Oncologic Signs & Symptoms Flashcards
What are the sensitive red flags for cancer? (4)
(1) age >50
(2) personal history of cancer
(3) unexplained weight loss
(4) failure of conservative therapy
* without any ¼ of these, the patient most likely doesn’t have cancer that is related to their back pain*
The number of new cancer cases is expected to [increase/decrease] from about 1.5 million/year to 1.9 million/year in 2020.
increase
The rate of people who get cancer in 2020 is expected to [increase/stay the same].
stay the same
The number of cancer deaths is expected to increase from 2010-2020, and the rate of people who die form cancer is expected to [increase/decrease].
decrease from 171/100000 to 151/100000
____% of all cancers are diagnosed in those 55+.
80%
___% of men and ___% of women will develop cancer during their lifetime.
41% of men
39% of women
American’s can prevent what ratio of common cancers?
⅓ of common cancers can be prevented
Awareness of risk factors and risk reduction are examples of [primary/secondary] prevention.
primary prevention
Screening for early detection, prevention of progression, and doesn’t prevent occurrence but improves outcome are examples of [primary/secondary] prevention
secondary prevention
_______ is detecting pathology before patient seeks care because of symptoms.
screening
____% of cancers are caused by smoking.
19%
___% of cancers are caused by excess body weight, alcohol consumption, poor diet, and sedentary lifestyle.
18%
As many as _______ skin cancers could be prevented.
5 million
What are the single most important non-modifiable and modifiable risk factors for cancer? (2)
age >50 (non-modifiable)
lifestyle: obesity, diet, tobacco, and excess alcohol (modifiable)
Age >50, previous history of cancer, ethnicity (minorities), and heredity/family history (1st generation) are all [non-modifiable/modifiable] risk factors for cancer.
non-modifiable risk factors
Lifestyle (obesity, diet, tobacco, or excess alcohol), encironmental factors (UV exposure, carcinogens), or STDS are all [non-modifiable/modifiable] risk factors for cancer.
modifiable risk factors
Detection of tumors is rare before they have doubled ___ times and contain _____ cells.
>30 times and contain 1 billion cells
What are the early warning signs of cancer according to the acronym “CAUTIONS”?
C-change in bowel/bladder function
A-a sore that doesn’t heal in 6 weeks
U-unusual bleeding or discharge
T-thickening/lump in breast or elsewhere
I-indigestion of difficulty swallowing
O-obvious change in mole or wart
N-nagging cough or hoarseness
S-supplemental signs and symptoms (proximal weakness, change in deep tendon reflexes
Malignancies are subcategorized by cell type of origin, what are these categories? (4)
carcinomas, sarcomas, lymphomas, and leukemias
85% of cancers are _______, which originate from ________ cells.
carcinomas
epithelial cells
Carcinomas metastasize via the _______ system.
lymphatic system
Carcinomas can include what types of cancers? (7)
breast, colon, pancreas, skin, large intestine, lungs, and stomach
_______ originate from ______ tissues and are fleshy growths.
sarcomas
connective tissues
Sarcomas metastasize via _______ or _____ invasion.
circulation or local invasion
Sarcomas can include cancers of what tissues?
fat, muscle, bone, cartilage, synovium, and fibrous tissue
_______ originate from lymphoid tissue.
lymphomas
Lymphomas metastasize via _______.
infiltration
Where might lymphomas form?
lymph nodes, spleen, or intestinal lining
________ originate from cancers of the hematologic system or bone marrow.
leukemias
Leukemias metastasize via _____ or _______.
invasion or infiltration
What are possible biological mechanisms in chronic cancer pain? (5)
(1) bone destruction
(2) visceral destruction
(3) nerve compression
(4) skin or tissue distension
(5) tissue inflammation, infection, necrosis
Why might certain biological mechanisms lead to chronic cancer pain?
Because they are pain generators and lead to brain output of perceived pain.
Which biological mechanism is the most common cause of cancer pain?
bone destruction
What is the mechanism of bone destruction and its cause of chronic cancer pain?
increased release of prostaglandins and subsequent bone break down and resorption
Why might a cancer patient’s pain threshold be decreased?
Because of sensitization of nerve endings
What are the common sites of bone metastases? (5)
thoracic and lumbosacral vertebrae, pelvis, ribs (posterior), skull, femur (proximal)
An obstructed organ or duct lumen by tumor growth may lead to _____ ______, which is a biological mechanism for chronic cancer pain.
visceral destruction
How might visceral destruction pain be described?
dull, diffuse, boring, or poorly localized
If a cancer patient has pain from nerve compression, they may describe what, along with having altered sensation?
sharp, stabbing pain that follows a nerve distribution
Skin or tissue distension occurs in cancer patients can be painful due to stretching of the skin or subcutaneous tissue secondary to underlying tumor growth, and be characterized by what symptoms?
constant, severe, aching, and localized pain
If a cancer patient has chronic pain related to tissue inflammation, infection, or necrosis, they may report what?
sensitive tenderness (inflammation) or excruciating pain (necrosis)
If a cancer patient has metastases, what symptoms would they have for each of the following systems?
