Screening for Cancer Flashcards
what are the 2 most important risk factors for cancer?
- advancing age
- previous history of cancer of any kind
T/F: cancer is often symptomatic early on
FALSE
often asymptomatic in early stages
relationship between survival rates and early detection
survival rate increases with early detection and screening
mortality is decreasing due to new treatments and early diagnosis
list commonly suggested red flags for malignancy
- age>50
- no improvement in symptoms after 1 month
- insidious onset
- previous history of cancer
- no relief with bed rest
- unexplained weight loss, fever, thoracic pain
- systemically unwell
which red flags for cancer have a high false positive rate? (3)
- age >50
- insidious onset
- failure to improve after 1 month
which red flag increases the probability of malignancy?
previous history of cancer
cancer prevention begins with what?
What is the key?
risk factor assessment and reduction
the key is to minimize as many modifiable risk factors as possible
describe primary prevention of cancer (4)
- stopping the processes that lead to the formation of cancer
- general health promotion
- risk factor assessment
- risk reduction
describe secondary prevention of cancer
- regular screening for early detection of cancer
- prevention of progression of pre-malignant lesions through early ID
What are the most common Cancer risk factors? (4)
- age >50 → majority incidence of cancer/mortality occurs in those >65
-
ethnicity
- AA have highest mortality rate and have a 10% increased incidence of cancer compared to Caucasians
- Family history (1st generation) → hereditary cancer syndromes
- environment and lifestyles
describe hereditary cancer syndromes (5)
- diagnosis of cancer in 2 or more relatives in a family
- diagnosis of cancer in family member <50
- occurrence of same type of cancer in several members of a family
- occurrence of more than one type of cancer in one person
- occurrence of a rare type of cancer in one or more members of family
list the 3 categories of neoplasms
- Benign
- Invasive
- Metastatic
describe Benign neoplasms
non-cancerous tumors that are:
- localized
- encapsulated
- slow growing
- unable to move or metastasize to other sites
describe invasive neoplasms
malignant cancer that has invaded surrounding tissues
describe metastatic neoplasms
spread of cancer cells from primary site to secondary site
regional and distant/distal
primary cancers are not likely to present with _________
MSK S/S
a recurrence of previously treated cancer in metastasized form more often presents __________________
with bone, joint, or muscular presentation
when can metastatic spread occur?
as late as 15-20 years after initial diagnosis
this is why cancer screenings are very important during IE
list the 5 most common sites of cancer metastasis
- bone
- lymph node
- lung
- liver
- brain
“LBLBL”
List early warning signs of cancer
“CAUTIONS”
- Changes in bowel/bladder habits
- A sore that does not heal within 6 weeks
- Unusual bleeding or discharge
- Thickening or lump in breast or elsewhere
- Indigestion or difficulty in swallowing
- Obvious change in a wart or mole
- Nagging cough or hoarseness
- Supplemental S/S
list the supplemental S/S that are early warning sign of cancer
- rapid unintentional weight loss
- change in vital signs
- frequent infections
- night pain
- pathologic fracture
- proximal muscle weakness
- change in DTRs
what early warning signs of cancer are important for PTs? (3)
- change in vital signs
- proximal muscle weakness
- change in DTRs
List clinical manifestations of malignancies (3 categories)
1. Lumps, lesions and lymph nodes
2. Proximal muscle weakness
- may be early sign often due to hypercalcemia (ask about weakness with subjective measures)
3. Pain
- night pain that is rated higher than 7/10 red flag symptoms of primary/recurring cancer
- changes in 1 or more DTRs → diminished or hyperreflexia
describe lumps, lesions and lymph node changes indicative of cancer
- all suspicious lymph nodes should be evaluated by MD
- lymph nodes that are hard, immovable, and nontender raise suspicion for cancer
- especially in presence of previous history of cancer
T/F: all people with cancer experience night pain
FALSE
clinical manifestations are more likely to show up for ________
metastasis of cancer, not primary sites
We will most likely observe S/S affecting what systems? (5)
- integumentary
- pulmonary
- neurologic
- MSK
- hepatic
T/F: internal cancers can invade the skin
TRUE
Describe integumentary manifestations
- may be the first sign of malignancy
- particularly in breast or upper respiratory tract cancer
- typically present:
- asymmetrical
- firm
- skin-colored, red, purple, or blue nodules
- occur near site of primary tumor
when you are suspicious of a skin lesion what should you do?
Conduct a risk factor assessment by asking the following Q’s:
- Ask the following questions:
- how long have you had this area of skin discoloration/mole/spot?
- has it changed in the past 6 weeks to 6 months?
- has your physician examined this area?
