Intro to Oncology/ tumor markers / cancer screening

Alpha-fetoprotein (AFP)

Liver and germ cell tumors; Dx in blood

Beta-human chorionic gonadotropin (Beta-hcg)

Choriocarcinoma and germ cell tumors; Dx in blood or urine

BRCA1 and BRCA2 gene mutations

Ovarian and breast tumor; Dx in blood and/or tumor, common in Ashkenazi Jewish ethnicity

CA19-9

Pancreatic, gallbladder, bile duct, colon and gastric cancer; Dx in blood

CA-125

Ovarian cancer; Dx in blood

CA 27-29

Breast cancer; Dx in blood

Calcitonin

Medullary thyroid cancer; Dx in blood

CEA

Colorectal cancer; Dx in blood

EGFR gene mutation

Non-small cell lung cancer; Dx tumor

ER/PR

Breast cancer; Dx tumor

Fibrin/Fibrinogen

Bladder cancer; Dx urine

HER2/neu

Breast, ovarian, bladder, pancreatic, and stomach; Dx tumor

5-HIAA

Carcinoid tumor; Dx urine

PSA

Prostate cancer; Dx blood

Thyroglobulin

Thyroid cancer; Dx blood

bladder cancer screening

Grade I

breast cancer USPSTF screening

GRADE B

biennial mammogram, women age 40-74

breast cancer ACS screening

40-44 - option to start mammogram

45-54 - yearly

55 and over - biennial or yearly

clinical breast exams not recommended

(no mammogram if life expectancy under 10 yrs)

BRCA genetic testing

grade B with risk factors

Cervical cancer USPSTF screening

women 21-29 - PAP smear every 3 yrs (grade A)

women 30-65 - PAP smear every 3 yrs / every 5 yrs with HPV test

No screening w/hysterectomy

colorectal cancer screening (no risk factors)

age 45- 49 : grade B

age 50 - 75 : grade A

age 76 - 85: grade C

lung cancer screening

grade B : annual for 50-80 y/o if current smoker or quit w/in 15 yrs (20 pack a year)

oral cancer screening

grade I

ovarian cancer screening

grade D

pancreatic cancer screening

grade D

Prostate cancer screening

PSA blood test

grade C - individual basis men ages 55-69

skin cancer screening

age <24 - grade B- counseling

age >24 - grade C - counseling

testicular cancer screening

grade D

thyroid cancer screening

grade D

uterine cancer screening

no recommendations

post-menopausal bleeding is cancer until proven otherwise!

CRC screening options

colonoscopy - every 10 yrs

cologuard (sDNA-FIT) - every 3 yrs

sigmoidoscopy - every 5 yrs

FIT or fecal occult - every year

Proto oncogene

genes that help cells grow and divide

Oncogene

mutated pro-oncogene that can grow out of control and may lead to cancer

Tumor suppressor gene

normal genes that slow cell division or cause apoptosis

Dysplasia

abnormal cell growth, precursor for cancer

Carcinoma

any cancerous tumor that starts with the cells that cover inner and outer body surfaces (epithelial cells)

In situ

cancer cells are confined to the layer of cells where it began growing and has not spread

Primary

site of origin of the cancer

Metastases

spread of the primary to another place in the body

Biopsy

tissue sampling to determine histopathology, must be done to confirm diagnosis!!!

Adjuvant

after primary treatment (usually surgery)

Neoadjuvant

prior to primary treatment

cancer staging

T -tumor

N - nodes

M - metastasis

cancer staging - T

TX- main tumor can't be measured

T0 - can't find main tumor

T1-T4 - size based

cancer staging - N

NX

N0 - no spread

N1 -3 - spread to lymph nodes

cancer staging - M

MX

M0 - no metastasis

M1 - metastasis

cancer differentiation

how different cancer cells are from normal

well - similar

poor/ undifferentlated - look and act different

grading

higher grade = more differentiation (poor)

radiation therapy

high power energy , break down DNA

external beam radiation

MC radiation tx

Photon, electron, proton

brachytherapy

internal radiation

(ex. gyno or prostate cancers

radiation side effects

localized to where beam is aimed!!!

radiation is measured in

Grays (gr)

oncologic emergencies

- spinal cord compression

- increased intracranial pressure

- superior vena cava syndrome

- tumor lysis syndrome

CRC risk factors

FHx or ADFP (polyps)

Immunotherapy

use immune system to identify tumor and reject

targeted therapy

small molecule drugs or monoclonal antibodies

precisely identify and attack cancer cells

hormone therapy

targets hormones to stop growth of cancer

common for prostate or breast cancer

CAR-T and BiTE therapy

use pt's own T cells to fight cancer

bone marrow transplant

allogenic or autologous

induction chemotherapy

initial therapy with goal of complete remission

myelosuppression

suppression of the blood cell-producing function of the bone marrow (ex. neutropenia, nadir)

nadir

lowest point of cell counts, 7-10 days after chemo

neutropenic fever

ANC <1000, temp >38C

MC after chemo, tx with broad spectrum abx

tumor lysis syndrome

destruction of cancer cells

high K, phos, uric acid

low Ca

tx- aggressive hydration

extravasation

leakage of therapeutic agent to surrounding tissue

nausea initial treatment

5-HT3 receptor agonist (odansetron)

SE- constipation

fatigue management

physical activity, yoga, massage/acupuncture, CBT

pharm - methylphenidate

neuropathic pain managment

duloxetine, TCAs