cancer prevention, screening, diagnosis

Question 1

3 levels of prevention

Answer 1

primary, secondary, tertiary

Question 2

2 examples of primary prevention

Answer 2

1. education about risk factors, lifestyle

2. immunizations

Question 3

example of secondary

Answer 3

screening

Question 4

important intervention points for proimary prevention

Answer 4

tobacco, physcial activity, booze, infections, pollution, carcinogens, radiation

Question 5

how does tobaccor relate to CA

Answer 5

22% of CA

- lung, oral, larynx, esoph, bladder, kidney, pancreas, stomach, cervix

Question 6

what types of tobacco

Answer 6

all types - amount and duration dependent

Question 7

2 types of CA in obesity

Answer 7

breast and endometrial

Question 8

impact of diet

Answer 8

high fat, low fiber in colon

salt and nitrate in stomach

Question 9

what is alcohol effect dependent on

Answer 9

amount and duration, may synergize with tobacco

Question 10

mech of alcohol on CA (4)

Answer 10

1. toxinc intermediates
2. ROS
3. impaired absorption of vitamins
4. increased E

Question 11

examples of infection

Answer 11

h. pylori, HPV, HBV, HSV-8, EBV

Question 12

2 times when surgical prophylaxis might be used

Answer 12

1. herditary canccer syndromes

2. high risk circumstances (undescended testes)

Question 13

3 general principles of screening

Answer 13

1. disease - must be bad and recognizable in early form
2. test - cost effective, high sense and spec
3. treatment - able to help

Question 14

what does one screen for

Answer 14

preinvasive neoplasia

Question 15

3 examples of preinvasive neoplasia and the test

Answer 15

1. squamous intraepithelia lesion of cervix - PAP
2. ductal carcinoma in situ (DCIS)of breast - mammogram
3. ademoous polypous of GI- scope

Question 16

what define preinvasive neoplasia

Answer 16

haven’t yet invaded the basement membrane

Question 17

what defines dysplasia

Answer 17

loss of uniformity and architectural organization

• graded as mild, moderate, severe
• some based on specific site

Question 18

what do we look for in DCIS of breast

Answer 18

mammogram for calcifications

• can’t feel
• 10x risk of CA
• lumpectomy or masectomy

Question 19

breast cancer screening reccomendations

Answer 19

1. mammogram every 2 yr starting at 50

2. annually and with MRI every year at 30 for high risk

Question 20

what are colon polyps with high risk

Answer 20

1. > 1cm
2. villous
3. high grade dysplasia

Question 21

reccomended screening for colon CA

Answer 21

average risk: FOBT each 2 yrs and scope if +ve

high risk: scope at age 50

Question 22

how we have dropped cervical CA rates

Answer 22

vaccinate and screen with pap

Question 23

2 things might find on pap and recommendations

Answer 23

LSIL - repeat pap in 6 months

HSIL - colposcopy and biopsy

Question 24

cervical screening guidlines

Answer 24

every 3 years from 21-70

high risk - shorter intervals

Question 25

treatment of HSIL

Answer 25

local excision

Question 26

what is screening for lung CA

Answer 26

not really done - would be CT

- maybe only useful in smokers

Question 27

screening for prostate CA

Answer 27

DRE, ultrasound, PSA

• not very specific and better used to follow
• PSA evolution maybe more important

Question 28

when does CA become metastatic

Answer 28

at a lesion specific doubling number

Question 29

what is key timing to make a screening program useful

Answer 29

time to detection must be

Question 30

when is screening best (2)

Answer 30

1. there is a preinvasive lesion

2. preinvasive phase is longer

Question 31

what is tertiary screening

Answer 31

emphasis on treatment to reduce MandM

Question 32

4 methods used to diagnose/stage

Answer 32

1. clinical features
2. radiology
3. lab investigations
4. biopsy/cytology