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C M S 1 > Cancer Symposium (all 3 lectures) > Flashcards

Cancer Symposium (all 3 lectures) Flashcards

1
Q

Define cancer?

A
  1. UNCONTROLLED NEW GROWTH of tissue
  2. which is NON-PHYSIOLOGICAL and has the
  3. capacity to INFILTRATE, INVADE AND SPREAD from its point of origin, having a detrimental effect.
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2
Q

What is meant by ‘non-physiological’?

A

Not controlled by normal homeostatic mechanisms

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3
Q

Is thickened skin cancer?

A

Not normal without a stimulus (eg, a guitarist can get callouses)

It is a physiological response (a new growth of tissues) to trauma - if the trauma is stopped, it’ll go away

So no it is not cancer

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4
Q

Is lipoma cancer?

A

Fat tumour under the skin- common in shoulder blades/clavicles
Although not physiological as it isn’t controlled like the rest of the fat in body
BUT does not infiltrate other tissues, therefore is NOT cancer.

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5
Q

Who gets cancer?

A

1 in 2 people
Increases with age (60 years < especially)

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6
Q

How many cancer cases are preventable?

A

40%
Risk factor and screening is important

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7
Q

How do people know they have cancer?

A

Non specific symptoms so need high index of suspicion
Any persistent symptoms need to be taken seriously

Late stage features include:
pain
lumps
weight loss
lymphadenopathy

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8
Q

What are the big 4 cancers?

A

Make up over 50% of new cancer cases:
1. Breast
2. Prostate
3. Lung
4. Bowel / colorectal

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9
Q

What percentage of cancer patients will die?

A

50%

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10
Q

What percentage of cases are preventable?

A

40%

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11
Q

How are cancer outcomes measured (4 points)

A
  1. Survival
  2. Prognosis
  3. Overall survival - may not be that useful bc pt may die of difference cause (old age for example)
  4. Disease free survival - indicator of if/how well treatment works
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12
Q

What kind of graph do we map survival on?

A

Kaplan-Meier survival estimate graphs - can compare treatments and their stages

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13
Q

How does disease stage, survival and quality of life correlate to each other?

A

Higher stage= lower survival = lower quality of life

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14
Q

What type of medical team do cancer patients need?

A

Multidisciplinary team - oncologists, surgeons, pathologists, radiologists, nurses, therapists

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15
Q

What is the process by which cancer patients get help? (cancer diagnosis pathway)

A
  1. GP
  2. Hospital speciality (eg, oral surgery, lung clinic, breast clinic etc) who carry out examinations, biopsies, imaging etc
  3. Multidisciplinary team
  4. Treatment
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16
Q

Why is cancer caught late?

A

Patient may not have symptoms and not feel sick until late stage - patient won’t seek help until cancer is advanced

Leads to poorer survival rates and poorer quality of life

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17
Q

What are the signs and symptoms of breast cancer?

A
  1. Lump in breast
  2. Lump in axilla
  3. Nipple bleeding/discharge
  4. Men can also get breast cancer
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18
Q

What are the signs and symptoms of lung cancer?

A
  • Persistent cough
  • Heamoptysis- coughing up blood from respiratory tract
  • Abnormal Chest x ray
  • Finger clubbing
  • Supraclavicular lymph node
  • Weight loss
  • Fatigue
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19
Q

What are the signs and symptoms of prostate cancer?

A
  1. Urinary problems including:
    - Frequency
    -Hesitancy
    - Nocturia
    - Urgency
    - Retention
  2. Check PSA - prostate specific antigen released by prostate cells (both normal and cancer cells)
  3. Examine prostate - may find prostatic hypertrophy (most men over 60 have this which makes PSA go up)
20
Q

What are the signs and symptoms of colorectal cancer?

A
  • Unintentional weight loss
  • Change in bowel habit
  • Rectal bleeding
  • Abdominal pain
  • Positive FIT test - faecal Immunochemical Test to look for tiny traces of blood that may be in faeces
21
Q

What is screening?

A

Testing a population at risk of a disease (eg, no point testing women for prostate)
Aims to identify asymptomatic cases or those with pre-malignant disease

It helps the patient get into the cancer diagnosis pathways

22
Q

What are the benefits of screening?

A

Increases rate of detection
Improves outcomes, survival and quality of life

23
Q

How do we screen for breast cancer?

A

Mammography every 3 years
50-70 years most at risk

24
Q

How do we screen for colorectal cancer?

A

Feacal immunochemical test - FIT test every 2 years
60-75 years most at risk

25
Q

How do we screen for lung cancer?

A

CT scan
50-80 years and smokers/ex-smokers less than 15 years ago most at risk

26
Q

How do we screen for prostate cancer?

A

PSA test

27
Q

How do we screen for cervical cancer?

A

Smear test
women aged 25-49 years (every 3 years)
Women aged 50-64 years ( every 5 years)

28
Q

What are the disadvantages of screening?

