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Questions and Answers

What is a common feature of Acute Leukemia cells?

  • They are smaller in size
  • They are transparent
  • They are non-adherent
  • They are sticky (correct)

    • What is a potential complication of hypercalcemia in leukemia patients?

  • CNS mentation issues
  • Renal failure
  • Cardiac enzyme elevation
  • All of the above (correct)

    • What is the significance of Auer rods in Acute Promyelocytic Leukemia (APML)?

  • They are not associated with APML
  • They are specific for but not diagnostic of APML
  • They are non-specific for APML
  • They are specific for and virtually diagnostic of APML (correct)

    • What is the primary treatment for Acute Leukemia?

    <p>Chemotherapy</p> Signup and view all the answers

    What is the term for Clonal Hematopoiesis of Indeterminate Significance?

    <p>CHIP</p> Signup and view all the answers

    What is the name of the type of immunotherapy that is FDA approved for Multiple Myeloma and some cases of B-ALL?

    <p>CART</p> Signup and view all the answers

    What is the potential consequence of not treating Acute Promyelocytic Leukemia (APML) promptly?

    <p>Bleeding complications</p> Signup and view all the answers

    What is the term for a sudden change in the WBC count that may indicate leukemia?

    <p>Leukocytosis</p> Signup and view all the answers

    What is the definition of cancer?

    <p>Uncontrolled cell growth with loss of apoptosis</p> Signup and view all the answers

    What type of cancer originates from plasma cells, a type of B cell?

    <p>Myeloma</p> Signup and view all the answers

    What is the most common presentation of Acute Leukemia?

    <p>Severe fatigue associated with anemia</p> Signup and view all the answers

    What is the characteristic of blasts in the peripheral blood?

    <p>Blasts are never present in the peripheral blood</p> Signup and view all the answers

    What is the complication of high white cell count in Acute Leukemia?

    <p>Leukostasis</p> Signup and view all the answers

    What is the rare presentation of Acute Leukemia?

    <p>All of the above</p> Signup and view all the answers

    What is the characteristic of Acute Leukemia in terms of patient demographics?

    <p>A disease of older people, non-Hispanics white</p> Signup and view all the answers

    What is the consequence of not treating Acute Leukemia?

    <p>Death is inevitable, sometimes in a matter of hours, days, or weeks</p> Signup and view all the answers

    What is the primary diagnostic tool for Pylori infection (MALT tumors)?

    <p>EXCISIONAL biopsy of the LN</p> Signup and view all the answers

    What is a common symptom of Multiple Myeloma?

    <p>Mild back pain that is not alleviated when lying down</p> Signup and view all the answers

    What is a risk factor for developing Multiple Myeloma?

    <p>Agent orange exposure</p> Signup and view all the answers

    What is the term for the condition where the blood is full of cancerous plasma cells and proteins?

    <p>Multiple Myeloma</p> Signup and view all the answers

    When should a patient with Multiple Myeloma be referred to an oncologist?

    <p>All of the above</p> Signup and view all the answers

    What is the goal of treatment for Multiple Myeloma?

    <p>Prolong survival and improve quality of life</p> Signup and view all the answers

    What is a potential complication of hypercalcemia in Multiple Myeloma?

    <p>Confusion and increased thirst</p> Signup and view all the answers

    What is the definition of Myelodysplastic Syndrome (MDS)?

    <p>A premalignant disorder of the bone marrow</p> Signup and view all the answers

    What is the increased risk of developing lymphoma in relatives of probands?

    <p>3.5x higher</p> Signup and view all the answers

    Which of the following is a known risk factor for Chronic Leukemias?

    <p>Exposure to ionizing radiation</p> Signup and view all the answers

    What is the characteristic of the Philadelphia chromosome in Chronic Myeloid Leukemia (CML)?

    <p>BCR-ABL t(9;22) translocation</p> Signup and view all the answers

    What is the most common acute leukemia in children?

    <p>Acute Lymphoid Leukemia (ALL)</p> Signup and view all the answers

    What is the characteristic of the blasts in Acute Myeloid Leukemia (AML)?

    <p>&gt;20% blasts</p> Signup and view all the answers

    What is the presentation of Chronic Lymphoid Leukemia (CLL)?

    <p>Lymphadenopathy and very elevated WBC count</p> Signup and view all the answers

    What is the treatment for Hodgkin's Lymphoma?