A previous history of cancer in the presence of a suspicious skin lesion that has not been evaluated requires reccomendation to the patient that an evaluation takes place as soon as possible
List skin cancer risk factors (9)
- advancing age
- personal or family history of skin cancer (particularly melanoma)
- moles with any of ABCDE features
- complexion that is fair or light with green, blue or gray eyes
- skin that sunburns easily; skin that never tans
- history of painful sunburns with blistering during childhood or the adolescent years
- use of tanning beds or lamps
- short, intense episodes of sun exposure (the indoor worker who spends the weekend out in the sun w/o skin protection)
- transplant recipient
list the 3 primary types of skin cancer
- Basal cell carcinoma
- Squamous cell carcinoma
- Malignant melanoma
describe basal cell carcinoma (4)
- arises from bottom layer of epidermis
- occurs on hair-bearing areas exposed to the sun
- rarely metastasize
- nearly 100% cure rate
describe squamous cell carcinoma (4)
- arises from top of epidermis
- areas often exposed to the sun
- rarely metastasize
- nearly 100% cure rate
describe malignant melanomas (4)
- where can it appear?
- What are the survival rates?
- arises from melanocytes
- 96% 5-year survival rate if localized
- 13% 5-year survival rate if it is invasive or spread to other parts of the body
- can appear anywhere on the body not just areas exposed to the sun
Briefly describe the ABCDE criteria for S/S of skin cancer
- Asymmetry
- uneven edges, lopsided in shape, one-half unlike the other
- Border
- irregularity, irregular edges, scalloped or poorly defined edges
- Color
- black, shades or brown, red, white, occasionally blue
- Diameter
- larger than a pencil eraser (>6 mm)
- Evolving
- mole or skin lesion that looks different from the rest or is changing in size, shape or color
T/F: pulmonary metastases are the most common of all metastatic tumors
TRUE
primary bone tumors metastasize to the lungs first
what is the most common cancer to metastasize to the brain?
Primary lung cancer
a history of lung cancer calls for neurologic screening
symptoms of pulmonary metastasizes (2)
pleural pain
dyspnea
describe neurological manifestations of cancer
- metastasis of the brain occurs in 20-25% of cases of primary sites outside of CNS (lung, colon, kidney, breast and melanoma)
- Clinical S/S
- HA (typically worse upon awakening)
- personality changes
- tumor specific
- Nerve and cord compression
- Cauda Equina Syndrome
list early signs of nerve and cord compression
- pain
- sensory loss
- muscle weakness
- muscle atrophy
associated S/S of primary/metastatic tumors causing CES (5)
- abnormal weight loss
- hematuria
- hemoptysis
- melena
- constipation
T/F: primary bone cancer is common
FALSE
it is uncommon
more often metastatic origin → within the most vascularized regions of the bone (bone marrow and proximal ends)
what are the 2 major MSK manifestations
- Bone pain
- Back pain
describe bone pain as an MSK manifestation of cancer
- pathologic fracture (vertebral bodies) - often report sudden onset of severe pain
- deep, intractable and poorly localized pain
- cyclic with increasing frequency until constant
- worse w/activity
- unrelieved by rest or change in position
- nonresponsive to PT treatment
describe back pain as an MSK manifestation of cancer
- new onset with known history of cancer = suggestive of spinal metastasis
- insidious onset
- unrelieved with lying
- worse at night
- unexplained weight loss
liver metastases are typically from what primary sources?
stomach, colorectum, and pancreas
PT symptoms of hepatic manifestations (5)
- bilateral carpal/tarsal tunnel syndrome
- abdominal pain and tenderness
- general malaise and fatigue
- R upper quadrant pain/R shoulder pain
- Jaundice
what is included in the ROS for cancer?
- constant, intense pain, especially bone pain at night
- unexplained weight loss (10% of body weight in 10-14 days); most clients in pain are inactive and gain weight
- loss of appetite
- excessive fatigue
- unusual lump(s), thickening, change in a lump or mole, sore that does not heal; other unusual skin lesions or rash
- unusual or prolonged bleeding or discharge anywhere
- change in bowel or bladder habits
- chronic cough or hoarseness, change in voice
- rapid onset of digital clubbing (10-14 days)
- (proximal) muscle weakness, especially when accompanied by change in one or more DTRs
list MSK Oncologic Pathologiees
- Soft tissue sarcoma
- Osteosarcoma
- Ewing Sarcoma
list primary CNS Oncologic pathologies
- brain tumors
- spinal cord tumors
list cancers of the blood and lymph system (4)
- leukemia
- multiple myeloma
- Hodgkin’s disease
- Non-Hodgkin’s lymphoma
what are soft tissue sarcomas?
- where are they most common?
- are they usually symptomatic in the early stages?
