Day 1 part 1- Cancer Flashcards
Epidemiology: 2 reasons for different occurrence rate
~different forms of cancer
~gender
What is the top 3 new cases of cancer for females? *for your info
~Breast
~lung and bronchus
~colon and rectum
What is the top 3 new cases of cancer for males? *for your info
~prostate
~lung and bronchus
~colon and rectum
Does occurrence rate and mortality rate stay the same for different cancers?
No!
*also is difference between countries
What is the top 3 mortality rates of cancer for females? *for your info
~lung and bronchus
~breast
~colon and rectum
What is the top 3 mortality rates of cancer for males? *for your info
~lung and bronchus
~prostate
~colon and rectum
What are some of the most common risk factors for cancer?
~Age over 50
~ethnicity
~family history (first generation)
~env and lifestyle
Some extra info on risk factors:
~More than half of all cancer deaths in the US could be prevented through healthier lifestyle and better use of screening
~Some is just “the plain dumb bad luck of the universe”
What is the most important risk factor for cancer?
AGE!!
Name some of the nonmodifiable risk factors:
~Age ~Previous history of cancer ~Ethnicity ~Skin color ~Gender ~Heredity (identified oncogenes) ~Age of menarche, menopause ~Adenamotous polyps ~Inflammatory bowel disease ~Fat distribution patterns ~Congenital immunodeficiencies ~Congenital diseases ~Long-term helicobacter infection
Name some of the modifiable risk factors:
~Smoking/ use of smokeless tobacco ~Chemical or other exposure (eg paint, cadmium, dye, rubber, arsenic, asbestos, radon, benzene, ionizing radiation, Agent Orange, pesticides, herbicides, organic amines) ~Urban dwelling ~Alcohol consumption (more than 1-2 drinks per day) ~Sedentary lifestyle ~Obesity; high diet in animal fat ~Insulin resistance (elevated serum insulin) ~Radiation/ chemotherapy treatment ~Estrogen replacement therapy ~STDs ~Ionized radiation ~HTLV-1 (virus) ~Previous lung scarring ~Organ transplant (immunosuppression) ~HIV infection ~Chronic exposure to UV rays ~Geographic location ~Smoked foods, salted fish and meats (nitrates and nitrites) ~Tamoxifen use ~Vitamin B12 deficiency ~Lack of access to or use of health care and screening tests
More details on cancer and age
~cancer risk increase with age
~greater increase in men with age but also seen in women
~varies by cancer type
(testicular cancer is more common in men ages 20-40)
(breast cancer increases rapidly after age 45)
(childhood cancers- acute leukemia, etc)
More details on race and ethnicity and cancer
~Racial disparities in incidence & mortality
(increase risk African-American populations- 40% higher mortality rate)
(increased risk some Native American & Hispanic populations)
~Related to access to medical care
~Related to different environmental factors
~Related to preventable risk factors
More details on family history
~important factor only for first generation family members
~some basic hallmarks of families with a history of caner:
*diagnosis of caner in two or more relatives in the family
*diagnosis of caner in a family member under the age of 50
*occurrence of the same type of cancer in several family members
*occurrence of more than one type of cancer in one person
*occurrence of a rare type of cancer in one or more members of a family
More details on genetics
~BRCA 1 & 2 for breast cancer
~Li-Fraumeni Syndrome – inherited chromosomal mutations of the p53 or CHK2 tumor suppressor genes – very rare (400 people from 64 families)
*Variety of cancers in this group, but common denominator is the genetic mutation
~FAP (familial adenomatosis polyposis) – colon cancer
Which does she classify as a lifestyle risk factor?
~Smoking
~Excessive alcohol ~consumption
~Diet/Nutrition
*Low fiber-high fat diet
*High fiber vegetables & fruits
*Red meat
~Sedentary lifestyle
~Obesity & type 2 diabetes
~Sexual activity & reproductive behaviors
*Both high and low related to different cancers
*Pregnancy, child-bearing & lactation decrease cancer risk
What is HPV?
Human papilloma virus
~It has a strong link to cervical cancer
~Gardasil gives ~65% protection
Which does she classify as environmental risk factors?
