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Differential Diagnosis > Screening for Cancer > Flashcards

Screening for Cancer Flashcards

1
Q

what are the 2 most important risk factors for cancer?

A
  1. advancing age
  2. previous history of cancer of any kind
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2
Q

T/F: cancer is often symptomatic early on

A

FALSE
often asymptomatic in early stages

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3
Q

relationship between survival rates and early detection

A

survival rate increases with early detection and screening

mortality is decreasing due to new treatments and early diagnosis

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4
Q

list commonly suggested red flags for malignancy

A
  1. age>50
  2. no improvement in symptoms after 1 month
  3. insidious onset
  4. previous history of cancer
  5. no relief with bed rest
  6. unexplained weight loss, fever, thoracic pain
  7. systemically unwell
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5
Q

which red flags for cancer have a high false positive rate? (3)

A
  1. age >50
  2. insidious onset
  3. failure to improve after 1 month
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6
Q

which red flag increases the probability of malignancy?

A

previous history of cancer

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7
Q

cancer prevention begins with what?

What is the key?

A

risk factor assessment and reduction

the key is to minimize as many modifiable risk factors as possible

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8
Q

describe primary prevention of cancer (4)

A
  1. stopping the processes that lead to the formation of cancer
  2. general health promotion
  3. risk factor assessment
  4. risk reduction
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9
Q

describe secondary prevention of cancer

A
  1. regular screening for early detection of cancer
  2. prevention of progression of pre-malignant lesions through early ID
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10
Q

What are the most common Cancer risk factors? (4)

A
  1. age >50 → majority incidence of cancer/mortality occurs in those >65
  2. ethnicity
    1. AA have highest mortality rate and have a 10% increased incidence of cancer compared to Caucasians
  3. Family history (1st generation) → hereditary cancer syndromes
  4. environment and lifestyles
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11
Q

describe hereditary cancer syndromes (5)

A
  1. diagnosis of cancer in 2 or more relatives in a family
  2. diagnosis of cancer in family member <50
  3. occurrence of same type of cancer in several members of a family
  4. occurrence of more than one type of cancer in one person
  5. occurrence of a rare type of cancer in one or more members of family
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12
Q

list the 3 categories of neoplasms

A
  1. Benign
  2. Invasive
  3. Metastatic
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13
Q

describe Benign neoplasms

A

non-cancerous tumors that are:

  1. localized
  2. encapsulated
  3. slow growing
  4. unable to move or metastasize to other sites
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14
Q

describe invasive neoplasms

A

malignant cancer that has invaded surrounding tissues

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15
Q

describe metastatic neoplasms

A

spread of cancer cells from primary site to secondary site

regional and distant/distal

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16
Q

primary cancers are not likely to present with _________

A

MSK S/S

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17
Q

a recurrence of previously treated cancer in metastasized form more often presents __________________

A

with bone, joint, or muscular presentation

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18
Q

when can metastatic spread occur?

A

as late as 15-20 years after initial diagnosis

this is why cancer screenings are very important during IE

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19
Q

list the 5 most common sites of cancer metastasis

A
  1. bone
  2. lymph node
  3. lung
  4. liver
  5. brain

“LBLBL”

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20
Q

List early warning signs of cancer

A

“CAUTIONS”

  1. Changes in bowel/bladder habits
  2. A sore that does not heal within 6 weeks
  3. Unusual bleeding or discharge
  4. Thickening or lump in breast or elsewhere
  5. Indigestion or difficulty in swallowing
  6. Obvious change in a wart or mole
  7. Nagging cough or hoarseness
  8. Supplemental S/S
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21
Q

list the supplemental S/S that are early warning sign of cancer

A
  1. rapid unintentional weight loss
  2. change in vital signs
  3. frequent infections
  4. night pain
  5. pathologic fracture
  6. proximal muscle weakness
  7. change in DTRs
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22
Q

what early warning signs of cancer are important for PTs? (3)