    <p>Complex chemotherapy and radiation therapy</p> Signup and view all the answers

    What is the characteristic of Reed-Sternberg cells in Hodgkin's Lymphoma?

    <p>Owl eye cells</p> Signup and view all the answers

    What is the primary mechanism by which tumors produce paraneoplastic syndromes?

    <p>Aberrant production of hormones, peptides, or cytokines</p> Signup and view all the answers

    Which of the following is a treatment-related complication of cancer?

    <p>Neutropenia</p> Signup and view all the answers

    What is the primary characteristic of paraneoplastic syndromes?

    <p>Remote effects of cancer that cannot be attributed to direct invasion or metastasis</p> Signup and view all the answers

    Which type of cancer is most likely to be associated with paraneoplastic syndromes?

    <p>Small cell lung cancer</p> Signup and view all the answers

    What is the primary mechanism by which cancer can cause urinary obstruction?

    <p>Direct invasion of the urinary tract</p> Signup and view all the answers

    What is the primary complication of cancer in the liver?

    <p>3rd spacing into the belly</p> Signup and view all the answers

    What is the primary mechanism by which cancer can cause malignant effusions?

    <p>Direct invasion of the pleural space</p> Signup and view all the answers

    What is the primary take-home point for patients with cancer?

    <p>Patients with cancer can have emergent complications</p> Signup and view all the answers

    What is the primary goal of treating hypercalcemia in patients with cancer?

    <p>To alleviate symptoms and improve quality of life</p> Signup and view all the answers

    What is the primary mechanism of reversible myelosuppression in patients with cancer?

    <p>Direct bone marrow toxicity</p> Signup and view all the answers

    What is the primary indication for bisphosphonate therapy in patients with hypercalcemia?

    <p>Moderate or severe hypercalcemia</p> Signup and view all the answers

    What is the primary consideration when treating hypercalcemia in patients with cancer who have a poor prognosis?

    <p>Judicious treatment to balance symptom relief and quality of life</p> Signup and view all the answers

    What is the primary complication of untreated hypercalcemia in patients with cancer?

    <p>Mild sedation and decreased cognitive function</p> Signup and view all the answers

    What is the primary reason why calcium levels are not a reliable indicator of cancer prognosis?

    <p>Albumin levels are often low in cancer patients due to malnutrition or liver dysfunction</p> Signup and view all the answers

    What is the primary mechanism of hypercalcemia in cancer patients?

    <p>All of the above</p> Signup and view all the answers

    What is the most common site of malignant spinal cord compression?

    <p>Thoracic spine</p> Signup and view all the answers

    What is the characteristic physical finding in patients with Superior Vena Cava Syndrome?

    <p>All of the above</p> Signup and view all the answers

    What is the primary treatment for Superior Vena Cava Syndrome caused by non-small-cell lung cancer?

    <p>Radiation therapy</p> Signup and view all the answers

    What is the most common cancer causing hypercalcemia?

    <p>All of the above</p> Signup and view all the answers

    What is the significance of Lhermitte's sign in patients with malignant spinal cord compression?

    <p>It is an early sign of cord compression</p> Signup and view all the answers

    What is the goal of treatment for malignant spinal cord compression?

    <p>All of the above</p> Signup and view all the answers

    What is the initial treatment of choice for most patients with malignant spinal cord compression?

    <p>Radiation therapy plus glucocorticoids</p> Signup and view all the answers

    What is the significance of a corrected calcium level above 12 mg/dL in patients with hypercalcemia?

    <p>It may cause cardiac arrhythmia</p> Signup and view all the answers

    What is the primary diagnostic tool for evaluating patients with suspected malignant spinal cord compression?

    <p>MRI</p> Signup and view all the answers

    What term describes abnormal tissue that grows more rapidly than normal and continues to grow and proliferate in the absence of the originating growth signal?

    <p>Neoplasm</p> Signup and view all the answers

    What is the primary difference between solid tumors and liquid malignancies?

    <p>Solid tumors are composed of abnormal organ cells, while liquid malignancies are a disease of the bone marrow</p> Signup and view all the answers

    What is the second leading cause of death in the US, according to the provided information?

    <p>Cancer</p> Signup and view all the answers

    What is the most common cause of cancer deaths in the US?

