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PUBH204 > Lecture 19: Cancer > Flashcards

Lecture 19: Cancer Flashcards

1
Q

What is cancer?

A

The normal cell growth and death process breaks down and growing cells become abnormal. They divide and can form tumours. malignant tumours can spread into other parts of the body. Parts of the tumour can break off and travel through the blood or lymph to other parts of the body

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2
Q

how is cancer described?

A

By its grade - how abnormal the cells looks
and its stage - extent of its spread

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3
Q

why does cancer develop?

A
  • genetics
  • lifestyle: diet, smoking, exercise, alcohol, nutrition
  • environment exposure: carcinogens, asbestos, occupational chemical exposure
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4
Q

what is cancer epidemiology for Maori and non-Maori?

A
  • cancer and CVD are the two leading causes of death in NZ for Maori and non-Maori
  • for Maori males lung cancer is 2nd leading cause of death
  • for non-maori males lung cancer is 3rd leading cause of death
  • lung cancer is leading cause of death for maori women
  • for non-maori women 3 of the top 5 causes of death are breast, lung and colorectal cancer
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5
Q

what are the leading causes of death for maori females?

A
  • ischemic heart disease
  • lung cancer
  • chronic lower respiratory disease
  • cerebrovascular disease
  • diabetes
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6
Q

what are the leading causes of death for non-maori females?

A
  • ischemic heart disease
  • cerebrovascular disease
  • breast cancer
  • lung cancer
  • chronic lower respiratory disease
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7
Q

what are the leading causes of death in maori males?

A
  • ischemic heart disease
  • lung cancer
  • chronic lower respiratory disease
  • diabetes
  • cerebrovascular disease
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8
Q

what are the leading causes of death in non-maori males?

A
  • ischemic heart disease
  • lung cancer
  • cerebrovascular disease
  • chronic lower respiratory disease
  • bowel cancer
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9
Q

what can be done about cancer?

A
  • prevention
  • diagnosis
  • treatment (curative intent, extending quality and quantity of life without curative intent, palliative care
  • living well post-treatment/good survivorship
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10
Q

what are the goals of primordial prevention?

A

target population: general population

goals: reduce risk

underlying clinical disease: absent

example: reduce uptake of smoking, healthy diet and physical activity promotion, HPV vaccination

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11
Q

what are the goals of primary prevention?

A

target population: susceptible population

goals: reduce disease incidence

underlying clinical disease: at risk

example: smoking cessation, cervical smears, surveillance, high risk family colorectal cancer

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12
Q

what are the goals of secondary prevention?

A

target population: people with disease

goals: reduce prevalence or consequences

underlying clinical disease: first defect of lesion

example: mammography, bowel cancer screening, lung cancer screening

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13
Q

what are the goals of tertiary prevention?

A

target population: people with disease

goals: reduce complications or disability

underlying clinical disease: first symptom

example: surgery, chemotherapy, radiation therapy

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14
Q

how can cancer be diagnosed?

A
  • through screening
  • symptomatic
  • incidental
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15
Q

what are the types of cancer recovery?

A
  • palliative care
  • survivorship - adjusting to life post-Rx and thriving
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16
Q

explain a framework for disease, illness or condition?

A

What is the disease, illness, condition:
- definition, description
- epidemiology by ethnicity, equity, inequities
- aetiology

Why is it important
- impacts on patients, whanau, community, society
- by ethnicity, equity, inequities

What is known about outcomes by ethnicity, equity, inequities in prevention, screening and treatment

(next cards are using this framework for bowel cancer)

17
Q

what is colorectal cancer? aka bowel cancer

A

malignant tumour starting in large bowel of rectum

18
Q

what is the epidemiology of bowel cancer?

A
  • 2nd most common cause of cancer death in total population
  • 1214 deaths in 2017
  • NZ has one of the highest rates of bowel cancer in the world
  • Maori incidence is similar to non-maori (used to be lower)
  • Maori mortality is similar/higher to non-maori
19
Q

what is the issue with Maori representation of bowel cancer?

