Oncology, Radiation Therapy, Ethics, and Patient Care Midterm Review

Comprehensive review flashcards covering cancer biology, histologies, TNM staging, radiation oncology modalities, bioethics, legal doctrines, and patient assessment principles.

What occurs during the $G_0$ phase of the cell cycle?

Cells function normally but are not preparing to divide. Most cells in tissues reside in $G_0$ and can reenter the cell cycle when stimulated.

What cellular activities take place during the $G_1$ phase (First Growth Phase)?

The cell undergoes active growth and metabolism, produces RNA and proteins, and commits to DNA replication. The time spent in this phase varies by cell type.

What is the primary event during the $S$ phase (Synthesis) of the cell cycle?

DNA is replicated so that each daughter cell receives a complete, identical set of genetic material.

What is the key function of the $G_2$ phase (Second Growth Phase)?

The cell prepares for mitosis by producing enzymes and proteins needed for cell division.

During which cell cycle phases are cells most sensitive to radiation, and in which phase are they most resistant?

Cells are most sensitive during the $G_2$ and $M$ phases, and most resistant during the $S$ phase.

What are the defining characteristics of benign tumors?

They are generally well differentiated, encapsulated, slow-growing, push surrounding tissues aside rather than infiltrating them, and do not invade nearby tissues or metastasize.

What are the distinguishing characteristics of malignant tumors?

They demonstrate local invasion, destroy nearby tissues, metastasize to distant body sites, and often dedifferentiate with alterations in cell shape, size, and nuclear appearance.

What is meant by an undifferentiated or anaplastic cell?

A cell that has altered so significantly that it does not resemble the original cell at all, has lost its normal function, and behaves abnormally.

From what type of cells do sarcomas originate, and which tissues do they involve?

Sarcomas arise from mesenchymal cells, which form connective tissues including bone, cartilage, muscle, and fat.

What are the specific names given to mesenchymal cancers of the blood and lymphatic system?

Leukemias (blood cancers) and lymphomas (lymphatic system cancers).

From what tissue type do carcinomas arise?

Epithelial cells, which cover body surfaces and line organs and body cavities.

What cellular origins differentiate squamous cell carcinoma from adenocarcinoma?

Squamous cell carcinoma arises from squamous epithelium, whereas adenocarcinoma originates from glandular epithelial cells that produce secretions.

According to Table 1.3, what is the most common histology for the oral cavity, pharynx, lung, anus, and cervix?

Squamous cell carcinoma.

According to Table 1.3, what is the most common histology for colon and rectum, endometrium, and prostate cancers?

Adenocarcinoma.

According to Table 1.3, what are the most common histologies for breast cancer and brain cancer?

Breast: Infiltrating ductal carcinoma; Brain: Astrocytoma.

How does etiology differ from epidemiology?

Etiology is the study of the cause of disease, while epidemiology is the study of disease incidence within populations (e.g., via the SEER National Data Base analyzing age, sex, race, and location).

In cancer screening examinations, what do sensitivity and specificity represent?

Sensitivity is the ability of a test to obtain a true-positive result; specificity is the ability of a test to obtain a true-negative result.

What is the difference between a false-negative and a false-positive screening test result?

A false-negative falsely indicates no cancer is present when cancer actually is present; a false-positive indicates the presence of a tumor when there is no malignancy.

What is clinical staging, and when is it conducted?

Staging based on physical examinations, imaging (CT, MRI), and biopsies; it is performed before any major treatment begins.

Why is pathologic staging more accurate than clinical staging?

It incorporates findings from surgical resection of part or all of the tumor, allowing direct visualization and examination of the tumor.

When are posttherapy staging and restaging utilized?

Posttherapy staging is performed after initial therapy (chemotherapy, radiation, hormone therapy) to evaluate response; restaging is done if the cancer returns (recurs).

What does each component of the TNM staging system evaluate?

T evaluates tumor size or extent; N evaluates regional lymph node involvement; M evaluates distant metastasis to other organs.

How is tumor grade determined, and what are its four differentiation categories?

Determined by microscopic examination based on degree of differentiation: well differentiated, moderately well differentiated, poorly differentiated, and undifferentiated or anaplastic.

What is palliation in oncology?

Noncurative treatment administered to relieve pain and suffering.

What are the common biopsy methods used to confirm cancer?

Fine-needle aspiration, core needle, endoscopic, image-guided, incisional, and excisional biopsies.

How do neoadjuvant therapy and adjuvant therapy differ in oncology?

Neoadjuvant therapy is delivered prior to surgery to improve the odds of complete resection; adjuvant therapy is delivered in conjunction with chemotherapy and/or surgery.

What is brachytherapy, and which radioactive isotopes are commonly used in it?

Short-distance radiation therapy utilizing isotopes such as cesium-137 ($^{137}\text{Cs}$), iridium-192 ($^{192}\text{Ir}$), palladium-103 ($^{103}\text{Pd}$), cesium-131 ($^{131}\text{Cs}$), or iodine-125 ($^{125}\text{I}$).

What are the different delivery routes for chemotherapy drugs?

Oral administration (easiest), intraarterial infusion, intrathecal injection (into cerebrospinal fluid space), and central line intravenous access via a port-a-cath.

Which drugs are examples of alkylating agents, antimetabolites, and hormonal agents?

Alkylating agents: Carboplatin, Cisplatin; Antimetabolites: 5FU; Hormonal agents: Lupron, Tamoxifen.

According to Table 1.6, what are the common metastatic sites for primary lung cancer?

Liver, adrenal glands, bone, and brain.

According to Table 1.6, what are the common metastatic sites for primary breast cancer?

