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Cancer Screening Flashcards

1
Q

Number 1 Cancer in Males

A

Prostate

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2
Q

Number 1 Cancer in Females

A

Breast

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3
Q

Number 1 Cancer that Males & Females Die from Each Year

A

Lung & bronchus

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4
Q

General Cancer Prevention

A 
Avoid tobacco
Be physically active
Maintain a healthy weight
Limit alcohol
Avoid excess sun
Eat a diet rich in fruits, veggies, & whole grains & low in sat/trans fats
Protect against STIs
Regular screening for breast, cervical, & colorectal cancer
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5
Q

Principles of Screening

A

Disease has high prevalence
Disease has serious consequences
Detectable pre-clinical phase
Treatment for pre-symptomatic disease more effective than after symptoms develop
Positive impact on clinical health outcomes

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6
Q

Other Considerations for General Screening

A

What are patient’s co-morbid conditions?
Associated life expectancy, feasibility of treatment, effects of treatment on QOL?
What will you do with the results?

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7
Q

Which cancers are largely asymptomatic in the early stages?

A

Colorectal
Breast
Cervical

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8
Q

What is the leading cause of death from gynecologic malignancy in the U.S.?

A

Ovarian cancer

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9
Q

Pelvic Examination in Ovarian Cancer

A

No evidence they reduce mortality
Early stage tumors rarely found
Usually detected at an advanced stage & associated with a poor prognosis

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10
Q

Screening for Ovarian Cancer

A

CA 125 & TVUS
Family ovarian cancer syndrome or BRCA genes: CA 125 & TVUS
Initiation at 35 years or 5-10 years earlier than earliest age of first diagnosis

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11
Q

BRCA1 Carriers & Breast, Ovarian, & Contralateral Breast Cancer Risk

A

Breast risk: 60%
Ovarian risk: 59%
Contralateral breast risk: 83%

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12
Q

BRCA2 Carriers & Breast, Ovarian, & Contralateral Breast Cancer Risk

A

Breast risk: 55%
Ovarian risk: 16.5%
Contralateral breast risk: 62%

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13
Q

When to Test for BRCA for Non-Ashkenazi Jewish Women

A

2 1st-degree relatives with breast cancer, one

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14
Q

When to Test for BRCA for Women of Ashkenazi Jewish Descent

A

1st degree relative with breast or ovarian CA

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15
Q

Positive Impact on Clinical Health Outcomes for Ovarian Cancer

A

Annual pelvic, CA-125, and TVUS DO NOT decrease mortality from ovarian cancer

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16
Q

Prevention of Ovarian Cancer

A

Oral contraceptives
Gynecologic surgery: tubal, hysterectomy
Pregnancy
Breastfeeding

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17
Q

Cervical Cancer Prevention

A

Pap test

Death rate decreased 50% since pap administration

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18
Q

Cervical Cancer Screening Recommendations

A

Women should begin screening at age 21 unless HIV or immunocompromised
21-29 cytology every 3 years
30 years old: cytology every 3 years, co-testing cytology & HPV testing every 5
May stop after 65 if adequate screening in past 10 years with 2 negative screens

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19
Q

High Risk Groups for Cervical Cancer

A

Patients with HIV infection
Patients who are immunosuppressed
Those who had in utero DES exposure
Women who have been treated for CIN2, CIN3, or cervical cancer

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20
Q

Cervical Cancer: Hysterectomy Patients who Still Need Pap Smears

A

Surgery was done as treatment for cervical CA or pre-cancer

Hysterectomy without removal of the cervix

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21
Q

Cervical Cancer Prevention

A

Gardasil
Avoid exposure to HPV
Don’t smoke
Pap smear

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22
Q

Epidemiology of Breast Cancer

A

Most common in U.S
Second leading cause of cancer death in women
Diagnosed as a result of abnormal screening study