    <p>Lung and bronchus cancer</p> Signup and view all the answers

    What is the term for a disease of the bone marrow that can become diseased, leading to abnormal cell growth?

    <p>Hematologic malignancy</p> Signup and view all the answers

    What is the percentage of US cancer deaths related to tobacco use?

    <p>30%</p> Signup and view all the answers

    What is the current rate of adult tobacco use in the US?

    <p>14%</p> Signup and view all the answers

    What is the term for the process by which cell growth becomes dysregulated, leading to cancer?

    <p>Hits to the gene</p> Signup and view all the answers

    What is the primary goal of staging in cancer treatment?

    <p>To determine the best treatment option</p> Signup and view all the answers

    What is the term for the spread of cancer to distant sites in the body?

    <p>Metastasis</p> Signup and view all the answers

    What is the primary function of the TNM staging system?

    <p>To classify cancer into different stages</p> Signup and view all the answers

    What is the name of the type of radiation therapy that uses many precisely focused radiation beams to treat tumors?

    <p>Stereotactic radiation therapy</p> Signup and view all the answers

    What is the term for the absence or presence and extent of nodal metastases in the TNM staging system?

    <p>N</p> Signup and view all the answers

    What is the primary mechanism of hypercalcemia in cancer patients?

    <p>Cancer cells producing osteoclast-activating factors</p> Signup and view all the answers

    What is the term for the treatment of tumors using radiation therapy?

    <p>Radiation therapy</p> Signup and view all the answers

    What is the primary goal of cancer treatment?

    <p>To cure the patient</p> Signup and view all the answers

    What is the term for the process by which cancer cells spread to distant sites in the body?

    <p>Metastasis</p> Signup and view all the answers

    What is the primary reason for staging cancer?

    <p>To develop a treatment plan</p> Signup and view all the answers

    What is the primary goal of hospice care?

    <p>To provide comfort and support to the patient and their loved ones</p> Signup and view all the answers

    What is the significance of the phrase 'there is much to be done' in the context of hospice care?

    <p>It signals a shift from curative to palliative care</p> Signup and view all the answers

    What percentage of hospice patients die within 7 days of being admitted?

    <p>⅓</p> Signup and view all the answers

    What is the primary requirement for a patient to be eligible for hospice care?

    <p>A terminal illness with a life expectancy of 6 months or less</p> Signup and view all the answers

    What is the purpose of respite care in hospice?

    <p>To give caregivers a break and allow them to rest</p> Signup and view all the answers

    What is the significance of the 'circle of care' in hospice?

    <p>It refers to the hospice team's expertise and compassion in caring for dying patients</p> Signup and view all the answers

    What is the primary way that hospice care is typically paid for?

    <p>Medicare Part A or Medicaid</p> Signup and view all the answers

    What is the purpose of bereavement care in hospice?

    <p>To provide comfort and support to the patient's loved ones after they pass away</p> Signup and view all the answers

    What is the primary goal of Palliative Care?

    <p>To focus on quality of life for anyone dealing with serious illness</p> Signup and view all the answers

    What is a unique feature of hospices in North Carolina?

    <p>There are over a dozen hospices operating in the state</p> Signup and view all the answers

    What is the purpose of bereavement counseling?

    <p>To offer grief support to anyone in the community grieving the loss of a loved one</p> Signup and view all the answers

    What is the focus of Concurrent Care?

    <p>To allow patients under 18 to receive chemo and other treatments</p> Signup and view all the answers

    What is the primary difference between hospice and palliative care?

    <p>Hospice care is only for patients with a short life expectancy, while palliative care is for anyone with serious illness</p> Signup and view all the answers

    What is the goal of Advanced Illness Care Continuum?

    <p>To establish a continuum of care for patients with serious illness</p> Signup and view all the answers

    What is the purpose of CAP-C case management?

    <p>To require shifts of care in the home</p> Signup and view all the answers

    What is the primary difference between Palliative Care programs?