A
  1. change in vital signs
  2. proximal muscle weakness
  3. change in DTRs
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23
Q

List clinical manifestations of malignancies (3 categories)

A

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
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24
Q

describe lumps, lesions and lymph node changes indicative of cancer

A
  • 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
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25
Q

T/F: all people with cancer experience night pain

A

FALSE

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26
Q

clinical manifestations are more likely to show up for ________

A

metastasis of cancer, not primary sites

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27
Q

We will most likely observe S/S affecting what systems? (5)

A
  1. integumentary
  2. pulmonary
  3. neurologic
  4. MSK
  5. hepatic
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28
Q

T/F: internal cancers can invade the skin

A

TRUE

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29
Q

Describe integumentary manifestations

A
  1. may be the first sign of malignancy
    • particularly in breast or upper respiratory tract cancer
  2. typically present:
    • asymmetrical
    • firm
    • skin-colored, red, purple, or blue nodules
  3. occur near site of primary tumor
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30
Q

when you are suspicious of a skin lesion what should you do?

A

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

31
Q

List skin cancer risk factors (9)

A
  1. advancing age
  2. personal or family history of skin cancer (particularly melanoma)
  3. moles with any of ABCDE features
  4. complexion that is fair or light with green, blue or gray eyes
  5. skin that sunburns easily; skin that never tans
  6. history of painful sunburns with blistering during childhood or the adolescent years
  7. use of tanning beds or lamps
  8. short, intense episodes of sun exposure (the indoor worker who spends the weekend out in the sun w/o skin protection)
  9. transplant recipient
32
Q

list the 3 primary types of skin cancer

A
  1. Basal cell carcinoma
  2. Squamous cell carcinoma
  3. Malignant melanoma
33
Q

describe basal cell carcinoma (4)

A
  • arises from bottom layer of epidermis
  • occurs on hair-bearing areas exposed to the sun
  • rarely metastasize
  • nearly 100% cure rate
34
Q

describe squamous cell carcinoma (4)

A
  • arises from top of epidermis
  • areas often exposed to the sun
  • rarely metastasize
  • nearly 100% cure rate
35
Q

describe malignant melanomas (4)

  • where can it appear?
  • What are the survival rates?
A
  • 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
36
Q

Briefly describe the ABCDE criteria for S/S of skin cancer

A
  1. Asymmetry
    1. uneven edges, lopsided in shape, one-half unlike the other
  2. Border
    1. irregularity, irregular edges, scalloped or poorly defined edges
  3. Color
    1. black, shades or brown, red, white, occasionally blue
  4. Diameter
    1. larger than a pencil eraser (>6 mm)
  5. Evolving
    1. mole or skin lesion that looks different from the rest or is changing in size, shape or color
37
Q

T/F: pulmonary metastases are the most common of all metastatic tumors

A

TRUE

primary bone tumors metastasize to the lungs first

38
Q

what is the most common cancer to metastasize to the brain?

A

Primary lung cancer

a history of lung cancer calls for neurologic screening

39
Q

symptoms of pulmonary metastasizes (2)

A

pleural pain

dyspnea

40
Q

describe neurological manifestations of cancer

A
  1. metastasis of the brain occurs in 20-25% of cases of primary sites outside of CNS (lung, colon, kidney, breast and melanoma)
  2. Clinical S/S
    1. HA (typically worse upon awakening)
    2. personality changes
    3. tumor specific
  3. Nerve and cord compression
  4. Cauda Equina Syndrome
41
Q

list early signs of nerve and cord compression

A
  1. pain
  2. sensory loss
  3. muscle weakness
  4. muscle atrophy
42
Q

associated S/S of primary/metastatic tumors causing CES (5)

A
  1. abnormal weight loss
  2. hematuria
  3. hemoptysis
  4. melena
  5. constipation
43
Q

T/F: primary bone cancer is common

A

FALSE
it is uncommon

more often metastatic origin → within the most vascularized regions of the bone (bone marrow and proximal ends)