(1) skeletal:
(2) CNS:
(3) pulmonary:
(4) hepatic (liver):
(5) integumentary:
(1) skeletal: pain with weightbearing
(2) CNS: cognitive changes, weakness, dizziness, dysphagia, dysarthria, drop attacks, d____, nystagmus, nausea, numbness, ataxia
(3) pulmonary: SOB, orthopnea, fatigue
(4) hepatic (liver): jaundice, right shoulder pain, ascites, difficulty with digestion, etc.
(5) integumentary: skin changes
The ______ system is the most affected by metastatic cancer.
skeletal system
Which cancers are most likely to metastasize? (BLTKP)
B-breast
L-lung
T-thyroid
K-kidney
P-prostate
With skeletal metastases, what would be the patient’s reported symptoms? (3)
deep, poorly localized, sometimes stabbing pain
worse pain with weight bearing
often worse at night
Hypercalcemia occurs in metastatic bone disease with [osteolytic/osteoblastic] lesions, and is common in breast cancer and myeloma.
osteolytic lesions
How does hypercalcemia occur with metastatic bone disease?
parathyroid hormone protein induces increased bone resorption
How may the nervous system be impacted by metastatic disease? (2)
(1) osteolytic lesions lead to pathologic fractures and deformity of vertebral bodies
(2) tumors may invade and impinge on SC or nerve roots
What are the symptoms of brain tumors/metastases? (3)
(1) headaches due to increased intracranial pressure or CSF obstruction
(2) change in mentation
(3) reduced sensory or motor function
________ ________ is represented by fever, skin rash/pigmentation changes, clubbing fingers, proximal muscle weakness, malaise and fatigue, unexplained weight loss, and paresthesias or arthralgias.
paraneoplastic syndrome
Paraneoplastic syndrome might accompany what?
new tumor growth
With pulmonary metastases, the patient might report what? (2)
pleural pain or dyspnea
With hepatic (liver) metastases, a patient might report what?
bilateral carpal or tarsal tunnel syndrome, abdominal or right upper quadrant pain with right shoulder pain, general malaise and fatigue, and jaundice
Why would bilateral carpal or tarsal tunnel syndrome occur with liver metastases?
increased serum ammonia levels alters CNS metabolism and function, resulting in numbness and tingling
What is the timeline of paraneoplastic syndrome?
It develops quickly over days to weeks
What are the common signs/symptoms of breast cancer? (5)
Lump or mass in the breast
Persistent changes to the breast
Skin thickening
Breast swelling
Nipple abnormalities/discharge
What are the common signs/symptoms of colorectal cancer (usually 45-50 is when screening starts)? (7)
Rectal bleeding
Blood in the stool
Narrower stool shape
Feeling bowel is not completely empty
Abdominal cramping or pain
Decreased appetite
Weight loss
What are the common signs/symptoms of colorectal cancer? (6)
Blood in the urine
Pain or lump in the lower back or abdomen
Fatigue
Weight loss
Fever
Anemia
What are the common signs/symptoms of liver cancer? (6)
Abdominal pain and swelling
Weight loss
Weakness
Loss of appetite
Jaundice
Fever
Enlargement of the liver
What are the common signs/symptoms of lung cancer, usually screening recommended in those with 30+ pack years of smoking? (6)
Persistent cough
Sputum streaked with blood
Chest pain
Hoarse voice
Worsening shortness of breath
Recurrent pneumonia
What are the common signs/symptoms of ovarian cancer? (8)
Persistent nonspecific symptoms
Back pain
Bloating
Pelvic/abnominal pain
Difficulty eating
Feeling full quickly
Urinary urgency/frequency
Swelling of the abdomen cause by fluid accumulation (ascites)
What are the common signs/symptoms of cervical cancer, which is usually asymptomatic in early stages and 90% preventable with the HPV vaccine? (3)
Abnormal vaginal bleeding
Bleeding after intercourse, pelvic exam, or menopause
Increased vaginal discharge
What are the common signs/symptoms of pancreatic cancer, which doesn’t usually have symptoms until the cancer is advanced? (6)
Weight loss
Abdominal discomfort that may radiate to the back
Development of Type II diabetes mellitus
Sometimes jaundice
Abdominal pain
Nausea/vomiting
What are the common signs/symptoms of prostate cancer, which is usually asymptomatic in early stages? (5)
Weak/interrupted urine flow
Difficulty starting/stopping ruination
Frequent urination
Blood in the urine
Pain or burning with urination
What are the common signs/symptoms of bladder cancer, which is usually detected early because of blood in urine? (3)
Blood in the urine
Increased frequency/urgency of urination
Painful urination
What are the common signs/symptoms of thyroid cancer, which is usually diagnosed incidentally on imaging for another reason? (3)
Lump in the neck
Tight or full feeling in the neck
Difficulty breathing or swallowing
Hoarseness
Swollen lymph nodes
Pain in the throat
When you become suspicious of cancer, what are some questions you should ask? (3)
(1) How long has the symptom/sign been present?
(2) Has it changed?
(3) Is your physician aware of it?