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23
Q

Primary Risk Factors for Breast Cancer

A

Predominantly in females

Age: 85% age 50+

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24
Q

Screening Tools for Breast Cancer

A

Mammography
Ultrasound
MRI: high risk patients

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25
Proper Clinical Breast Exam (CBE) Technique
Flatten breast tissue against chest Examine in vertical strips Make circular motions with pads of the middle 3 fingers Examine each breast with 3 different pressure for at least 3 minutes
26
Epidemiology of Colorectal Cancer
3 most common cancer in U.S. | 2nd leading cause of cancer-related deaths in U.S.
27
Assess Colorectal Cancer Risk
Start at age 20 & every 5 year thereafter Have you ever had colorectal cancers or an adenomatous polyp? Have you had inflammatory bowel disease? Have any family members had CBC or adenomatous polyp? If so, how many were 1st degree relatives & at what age was cancer or polyp diagnosed?
28
Recommendations
Fecal occult blood test: begin at 50 Flexible sigmoidoscopy: begin at 50, every 5 years; + sensitive FOBT every 3 years Colonoscopy: begin at 50, every 10 years Virtual colonoscopy: every 5 years
29
FOBT
``` Finds blood in the stool (3 samples) Stool guaiac Immunochemical stool tests Check for some intestinal conditions or colorectal cancer + test = colonoscopy ```
30
Sigmoidoscopy
View rectum, sigmoid, and last 2 feet of large intestine | Biopsies can be taken
31
Risks of Sigmoidoscopy
Bleeding from site where biopsy was taken | Tear in colon or rectum wall
32
Drawbacks of Sigmoidoscopy
Cannot see entire colon | Proximal lesions may not be seen
33
Define Colonoscopy
Endoscopic exam of the colon AND the distal part of the small bowel with a fiber optic camera on a flexible tube passed through the rectum
34
Positives of a Colonoscopy
Visual diagnosis | Opportunity for biopsy or removal of lesions
35
Complications of Colonoscopy
Bleeding from biopsy site | Tear in the colon or rectum wall
36
CDC Colorectal Cancer Control Program
Colorectal CA screening services to low-income men & women aged 50-64 Program sites also provide diagnostic follow-up
37
Screening for High Risk Populations
Family history Family adenomatous polyposis (FAP) Hereditary non-polyposis colon cancer (HNPCC)
38
Screening for High Risk Populations: History of Adenomatous Polyps
Colonoscopy age 40 or 10 years prior to earliest diagnosis; repeat every 5 years Based on pathology & # of adenomas Adenoma with high grade dysplasia- repeat in 3 years 1-2 small tubular adenomas with low grade dysplasia- repeat in 5 years
39
Screening for High Risk Populations: Family Adenomatous Polyposis
Sigmoidoscopy starting at age 10-12
40
Screening for High Risk Populations: Hereditary Non-Polyposis Colon Cancer
Colonoscopy q1-2 years beginning at age 20-25 or 10 years prior to earliest CA diagnosis in family
41
Virtual Colonoscopy
Uses a CT scanner to take images of the entire bowel | 2D & 3D
42
PROs of Virtual Colonoscopy
Doesn't require sedation Non-invasive Entire bowel can be examined
43
CONs of Virtual Colonoscopy
Abnormality will need colonoscopy
44
Epidemiology of Prostate Cancer
Most common cancer in men Mainly in older men 2nd leading cause of cancer death in U.S. men
45
Screening Tests for Prostate Cancer
DRE | PSA
46
DRE Testing in Prostate Cancer
Can detect 85% of tumors | Doesn't show reduction in morbidity or mortality
47
PSA Screening Prostate CA
Give men the pros & cons and let them make their own screening diagnosis
48
Potential Benefits of Prostate Cancer Screening
Detect cancers early Treatment more effective when it is found early 5-year survival with localized cancer 100%
49
Potential Risks of Prostate Cancer Screening
False positive test results lead to further tests Potential SE: infection from biopsies Treatment may have never affected a man's health if left untreated
50
Complications of Prostate Cancer Treatment
Sexual dysfunction Urinary incontinence Bowel dysfunction
51
Screening in Regular Risk Men
Age 50 unless life expectancy
52
Screening in High Risk Men
Age 40 African American men Family history of prostate CA esp.
53
Screening Guidelines for Lung Cancer for People at High Risk
55-74 years old Fairly good health At least 30 pack year history, still smoking, having quit last 15 years
54
Recommend Screening for Lung Cancer
Method: LDCT scan Location: center that can accurately do scans; expertise to interpret & advise the patient Risk: unnecessary biopsies, partial removal of lung
55
Principles of Lung Cancer Screening
``` Disease has high prevalence Disease has serious consequences Detectable preclinical phase Treatment for pre-symptomatic disease more effective than after symptoms develop Screening reduces cancer mortality ```
56
High Prevalence of Lung Cancer
2nd most common cancer in the US
57
Serious Consequences of Lung Cancer
#1 cause of cancer mortality
58
Prevention of Lung Cancer
Smoking cessation
59
Prevention of Skin Cancer
Wear sunscreen | Don't use tanning beds
60
Factors that Effectiveness Depends on for Skin Cancer
Whether clinician can identify early stage disease Whether pathologist can accurately diagnose & histologically stage disease Whether tumor is identified at a stage where treatment would be effective Whether tumor identified by screening would become clinically meaningful
61
Epidemiology of Oral Cancers
Men > Women | Oropharyngeal CA linked with HPV

Oncology (11 decks)

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