    <p>Program variations, team make-up, services provided, and location of services provided</p> Signup and view all the answers

    Study Notes

    Cancer Generalities

    • Cancer is characterized by uncontrolled cell growth with loss of apoptosis (programmed cell death)
    • Can occur in any cell in the body

    Types of Cancer

    • Leukemia: originates from a blood cell (either myeloid or lymphoid)
    • Lymphoma: originates from lymphoid tissue (either in bone marrow or peripheral)
    • Myeloma: originates from plasma cells, a type of B cell

    Marrow Components

    • Neutrophils: can lead to Acute Myeloid Leukemia
    • Lymphocytes: can lead to Acute Lymphocytic Leukemia
    • Monocytes: can lead to Acute Myeloid Leukemia
    • Eosinophils: can lead to Hypereosinophilic Syndrome
    • Basophils: can lead to Acute Myeloid Leukemia (seen in CML, also in HD)
    • RBCs: can lead to Acute Erythroid Leukemia (rare)
    • Platelets: can lead to Acute Megakaryoblastic Leukemia (rare)

    Normal Maturation of Neutrophil

    • Myeloblast → Promyelocyte → Myelocyte → Metamyelocyte → Band → Neutrophil

    Acute Leukemia

    • Epidemiology: generally a disease of older people, non-Hispanics, and whites
    • Genetic disorders: Down syndrome, Ataxia telangiectasia, Fanconi Anemia, Li Fraumeni
    • Radiation exposure and chemical exposure increase risk
    • Without treatment, death is inevitable within hours, days, or weeks
    • Must be able to identify findings quickly for referral

    Signs and Symptoms of Acute Leukemia

    • CBC with "BLAST" in the differential (blasts are never normal in peripheral blood)
    • Severe fatigue associated with anemia and possible signs of symptomatic anemia
    • High white cell count (can be >50-100K, requiring leukapheresis to reduce leukostasis)
    • Anemia, fevers, bleeding/bruising, or DIC
    • Bone/Joint pains, skin manifestations, pallor, petechiae, and ecchymosis
    • Rare: gingival hyperplasia (monocytic), oral candida, herpetic lesions, and CNS involvement

    Metabolic/Electrolyte Abnormalities

    • Hyperphosphatemia
    • Hypocalcemia
    • High uric acid
    • Hyperkalemia
    • High LDH

    Why is Acute Leukemia so Dangerous?

    • ACUTE Leukemia cells are "sticky"
    • Acute leukemia is a MEDICAL EMERGENCY

    Treatment of Acute Leukemia

    • Always involves chemotherapy (unless palliative care)
    • Special case: Acute Promyelocytic Leukemia (APML) aka M3
    • Requires immediate treatment with ATRA if suspected
    • Auer Rods are specific for and virtually diagnostic of APML

    Advanced Treatments

    • Bone Marrow Transplant
    • Chimeric Antigen Receptor T cell (CART) therapy
    • Type of immunotherapy
    • FDA approved for: Multiple Myeloma and some B-ALL cases
    • Major side effects: fever, Cytokine Release Syndrome (CRS), and long-term B cell aplasia

    Leukemias

    • Relatives of probands have a 3.5x higher chance of developing lymphoma
    • Higher incidence in RA, hemolytic anemia, psoriasis, SLE, Systemic sclerosis, Polyarteritis nodosa, sarcoidosis, Crohn Disease, motor and Celiac disease
    • Immunosuppression and viral infections (HIV, HTLV, EBV) are risk factors

    Myeloid Leukemias

    • Acute: AML (acute myeloid leukemia)
      • Sudden onset
      • >20% blasts
      • Severe symptoms
      • Most common acute leukemia in adults
    • Chronic: CML (chronic myeloid leukemia)
      • Philadelphia chromosome translocation BCR-ABL t(9;22)
      • Elevated WBC and platelet count
      • Often normal hemoglobin
      • Always has splenomegaly
      • Can progress to accelerated phase (30% blasts)
      • Treatment: Tyrosine kinases (e.g. imatinib)

    Lymphoid Leukemias

    • Acute: ALL (acute lymphoid leukemia)
      • Most common in children
    • Chronic: CLL (chronic lymphoid leukemia)
      • Affects older people
      • Smudge cells present
      • VERY elevated WBC count (hundreds of thousands)
      • New drugs available in pill form
      • Can have normal life expectancy
      • Increased risk of infections → may benefit from monthly IVIG infusions

