Cancer Basics and Epidemiology

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the most common structure affected by metastasis in the eye?

Ciliary body

Iris

Choroid (correct)

Retina

Which type of choroidal melanoma typically has pigmentation?

Metastatic melanoma

Atypical melanoma

Primary melanoma (correct)

Secondary melanoma

What is the mean survival time from diagnosis of metastatic orbital tumors?

Approximately one year

Around three years

Less than two years (correct)

Greater than five years

Which primary systemic cancers are most commonly associated with secondary orbital tumors?

Breast, lung, and prostate cancers Signup and view all the answers

What sign is associated with orbital metastases and involves changes in pupil reaction?

Relative afferent pupillary defect (RAPD) Signup and view all the answers

What characterizes the definition of cancer?

Uncontrolled division of abnormal cells Signup and view all the answers

Which group has the highest cancer-related death rates according to epidemiological data?

Men and African-Americans Signup and view all the answers

What does the 'T' in TNM staging refer to?

Tumor size and extent Signup and view all the answers

Why have cancer death rates declined over the past 30 years?

Scientific progress and advancements in treatment Signup and view all the answers

What does 'M1' indicate in the context of TNM staging?

Distant metastasis present Signup and view all the answers

Which factor is indicated as significantly influencing cancer survival rates?

Socioeconomic status Signup and view all the answers

What is true about the progress in cancer death rates relative to other chronic diseases?

Progress has stalled compared to other chronic diseases Signup and view all the answers

What is indicated by 'N3' in TNM staging?

Increasing number and/or extent of nodal involvement Signup and view all the answers

Which blood test is specifically indicated for detecting autoimmune antibodies related to CAR?

Alpha-enolase Signup and view all the answers

What is a critical reason for referring patients to oncology urgently, even without a cancer diagnosis?

History of parapneoplastic disease Signup and view all the answers

Which of the following statements regarding treatment outcomes for CAR is true?

Poor visual prognosis may occur even with treatment Signup and view all the answers

What crucial information should be included when taking a case history from cancer patients?

Status of remissions and past treatments Signup and view all the answers

Which characteristic is indicative of generalized dysfunction evident in the Electroretinogram (ERG) test for CAR?

Generalized dysfunction across multiple regions Signup and view all the answers

What is the primary mechanism by which paraneoplastic diseases affect the body?

By triggering an autoimmune response Signup and view all the answers

Which tests are used to diagnose paraneoplastic diseases?

Autoantibody detection in blood or cerebrospinal fluid Signup and view all the answers

What is a characteristic ocular effect of melanoma-associated retinopathy (MAR)?

Altered saccadic movements Signup and view all the answers

Which of the following symptoms is typically associated with cancer-associated retinopathy (CAR)?

Photophobia Signup and view all the answers

In which cancers is cancer-associated retinopathy (CAR) most commonly associated?

Small cell lung, breast, ovarian, endometrial, and cervical cancers Signup and view all the answers

What is the major symptom of nyctalopia associated with paraneoplastic diseases?

Night blindness Signup and view all the answers

Which of the following is a common sign of cancer-associated retinopathy during examination?

Macular edema Signup and view all the answers

What is meant by paraneoplastic optic neuropathy (PON)?

A type of cranial nerve palsy affecting vision Signup and view all the answers

What is a common side effect of chemotherapy that affects the gastrointestinal system?

Alopecia Signup and view all the answers

Which of the following ocular symptoms is NOT associated with radiation retinopathy?

Periorbital edema Signup and view all the answers

Which drug class is associated with retinal toxicity?

Cytotoxic agents Signup and view all the answers

What is a recommended preventative measure during radiation treatments to protect the eyes?

Using eye protection Signup and view all the answers

What type of toxicity is typically associated with cisplatin?

Optic nerve toxicity Signup and view all the answers

Which of these statements is true regarding anti-VEGF injections?