Lungs, bone, and brain.

According to Table 1.6, what are the common metastatic sites for primary prostate cancer?

Bone, liver, and lungs.

According to Table 1.6, what are the common metastatic sites for stomach, anus, bladder, and cervix cancers?

Stomach: liver; Anus: liver and lungs; Bladder: lungs, bone, and liver; Uterine cervix: lungs, bone, and liver.

What is the distinction between retrospective and prospective clinical trials?

Retrospective studies analyze past events or records; prospective studies are planned before treatment and establish predefined eligibility criteria for patient enrollment.

Which professionals comprise the radiation oncology team under the radiation oncologist?

Radiation physicist, dosimetrist, radiation therapists, nurses, support staff members, and clerical staff members.

What are the primary responsibilities of the ASRT versus the ARRT?

ASRT is the professional society providing journals, education, grants, and advocacy; ARRT is the credentialing agency providing board examinations, certification, and registration.

What are the four primary sources of values in ethics?

Culture, experience, religion, and science.

What are the seven core bioethical principles?

Autonomy, beneficence, confidentiality, justice, nonmaleficence, role fidelity, and veracity.

How are autonomy, beneficence, and nonmaleficence defined in healthcare ethics?

Autonomy: patient self-determination and independent decision-making; Beneficence: acting in the patient's best interest; Nonmaleficence: avoiding harm or mistreatment.

How are confidentiality, role fidelity, and veracity defined in healthcare ethics?

Confidentiality: keeping patient information private (unless the patient is in danger); Role fidelity: remaining faithful to one's professional scope; Veracity: truthfulness in healthcare practice.

How do the Engineering and Priestly models of provider-patient interactions function?

The Engineering/Analytical model focuses exclusively on clinical facts while disregarding the patient as a person; the Priestly model assumes a paternalistic, godlike stance where the provider makes all decisions.

What characterizes the Collegial, Contractual, and Covenant ethical models?

Collegial: cooperative partnership based on trust and dignity; Contractual: shared decision-making guided by agreements like informed consent; Covenant: trust fostered through traditional duties and experiences.

What are the seven stages of Dr. Kübler-Ross's grief cycle in chronological order?

1. Shock, 2. Denial, 3. Anger, 4. Bargaining, 5. Depression, 6. Testing, 7. Acceptance.

What is tort law, and how does it function?

A branch of civil law concerning wrongful acts to individuals or property (not breaches of contract) that establishes liability, deters harm, and awards damages to injured parties.

What distinguishes libel from slander?

Libel is written defamation; slander is oral defamation.

What do the legal doctrines of Respondeat Superior and Res Ipsa Loquitur dictate?

Respondeat superior holds employers liable for employees' negligent acts committed during assigned duties; Res ipsa loquitur ('the thing speaks for itself') requires the defendant to prove negligence did not occur.

What is the Doctrine of Foreseeability?

A legal concept asserting that individuals should reasonably anticipate that certain actions or failures to act could lead to injury to others.

How does cognitive content differ from affective content in patient communication?

Cognitive content encompasses the objective facts and words spoken; affective content involves verbal or nonverbal feelings, attitudes, and behaviors.

What are reflective listening and empathy in patient assessments?

Reflective listening is reflecting specific content or implied emotions with empathy; empathy is identifying with the thoughts, feelings, or experiences of another individual.

What is cachexia?

A wasting syndrome characterized by the loss of skeletal muscle mass with or without the concurrent loss of fat mass.

What are the hematologic definitions of myelosuppression, anemia, leukopenia, thrombocytopenia, and pancytopenia?

Myelosuppression: reduced bone marrow function; Anemia: low RBC count; Leukopenia: low WBC count; Thrombocytopenia: low platelet count; Pancytopenia: reduction of all circulating blood cell types.

What constitutes a Culture of Safety in a medical setting?

A framework that supports safe clinical decisions, encourages requesting assistance, reduces injury risk, and enforces safety policies (e.g., refusing an unsafe transfer until sufficient help arrives).

What is the golden rule for patient wheelchair transfers?

Always transfer toward the patient's stronger side; if strength is symmetrical, select the safest and most convenient path.

What are the three common wheelchair transfer methods used by radiation therapists?

Standby Assist Transfer, Assisted Standing Pivot Transfer, and Hydraulic Lift Transfer.

What is orthostatic hypotension, and how should it be managed during patient transfers?

A sudden reduction in blood pressure upon rising from a recumbent or seated position; the clinician should assist the patient into a stable posture and evaluate stability prior to ambulation.

What is the difference between a fully automatic and a semiautomatic automated external defibrillator (AED)?

A fully automatic AED delivers a necessary shock automatically; a semiautomatic AED instructs the operator to manually press the shock button.

What are the four primary classifications of shock and their underlying causes?

Hypovolemic (fluid/blood loss), Cardiogenic (cardiac failure/myocardial infarction), Neurogenic (spinal anesthesia/spinal cord injury), and Vasogenic (sepsis, deep anesthesia, or anaphylaxis).

Which forms of shock are most frequently encountered by imaging and radiologic professionals?

Hypovolemic shock and anaphylactic shock (most often due to adverse reactions to iodinated contrast media).

What are the hallmark signs differentiating hypoglycemia from hyperglycemia?

Hypoglycemia: hunger, tremors, diaphoresis, and irritability; Hyperglycemia: polyuria, polydipsia (thirst), and dry mucous membranes.

What are the medical definitions of vertigo and syncope?

Vertigo is the false sensation of revolving or spinning movement; syncope is a temporary loss of consciousness resulting from insufficient cerebral blood flow.