Diagnosis

Question 1

What are the types of population screening in the NHS?

Answer 1

• breast; mammography (every 3 years for 50-71yrs)
• colorectal; faecal immunochemical test (every two years for 60-74 yrs old)
• cervical cancer (every 3 years for 25-64 years)
• prostate; PSA test and/or DRE test for men over 50yrs
• lung; low dose CT for high risk patients (55-74yrs)

Question 2

priniciples of screening; the disease

Answer 2

• natural history must be well understood
• has recognisable ‘early stage’
• treatment at early stage is more successful than at later stage
• sufficiently common in target population to warrant screening

Question 3

principles of screening: the test

Answer 3

• sensitive and specific
• acceptable
• safe
• inexpensive

Question 4

priniciples of screening: the programme

Answer 4

• adequate facilities for diagnosis in those with +ve test
• high quality of treatment for screen-detected disease
• screening repeated at intervals if disease is of insidious onset
• benefit must outweigh psychological harm (false -ve or +ve tests)
• benefit must justify financial cost

Question 5

what is lead time bias?

Answer 5

• early diagnosis advances time of diagnosis of disease then patient will live with the disease longer, irrespective of whether or not treatment has altered natural history of disease.
• screening only be of value if it improves survival curve of screened population compared with unscreened

Question 6

what is length time bias?

Answer 6

• slow growing tumors are more likely to be detected by screening tests, compared to fast growing tumors which are more likely to present with symptoms before screening tests

Question 7

what is selection bias?

Answer 7

• could be reasoned that the kind of person that will present for screening may be more health-conscious and therefore more likely to survive longer, irrespective of disease process.

Question 8

what are early-stage signs and symotoms?

Answer 8

• change in bowel habit or bladder function (blood, diarrhea, constipation)
• sores that don’t heal (mouth, skin, genitals)
• unusual bleeding / discharge / phlegm (lungs, endometrium, vagina)
• thickening or lumps (lymph nodes, breast, testicle, bowel)
• indigestion or trouble swallowing (oesophagus, stomach, pharynx)
• recent changes to wart or mole (skin)
• nagging cough or hoarseness (lung, larynx, thyroid)
• rapid, unexplained weight loss

Question 9

late stage signs and symptoms (heart)

Answer 9

• chest pain, cough, cyanosis, dysphagia, dysponea, distended neck and chest veins
• could be that cancer is obstructing blood flow in superior vena cava

Question 10

late-stage signs and symptoms (GI malignancy)

Answer 10

• distended abdomen, distended veins, inverted umbilicus (rare), dullness on palpation and percussion
• could be ascites, fluid collection within the peritoneal cavity

Question 11

what could the late stage signs and symptoms of a GI malignancy be from?

Answer 11

• stomach irritation = leakage
• lymph fluid
• liver metastasis = increased pressure on the hepatic portal vein = exudate

Question 12

late stage signs and symptoms of a malignancy

Answer 12

• fistula
• infection
• jaundice
• lymphodema
• airway obstruction
• nausea and vomiting
• pain
• tenesmus (feeling like you need to defecate all the time)
• tiredness and fatigue
• ulcerating cancer wonds