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Oncology Midterm > Introduction to Cancer > Flashcards

Introduction to Cancer Flashcards

1
Q

Cancer statistics

A

1.7million new diagnosis for 2016
39.6% of people will be diagnosed
#1 cause of death worldwide (8.2 million/year)
#2 cause of death by disease in US (after heart)

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2
Q

1 cancer diagnosis

A

Lung cancer

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3
Q

Survivorship

A

14.5 million adult and ped survivors, survival increasing,

need for resources post-cancer treatment related to therapy and radiation

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4
Q

Cancer Disparities

A
  • Socioeconomic increases death rates, independent of demographics of race and ethnicity
  • Lack of access to preventive health care, early detection, and treatment
  • Discrimination
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5
Q

Childhood cancers

A

0-14
~16,000 new diagnosis
Leukemia (acute)
overall survival ~90%

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6
Q

Adolescent and Young adult cancers

A

15-39
~70,000 new diagnosis, 5% of cancer diagnosis
leading cause of disease related death
unique diagnoses and genetics
18-20 pediatric treatment improves survival (more aggressive care)

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7
Q

What is cancer?

A

> 100 related diseases

uncontrolled division of normal cells, invading surrounding tissue and disrupting normal function

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8
Q

how does cancer spread?

A

through lymph

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9
Q

How is cancer named?

A

primary tissue or organ

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10
Q

Cancer spread

A

metastasis

  1. Cancer cell invades surrounding tissues and blood vessels
  2. Cancer cells are transported by circulatory system to distant sites
  3. Cancer cells reinvade and grow at new locations
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11
Q

Cancer Etiology

A

Multifactorial:

  • Genetic
  • Environment
  • Lifestyles
  • Medical conditions
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12
Q

Cancer is genetic disease

A
  • Inherited genetics abnormalities/mutations 5-10% of all cancer diagnosis
  • Genetic alterations over course of lifetime: errors during cell replication, DNA mutations due to exposure (smoking, UV rays)
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13
Q

Cancer Therapy

A 
Traditional: Surgery, radiation, chemo
Future: Personalized medicine
Genetics
Targeted Therapy
Immunotherapy
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14
Q

Cancer Therapy

A
  • knowledge of molecular changes
  • Tumor DNA sequencing
  • Tumors grouped by mutation, not location
  • treatment based on mutation
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15
Q

Cancer Risk

A

-everyone at risk
-increases with age
-Risk factors
Goal: Prevention

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16
Q

Cancer Risk Factors

A

Genetic - inherited vs mutations over lifetime
environmental (radiation)
Lifestyle (tobacco and alcohol)
Medical conditions (HPV)

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17
Q

Goal of Prevention

A

Primary health
secondary screening
tertiary treatment

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18
Q

Primary Prevention

A

Before cancer
Health and wellness (diet, weight, activity)
Lifestyle modifications

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19
Q

Primary prevention: Diet

A 
5+ veggies and fruit
whole grains
limit processed foods
limit sugar intake
limit processed and red meats
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20
Q

Primary Prevention: Weight

A
  • balance calorie intake with physical activity
  • healthy BMI (obese >30)
  • > 60million Americans are obese
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21
Q

Obese women increased risk for:

A

breast, endometrial cervical, kidney, GB and ovarian

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22
Q

obese men increased risk for:

A

colon, gastric, esophageal

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23
Q

Diabetes increases risk

A

2011 study association between diabetes and higher cancer mortality rates
women: 11% increase risk for cancer mortality
men: 17% risk for cancer mortality
overall inc risk for colon, rectum and liver cancer

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24
Q

Primary Prevention: Activity

A

Exercise:

  • improves energy metabolism
  • reduces circulating estrogen
  • reduces insulin and insulin-like growth factor
  • evidence links to reduced rsk of breast, colon, endometrial, lung and prostate cancer
25
Q

Adult Activity guidelines

A

Adults
Minimum 20 min x 5 days /wk
goal: 30 min 5x/week
Preferred: 45 - 60 min

Kids and Adolescents
60 min 5 days/week

26
Q

Primary prevention: Lifestyle

A

Sun safety, sexual health, alcohol, tobacco,

27
Q

Sun Safety

A

Skin cancer #1 in US
Ultraviolet radiation known carcinogen
-UVA = premature aging
-UVB = sunburn

28
Q

Risk factors for Skin cancer

A

Caucasian
red or blond hair
family hx
medical conditions (xeroderma pigmentosum)
90% non melanoma and 65% melanoma directly related to UV rays from sun

29
Q

Sun Safety Prevention

A

Decrease time spent in direct sun 11am - 4pm
sun screen application 30 min prior, repeat 90 to 120 minutes
SLOP, SLIP, SLAP (SPF 40+)
tanning beds 20% increased risk, doubles if start before 35

30
Q

Primary prevention: Sexual health

A 
unsafe sex linked to cervical, liver, anal and genital cancers
-Reduce risk:
limit # of partners in lifetime
use condoms
STI testing
note changes and report
HPV vaccine
31
Q

HPV vaccine

A

only known way to prevent cancer with vaccine
HPV 6, 11, 16 and 18
females 9-26
males 9-18

32
Q

Primary Prevention: Alcohol use

A

increased risk with excessive alcohol intake
men no more than 2.day
women no more than 1/day
avoid binge