A
  1. May miss some cancers providing false reassurance
  2. A positive screening result may cause anxiety by diagnosing a slow-growing tumour that may never cause any harm or symptoms.
29
Q

What are the Wilson and Jungner principles for screening?

A
  1. Knowledge of disease:
    -The condition should be important.
    -There must be a recognisable latent or early symptomatic stage.
    -The natural course of the condition, including development from latent to declared disease, should be adequately understood.
  2. Knowledge of test:
    -Suitable test or examination.
    -Test acceptable to population.
    -Case finding should be continuous (not just a ‘once and for all’ project).
  3. Treatment for disease:
    -Accepted treatment for patients with recognised disease.
    -Facilities for diagnosis and treatment available.
    -Agreed policy concerning whom to treat as patients.
  4. Cost considerations:
    -Costs of case finding (including diagnosis and treatment of patients diagnosed) economically balanced in relation to possible expenditures on medical care as a whole.
30
Q

How long does it take to get treated?

A
  1. There is a 2 week wait referral (2WW referral)-seen and examined within 2 weeks
  2. If diagnosis positive, staging complete and txt plan within 31 days
  3. Start treatment within 62 days

14 : 31 : 62 day pathway
- audited and published, trusts are fine if dates not met

31
Q

How do we stage cancer?

A

TNM system
1. Tumour
2. Nodes (regional)
3. Metastases (distant)

We then stage the cancer from 1-4 which is an accumulation if all these factors

32
Q

Explain the T section of TNM staging?

A

Tumour size (primary tumour)
T1 to T4

T1: 0-2CM
T2: 2-5CM
T3: 5<CM
T4: Tumour has broken through skin or attached to chest wall

33
Q

Explain the N section of TNM staging?

A

N0-N3
Check regional lymph nodes- number/ bilateral/unilateral
Neck for head&neck cancer
Armpits for breast

34
Q

Explain the M section of TNM staging?

A

M0-M1
Distant metastasis - tested by PET CT scan

35
Q

Explain surgery in cancer management?

A

COORDINATED BY MDT (MULTIDISCIPLINARY TEAM)
1. Remove primary tumour with a margin of normal tissue around it
2. Remove involved lymph nodes for examination
3. Reconstruction of area if needed.

36
Q

Explain radiotherapy in cancer management?

A

COORDINATED BY MDT (MULTIDISCIPLINARY TEAM)
1.External beam
2. Implant- brachytherapy: planted in tumour, focused locally (common in cervical and prostate cancer)

Can be used in start metastases or lymph nodes

37
Q

Problems with radiotherapy?

A
  1. Limited dose
  2. Can only treat once as increased risk of killing normal tissues
  3. Radiation reaction
  4. Mucositis - ulceration/inflammation of GI tract
  5. Osteoradionecrosis if radiated on bone
38
Q

Explain chemotherapy in cancer management?

A

COORDINATED BY MDT

Often in combination with radiotherapy. Side effects include:
* Toxicity
* Hair loss
* Nausea
* Weight loss
* Fatigue
* Effects on blood

39
Q

Who is immunotherapy coordinated by?

A

MDT (MULTIDISCIPLINARY TEAM)

40
Q

Explain anti-resorptive medication in cancer management?

A

COORDINATED BY MDT (MULTIDISCIPLINARY TEAM)
1. Bisphosphonates - prevents risk of bone being metastasis
2. RANK-L inhibitors (denosumab)

  • Reduce bone turnover
  • MUST BE KEPT DENTALLY FIT so patients can cope with their cancer treatments - MRONJ
  • EXTRA CAUTION WITH EXTRACTIONS
41
Q

Explain hormone therapy in cancer management?

A

COORDINATED BY MDT (MULTIDISCIPLINARY TEAM)
- Can change growth pattern of their cancer
- Used for breast and prostate cancers

42
Q

At what point does follow up and survivorship link flatten out?

A

5 years (or 5-10 years) - likely to survive further at this point

However the compromise between continuing follow ups is the cost VS peace of mind

43
Q

Why might follow ups be important especially for childhood cancers?

A

The effects can last a lifetime (eg, MRONJ, osteoradionecrosis)

44
Q

What is our role as dentists in the management of cancer patients?

A
  • Champion healthy living
  • Smoking, alcohol, diet
  • Be aware of red flag signs
  • Signpost patients to GP
  • Champion screening
  • Oral Health promotion
45
Q

Hannah has a lump in her breast. She has a family history of breast cancer and thinks that her lump is a cancer.
What things does Hannah want her treatment to achieve?

A

*Wants to be cured

  • Go back to her old life
  • Minimal impact/side effects:
    -Cosmetic
    -Functional
    -Family/children
  • Quick diagnosis
  • Quick treatment
  • Involvement in her care choices
  • Doctors and nurses with good
    communication skills
  • Access to her cancer team
  • Minimal pain
  • Minimal complications
  • Regular follow up for as long as she needs it
  • Genetic counselling for her and her family

C M S 1 (23 decks)

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