44
Q

what are the 2 major MSK manifestations

A
  1. Bone pain
  2. Back pain
45
Q

describe bone pain as an MSK manifestation of cancer

A
  1. pathologic fracture (vertebral bodies) - often report sudden onset of severe pain
  2. deep, intractable and poorly localized pain
  3. cyclic with increasing frequency until constant
  4. worse w/activity
  5. unrelieved by rest or change in position
  6. nonresponsive to PT treatment
46
Q

describe back pain as an MSK manifestation of cancer

A
  1. new onset with known history of cancer = suggestive of spinal metastasis
  2. insidious onset
  3. unrelieved with lying
  4. worse at night
  5. unexplained weight loss
47
Q

liver metastases are typically from what primary sources?

A

stomach, colorectum, and pancreas

48
Q

PT symptoms of hepatic manifestations (5)

A
  1. bilateral carpal/tarsal tunnel syndrome
  2. abdominal pain and tenderness
  3. general malaise and fatigue
  4. R upper quadrant pain/R shoulder pain
  5. Jaundice
49
Q

what is included in the ROS for cancer?

A
  1. constant, intense pain, especially bone pain at night
  2. unexplained weight loss (10% of body weight in 10-14 days); most clients in pain are inactive and gain weight
  3. loss of appetite
  4. excessive fatigue
  5. unusual lump(s), thickening, change in a lump or mole, sore that does not heal; other unusual skin lesions or rash
  6. unusual or prolonged bleeding or discharge anywhere
  7. change in bowel or bladder habits
  8. chronic cough or hoarseness, change in voice
  9. rapid onset of digital clubbing (10-14 days)
  10. (proximal) muscle weakness, especially when accompanied by change in one or more DTRs
50
Q

list MSK Oncologic Pathologiees

A
  1. Soft tissue sarcoma
  2. Osteosarcoma
  3. Ewing Sarcoma
51
Q

list primary CNS Oncologic pathologies

A
  1. brain tumors
  2. spinal cord tumors
52
Q

list cancers of the blood and lymph system (4)

A
  1. leukemia
  2. multiple myeloma
  3. Hodgkin’s disease
  4. Non-Hodgkin’s lymphoma
53
Q

what are soft tissue sarcomas?

  • where are they most common?
  • are they usually symptomatic in the early stages?
A
  1. a relatively rare malignancy
  2. can arise anywhere in the body
    1. most commonly in the extremities followed by the trunk
  3. usually do not cause symptoms in early stages
54
Q

Clinical S/S of soft tissue sarcomas

A
  1. persistent swelling or lump in a muscle
  2. pain
  3. pathologic fracture
  4. local swelling
  5. warmth of overlying skin
55
Q

describe osteosarcomas

what is the most common age for it?

A
  1. most common type of bone cancer
  2. ages 10-25 years
  3. risk factors include:
    1. rapid bone growth
    2. previous cancer history
  4. usually occurs in long bones
  5. surgery, pre and post chemo → high incidence of cure
56
Q

Clinical S/S of osteosarcomas

A
  1. Pain and swelling of involved region
  2. loss of motion/function movement of adjacent joints
  3. tender lump may develop
  4. pathologic fracture
  5. weight loss
  6. malaise and fatigue
  7. warmth of overlying skin
57
Q

what is a Ewing’s Sarcoma?

A
  1. a rapidly growing tumor that erodes bone cortex
  2. most common in 5-16 yo Caucasian/Hispanic
  3. boys > girls
  4. frequently in long bones and pelvis
58
Q

Clinical S/S of Ewing’s Sarcoma

A
  1. Increasing and persistent bone pain
  2. Increasing and persistent swelling over a bone
  3. Limited ROM if extremity involvement
  4. Fever, fatigue, weight loss
  5. bowel and bladder disturbances
59
Q

