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Questions and Answers
What is the primary purpose of radical surgeries in cancer treatment?
What is the primary purpose of radical surgeries in cancer treatment?
What is a significant systemic side effect of radiation therapy?
What is a significant systemic side effect of radiation therapy?
Which dose of radiation is likely to cause severe ocular damage?
Which dose of radiation is likely to cause severe ocular damage?
What aspect of radiation treatment poses the highest risk for developing radiation retinopathy?
What aspect of radiation treatment poses the highest risk for developing radiation retinopathy?
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Which ocular effect is associated with radiation treatment?
Which ocular effect is associated with radiation treatment?
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What is a common misconception about the side effects of radiation on healthy tissues?
What is a common misconception about the side effects of radiation on healthy tissues?
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What is the primary characteristic that defines cancer cells?
What is the primary characteristic that defines cancer cells?
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Which demographic group has the highest cancer death rates according to cancer epidemiology?
Which demographic group has the highest cancer death rates according to cancer epidemiology?
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What condition can occur as a predictable complication of radiation therapy?
What condition can occur as a predictable complication of radiation therapy?
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What is a primary method of radiation delivery in brachytherapy?
What is a primary method of radiation delivery in brachytherapy?
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What does the 'T' in the TNM staging system represent?
What does the 'T' in the TNM staging system represent?
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Why might a patient receive fractionated doses of radiation over multiple visits?
Why might a patient receive fractionated doses of radiation over multiple visits?
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What is a significant cause of the decline in cancer death rates over the past 30 years?
What is a significant cause of the decline in cancer death rates over the past 30 years?
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Which of the following is NOT a common effect seen in the anterior segment as a result of radiation?
Which of the following is NOT a common effect seen in the anterior segment as a result of radiation?
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Which of the following correctly describes the 'N' in the TNM staging system?
Which of the following correctly describes the 'N' in the TNM staging system?
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How are the scores from the TNM staging system utilized in cancer treatment?
How are the scores from the TNM staging system utilized in cancer treatment?
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Which statement about the causes of cancer is accurate?
Which statement about the causes of cancer is accurate?
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What does the 'M' signify in the TNM staging system?
What does the 'M' signify in the TNM staging system?
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Which factors are significant social determinants of health that influence cancer survival rates?
Which factors are significant social determinants of health that influence cancer survival rates?
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What is a common side effect of chemotherapy related to mucositis?
What is a common side effect of chemotherapy related to mucositis?
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Which of the following treatments is NOT typically used for radiation retinopathy?
Which of the following treatments is NOT typically used for radiation retinopathy?
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Which type of cancer therapy involves drugs that specifically target genetic and molecular mechanisms of cancer?
Which type of cancer therapy involves drugs that specifically target genetic and molecular mechanisms of cancer?
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What can NOT be considered a systemic ophthalmic effect of chemotherapy?
What can NOT be considered a systemic ophthalmic effect of chemotherapy?
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Which of the following is most commonly associated with uveitis as a toxicity from chemotherapy?
Which of the following is most commonly associated with uveitis as a toxicity from chemotherapy?
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Which of the following describes the purpose of anti-VEGF injections in managing radiation retinopathy?
Which of the following describes the purpose of anti-VEGF injections in managing radiation retinopathy?
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What is a primary role of immunotherapy in cancer treatment?
What is a primary role of immunotherapy in cancer treatment?
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Which characteristic is associated with optic nerve toxicity from chemotherapy?
Which characteristic is associated with optic nerve toxicity from chemotherapy?
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Which class of chemotherapy agents is associated with causing periorbital toxicity?
Which class of chemotherapy agents is associated with causing periorbital toxicity?
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What is an effect of hyper-fractionation in radiation treatment?
What is an effect of hyper-fractionation in radiation treatment?
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Which testing method is specifically mentioned for diagnosing CAR?
Which testing method is specifically mentioned for diagnosing CAR?
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What is indicated by blood testing for autoantibodies in CAR diagnosis?
What is indicated by blood testing for autoantibodies in CAR diagnosis?
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Which treatment option is associated with poor visual prognosis even with intervention?
Which treatment option is associated with poor visual prognosis even with intervention?
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What should be included in the case history questions for cancer patients?
What should be included in the case history questions for cancer patients?
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In what scenario should an individual without a cancer diagnosis be referred to oncology?
In what scenario should an individual without a cancer diagnosis be referred to oncology?
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What is a critical factor to look for in all cancer survivors?
What is a critical factor to look for in all cancer survivors?
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What characterizes Paraneoplastic Disease?
What characterizes Paraneoplastic Disease?
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Which test can help diagnose Paraneoplastic Disease?
Which test can help diagnose Paraneoplastic Disease?
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Which condition is considered the most common ocular paraneoplastic disease?
Which condition is considered the most common ocular paraneoplastic disease?