    Lymphomas

    • Hodgkin's Lymphoma
      • Peak incidence at young (20-24) and old (80-84) ages
      • "Owl Eye cells" (Reed-Sternberg cells)
      • Presentation: lymphadenopathy, fatigue, pruritus
      • Treatment: complex chemotherapy, radiation, or combination therapy, BMT, CART
    • Non-Hodgkin's Lymphoma
      • Affects all ages, races, and socioeconomic statuses
      • Splenomegaly and implants associated with increased risk
      • Presentation: lymphadenopathy, fever of unknown origin
      • Can be associated with immunodeficiencies and H. pylori infection (MALT tumors)

    Plasma Cell Dyscrasias - Multiple Myeloma

    • Mild back pain, especially mid-thoracic and when lying down
    • Middle-aged individuals affected
    • Epidemiology:
      • Higher incidence in African Americans
      • Association with agent orange exposure and family history
      • Increased risk with Body Mass Index
    • CRAB criteria:
      • Calcium deviation
      • Renal insufficiency
      • Anemia
      • Bone disease
    • Symptoms: throughout the body, blood with cancerous plasma cells and proteins
    • Pitfalls:
      • Worsening hypercalcemia (beware dental work 6 weeks before or after)
      • Increased thirst and urination frequency
      • Confusion and bone lesions with pathological fractures
    • Referral criteria:
      • Anemia with renal insufficiency +/- hypercalcemia
      • Lytic lesions on imaging
      • Oncologist will risk stratify; consider autologous transplant
    • Treatment:
      • Induction chemotherapy followed by maintenance therapy (if ineligible for transplant)
      • Autologous transplant prolongs time to first relapse, but MM is not curable

    Myelodysplastic Syndrome (MDS)

    • Premalignant disorder that can become cancer if left untreated
    • Defined as a pre-malignancy of the bone marrow

    Oncologic Emergencies

    • Classified into 3 groups:
      • Pressure or obstruction caused by a space-occupying lesion
      • Metabolic or hormonal problems (paraneoplastic syndromes)
      • Treatment-related complications

    Mechanical/Obstructive Emergencies

    • SVCS (Superior Vena Cava Syndrome)
    • MSCC (Metastatic Spinal Cord Compression)
    • Pulmonary Embolism
    • Urinary Obstruction
    • Malignant Effusions

    Metabolic or Hormonal Emergencies

    • Paraneoplastic Syndromes
      • Due to aberrant tumor production of hormones, peptides, or cytokines
      • Or due to the body's immune attack on normal tissues
    • Tumor Lysis Syndrome
      • Tumor bursts due to chemotherapy, leading to metabolic damage
    • Hypercalcemia
    • SIADH (Syndrome of Inappropriate Antidiuretic Hormone)
    • Neutropenia
    • Anemia
    • Thrombocytopenia
    • Bleeding Disorders
    • Clotting disorders

    Cancer in the Liver

    • Usually metastatic from other organs (e.g. Colon cancer)
    • Liver stops making albumin and clots, leading to 3rd spacing into the belly

    Paraneoplastic Syndromes

    • General problems observed in many patients with advanced or widespread metastatic cancer
    • Symptoms resemble those of primary endocrine, dermatologic, rheumatologic, hematologic, or neuromuscular disorders
    • Small cell lung cancer (SCLC) is most likely to be associated with paraneoplastic syndromes

    Take Home Points

    • Patients with cancer can have emergent complications from their disease or treatment
    • If a patient presents with a common condition, they have cancer until proven otherwise

    Oncologic Emergencies

    Superior Vena Cava Syndrome (SVCS)

    • SVCS is the clinical manifestation of superior vena cava (SVC) obstruction
    • SVC obstruction results in severe reduction in venous return from the head, neck, and upper extremities
    • Malignant tumors (lung cancer, lymphoma, metastatic tumors) are responsible for the majority of SVCS cases

    Presentation

    • Patients with SVCS usually present with neck and facial swelling, dyspnea, and cough
    • Other symptoms include hoarseness, tongue swelling, headaches, nasal congestion, epistaxis, hemoptysis, dysphagia, pain, dizziness, syncope, and lethargy
    • Bending forward or lying down may aggravate the symptoms
    • Characteristic physical findings are dilated neck veins, increased collateral veins, cyanosis, and edema of the face, arms, and chest

    Diagnosis and Treatment

    • Diagnosis is a clinical one, with a chest radiograph (CXR) as the first step
    • CXR findings include widening of the superior mediastinum, usually on the right side
    • CT provides the most reliable view of the mediastinal anatomy
    • Chemotherapy is effective for small-cell carcinoma of the lung, lymphoma, or germ cell tumor
    • Radiation therapy is the primary treatment for SVCS caused by non-small-cell lung cancer and other metastatic solid tumors