33
Q

Primary Prevention: Tobacco use

A

affects almost every organ
linked to 15 cancers types
30% of all cancer deaths
inhaling causes inflammation, leading to DNA damage, can lead to cancer

34
Q

Tobacco

A

smoking cessation offered to EVERY patient
behavioral therapy: stressors, coping mechanisms
Pharmacotherapy: NRT, Zyban, Chantix
Behavioral and Pharmacotherapy: success 40-60%, <10% on own

35
Q

Secondary Prevention: Screening

A

early detection = discovery at earlier stage
Cancer check ups:
-health counseling
-medical and family hx
-age and gender specific exams
-referral for age and gender specific screenings

36
Q

Screening for early detection

A
  • must be available earlier than if the cancer were detected as a result of symptom development
  • evidence must show that treatment initiated earlier as a consequence of screening will improve outcome
37
Q

Effective screening test (4)

A

Sensitivity
Specificity
Positive Predictive value
Negative predictive value

38
Q

Sensitivity

A

test correctly identifies those with the disease (true positive)

39
Q

Specificity

A

test correctly identifies those without the disease (true negative)

40
Q

Positive predictive value

A

probability that subjects with a positive screening test truly have the disease

41
Q

Negative predictive value

A

probability that subjects with a negative screening test truly don’t have the disease

42
Q

Screening: Testicular cancer

A
  • most common in men 15-34
  • annual testicular exam clinically
  • monthly testicular self-exam
  • U/S for abnormal
43
Q

Testicular: when to seek help

A

new lumps/bumps

feeling of heaviness

44
Q

Screening: Breast cancer

A

most common in women
Guidelines:
-monthly self breast exam starting at 20
- Clinical breast exam (3yrs for 20-30s, annually for >40)
-mammogram starting at 40 yearly and continuing as long as in good health
-women with high risk (>20% lifetime risk) should discuss for screening plan (strong family hx, BRCA)

45
Q

Screening: Prostate cancer

A

Annual starting at age 50 (to men w/ 10 yr life expectancy)

  • PSA blood test (not anymore)
  • DRE (digital rectal exam)
  • discuss benefits, limitations and harms of early detection and treatment of prostate cancer with HCP
  • expect elevated PSA with age
46
Q

Screening: Colorectal cancer

A 
screening at age 50 standard
colonoscopy every 10 years for CRC screening
Alt screening methods
-flex. sigmoidoscopy q5yrs
-double contrast barium enema q5yrs
-CT colonography q5yrs
*colonoscopy if abnormal
47
Q

Colorectal high risk patients

A
  • personal hx or CRC or adenomatous polyps
  • personal hx of chronic inflammatory bowel disease (crohns or ulcerative colitis)
  • strong fam hx CRC or polyps: cancer or polyps in first degree relative younger than 60 or in 2+ first degree at any age
  • known family hx of CRC syndrome (FAP or HNPCC)
48
Q

Screening: Cervical cancer

A
  • All women should begin screening at age 21
  • Between 21-29: pap every 3 yrs, no HPV testing unless abn PAP result
  • 30-65: PAP and HPV test every 5, alternate PAP every 3
49
Q

Screening: Cervical cancer 2

A
  • women over 65 who had regular screenings with normal results should not be screened
  • women diagnosed with cervical pre-cancer should continue screening
  • women who’ve had uterus and cervix removed and no hx of cervical precancer should not be screened
  • women who have had HPV vaccine should still follow screening rec for age group
  • women at high risk may need more frequent screening
50
Q

women at high risk for cervical cancer

A

HIV coinfection
organ transplant
exposure to DES

51
Q

Screening: Skin cancer

A

once a month, check for abnormal/changes

yearly clinical exam

52
Q

ABCDs of skin cancer

A

A- asymmetry
B - border irregularity
C - Color changes
D - Diameter, larger than 6mm or growing

53
Q

screening: Lung cancer

A

High risk: 55-74 with >30 pack year hx, or >50 + 20 year hx plus other risk factors
Screening with low-dose CT (LDCT)

54
Q

Tertiary prevention

A

pt already diagnosed with cancer
monitoring for recurrence
Monitoring for second malignancy

55
Q

Childhood cancers: etiology

A

no known external causes
limited factors: radiation, exposures, more studies needed
most not caused by inherited DNA mutations
not preventable
*ex. chernobyl (radiation –> ALL)

56
Q

Childhood cancers: Screening

A

not recommended for those not at high risk
increased risk bc of hereditary cancers: careful, regular check ups, special tests to look for early signs
usually found early by doctor or parents
hard to diagnose right away bc early symptoms often like common illnesses

57
Q

Childhood cancer: Symptoms

A 
unusual S&amp;S that do not resolve:
lumps or swelling
unexplained paleness or dec energy
easy bruising, generalized bruising, petechial rash
ongoing localized pain
limping without injury
unexplained prolonged fever
frequent illnesses, prolonged
frequent headaches, often with vomitting
sudden eye or vision changes
sudden unexplained wt loss
58
Q

APRN role

A 
education of patients and public
focus on health promotion and disease
ONS encourages "screening to prevent illness and PROMOTE wellness"
care for patients
develop EBP

Oncology Midterm (4 decks)

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