Diagnosing Cancer Flashcards
Average risk breast cancer age 50-74 what’s the screening interval
Mammogram every 2yrs
High risk breast cancer age 30-69yrs
Screening yearly with both mammogram and MRI
Colorectal cancer screening
50-74yrs no parent or siblings or child with colorectal cancer (average risk) screening every 2yrs with fecal immunichemical test (FIT)
Colorectal screening for those at increased risk- parent or siblings or child diagnosed before before 60
Age 50yrs or 10yrs earlier than age relative was diagnosed
Colonoscopy every 5yrs
Colorectal cancer screening for those whose relative were diagnosed after 60yrs
Age 50yrs or 10yrs earlier than relative was diagnosed with colorectal cancer
Colonoscopy every 10yrs
Lung cancer screening
55-74yrs and have smoked every day for at least 20yrs
What is the most common cancer in female
Breast cancer
Cancer most common in men
Prostate cancer
Cancer most common in children
Leukaemia
Which are the most common cancers in Canada
Breast cancer, prostate cancer and colorectal cancer
Lung cancer prevalence is what?
Second most common cancer in both men(12.5%) women (13.3%)
Lung cancer is number 1 cancer in which age range
79-84yrs
What is the basis of diagnosis of cancer?
Manifestation based on site, tumor site and diagnostic testing
What are the staging systems for cancer!
Microscopic analysis which is based on presence of metastasis
WHO’s TNM
TNM is used in staging what kind of cancer?
Solid cancer
Microscopic analysis staging are
Stage I - No metastasis
Stage II - local invasion
Stage III - spread to regional structures
Stage IV - distant metastasis
WHO’ TNM
T: primary tumor size and extent
N: node involvement
M: extent of distant metastasis
TNM system T is what?
T 1: 0-2 cm
T2: 2-5cm
T3: >5cm
T4: tumor broke through skin or attached to chest wall
TNM system N staging includes
Lymph node status
N -0: surgeon can’t feel any node
N-1: surgeon can feel swollen node
N-2: node feel swollen and lumpy
N-3: swollen node located at collerbone
M in the TNM staging stand for what?
Metastasis
M-0: Tested node cancer free
M-1: Tested node show cancer cells or micro metastasis
What are tumor markers?
Substance produced by cancer cells that are found in tumor cells in blood, CSF or urine
Tumor markers could be
Hormone
Enzymes
Genes
Antigens
Antibodies
What’s the use of tumor markers?
For screening and identify individuals at high risk for cancer
Diagnose specific types of tumor
Observe clinical course of cancer
What are the problem of tumor markers?
False positives and negatives
What is the benefit of histology of cancer cells?
It help with molecular characterization to subdivide cancer into therapeutically and prognostic smaller groups
What is the definition of histology?
Scientific study of microscopic structures (micro anatomy) of cells and tissue
Origin Greek
Histos = tissue or columns
Logia= study
What’s the 4 classification of tissue
Nervous tissue
Muscle tissue
Epithelial tissue
Connective tissue
What are the sub categories of tissue?
Epithelium
Endothelium
Mesothelium
Mesenchyme
Germ cells
Stem cells
What are the 3 historic treatment of cancer?
Surgery
Radiation
Chemotherapy
What are the ways surgery is used in cancer
- Dignosis- surgical excision of suspected area lymph node or mass
- Treatment - removal of cancerous tumours
- Palliation: debunking of an area where cancer has invaded surrounding organ or tissue e.g ureter
4 as adjunct treatment to debunking tumours before chemotherapy
Can surgical removal of tumor be used as cure?
Yes
Immunotherapy
Used recently in cancer management
In the treatment of Breast cancer what is used
Surgery, radiation and chemotherapy
What are the 2 ways radiation can be used in cancer treatment
Systemic treatment
Local treatment
Today body radiation (systemic) is used in what cancer treatment
Haematological cancer such as lymphoma as an adjunt
Radiation can be used as local treatment or cure in what type of cancer
Prostate cancer- brachytherapy
What is brakytherapy
Radiotherapy beads are inserted near the prostate to get rid of the prostate cancer
Targeted radiation therapy is used in paillative care
True or false
True
Immunotherapy
Harnessing immune system in an effort to up regulate immune function and use the bodies own defence to treat cancer
What is immunotherapy used for
Hard to treat cancers such as malignant melanoma, lung cancer and myeloma
What are the 2 well know treatment in immunotherapy
Immune checkpoint inhibitors
CAR T cell therapy
What are the adverse effects of immunotherapy?
Relate to stimulation of immune system and hyper immune response example
Rashes
Inflammation etc
What is the name of the adverse events from immunotherapy called
Immune related adverse events
IRAEs
What is the treatment of Immune related Adverse events (IRAS)
Steroids to dampen the events
What are the risk factors for lymphoma of GI
H pylori
HIB chronic immunosuppressant therapy
IBD celiac disease
Autoimmune disease
What is the gold test for colorectal cancer
Colonoscopy
What are the risk of colonoscopy
Bowel perforation
Heavy bleeding
Adverse reaction to sedatives
Infection
Nausea and vomiting
What’s the stats of colorectal cancer
1 in 15 diagnosed with the disease
1 in 31 die of it
Survival rate average
Highest incidence for men and women occurs in Newfoundland Labrador
Cervical cancer screening use what
Pap smear
Done a 3yrs age 25- 69 yrs
>79yrs Pap test negative 3x in past 10yrs stop
What is the frequency of diagnosis if colorectal cancer in Canada
3rd most diagnosed cancer
Preferred opioid in cancer
Pain not too intense - oxycodone
Moderate to severe. - morphine
Benefit of opioid rotation
Can minimize adverse event. Stop abruptly and replace with another
Opioid to avoid in cancer
Demerol ( toxic metabolite normeperidine can accumulate)
Buperenorphine
Butorphanol
Nalbuphine
Pentazocine
WHO recommendation
Pain ladder
1-3 use none opioid
4- 10 start opioid
First choice of none opioid in cancer
Acetaminophen
Benefit - relief pain, suppresses inflammation and reduce fever
AE: gastric ulcers, renal failure and bleeding
