Cancer and Health Promotion

Question 1

Cancer

Answer 1

group of appox 200 diseases characterized by uncontrolled and unregulated cell growth

two types:

• benign neoplasm: well differentiated, w/o metastasis (slow growing)
• malignant neoplasm: poorly differentiated, w/ metastasis

Question 2

Causes of Cancer

Answer 2

carcinogens (agents capable of producing cellular alterations):

• chemicals (tobacco, cleaning agents)
• radiation (UV, a-bomb)
• viruses (HPV, epstein-barr)
• genetics (BRCA)
• hormones
• immune conditions

Question 3

Development of Cancer

Answer 3

defect in cell proliferation (growth):

• proliferation activated by cell degeneration (death or apoptosis) or increased need for cells which maintains equilibrium
• Ca cells divide indiscriminately
• contact inhibition: respect boundaries by normal cells
• Ca cells do not have this

defect in cell differentiation (usually stable and organized):

• problems w/ proto-oncogenes, which normally promotes growth in normal limit cells
• problem w/ tumor suppressor genes - which normally suppresses growth in normal cells

Question 4

Classification of Cancer

Answer 4

• based on anatomic site, histologic grading, and staging (extent of disease)
• provides Ca status to health care team
• determines most effective tx plan
• evaluation of tx plan can occur
• statistical info for like groups

Question 5

Anatomical Site

Answer 5

Carcinomas: skin, glands, mucous membranes of rep, GI, and GI tracts

Sarcomas: connective tissue, bone, muscle, fat

Lymphomas and leukemias: hematologic system

Question 6

Histologic Grading

Answer 6

appearance and degree of differentiation of cells

I- slightly differ (mild dysplasia), well differentiated
II- inc. abnormality (mod dysplasia) and dec differentiation
III- very abnormal (severe dysplasia), poor differentiation
IV- immature, primitive cells (anaplasia) and undifferentiated
X-Grade cannot be assessed

Question 7

Clinical Staging

Answer 7

based on extent of disease
0- cancer in situ- no invasion of surrounding tissue
I- limited to primary site, localized tumor growth
II- limited local spread
III- extensive local and regional spread
IV- metastasis

Question 8

TNM Classification System

Answer 8

T: tumor size
N: lymph node involvement
M: metastasis

Question 9

Prevention and Detection of Cancer

Answer 9

• decrease or avoid exposure to known carcinogens
• nutritional changes (5 fruits/veggies per day, increase fiber, decrease fats and high sodium foods)
• exercise
• rest
• screenings

Question 10

Screening for Colorectal Ca

Answer 10

beginning at age 45

Fecal Occult Blood annually
Multi-target sDNA – q 3 years
Sigmoidoscopy -  q 5 yrs
CT Colonography – q 5 yrs
Colonoscopy- q 10 yrs

Question 11

Screening for Prostate Ca

Answer 11

begin at age 50

PSA and DRE annually
If inc. risk begin at age 45

Question 12

Screening for Testicular Ca

Answer 12

young man’s disease

check yourself regularly

Question 13

Screening for Breast Ca

Answer 13

After age 40 Annual mammogram with CBE (clinical breast exam)
CBE q 3 yrs if age 20-39
Inc. frequency if inc. risk or problems detected

Question 14

Screening for Lung Ca

Answer 14

Low-dose helical CT- current or former smokers ages 55-74 in good health with at least a 30 pack-year history

Question 15

Screening for Cervical Ca

Answer 15

25-65YO: primary HPV test, pap test

66+ YO: may stop screening depending on previous results

Question 16

7 Warning Signs of Cancer

Answer 16

C- change in bowel or bladder habits
A- any sore that does not heal
U- unusual bleeding or discharge
T - thickening in breast or elsewhere
 Indigestion
O- obvious change in wart or mole
N- nagging cough or hoarse voice

Question 17

Lung Ca: Detection

Answer 17

• chest xray or CT
• biopsy via needle aspiration, bronchoscopy, video assisted thoracoscopic surgery (VATS)
• metastasis has usually occurred at time of dx

Question 18

Colorectal Ca

Answer 18

RF: increases w/ age, hx or family hx of Ca/polyps/IBD, smoking, ETOH, obesity, physical activity, high fat diet

S/sx: blood in stool, change in bowel habits

Question 19

Breast Ca

Answer 19

RF: age, hx or family hx, obesity, use of OCP’s, HRT, no children until after 30

s/sx: lump, thickening, tenderness, skin irritation, dimpling, nipple retraction, scaliness, ulceration

Question 20

Prostate Ca

Answer 20

RF: age, ethnicity (African American), hx

S/Sx: no early sx, weak urine flow, inability to urinate, difficulty starting and stopping stream, polyuria, hematuria

Question 21

Skin Ca

Answer 21

RF: hx, moles, sunburn easily, blonde or red hair, hx of tanning or excessive sun exposure

Sunburn as child > increased risk of melanoma as adult

melanoma: new moles after age 40 are more concerning
- do ABCDE guidelines

Dysplastic Nevi: “atypical moles”, benign moles which resemble melanoma, associated with increased risk of melanoma

Question 22

Leukemia

Answer 22

RF: no single known cause

S/Sx: manifestations are result of bone marrow failure

detection: dx studies done include blood tests and bone marrow biopsy
tx: chemo

Question 23

Lymphoma

Answer 23

Hodgkin’s Lymphoma: dx itself

Non-Hodgkin’s Lymphoma: can be broken down in to more specific dx

Cause: unknown

S/Sx: mainly enlarged lymph nodes, “B symptoms” - fever/night sweats/weight loss/ fatigue

dx: blood tests, biopsy, PET or CT scan, sometimes MRI or LP needed

Question 24

Multiple Myeloma

Answer 24

cancer of plasma cells
cause unknown
s/sx: no sx until advanced (skeletal pain, diffuse osteoporosis, osteolytic lesions, vertebral destruction, pathologic fractures)

dx: blood tests, radiologic tests (PET, CT, MRI), bone marrow bx

rarely curable, goal of tx is to manage sx and prolong life