    Malignant Spinal Cord Compression (MSCC)

    • MSCC is defined as compression of the spinal cord and/or cauda equina by an extradural tumor mass
    • Thoracic spine is the most common site (70%), followed by lumbosacral spine (20%), and cervical spine (10%)
    • Lung cancer is the most common cause
    • Most common initial symptom is localized back pain and tenderness
    • Pain is exacerbated by movement and coughing or sneezing
    • Radicular pain is less common than localized back pain and usually develops later
    • Lhermitte's sign may be an early sign of cord compression

    Treatment

    • Treatment is aimed at relief of pain and restoration/preservation of neurologic function
    • Management requires a multidisciplinary approach
    • Radiation therapy plus glucocorticoids is the initial treatment of choice for most patients
    • The management decision of SCC involves assessment of neurologic (N), oncologic (O), mechanical (M), and systemic factors (S) (NOMS)

    Hypercalcemia

    • Elevated levels of calcium in the blood (>/10.5 mg/dL)
    • Affects 20-30% of patients with cancer at some point during their illness
    • Most common cancers causing hypercalcemia are myeloma, breast carcinoma, and NSCLC
    • Hypercalcemia is caused by one of three mechanisms: systemic effects of tumor-released proteins, direct osteolysis of bone by tumor, and vitamin D-mediated osteoabsorption

    Presentation

    • Symptoms and signs can be subtle; more severe symptoms occur with higher levels of hypercalcemia and rapidly rising calcium levels
    • Early symptoms include anorexia, nausea, fatigue, constipation, and polyuria
    • Later findings may include muscular weakness, hyporeflexia, confusion, psychosis, tremor, and lethargy

    Diagnostic Workup

    • Calcium level corrected for albumin
    • Corrected calcium = measured calcium – measured albumin + 4
    • Ionized calcium level is more specific, sensitive, and expensive
    • ECG in hypercalcemia often shows a shortening of the QT interval
    • Initial workup includes obtaining serum PTH, PTHrP, and calcitriol levels

    Treatment

    • Emergency management begins with IV 0.9% saline to ensure rehydration with brisk urinary output
    • For moderate or severe hypercalcemia, treatment with bisphosphonate is indicated
    • Treatment is then directed to control of tumor; reduction of tumor mass usually corrects hypercalcemia

    (Febrile) Neutropenia

    • Cytotoxic chemotherapeutic agents affect bone marrow function
    • The nadir count of each cell type in response to classes of agents is characteristic
    • Complications of myelosuppression result from the predictable sequelae of the missing cells' function
    • Febrile neutropenia refers to the clinical presentation of fever and

    Cancer Definition

    • Cancer refers to a wide array of disorders characterized by unregulated cell growth
    • Medical and biological term: neoplasm (abnormal tissue that grows rapidly and continues to grow in the absence of the originating growth signal)

    Types of Cancer

    • Solid tumors: pieces of organ where cells grow out of control and can compress other organs
    • Liquid/Hematologic: a disease of the bone marrow, affecting any of the three cell lines (RBC, WBC, Platelets)

    Common Cancers

    • Top 10 cancers by rates of new cases:
      • Female breast cancer
      • Prostate
      • Lung and bronchus
      • Colon and rectum
      • Corpus and uterus, NOS
      • Melanomas of the skin
      • Urinary bladder
      • Non-Hodgkin lymphoma
      • Kidney and renal pelvis
      • Pancreas
    • Top 10 cancers by rates of cancer death:
      • Lung and bronchus
      • Female breast
      • Prostate
      • Colon and rectum
      • Pancreas
      • Liver and intrahepatic bile duct
      • Ovary
      • Leukemias
      • Corpus and uterus, NOS
      • Non-Hodgkin lymphoma