~Smoke
~Chemicals (herbicides, insecticides, dyes)
~Asbestos & other particulate matter
~Ionizing radiation – healthcare workers, power plants, construction, geological work
~Agent Orange – chronic lymphocytic leukemia, soft tissue sarcoma, non-Hodgkin’s lymphoma
Carcinomas are
a malignant tumor that comprises epithelial tissue
~it accounts for 85% of cancers
~can arise form breast, colon, pancreas, skin, large intestines, lungs, stomach
~metastasizes through lymphatic
Sarcomas are
a fleshy over growth
~refers to a large variety of tumors arising in the connective tissues
~can develop from fat, muscle, bone, cartilage, synovium, fibrous tissues
~metastasizes hematogenously
Lymphomas are
originates in the lymphoid tissues
~lymph nodes, spleen, intestinal lining
Leukemias are
cancers of the hematologic system
S/S of cancer (basic)
**Symptoms often only occur when the disease has progressed
~Lumps & abnormal growths
~Persistent cough
~Fatigue
~Change in bowel & bladder habits
~Unusual bleeding or discharge
~Pain, which may be specific or not (myalgia, fibromyalgia, arthralgias, headaches)
S/S of integumentary (table 13-5)
~any skin lesion or observable/ palpable skin changes
~any observable or palpable changes to the nail beds
~unusual mole (ABCDE)
~cluster mole formation
~bleeding or discharge from mole, skin lesion, scar, or nipple
~ tenderness and soreness around mole; sore than does not heal
S/S of musculoskeletal (table 13-5)
~may present as an asymptomatic soft tissue mass ~bone pain **deep or localized **increased with activity **decreased tolerance to WB; antalgic gait **does not respond to physical agents ~soft tissue swelling ~pathologic fracture ~hypercalcemia ~back or rib pain
S/S of Neurologic (table 13-5)
~drowsiness, lethargy ~HA ~N/V ~Depression ~increased sleeping ~irritability, personality change ~confusion ~change in mental state, memory loss, difficulty concentrating ~vision changes (blurring, blind spots, double vision) ~N/T ~balance and coordination issues ~change in deep tendon reflexes ~change in muscle tone for ind with previously diagnosed neurologic conditions ~+ Babinski reflex ~changes in B/B ~myotomal weakness pattern ~paraneoplastic syndrome
S/S of pulmonary (table 13-5)
~pleural pain
~dyspnea
~new onset of wheezing
~productive cough with rust, green, or yellow-tinged sputum
S/S of hepatic (table 13-5)
~Abdominal pain and tenderness ~jaundice ~ascites ~distended abdomen ~dilated upper abdominal veins ~peripheral edema ~general malaise and fatigue ~bilateral carpal/ tarsal tunnel syndrome ~asterixis (liver flap) ~palmar erythema (liver palm) ~spider angiomas (over the abdomen ~Nail beds of Terry ~right shoulder pain
What are the 3 screening approaches (categories)?
~Inspection & Palpation
~Blood tests & Cytology
~Imaging
What are the 4 inspection/ palpation mentioned in the slides?
~Regular physical exam
~Skin inspection
~Buccal cavity & throat inspection
~Palpation of thyroid, testicles, breast (self/clinical), prostate (DRE, digital rectal exam) & lymph nodes
What does ABCDE stand for?
A = asymmetrical B = "borders" (irregular = "Coast of Maine sign"), C = "color" (variegated) D = "diameter" (larger than 6 mm—the size of a pencil eraser) E = evolving over time
Other notes on skin inspections:
~But often not as obvious – just darkening area – but most commonly on exposed body parts, including hair
~High risk in areas & individuals with high unprotected sun exposures
What are you looking for on a buccal and throat inspection?
looking for abnormal coloration or growths, sores, or lumps
Details on Breast Exams
~Monthly breast self-exams (BSE)
~Women 20-39 should have a physical examination including a clinical breast exam (CBE) every three years
~Older than 39- every year
~Women 20 years of age and older should perform breast self-examination (BSE) monthly
~Buddy-check 3 – collaboration of St. Joseph’s Candler & WSAV
How is a prostate exam preformed and when should males start getting one?
~DRE- digital rectal exam
~males should have it yearly after the age of 40
Where are the 3 main areas to screen lymph nodes?
~axillary
~cervical
~inguinal
What are 5 ways that cytology can be collected/ done to screen for cancer?
~Complete blood cell counts (CBC) ~PSA levels ~PAP test ~Fecal occult blood test ~Urine cytology
What is looked at during the CBC (complete blood cell count)?
~if there are too few or too many of the different blood types
What are the 3 types of abnormal cell types called?
Metaplasia
Dysplasia
Hyperplasia
What are metaplasic cells?
replacement of one differentiated cell type with another mature differentiated cell type
What are dysplasic cells?
expansion of immature cells with decrease in the number and location of mature cells
What are hyperplasic cells?
increased number of cells, which may signal a pre-cancerous or cancerous process
What does PSA stand for?
Prostate specific antigen
What does PSA relate to?
~Elevated levels related to prostate hyperplasia and prostate cancers
~Not just total but ratio bound to total also important
~High risk for prostate cancer if > 65 years old and/or African-American male
What is a PAP test?
It is a test where cervical tissue sample taken with regular pelvic exam
Why should you have a PAP test?
~Looking for abnormal cells – dysplasia or metaplasia
~High sensitivity and specificity
What causes an increased risk for cervical cancer?
~Frequent intercourse ~Multiple partners ~STDs – particularly HPV & chlamydia ~Smoking ~Stress ~Oral contraceptives
How many stages are there for Pap Staging?
7
*I will list the stages in cards, but she said we don’t have to know them by heart. It’s more so you can get a better idea of the staging.
Stage 1 for Pap Staging
Negative for intraepithelial lesion or malignancy.
Stage 2 for Pap Staging
Atypical squamous cells of undetermined signficance (ASC-US).
Stage 3 for Pap Staging
Low grade squamous intraepithelial lesion (LSIL). This includes HPV and mild dysplasia.
Stage 4 for Pap Staging
Atypical squamous cells— cannot exclude high grade SIL (ASC-H).
Stage 5 for Pap Staging
High grade squamous intraepithelial lesion (HSIL) encompassing moderate dysplasia (CIN2), as well as CIN 3, which includes severe dysplasia carcinoma in situ (CIS).
Stage 6 for Pap Staging
Squamous cell carcinoma
Stage 7 for Pap Staging
Abnormal glandular cells including atypical glandular cells of undetermined significance (AGUS): endocervical adenocarcinoma; endocervical adenocarcinoma in situ; endometrial adenocarcinoma; extrauterine adenocarcinoma; adenocarcinoma, NOS
