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Family medicine > Oncological alertness > Flashcards

Oncological alertness Flashcards

1
Q

What are the advantages of opportunistic screening

A

Simple, cheap to administer. Not dependent on patient compliance. Reach people who do not come only for preventative measures.

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2
Q

What are the disadvantages of opportunistic screening?

A

Does not cover 100%. Time not protected. Patient may be less receptive when ill.

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3
Q

How is cancer therapy improving?

A
  • Finance, dx and tx
  • Modern techniques tharapy availability
  • Staff knowledge, awareness, experience
  • organization of health care system
  • early detection
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4
Q

What is early cancer detection based upon ?

A

Screening and oncological alertness

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5
Q

What is the definition of oncological alertness?

A

Patient: awareness of cancer sx and immediate visit to the doctor when developed
Doctor: Active cancer seeking through standard Dx procedures in all cases of non-specific sx, which could suggest cancer

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6
Q

What are the general sx that may suggest cancer?

A
  • recurrent inf
  • fever of unknown origin
  • unexplained loss of weight / appetite
  • tiredness, weakness
  • N/V
  • chronic pain
  • bleeding, anemia, unexplained bruised
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7
Q

What are the organ specific symptoms suggesting cancer?

A
  • palpable tumor
  • lymphadenopathy
  • hematuria, GI bleed, abnormal PV (?) bleed
  • chronic unexplained cough
  • hoarseness
  • GI: diarrhea, constipation, difficulty in swallowing
  • Indrawn breast nipple
  • Skin: chronic wounds, change in appearance / color / size
    CAUTION mnemonic
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8
Q

What are the NICE guidelines regarding cancer?

A

Suspected cancer, recognition and referral advice

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9
Q

NICE lung ca - refer via ca pathway

A
  • CXR finding suggestive of ca

- aged >40y w unexplained hemoptysis

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10
Q

NICE lung ca - offer urgent CXR

A
  • age >40y w following sx that are unexplained (if smoker/ ex-sm/ asbestos exp), 1 sx is needed, if never smoked 2 sx are needed:
    1. Cough
    2. Fatigue
    3. Shortness of breath
    4. Chest pain
    5. Weight loss
    6. appetite loss
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11
Q

NICE lung ca - consider urgent CXR within 2w

A

Aged > 40 w

  1. Persistent/ recurrent chest inf
  2. Finger clubbing
  3. Supraclavicular / persistent cervical lymphadenopathy
  4. Chest signs consistent w lung ca or pleural disease
  5. Thrombocytosis
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12
Q

What are NICE recommendation for children w unexplained visible hematuria?

A

Very urgent referral within 48h, Wilms?

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13
Q

NICE for 45 or older w unexplained hematuria + w/o UTI or persistent/ recurrent hematuria after treated UTI?

A

Cancer pathway referral within 2 weeks, bladder or renal

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14
Q

NICE for women 55 or older w visible hematuria + 1) unexplained vaginal discharge or 2) low Hb or 3) thrombocytosis or 4) high blood glucose?

A

Direct access transvaginal US to assess endometrial thickness

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15
Q

NICE for men w visible hematuria

A

Consider DRE and PSA

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16
Q

> 60 y w unexplained non visible hematuria + either dysuria or FBC shows raised WCC

A

Cancer pathway referral (within 2w) -> bladder

17
Q

What is the incidence of prostate cancer?

A
  • 3rd leading cause of cancer death
  • lifetime risk of dx is 15%, risk of death 2-3%
  • 70 % of men aged 70 have occult prostate ca
  • older age increase likelihood of prostate ca but decrease likelihood of death from it due to increased mortality from other causes
18
Q

What are the cancer screening for prostate ca

A
  • DRE: sens 59% and PPV 5-30%
  • PSA > 4 ng/ml have a sens of 70-80% and PPV 40%
    • cancer is also found w PSA levels <0,5ng
    • randomised trials increase dx frequency bu no difference in prostate cancer mortality
19
Q

What is the prevalence of lung cancer?

A

Leading cause of cancer death. Cigarette smoking responsible for 85% of cancer

20
Q

What are the screening methods for lung cancer?

A
  • CXR have 60% sens
  • CT scan have 94% sens
  • number needed to screen to prevent 1 cancer death = 320
  • annual low dose CT are used to screen smokers w 30y pack-year history in the age of 55-80
21
Q

Colorectal cancer prevalence

A

2nd leading cause of death from cancer. 5% lifetime risk of developing colorectal cancer. 90% of cases happen >50 y

22
Q

What are used to screen for colorectal cancer?

A

FOBT, sigmoidoscopy, colonoscopy, CT, colonoscopy. Screening should be in men and women aged 50-75y

23
Q

Breast cancer prevalence

A

Is the most frequent cancer in women. Overall lifetime risk is 12%. 10y risk at age 40 is 1,5%, at age 50 it is 2,4% and at 60 it is 3,5%.
W BRCA1/2 relative risk is 10-32 (?)

24
Q

What are the screening methods in breast cancer?

A
  • Self-examination: no effect on cancer mortality
  • Mammography have sens 70% and spec og 90%. 23% have false positive result, require biopsy. Rate of overdo is up to 32%, small risk of radiation induced breast cancer.
  • Recommendation is mammography 40(50) - 74y
25
Q

What is the Wilson and Junger criteria for screening?

A

1) Knowledge of disease 2) knowledge of test 3) tx of disease 4) cost consideration

26
Q

What is included in criteria 1 og W&J

A

The disease

  • important health problem
  • recognizable latent period w disease marker, or early symptomatic stage
  • natural course of condition should be adequately understood
27
Q

What is included in criteria 2 of W&J

A

The test

  • should be simple, safe, precise and validated
  • distribution of test values in the target population should be known, and is a suitable cut-off level defined and agreed upon
  • the test should be acceptable to populations
28
Q

What is included in criteria 3 of W&J

A

The treatment

  • effective tx or intervention for pat is identified through early detection w evidence of early tx rather than late tx leading to better outcomes
  • agreed evidence-based policies covering which individuals should be offered tx, and the appropriate tx to be offered
29
Q

What is included in criteria 4 of W&J

A

Cost considerations

  • All the cost effective primary prevention intervention should have been implemented as far as practicable
  • Cost of case finding (including dx and tx) economically balanced in relation to possible expenditures on medical care as a whole
30
Q

What is lead time bias?

A
  • Longer perceived survival w screened, even if the course of disease is not altered
  • Screening is more likely to detect slow growing tumors which may be less deadly
31
Q

Selection bias

A
  • If people w increased risk of disease are more likely to be screened (eg women w fh of breast ca), are more likely to join mammography program , then screening test will look worse than it is (negative outcomes among screened population will be higher than for a random sample)
  • if test is more available for young healthy people (travel distance) then fewer people will have negative outcome and test seen better than it is
32
Q

What are the advantages of formal screening?

A
  • Protected tim
  • Purpose of attendance understood
  • as attendees are more motivated so more receptive to advice
  • comprehensive coverage of the topic
  • financial incentive
33
Q

What are the disadvantage of formal screening?

A
  • requires organization, time and commitment
  • nonattendance problem
  • users are often those in least need of the service
34
Q

What are the recommended cancer screenings?

A
  • Breast mammography 50-74y
  • cervical: pap smear 21-65 or 30-65 w HPV test
  • colorectal: screening adults aged 50-75
  • lung: adults 55-80 who have a 30 pack year smoking history and currently smoke or have quit within past 15y

Family medicine (14 decks)

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