Brain tumor symptoms are dependent on __________

A

location

60
Q

there is an increased incidence of brain tumors in older adults with _________

A

immunodeficiency

61
Q

Clinical S/S of brain tumors

A
  1. HA (sometimes worse upon awakening then improves during the day)
  2. vomiting
  3. visual changes
  4. changes n mentation
  5. personality change, irritability
  6. unusual drowsiness, increased sleeping
  7. seizures
  8. sensory changes muscles weakens
  9. bladder dysfunction
  10. increased LE reflexes compared with UE
  11. decreased coordination, gait changes, ataxia
  12. clonus
  13. vertigo
62
Q

T/F: spinal cord tumors are more common than intracranial tumors

A

FALSE

much less common

occur most often in the thoracic region

symptoms consistent w/cord level of lesion

63
Q

Clinical S/S of spinal cord tumors

A
  1. pain
  2. decreased sensation
  3. spastic muscle weakness
  4. progressive muscle weakness
  5. muscle atrophy
  6. paraplegia/quadriplegia
  7. thoracolumbar pain
  8. unilateral groin or leg pain
  9. pain at rest and/or night pain
  10. bowel/bladder dysfunction
64
Q

T/F: leukemia is the most common malignancy in children and young adults

A

TRUE

multiplication of immature WBCs

prevents production of mature WBCs

65
Q

Clinical S/S of Leukemia

A
  1. infections, fever
  2. abnormal bleeding
  3. pallor fatigue
  4. anorexia
  5. anemia
  6. enlarged lymph nodes
  7. easy bruising
  8. bone and joint pain
66
Q

what is multiple myeloma?

A

a cancer of uncontrolled growth of plasma cells in bone marrow

destroys bone tissue and produces osteolytic lesions

67
Q

Clinical S/S of multiple myeloma

A
  1. recurrent bacterial infections
  2. anemia with weakness
  3. bleeding tendencies
  4. skeletal/bone pain (pelvis, spine and ribs)
  5. spontaneous fracture
  6. osteoporosis
  7. also associated with renal involvement and can cause neurologic abnormalities
68
Q

describe Hodgkin’s disease

A

a chronic, progressive, neoplastic disorder of lymphatic tissue

progresses to extra-lymphatic sites such as spleen and liver

Red flag → changes in lymph nodes

69
Q

Clinical S/S of Hodgkin’s disease

A
  1. painless, progressive enlargement of unilateral lymph nodes, often in the neck
  2. Other early symptoms:
    1. pruritus over entire body
    2. unexplained fever, night sweats
    3. anorexia, weight loss
70
Q

describe Non-Hodgkin’s lymphoma

A
  • 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
71
Q

Clinical S/S of non-Hodgkin’s lymphoma

A
  1. enlarged lymph nodes
  2. fever
  3. night sweats
  4. weight loss
  5. bleeding
  6. infection
  7. red skin and generalized itching of unknown origin
72
Q

list clues to screening for cancer

A
  1. age >50
  2. previous hx of cancer or hx of cancer treatment
  3. female w/chest, breast, axillary, or shoulder pain of unknown cause >40
  4. back, pelvic, groin, hip pain w/abdominal complaints, palpable mass
  5. recent weight loss 10% of BW within 2 week-1 month period
  6. shoulder, back, hip, pelvic, sacral pain with changes in bowel/bladder function
  7. hip or groin pain reproduced from strike test
  8. back injury does not progress as expected or worsens
  9. proximal weakness, DTR changes
  10. constant pain unrelieved
  11. intense night pain
  12. signs of nerve root compression
  13. new neurologic deficits
  14. lymph node changes
  15. growing mass
  16. S/S seem disproportionate to injury and last longer than normal physiologic healing time
73
Q

list guidelines for medical referral

A
  1. recently discovered lumps, nodules
  2. changes in lymph nodes or presence of palpable mass
  3. idiopathic muscle weakness with diminished DTRs
  4. unexplained bleeding from any area
  5. S/S of metastasis in pt w/previous hx of cancer
  6. male w/pelvic, groin, SI, lumbar pain with sciatic symptoms and hx of prostrate cancer

Differential Diagnosis (14 decks)

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