    Risk Factors for Cancer

    • Tobacco Use:
      • 30% of US cancer deaths related to tobacco use
      • Tobacco risk linked to at least 12 types of cancer
      • 81% of lung cancer deaths attributed to smoking
      • Current rate of adult tobacco use: 14%
    • Vaping:
      • Electronic cigarette aerosol can contain harmful substances (nicotine, heavy metals, volatile organic compounds, carcinogenic substances)
      • Vaping among high school students increased from 1.5% in 2011 to 21% in 2018
    • Nutrition & Physical Activity:
      • Prudent recommendations to reduce cancer risk:
        • Be physically active
        • Maintain a healthy weight
        • Consume a diet rich in fruits, vegetables, and whole grains
        • Lower consumption of saturated and trans dietary fats
        • Limit alcohol use
        • Avoid excess sun exposure
        • Utilize SPF every day
    • Radiation:
      • Individuals exposed to significant radiation doses may increase their lifetime risk of cancer
      • Standardization of CT radiation doses and limiting testing have been important steps in minimizing this risk

    Staging

    • Staging refers to where a cancer is located and if it has spread from its original source
    • TNM system:
      • T: tumor location, size, and level of invasion
      • N: absence or presence and extent of nodal metastases
      • M: absence or presence of systemic metastases
    • Cancer spreads to the biggest organ near it
    • Once the TNM designations have been determined, an overall “clinical stage” (I, II, III, or IV) is assigned
    • IV: metastasis of disease

    Oncology Treatment

    • Surgery:
      • Tumor removal
      • Debulking surgery
      • Palliative surgery
    • Chemotherapy:
      • Systemic chemotherapy
      • Localized chemotherapy
      • Biologic agents
      • Hormonal agents
      • Palliative chemotherapy
    • Radiation Therapy:
      • Radiation therapy
      • Stereotactic radiation therapy (Stereotactic radiosurgery)
      • Brachytherapy
      • Palliative radiation therapy

    Hospice Care

    • Designed to create a 'holding space' for dying persons and their loved ones
    • Focuses on providing comfort and support to patients with a terminal illness and a life expectancy of six months or less
    • ⅓ of patients die within 7 days of being in hospice
    • Challenges a death-denying culture, shifting the medical mindset from "there's nothing more we can do" to "there is much to be done"

    Hospice Team and Services

    • A circle of care offering expertise and compassion in the service of dying persons' comfort and support of their loved ones
    • Plan of care is established and constantly updated to reflect the goals for today
    • Services include medical equipment and supplies, related medications, 24-hour on-call, bereavement care, physical therapy, nutritionist, horticultural therapist, music, and respite care

    Eligibility and Payment

    • Eligibility requires a terminal illness and a life expectancy of six months or less, or choosing comfort care over curative care
    • 2 physicians certify that a patient is eligible for hospice care
    • Almost 98% of the time, hospice is provided under Medicare Part A or Medicaid, and private insurances often provide a hospice benefit as well

    Signs it might be Time for Hospice Care

    • Decreased energy
    • Less capacity to do daily activities
    • Weight loss
    • Frequent infections
    • More hospitalizations
    • More pain
    • Failure to thrive

    Starting Hospice Care

    • Hospice is started by contacting the hospice organization, and they complete the communication with all parties and deem eligibility
    • Doctor writes an order for hospice care, and admission visit is set up
    • Patient or family signs consents for care, and then it's official

    Bereavement Counseling

    • Grief support for hospice bereaved and anyone in the community grieving the loss of a loved one
    • Services include individual counseling, loss-specific groups, literature, workshops, and memorial services

    Other Services

    • Kids Path: hospice care, home health, perinatal care, and bereavement services
    • CAP-C case management: require shifts of care in home
    • Concurrent care: anyone under 18 can still receive chemo, etc.
    • Advanced Illness Care Continuum: focuses on quality of life for anyone dealing with serious illness

    Palliative Care

    • = Comfort Care, focuses on quality of life for anyone dealing with serious illness, at any time, regardless of diagnosis, prognosis, or treatment
    • Establishes goals of care, assists with completion of advance directives, and helps navigate complex medical decisions
    • Relieves suffering associated with serious illness, and provides timely transfer to hospice when appropriate
    • Any diagnosis, any age, and any time in the course of disease can be eligible for palliative care

    Centers for Medicare and Medicaid Services Innovation Center

    • Building an Improved Dementia Experience (GUIDE) Model: a program variation with a unique team make-up, services, and location

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    Learn about the basics of cancer, including characteristics, types, and how it affects different cells in the body. Explore leukemia, lymphoma, and myeloma, and how they relate to marrow components.

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