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Disease & prevention > Case 7 cancer > Flashcards

Case 7 cancer Flashcards

1
Q

How can cancer spread in the body?

A
  • Tissue → cancer spreads from where began by growing into nearby areas.
  • Lymph system → cancer spreads from where it began by getting into lymph system. travels through lymph vessels to other parts of the body.
  • Blood → cancer spreads from where it began by getting into the blood. travels through blood vessels to other parts of body.
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2
Q

What are carcinogens?

A
  • substance, organism or agent capable of causing cancer.
  • Occur naturally in environment (e.g. UV rays and certain viruses) or may be generated by humans (e.g. car fumes and cigarette smoke).
  • carcinogens interact with cell’s DNA to produce mutations.
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3
Q

What is carcinogenesis?

A
  • formation of a cancer, whereby normal cells are transformed into cancer cells.
  • Process is characterized by changes at cellular, genetic, & epigenetic levels & abnormal cell division
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4
Q

What are the general causes of cancer?

A

35% attributable to lifestyle (nutrition, smoking, physical activity, alchol, weight, etc)

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5
Q

What is the clinical development of cancer?

A
  1. Starts locally - starts someplace where cells divide & during cell division, errors occur? Rate of cell division grows faster.
  2. Some point cells grow through structures into other tissues & attract blood/lymph vessels coz tumor needs lot of nutrients & oxygen.
  3. Spread of tumour cells through body through blood/lymph vessels.
  4. Implantation elsewhere
  5. Development of metastases
  6. Death
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6
Q

What stages are there for cancer?

A

Stage 1 → small localised tumour
Stage 2 → larger but still localised tumour
State 3 → either tumours that have grown into other tissues or have metastasized to the lymph nodes
Stage 4 → tumours that have metastasis to brain, liver, lungs, skeleton, etc.

Higher stage = lower chance of survival

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7
Q

What factors determine survival?

A
  • Stage of cancer (one of most important determinants)
  • Original primary site of cancer
  • What kind of cells have become cancer
  • What kinds of genes have changed
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8
Q

Is cancer one disease?

A
  • Cancer is not one disease, but hundreds of different diseases
  • Subgroups according to localisation, cell type, genetics, etc
  • Differences relevant for: causes, treatment & prognosis, survival, opportunities for prevention
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9
Q

What is the most frequent cause of death in NL?

A

Lung cancer

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10
Q

Define lung cancer

A

Cancer that forms in tissues of the lung, usually in the cells lining air passages.

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11
Q

2 types of lung cancer

A
  • non-small cell lung cancer (NSCLC)
  • small cell lung cancer (SCLC)
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12
Q

What is NSCLC?

A
  • cancer cells form in your lung tissues. More common & less aggressive than SCLC.
  • It grows and spreads more slowly than small cell lung cancer.
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13
Q

What is SCLC?

A
  • abnormal cells in your lung grow fast and uncontrollably.
  • aggressive form that often starts in airways & then spreads, or metastasizes, to other parts of body.
  • occurs almost exclusively in people who smoke
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14
Q

What is SCLC?

A
  • abnormal cells in your lung grow fast and uncontrollably.
  • It’s an aggressive form of cancer
  • occurs almost exclusively in people who smoke
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15
Q

What are the symptoms for lung cancer?

A
  • Chest pain
  • Coughing / wheezing
  • Dyspnoea - shortness of breath.
  • Blood in sputum (mucus coughed up from the lungs).
  • Hoarseness.
  • Loss of appetite.
  • Weight loss for no known reason.
  • Feeling very tired.
  • Trouble swallowing.

Sometimes symptoms related specific to the tumour (location of tumour).

Asymptomatic (25% of cases)

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16
Q

What are the risk factors for lung cancer?

A
  • Smoking / secondhand smoke
  • Air pollution
  • Family history
  • HIV infection
  • Occupational exposures to lung carcinogens e.g. asbestos, arsenic, nickel, and chromium, is the most important contributor to the lung cancer burden.
  • Genes - some genes that are associated with higher risk of LC, genes that determine how vulnerable you are to get addicted to smoking
  • Low intake of vegetables and fruits

Combination of smoking + these other non-smoke risk factors = increase risk of LC

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17
Q

What is the natural development of LC?

A
  • normal lung cells mutate & alters natural growth & death cycle = unregulated cell division that produces too many cells.
  • Rapidly dividing cells don’t carry out functions of normal lung cells/develop into healthy lung tissue.
  • Instead = accumulate & form lung tumours
  • Cellular mutation that leads to development of LC is series of permanent changes in DNA sequence of gene.
  • Often changes occur when toxic substances e.g. asbestos, chemicals in smoke, are inhaled.
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18
Q

What are the diagnostics of LC?

