Red Book - Cancer Flashcards
Prostate Ca - what are screening recommendations? Who is at higher risk?
Routine screening w PSA is NOT recommended
Complete on request w counselling
High risk if 1 x 1st° relative Dx w prostate Ca <65yo or BRCA1/2 positive
Colorectal Ca - who is at average risk and what are screening recommendations?
ASx
and NO PHx of bowel Ca, colorectal adenomas, IBD or FHx CRC
or
1 x 1st° or 2nd° relative w CRC Dx ≥55yo
FOBT 2yly from 50-74yo
Colorectal Ca - who is at increased risk and what are the screening recommendations?
ASx
and 1 x 1st° relative w CRC Dx <55yo
or
2 x 1st° or 1 x 1st° and 1 x 2nd° relative from same side w CRC Dx at any age
Colonoscopy 5yly from earliest of 50yo or 10y prior to Dx of youngest relative
Consider FOBT in intervening years
Colorectal Ca - who is at high risk and what are the screening recommendations?
ASx
w suspected Lynch syndrome/HNPCC (due to extensive FHx CRC)
or
2 x 1st° or 2nd° relatives w high-risk CRC (multiple CRC in one person, CRC Dx <50yo, Lynch syndrome related Ca)
or
1 x 1st° or 2nd° relative w suspected familial adenomatous polyposis
or
proven gene mutation
Refer for genetic screening + bowel Ca specialist for surveillance plan
Breast Ca - who is at average risk and what are screening recommendations?
> 95% of the population
No FHx
1 x 1st° relative Dx ≥50yo
1 x 2nd° relative Dx any age
2 x 2nd° relatives on same side Dx ≥50yo
2 x 1st° or 2nd° on each side Dx ≥50yo
Mammogram 2yly from 50-74yo
Opt-in from 40yo
Breast Ca - who is at moderately increased risk and what are screening recommendations?
<4% of the population
1 x 1st° relative Dx <50yo
2 x 1st° relatives on same side
2 x 2nd° relatives on same side w 1 Dx <50yo
Annual mammogram from 40yo
Consider referral to family cancer clinic
Breast Ca - who is at potentially high risk of genetic mutation and what are screening recommendations?
<1% of the population
Women at high risk of ovarian Ca
2 x 1st° or 2nd° relatives on same side Dx w breast or ovarian Ca w high risk features: additional relatives w breast or ovarian Ca, breast Ca Dx <40yo, bilateral breast Ca, breast + ovarian Ca in same person, male breast Ca, Ashkenazi Jew
1 x 1st° or 2nd° relative Dx <45yo + another 1st° or 2nd° relative on same side w sarcoma Dx <45yo
FHx high risk gene mutation already identified
Individualised surveillance program: usually annual examination + MRI/mammogram/US from 25-50 then annual examination + mammogram from 50yo
Refer to cancer specialist for risk Ax, genetic testing, chemo-prevention and consideration of surgery
Skin Ca - what are screening recommendations? What are the risk factors?
Screening of ASx low-risk people is NOT recommended, instead provide sun protection (primary prevention) advice for everyone, and opportunistic skin checks if increased risk
Risk factors:
Fair complexion, tendency to burn, freckles, high naevus count (>100), light eye colour, light or red hair
FHx 1st° relative (melanoma) or any (NMSC)
Actinic damage (melanoma) or multiple solar keratoses (NMSC)
PHx NMSC <40yo (melanoma)
High UV exposure and sunburn in childhood (melanoma) or throughout life (NMSC)
Skin Ca - who is at high risk of melanoma and what are the screening recommendations?
PHx melanoma or >5 atypical/dysplastic naevi
Skin check every 6-12m
Skin Ca - what characteristics of suspicious naevi are concerning for melanoma?
A symetry
B order irregularity
C olour variability
D diameter >6mm
+ ‘ugly duckling’
Or for nodular melanomas:
E levated
F irm
G rowing over past month
Skin Ca - who is at high risk of NMSC and what are the screening recommendations?
PHx NMSC, immunsuppressed, past exposure to arsenic
Skin check every 12m or when new skin lesion develops
Cervical Ca - what are screening recommendations?
CST for HPV PCR +/- LBC every 5 years from 25-74yo (or 2y after first sex, whichever is later)
CST - HPV not 16/18 detected, now what?
LBC
If negative or LSIL -> repeat HPV in 12m
If pHSIL or worse -> colposcopy
At 12m:
If HPV ND -> routine CST
If HPV not 16/18 detected** -> LBC
If HPV 16/18 detected -> colposcopy
**ATSI, >50yo or screening overdue >2y, refer for colposcopy
12m LBC:
If negative or LSIL -> repeat in 12m
If pHSIL or worst -> colposcopy
At 24m (after HPV not 16/18 w negative or LSIL LBC x2):
If HPV ND -> routine CST
If any HPV detected -> colposcopy
CST - HPV 16/18 detected, now what?
Colposcopy
Ovarian Ca - what are screening recommendations? Who is at higher risk?
Screening is NOT recommended
If known BRCA gene or FHx ovarian Ca, consider increased frequency of breast and bowel Ca screening