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Which symptom is NOT typically associated with Cancer-Associated Retinopathy (CAR)?
Which symptom is NOT typically associated with Cancer-Associated Retinopathy (CAR)?
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Which cancers is Cancer-Associated Retinopathy (CAR) most commonly associated with?
Which cancers is Cancer-Associated Retinopathy (CAR) most commonly associated with?
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What does the presence of photopsia indicate in a patient with ocular paraneoplastic disease?
What does the presence of photopsia indicate in a patient with ocular paraneoplastic disease?
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Which of the following is a known ocular effect of Paraneoplastic Disease?
Which of the following is a known ocular effect of Paraneoplastic Disease?
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What is the typical onset pattern for symptoms of Cancer-Associated Retinopathy (CAR)?
What is the typical onset pattern for symptoms of Cancer-Associated Retinopathy (CAR)?
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Which ocular sign is commonly associated with Cancer-Associated Retinopathy (CAR)?
Which ocular sign is commonly associated with Cancer-Associated Retinopathy (CAR)?
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In Paraneoplastic Disease, what may autoantibodies cause when reacting with photoreceptors?
In Paraneoplastic Disease, what may autoantibodies cause when reacting with photoreceptors?
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Study Notes
Cancer Basics
- Cancer is defined as uncontrolled division of abnormal cells that invade surrounding tissues and evade normal cell cycle regulation and programmed cell death (apoptosis).
- Both genetic (non-modifiable) and environmental (modifiable) factors contribute to cancer development.
Cancer Epidemiology
- Cancer is the second leading cause of death in the U.S., with significant declines in mortality over the past 30 years attributed to scientific advancements.
- Most pronounced improvements in death rates have slowed compared to other chronic diseases.
- Higher mortality rates observed among men and African-Americans, indicating disparities influenced by social determinants of health.
TNM Staging System
- The TNM system assesses cancer severity through:
- T (Tumor): Size and extent of the primary tumor (T0 = no tumor; Tis = carcinoma in situ; T1-4 = increasing size).
- N (Node): Lymph node involvement (N0 = no involvement; N1-3 = increasing extent).
- M (Metastasis): Presence of distant metastases (M0 = no metastasis; M1 = distant metastasis).
- Higher scores correlate with worse prognosis and influence treatment decisions.
Cancer Treatment
- Surgery: Primary treatment for diagnosis, staging, and tumor removal, often combined with other therapies to enhance effectiveness.
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Radiation Therapy: Utilizes ionizing radiation to target cancer cell DNA during mitosis; effective doses are measured in Gray (Gy).
- Side effects can include fatigue, skin changes, and myelosuppression.
- Ocular effects of radiation can vary significantly based on dosage; 25-30 Gy may cause minor damage, while 50+ Gy risks severe injury.
Ocular Effects of Radiation
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Common Complications:
- Radiation retinopathy due to damage to vascular endothelial cells, leading to ischemia.
- Symptoms can manifest between 1 month to 15 years post-treatment, with heightened risk between 6 months and 3 years.
- Signs include microaneurysms, retinal hemorrhages, and vascular occlusions.
Chemotherapy
- Involves pharmaceuticals targeting specific phases of the cell cycle to halt cancer cell proliferation.
- Administered in various forms and can be combined with radiation or surgery.
- Common side effects include nausea, hair loss, myelosuppression, and mucositis.
Ocular Toxicity from Chemotherapy
- Chemotherapeutic agents can cause various ocular side effects including:
- Corneal toxicity: keratitis, conjunctivitis.
- Orbital toxicity: periorbital edema, inflammation, nasolacrimal duct obstruction.
- Retinal and optic nerve toxicities: causing various retinal pathologies and possibly vision loss.
Other Types of Cancer Therapy
- Targeted Therapy: Utilizes drugs that focus on specific molecular mechanisms within cancer cells.
- Hormonal Therapy: Aims to inhibit hormone-driven tumors by blocking hormone receptors.
- Immunotherapy: Enhances immune system recognition and response to cancer cells.
Paraneoplastic Disease
- Occurs when malignancies induce autoimmune responses in other parts of the body, detectable via autoantibodies in blood or cerebrospinal fluid.
- Ocular effects can include bilateral diffuse uveal retinopathy and paraneoplastic optic neuropathy.
Cancer-Associated Retinopathy (CAR)
- Most prevalent ocular paraneoplastic condition linked with several cancers (e.g., small cell lung, breast).
- Symptoms typically include central vision loss, night blindness, and photophobia, with potential uveitis and retinal vasculitis observed on examination.
Clinical Pearls
- Detailed patient history should include cancer type, stage, treatment history, and remission status.
- Vigilance for signs of metastasis and paraneoplastic disease in all cancer patients is essential.
- Emergent referrals to oncology are warranted for patients exhibiting paraneoplastic symptoms without a current cancer diagnosis.
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