A

WHO chooses age standardised data instead of age specific date. this creates inequity as it looks like Maori rates are similar to non-maori rates but because the maori population is younger, and cancer is an age related disease, Maori cancer rates are not accurately presented.

20
Q

what are the changes in bowel cancer mortality?

A

12.9 per 100,000 - Maori
14 per 100,000 - non-Maori

  • this will be changing with the roll out of bowel screening programme
21
Q

why is bowel cancer important?

A

Costs to society
- health related costs
- costs associated with morbidity and premature mortality

Much of colorectal cancer is preventable/curable is diagnosis is early enough

Costs to whanau due to stress, morbidity, mortality

22
Q

what are the determinants of colorectal cancer?

A
  • age
  • sex
  • history of polyps in colon
  • History of inflammatory bowel disease
  • family history of bowel cancer - genetic mutations
  • hereditary conditions
  • geographical differences
  • smoking
  • diet - red meat, animal fats, low in fruit and vegetable fibre
  • insufficient physical activity/exercise
  • alcohol
23
Q

what are the causes of inequities in bowel cancer mortality?

A
  • maori are 20% more likely to die than non-Maori
  • differences in incidence
  • difference in tumour characteristics at diagnosis
  • differences in patient characteristics that may affect outcome
  • inequities in access to screening, surveillance, primary care
  • differences in investigation and/or treatment
24
Q

what is known about colon cancer management?

A
  • there is a very clear, evidence based treatment pathway from colon cancer management
25
Q

what did the hill et all articles do?

A
  • had a cohort of Maori and non-Maori with a first diagnosis of colon cancer
  • only includes colon cancer (not appendix, rectum, anal)
  • mean age of first diagnosis was 60.3 in Maori and 70.6 in non-Maori
  • they found differences in cancer treatment that contribute to inequities
26
Q

what differences did the Hill et al article find in colon cancer between maori and non-maori?

A
  • no differences in stage
  • tumour grade in maori was well differentiated (good thing)
  • maori were more likely to have a bowel obstruction
  • maori were more likely to have comorbidities e.g diabetes, respiratory disease, renal disease, heart failure
  • maori were more likely to be treated in a public hospital or non-cancer centre
  • maori were less likely to be treated in a private hospital

^important for explaining inequitable mortality through patient/tumour characteristics

27
Q

what significant treatment differences did the Hill et all article find?

A
  • maori less likely to have primary tumour removed
  • maori more likely to have emergency surgery
  • maori more likely to have palliative bypass
  • maori more likely to have bowel obstruction
  • maori less likely to have glands removed
  • maori most likely to die after surgery
  • in those with stage 3, maori less likely to be offered or receive adjuvant chemotherapy
  • maori wait longer for surgery and chemotherapy
  • in those with stage 4, maori less likely to be offered or receive palliative chemotherapy
28
Q

what does the hazard ratio findings of the hill et al article show about equity?

A

Inequities is a combination of several small inequities along the pathway. It is not a simple solution. a lot of things need to be addressed to reach equity.

29
Q

what is a primordial prevention for colorectal cancer?

A
  • reducing risk of bowel cancer in the population
  • improve diet
  • exercise
  • weight management
  • don’t smoke
  • limit alcohol
30
Q

what are primary preventions of colorectal cancer?

A

surveillance people at high risk
- past history or known hereditary condition
- have regular colonoscopy

screening - remove polyps

people who have previously had cancer
- intensive clinical follow up, regular colonoscopy

31
Q

what are secondary preventions for colorectal cancer?

A
  • identifying a cancer before it causes symptoms
  • bowel cancer screening programme
32
Q

what is the bowel cancer screening programme?

A
  • occurs age 60-74
  • self administered
  • but maori bowel cancer is already diagnosed at age 50-59
  • bowel cancer needs to start at 50 for Maori in order for equity to be reached.
  • non-maori 30% diagnosed before aged 60, if Maori screening started at 50, 30% will be diagnosed in Maori too.

PUBH204 (11 decks)

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