Cancer in Primary Care Flashcards
Most common causes of death by cancer (which types)? (4)
- lung
- liver
- stomach
- bowel
What proportion of people get cancer at some point in their lives?
of those born after 1960, 50% will get some form of cancer
What cancers have increased 2006-16? (8)
- thyroid
- kidney; picked up more often on CT/US
- liver
- oral; alcohol, smoking and HPV
- skin
- uterine
some we know why but others we don’t
What proportion of cancers are preventable? (1)
what are the preventable causes of cancer? (10)
- 42% preventable!
1- tobacco=22% of cancer deaths/year and 77% of lung cancer
2- obesity
3- physical activity
4- alcohol
5- environmental pollution
6- occupational carcinogens
7- radiation (soil/ building materials/ UV light/ radiotherapy)
8- iatrogenic (chemotherapy, immunosuppresants, HRT)
9- infections: Hep B & C, HPV, H.Pylori
22% of cancers in developing world and 6% in industrialized countries
10- deprivation
How is deprivation linked to cancer? (2)
possible causes of this? (7)
increased risk of cancer INCIDENCE and MORTALITY
- diet
- smoking
- alcohol
- exercise
- access to screening
- occupation
- health seeking behavior
overall cancer survival has improved but mainly in affluent rather than deprived areas
Why does obesity cause cancer? (2)
10 cancers with definite evidence of link to obesity? (10)
fat secretes:
- oestrogen
- GH
- breast
- bowel
- liver
- ovarian
- prostate
- pancreatic
- uterus
- kidney
- gallbladder
- oesophagus
(Cancer Research Fund UK)
Case study:
lady with pain in right shoulder and chest, with stiffness on neck
what do you ask in history?
what do you examine? (3)
what management is appropriate if musculoskeletal pain? (2)
ICE SOCRATES - can she do ADLs - before? - PMH, FH, DH, SH
- general inspection
- chest
- examine shoulder and neck
Musculo-skeletal pain:
- NSAIDS (Ibuprofen 400mg tds OTC) for 2 weeks AFTER food
- come back if persists (SAFETY NET)
Causes of ‘tiredness’? (5)
Endocrine:
- diabetes (polydipsia, polyuria)
- thyroid (periods, skin changes, weight changes, bowels)
Pscyh:
- depression (early morning waking, mood, appetite)
- anxiety
Anaemia:
breathlessness, pale
Infection:
fever, cough
When requesting bloods, why not just ask for all of them? (1)
only ask for things you can JUSTIFY
..otherwise if you get an abnormal result you’ll have to act..
–> NOT USEFUL
What are the 3 intervals of delay that occur in cancer diagnosis? (3)
- PATIENT INTERVAL: patient symptoms > present at GP
- PRIMARY CARE INTERVAL: presentation > date of referral
- REFERRAL INTERVAL: GP referral to first attended specialist care
What % of patient with cancer present in emergency setting? (1)
which cancers is emergnacy presentaiton more common in? (5)
what tools help us diagnose cancer? (1)
~12.9%
- brain
- leukaemia
- liver
- pancreas
- myeloma
associated with worse outcomes
QCANCER: put in symptoms and you get a % of cancer
Long term consequences of cancer commonly dealt with in primary care? (8)
- chronic fatigue
- sexual difficulties
- mental health
- pain
- change in urinary function
- change in GI function
- menopausal/ hormonal symptoms
- endocrine disorders
Multimorbidities:
what percentage of England has multimorbidity? (1)
what % of those with multi-morbidity have mental health conditions? (1)
which groups is this higher in? (2)
27%
1/3
rates of multi-morbidity higher in lower SES and elderly
same pattern with long-term conditions
Multimorbidity:
what is important to ask about in consultations? (3)
- ICE/ what is important to them
- mental health
- CARERS? ask what support they have and who provides it… do they need support?
Health inequalities:
definition? (1)
examples? (4)
what is the inverse care law? (1)
avoidable and unfair differences in health status between groups of people or communities
lower SES have increased:
- tooth decay
- low birth weight
- 2* more likely to die prematurely from cancer deaths
= 4* more likely to die prematurely from CVD
- need for healthcare are least likely to get access to good healthcare
e. g. recruitment challenge: hard to recruit in deprived areas for GPs
UTI treatment:
what is first line? (1)
who is this not allowed in? (2) why?
- nitrofurantoin
100 mg twice daily for 3 days (7 days in males and pregnant women)
- eGFR < 45mmol/l
- pregnancy 3rd trimester —> neonatal haemolysis
- trimethoprim (2nd line) can be given in 3rd trimester BUT NOT in 1st —> this is first line in pregnancy. (anti-folate)
Nitrofurantoin is 1st line because it wont harm baby in early stages when the mother might not realise she is pregnant!
When to refer to the coroner? (8)
When to refer to the police? (3)
- a doctor did not treat the person during their last illness or see them for 28 days of death
- sudden, violent or unnatural such as an accident, or suicide, murder
- industrial disease (asbestosis/ mesothelioma)
- any other circumstances that may require investigation
A death in hospital should be reported if:
• there is a question of negligence
• they died before a provisional diagnosis was made and the general practitioner is not willing to certify the cause
• the patient died as the result of the administration of an anaesthetic
A death should be reported to a Coroner by the police, when:
• a dead body is found
• death is unexpected or unexplained
• a death occurs in suspicious circumstances
Why is hypercalcaemia unusual in prostate cancer? (1)
sclerotic not lytic mets