They address neovascularization in radiation retinopathy. Signup and view all the answers

Which chemotherapy side effect can lead to infection risk due to blood cell production inhibition?

Myelosuppression Signup and view all the answers

What effect can targeted therapy have on cancer treatment?

It may have fewer side effects than chemotherapy. Signup and view all the answers

Which of the following is NOT an ocular toxicity associated with cyclophosphamide?

Chronic dry eye Signup and view all the answers

How does hormonal therapy primarily function in cancer treatment?

It blocks hormone receptors to slow tumor growth. Signup and view all the answers

What is a key feature of immunotherapy in cancer treatment?

It enhances cancer cell recognition by the immune system. Signup and view all the answers

Which method is utilized for imaging in the assessment of radiation retinopathy?

OCT-A Signup and view all the answers

Which class of drugs has been linked to side effects including uveitis in patients undergoing cancer treatment?

Cytotoxic agents Signup and view all the answers

What is the primary goal of hyper-fractionation in radiation therapy?

To use the minimal total radiation needed for efficacy. Signup and view all the answers

Study Notes

Cancer Basics

Cancer arises from the uncontrolled division of abnormal cells that circumvent the cell cycle and apoptosis.
Cancer has both genetic (non-modifiable) and environmental (modifiable) causes.

Cancer Epidemiology

Cancer is the second leading cause of death in the United States.
Cancer deaths have significantly declined in the past 30 years due to scientific progress.
Progress in improving cancer death rates has stalled compared to other chronic diseases.
Cancer rates are highest among men and African-Americans.
Social determinants of health play a significant role in cancer survival rates.

TNM Staging

The TNM staging system is used to describe the severity of cancers.
Information is gathered from clinical exams, imaging, and/or surgery.
T refers to the size and/or extent of the tumor.
- T0 = no primary tumor, Tis = carcinoma in situ, T1-4 = increasing tumor size and spread.
N describes lymph node involvement.
- N0 = no regional node involvement, N1-3 = increasing number and/or extent of nodal involvement.
M describes whether there are any distant metastases.
- M0 = no metastasis, M1 = distant metastasis.
Scores are used to predict prognosis and dictate treatment options.
The higher the scores, the worse the prognosis.

Radiation Therapy

Younger patients are at a higher risk for proliferative disease from radiation therapy.
Signs of Radiation Retinopathy: microaneurysms, hemorrhages, telangiectasias, hard exudates, macular edema, cotton-wool spots, neovascularization of the retina, iris, angle, and/or optic nerve head, vitreous heme, retinal detachment.

Radiation Retinopathy Management

Testing
- OCT-A
- FA
- FAF
Prevention
- Hyper-fractionation of treatment
- Using the minimal total radiation needed for effective treatment
- Eye protection during radiation treatments
- Prophylactic triamcinolone injections
Treatment
- Anti-VEGF injections
- Sectoral or Pan-retinal laser photocoagulation

Chemotherapy

Chemotherapy uses pharmaceuticals to arrest the reproduction of cancer cells.
Different classes of drugs target different stages of the cell cycle.
Various routes of administration exist.
Chemotherapy can be used in combination with radiation or surgery.
- May be given before surgery to shrink the tumor and improve outcomes.
Chemotherapy causes side effects including nausea, alopecia, vomiting, myelosuppression, and mucositis.

Ophthalmic Effects of Chemotherapy

Cornea and Conjunctival Toxicity: keratitis, corneal deposits, conjunctivitis.
Periorbital, Orbital, and Eyelid Toxicity: periorbital edema, orbital inflammation, blepharitis, ectropion/entropion, nasolacrimal duct obstruction.
Uveitis
Retinal Toxicity: pigmentary retinopathy, hemorrhagic retinopathy, serous retinopathy, macular edema, cotton wool spots, retinal vascular occlusion.
Optic Nerve Toxicity: edema, inflammation, atrophy.
Other Neuro-ophthalmic Toxicities: cranial nerve palsy, internuclear ophthalmoplegia, nystagmus, transient cortical blindness, or visual field loss.
Other Visual Symptoms: vision loss of unclear cause, scintillating scotoma, photopsia.