A
  • Imaging tests (e.g. CT, MRI)
  • Sputum cytology (cough & producing sputum = analysing sputum under microscope)
  • Bronchoscopy
  • Tissue sample (biopsy)
  • Thoracentesis → removal of fluid from the space between the lining of the chest and the lung, using a needle.
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19
Q

What is the incidence & mortality of LC?

A
  • 2nd most common cancer worldwide
  • # 1 in men & #2 in women worldwide.
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20
Q

Why was the incidence of LC for men higher than women in the past?

A
  • In NL in 1989 was more common that men smoked and women didn’t therefore men higher incidence.
  • Caused by changes in smoking habits (past was that every man smoked and women didn’t) now more women smoking.
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21
Q

What is treatment of LC?

A
  • Chemotherapy
  • Surgery
  • Radiation therapy
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22
Q

What is primary prevention for LC?

A
  • Quit/don’t smoking
  • Lower exposure to workplace risk factors
  • Lower exposure to radon
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23
Q

What is secondary prevention for LC?

A

smoking cessation and screening.

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24
Q

What is tertiary prevention for LC?

A

Number of tobacco control strategies at community, state, & national level = reduce prevalence of smoking.

  • Reducing minors’ access to tobacco products.
  • Effective school-based prevention together with media strategies.
  • Raising cost of tobacco products by raising taxes.
  • Using tobacco excise taxes to fund community-level interventions including mass media.
  • Providing quitting strategies through health care organisations.
  • Adopting smoke-free laws and policies.
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25
Q

What are the opportunities for screening for LC?

A
  • Low dose computed tomography
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26
Q

What is low dose computed tomography (LDCT)?

A
  • Procedure that uses a computer linked to an x-ray machine that gives off a very low dose of radiation to make a series of detailed pictures of areas inside the body
  • Differentiate between benign and malignant tumours.
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27
Q

*Why don’t use x-ray for screening for LC?

A

Trials that studied chest X-ray, did not show a statistically significant reduction of LC mortality - required a lot of unnecessary surgery.

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28
Q

Why according to the Wilson & Jungner criteria can’t we screen for LC?

A
  • Recognizable latent stage but difficult because can’t test for it.
  • Suitable test - not yet certain if it is usable & if benefits outweigh the harm
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29
Q

What is colorectal cancer? (CC)

A

disease in which malignant (cancer) cells form in the tissues of the colon or the rectum.

30
Q

What are the risk factors for CC?

A
  • Age - risk increases after 50 yrs old.
  • Family history of colorectal cancer
  • Excessive alcohol
  • Cigarette smoking
  • Race
  • Obesity/overweight
  • Lack of physical activity
  • Nutrition - Low intake of vegetables and fruits & high consumption of red and processed meat
  • Diabetes

No single risk factor (co-occurrence of risk factors often)

31
Q

What are the symptoms of CC?

A
  • Change in bowel habits (diarrhea, constipation, etc) that lasts for more than a few days
  • Rectal bleeding with bright red blood
  • Blood in the stool, which might make the stool look dark brown or black
  • Cramping or abdominal (belly) pain
  • Weakness and fatigue
  • Unintended weight loss
  • Anaemia
32
Q

What are the symptoms of CC?

A
  • Change in bowel habits (diarrhea, constipation, etc) that lasts for more than a few days
  • Rectal bleeding with bright red blood
  • Blood in the stool, which might make the stool look dark brown or black
  • Cramping or abdominal (belly) pain
  • Weakness and fatigue
  • Unintended weight loss
  • Anaemia
33
Q

What is the natural development of CC?

A
  • start as a growth on inner lining of colon/rectum. Growths = polyps.
  • Some types of polyps can change into cancer over time, but not all polyps become cancer.
  • chance of a polyp turning into cancer depends on type of polyp it is. There are different types of polyps.
34
Q

What is the natural development of CC?

A
  • Most colorectal cancers start as a growth on the inner lining of the colon or rectum. Growths = polyps.
  • Some types of polyps can change into cancer over time (usually many years), but not all polyps become cancer.
  • The chance of a polyp turning into cancer depends on the type of polyp it is. There are different types of polyps.
35
Q

What are the different pathways of the natural development of CC?