- a relatively rare malignancy
- can arise anywhere in the body
- most commonly in the extremities followed by the trunk
- usually do not cause symptoms in early stages
Clinical S/S of soft tissue sarcomas
- persistent swelling or lump in a muscle
- pain
- pathologic fracture
- local swelling
- warmth of overlying skin
describe osteosarcomas
what is the most common age for it?
- most common type of bone cancer
- ages 10-25 years
- risk factors include:
- rapid bone growth
- previous cancer history
- usually occurs in long bones
- surgery, pre and post chemo → high incidence of cure
Clinical S/S of osteosarcomas
- Pain and swelling of involved region
- loss of motion/function movement of adjacent joints
- tender lump may develop
- pathologic fracture
- weight loss
- malaise and fatigue
- warmth of overlying skin
what is a Ewing’s Sarcoma?
- a rapidly growing tumor that erodes bone cortex
- most common in 5-16 yo Caucasian/Hispanic
- boys > girls
- frequently in long bones and pelvis
Clinical S/S of Ewing’s Sarcoma
- Increasing and persistent bone pain
- Increasing and persistent swelling over a bone
- Limited ROM if extremity involvement
- Fever, fatigue, weight loss
- bowel and bladder disturbances
Brain tumor symptoms are dependent on __________
location
there is an increased incidence of brain tumors in older adults with _________
immunodeficiency
Clinical S/S of brain tumors
- HA (sometimes worse upon awakening then improves during the day)
- vomiting
- visual changes
- changes n mentation
- personality change, irritability
- unusual drowsiness, increased sleeping
- seizures
- sensory changes muscles weakens
- bladder dysfunction
- increased LE reflexes compared with UE
- decreased coordination, gait changes, ataxia
- clonus
- vertigo
T/F: spinal cord tumors are more common than intracranial tumors
FALSE
much less common
occur most often in the thoracic region
symptoms consistent w/cord level of lesion
Clinical S/S of spinal cord tumors
- pain
- decreased sensation
- spastic muscle weakness
- progressive muscle weakness
- muscle atrophy
- paraplegia/quadriplegia
- thoracolumbar pain
- unilateral groin or leg pain
- pain at rest and/or night pain
- bowel/bladder dysfunction
T/F: leukemia is the most common malignancy in children and young adults
TRUE
multiplication of immature WBCs
prevents production of mature WBCs
Clinical S/S of Leukemia
- infections, fever
- abnormal bleeding
- pallor fatigue
- anorexia
- anemia
- enlarged lymph nodes
- easy bruising
- bone and joint pain
what is multiple myeloma?
a cancer of uncontrolled growth of plasma cells in bone marrow
destroys bone tissue and produces osteolytic lesions
Clinical S/S of multiple myeloma
- recurrent bacterial infections
- anemia with weakness
- bleeding tendencies
- skeletal/bone pain (pelvis, spine and ribs)
- spontaneous fracture
- osteoporosis
- also associated with renal involvement and can cause neurologic abnormalities
describe Hodgkin’s disease
a chronic, progressive, neoplastic disorder of lymphatic tissue
progresses to extra-lymphatic sites such as spleen and liver
Red flag → changes in lymph nodes
Clinical S/S of Hodgkin’s disease
- painless, progressive enlargement of unilateral lymph nodes, often in the neck
- Other early symptoms:
- pruritus over entire body
- unexplained fever, night sweats
- anorexia, weight loss
describe Non-Hodgkin’s lymphoma
- similar to Hodgkin’s disease in that it affects lymphoid tissue but is usually more widespread and less predictable
- less systemic symptoms
- painless enlargement of one or more peripheral lymph node sites
Clinical S/S of non-Hodgkin’s lymphoma
- enlarged lymph nodes
- fever
- night sweats
- weight loss
- bleeding
- infection
- red skin and generalized itching of unknown origin
list clues to screening for cancer
- age >50
- previous hx of cancer or hx of cancer treatment
- female w/chest, breast, axillary, or shoulder pain of unknown cause >40
- back, pelvic, groin, hip pain w/abdominal complaints, palpable mass
- recent weight loss 10% of BW within 2 week-1 month period
- shoulder, back, hip, pelvic, sacral pain with changes in bowel/bladder function
- hip or groin pain reproduced from strike test
- back injury does not progress as expected or worsens
- proximal weakness, DTR changes
- constant pain unrelieved
- intense night pain
- signs of nerve root compression
- new neurologic deficits
- lymph node changes
- growing mass
- S/S seem disproportionate to injury and last longer than normal physiologic healing time
list guidelines for medical referral
- recently discovered lumps, nodules
- changes in lymph nodes or presence of palpable mass
- idiopathic muscle weakness with diminished DTRs
- unexplained bleeding from any area
- S/S of metastasis in pt w/previous hx of cancer
- male w/pelvic, groin, SI, lumbar pain with sciatic symptoms and hx of prostrate cancer