Other Types of Cancer Therapy

Targeted Therapy: Drugs that target specific genetic and molecular mechanisms of the cancer. Includes monoclonal antibodies.
Hormonal Therapy: Used to treat hormone-driven tumors. Blocks hormone receptors. Has multiple side effects.
Immunotherapy: Increases recognition of cancer cells by the immune system. Makes the cells more susceptible to cellular checkpoints. May be used in conjunction with radiation.

Metastasis

The globe and orbit are uncommon sites for metastasis.
Metastasis indicates very poor prognosis.
Most common structures affected by metastasis is the uveal tract.
The choroid is the most frequently affected site.
- Metastasis in the choroid can be the first indication of malignancy, even in patients with a known cancer diagnosis.

Types of Choroidal Melanomas

Primary: Typically pigmented. Subretinal fluid may be present. Growth over months to years. Seeding uncommon.
Secondary: Typically amelanotic (no pigmentation, yellowish). Significant subretinal fluid larger than the lesion size. Growth within weeks. Seeding is more common in the retina and vitreous.

Metastatic Orbital Tumors

Uncommon site of metastasis.
Comprise up to 13% of all orbital tumors.
Most secondary orbital tumors come from breast, lung, or prostate cancers.
Mean survival time is less than two years.
Symptoms: pain, diplopia, and vision loss.
Onset of symptoms is usually sudden.
Signs include a mass upon orbital palpation, anterior segment vessel congestion, RAPD, optic nerve edema, and ophthalmoplegia.
Diagnosis is confirmed with imaging (MRI).

Paraneoplastic Disease

Paraneoplastic disease occurs when a malignancy triggers an autoimmune response in another part of the body.
Patients do not necessarily have an active cancer diagnosis.
Diagnosis is confirmed by detecting autoantibodies in the blood or cerebrospinal fluid (CSF).

Ocular Effects of Paraneoplastic Disease

Melanoma-Associated Retinopathy (MAR): Enlargement of the ONH.
Bilateral Diffuse Uveal Melanocytic Proliferation (BDUMP): Addressing tumors.
Paraneoplastic Optic Neuropathy (PON):
- Other ocular effects: Cranial nerve palsies, saccadic eye movement deficits, deficits in pursuits, Cancer-associated retinopathy (CAR).

Cancer-Associated Retinopathy

Most common ocular paraneoplastic disease.
Diagnosis of exclusion.
Most associated with small cell lung, breast, ovarian, endometrial, and cervical cancers.
Autoantibodies react with the photoreceptors causing their destruction.
Typically no signs of disease on DFE.
Insidious onset of symptoms.

CAR Signs and Symptoms

Symptoms (usually bilateral): Central vision loss, nyctalopia, dyschromatopsia, photopsia, and photophobia.
Signs: Uveitis, macular edema, retinal vasculitis.

CAR Diagnosis and Management

Testing: OCT, electroretinogram (ERG), blood testing for autoantibodies.
Management: Systemic steroids, systemic immunomodulatory therapy, referral to an oncologist if no cancer diagnosis exists.

Clinical Pearls

Ask detailed case history questions for cancer patients including family history, type of cancer, stage, metastasis (if any), treatments performed, and remission status.
Carefully look for signs of metastasis and paraneoplastic disease, even in patients with a cancer diagnosis.
Refer anyone with these conditions but no cancer diagnosis to oncology emergently.
Be compassionate when discussing these diagnoses with patients.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers the fundamentals of cancer, including its biological basis, epidemiology, and the TNM staging system. Explore the causes, impacts on mortality rates, and the factors influencing cancer survival. Test your knowledge on this critical health topic.