones, some are inhibited by hormones. | True |
| What are some examples of hormones used for prevention. | -estrogen (Diethylstibestrol or DES) -androgens (testosterone) -tamoxifen -lupro |
| Examples od adrenocorticosteroids. | -prednisone -decadron |
| Agents such as asparaginase, hydroxyurea, and procarbazine act during different phases of the cell cycle and inhibit __________ synthesis or __________ synthesis. | protein;DNA |
| Factors included in choosing chemo drug treatment. | -general health -cancer cell type -tumor location -route of drug absorption -tumor burden -tumor resistance to chemo |
| With tumor burden, the larger tumors are usually _________ responsive to chemo. | less |
| Combining chemo agents _______________ the effectiveness. | increases |
| What are the guidelines for combining chemo agents? | -agents should have different major side effects -agents belonging to the same category aren't normally combined -treatment should be pulsed |
| Chemo combo for brain | PLV |
| Chemo combo for Hodgkin's **original | MOPP |
| Chemo combo for Hodgkin's **New | ABVD |
| Chemo combo for lymphoma | CHOP |
| What is a major side effect of chemo? | myelosuppression |
| What is the normal and critical value of a leukocyte (WBC)? | normal: 5,000-10,000/mm^3 critical: 2,000/mm^3 |
| What is the normal value of erythrocytes (RBC)? | men: 4.5-5.5 million/mm^3 women: 4.2-4.8 million/mm^3 |
| What is the normal and critical value of thrombocytes (platelets)? | normal: 200,000-300,000/mm^3 critical: 50,000-75,000/mm^3 |
| What is the normal value of a hematocrit? | men: 43-49% women: 37-43% |
| What is the normal and critical value of hemoglobin? | men: 13.5-18 g/dl women: 12-16 g/dl critical: 10 g/dl |
| Which chemo drug can cause nerve toxicity (numbness, tingling, hearing loss)? | vincristine |
| Most common chemo drug used for GI cancers. | 5-FU |
| Which chemo drug has a limited lifetime dose due to lung scarring and decreased breathing function? | bleomycin |
| Which chemo drug can cause liver enzyme abnormalities and jaundice? | lomustine |
| Which chemo drug has a limited lifetime dose due to cardiac toxicity? | Doxorubicin |
| Which chemo drug has the ability to cross the BBB and can cause lung and liver toxicity? | lomustine |
| Which chemo drug can cause loss of nerve function (foot droop and partial paralysis)? | vincristine |
| Which hormone agent is often prescribed for brain met patients to help with swelling and side effects, but can have several terrible side effects? | adrenocorticosteroids |
| Which hormone agent is often used for breast cancer patients but can cause menopausal symptoms? | tamoxifen |
Created by:
lheard
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