A
  • About 70% of the CRC cases: normal → hyperproliferation (risk that something goes wrong is large because cells dividing so frequently) → adenomatous polyps (if some mutation can cause proliferation of cells & get tumour) → cancer.
  • About 30% of the cases >60 years have polyps in the colorectal, it has been estimated that roughly 5% of the polyps will progress to cancer.
36
Q

What are the diagnostics of CC?

A
  • Colonoscopy
  • CT or MRI of colon
  • Blood tests
37
Q

What are the treamtent options for CC?

A
  • Dependent of stage, localisation (& molecular characteristics)
  • Surgery (removal of part of bowel)
  • Polyps, if small colonoscopy (otherwise surgery)
  • Radiotherapy
  • Chemotherapy
  • Targeted therapy
38
Q

What are the treatment options for only rectal cancer?

A
  • surgery is most common treatment
  • Surgeon either performs anatomosis (sews healthy parts of rectum together) or stoma.
  • active surveillance
39
Q

What is targeted therapy?

A
  • Type of treamtend that uses drugs or toher substances to identify and attack specific cancer cells.
  • Cause less harm to normal cells thna chemotherapy or radiation.
40
Q

What is the incidence & mortality of CC?

A
  • 3rd incidence
  • 4th mortality worldwide
  • In several high-income countries, countries of east Asia, eastern Europe, mortality decreasing coz of improved early detection & treatment, but rates have continued to increase in countries or areas with poor health-care resources.
41
Q

What are the opportunities for screening for CC?

A
  • Guaiac-based faecal occult blood test (gFOBT)
  • Faecal immunochemical test (FIT)
  • Colonoscopy
42
Q

What is the gFOBT test?

A

uses the chemical guaiac to detect blood in the stool. It is done once a year.

43
Q

What is the FIT test?

A

fecal immunochemical test

uses antibodies to detect blood in the stool. It is also done once a year in the same way as a gFOBT.

44
Q

What is a colonoscopy?

A
  • long, thin, flexible, tube to check for polyps or cancer inside rectum and entire colon.
  • doctor can find and remove most polyps and some cancers.
  • Every 10 years (for people who don’t have an increased risk of colorectal cancer).
  • Every 2 years if at risk ?
45
Q

How does screening in NL work for CC?

A
  • Screening started in 2014
  • Complete implementation in 2019
  • Men & women 55-75 years
  • Invitation every 2 years
  • Postal faecal test (iFOBT) by mail
46
Q

Wilson & jugner criteria for CC?

A
47
Q

What is primary prevention for CC?

A

The following protective factors decrease the risk of colorectal cancer: physical activity, Aspirin, combination hormone replacement therapy, polyp removal

  • Promote lifestyle - increased physical activity, avoidance of overweight & obesity
  • Less alcohol consumption
  • Stop smoking
48
Q

What is secondary prevention for CC?

A
  • Prevention by early detection & screening (esp for people at risk)
  • Surveillance via colonoscopy, involving removal of adenomas
  • Detection of faecal occult blood. But the method suffers from low specificity and, to a lesser extent, low sensitivity, in particular in the ability to detect adenomas.
49
Q

What is prostate cancer?

A

disease in which malignant (cancer) cells form in tissues of the prostate.

50
Q

What is the prostate?

A
  • gland in male reproductive system & is below the bladder and in front of the rectum (the lower part of the intestine).
  • Surrounds part of urethra (the tube that empties urine from the bladder).
  • Produces fluid that makes up part of the semen.
51
Q

What are the risk factors for prostate cancer (PC)?

A
  • Age - more common after 50
  • Family history of prostate cancer
  • Race/ethnicity
  • Geography
  • Many genetic variants (mutations) have been identified that increase risk of prostate cancer slightly.
52
Q

What are the symptoms of PC?

A
  • Mostly without symptoms
  • Difficulty urinating
  • Pain or burning during urination.
  • Blood in the urine or semen.
  • Painful ejaculation.

When prostate cancer is detected in an advanced stage, symptoms may include:
* Pain in the back, hips, or pelvis (pain in bones)
* Shortness of breath, feeling very tired, fast heartbeat, dizziness, or pale skin caused by anaemia.

53
Q

*What is the natural development of disease?

A
54
Q

What are diagnostics of PC?

A
  • Physical exam and health history
  • Prostate-specific antigen (PSA) test
  • PSMA PET scan: An imaging procedure that is used to help find prostate cancer cells that have spread outside of the prostate, into bone, lymph nodes, or other organs.
  • Transrectal ultrasound or transfectal MRI
  • Biopsy of the prostate
55
Q

What is the PSA test ?

A

Prostate-specific antigen (PSA) test
* A test that measures the level of PSA in the blood.
* Protein that is produced by prostate cells. In cancer cells this protein leaks into the blood

56
Q

What is PSMA Pet scan?

A

An imaging procedure that is used to help find prostate cancer cells that have spread outside of the prostate, into bone, lymph nodes, or other organs.

57
Q

WHat is transrectal ultrasound?

A

A procedure in which a probe is inserted into the rectum to check the prostate.

58
Q

What is treatment of PC?

A
  • radiotherapy
  • Surveillance (not always necessary to treat)
  • Surgery to remove prostate
  • Hormone therapy - testosterone helps prostate cancer cells grow
  • Chemotherapy
59
Q

What is the incidence & mortality of PC?

A
  • 2nd most common cancer in men
  • 4th overall worldwide
60
Q

What are the opportunities for screening for PC?

A

There is no standard or routine screening test for prostate cancer.
* Digital rectal exam
* Prostate-specific antigen test

61
Q

Why is there no screening for prostate cancer?

A
  • Difficult to see effect of screening because also treatment has improved so don’t always know.
  • Stress because of false-positive diagnosis
  • Insufficient evidence of effectivity
  • Overdiagnosis certain
  • Overtreatment with frequent complications and side effect
  • PSA not very predictable.

look at wilson & jungner criteria of PC screening

62
Q

What is primary prevention for PC?

A
  • Healthy diet
  • Physical activity
  • Healthy weight
  • Stop smoking
  • Less alcohol consumtpion
  • Increase vitamin D
  • Staying sexually active
63
Q

*What is secondary prevention for PC?

is it primary or secondary these answers?

A
  • PSA testing
  • Digital rectal exam
64
Q

What is the wilson & jungner criteria?

A

WHO principles for population screening state that screening should be implemented only when there is a good balance between costs and benefits.

65
Q

Why was the Wilson & Jungner criteria updated?

A
  • Large-scale screening for genetic conditions
  • Original criteria were criticised for being too vague or theoretical.
66
Q

What are the Wilson & Jungner criteria related to the disease?

A
  • Conditions sought should be an important health problem → rare disease probably not useful to screen for.
  • Should be a recognizable latent or early symptomatic stage
  • Natural history of the condition, including development from latent to declared disease, should be adequately understood. → e.g. should be clear that what you are treating will become cancer in a few years.
67
Q

What are the Wilson & Jungner criteria related to screening test?

A
  • Should be a suitable test or examination
  • Test should be acceptable to the population (if painful, invasive not everybody willing to do the test)
68
Q

What are the Wilson & Jungner criteria related to diagnostic test & treatment?

A
  • Should be an accepted treatment for patients with recognized disease
  • Should be an agreed policy on whom to treat as patients → clear definition on which patients to treat and which not to treat? E.g. for breast cancer screening programme, there is one specific form of breast cancer which has had a lot of debate on if it should be treated and how?
  • Facilities for diagnosis & treatment should be available.
69
Q

What are the Wilson & Jungner criteria related to the overall screening programme?

A
  • Cost of case-finding (including diagnosis & treatment of patients diagnosed) should be economically balanced in relation to possible expenditure on medical care as a whole
  • Case-finding should be a continuing process and not a “once and for all” project.
70
Q

What are the harms of screening?

A
  • harms and inconvenience caused by the initial test;
  • negative labelling effects: stress and anxiety caused by a false positive result;
  • harms and inconvenience caused by unnecessary investigations in false positive persons;
  • harms and inconvenience caused by unnecessary treatment of those who do not have the disease or have the disease that would never progress to the clinical stage and would have not been treated if there were no screening;
  • prolonged stress and anxiety if detected patients cannot be effectively treated;
  • a false sense of security caused by false negative results which could delay final diagnosis.
71
Q

What is the legislation in NL for screening programmes?

A

In NL a screening programme needs permission from Minister of Health if:
* Use is being made of ionising radiation (mammogram, CT scan, radiology, etc)
* Is aimed at cancer
* Is aimed at a disease for which a treatment or cure is not possible

Decision has to be taken by Minister after advice by health council

72
Q

What elements should be included in smoking-cessation treatment? (primary prevention for LC)

A
  • Nicotine-replacement (e.g., nicotine patches and gum)
  • Social support from clinician in the form of encouragement and assistance.
  • Skills training and problem solving (cessation and abstinence techniques)

Disease & prevention (10 decks)

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