Slaying the dragon Flashcards
What are the different stages of a cancer diagnosis?
Awareness – patient is aware that changes have occurred in the body that could indicate cancer.
Receiving the Diagnosis – Patient’s should be told directly about their diagnosis
Response to Diagnosis – patients usually experience disbelief, numbness and anxiety. Can be associated with peak of negative mood and distress.
Family Reactions – Cancer enters the emotional, social, physical and spiritual wellbeing of not only the patient but their families as well. Ideas of feelings of loss of control, disruption of family life and altered relationships.
Life Span Considerations – Issues with financial demands and the idea of what is going to happen after potential end of life in terms of the family that is left behind.
What are the phases of cancer survivorship?
Acute: Starts at diagnosis through to the end of the initial treatment – with the focus being treatment.
Extended: Starts at the end of the initial treatment through the months after – This focus is the treatment and the effects.
Permanent: – Is the years that have passed after the treatment so less chance of it coming back – The focus is the long-term effects and treatment of these.
What is screening?
Screening refers to the application of a test to a population which has no overt signs or symptoms of the disease in question to detect disease at a stage when treatment is more effective. It looks at targeting those who might be at high risk in a category but don’t necessarily have signs or symptoms.
Lead to referral for diagnosis if positive outcome.
What are the criteria for screening?
Important health problem.
Natural history of the disease is well understood – Long enough period for detection and treatment.
Recognisable at early stage.
Treatment better at early stage.
Suitable test exists.
Acceptable test exists.
Adequate facilities to cope with abnormal results.
Screening at intervals for insidious onset.
Chance of harm is less than chance of benefit.
Cost balanced against benefit.
What are the different types of screening?
Mass Screening; whole population or subgroup of population
High risk or Selective Screening: people at high risk
Multiphasic Screening: 2 or more screening tests to a large population at the same time
What is bowel cancer screening?
Checking for small amounts of blood in the stool and allowing for the removal of small growths in the bowel called polyps. Screening done in over 55 years of age in some areas. One of the 11 national screening programmes in UK.
60-74 days - every 2 years
75 and over - request a screening kit every 2 years
What are the different types of bowel cancer screening?
Bowel Scope Screening – Involves a thin, flexible tube with a camera attached to the end is used to look for and remove any polyps inside your bowel that could become cancerous. It carried out in hospital.
The FIT = Faecal immunochemical Test involves one sample of stool and then putting the sample in a small plastic bottle to be sent off.
The FOB = Faecal occult blood Test involves collecting small stool samples and then wiping this onto a special card. It requires 2 samples of stool on 3 separate occasions before it sent off.
What is bowel cancer?
Bowel cancer is also called colorectal cancer. It affects the large bowel which is made up of the colon and rectum.
Most bowel cancers develop from pre-cancerous growths, called polyps. Not all polyps are cancerous some are benign.
Most tumours are in left side of the colon and cause rectal bleeding and stenosis, with symptoms of increasing intestinal obstruction such as alteration in bowel habit.
It is treatable and curable especially if diagnosed early.
At later stage it is difficult to cure.
What is the examination process for suspected bowel cancer?
Initially GP will ask about your symptoms and any family history
A simple examination of your bottom called Digital Rectal examination (DRE)
Examine your tummy (abdomen) to see any lumps
Check blood to see any iron deficiency anaemia, lack of iron due to bleeding from the cancer.
What is a flexible sigmoidoscopy?
An examination of your back rectum and some of your large bowel using a device called a sigmoidoscope. A sigmoidoscope is a long, thin, flexible tube attached to a very small camera and light. It’s inserted into your rectum and up into your bowel.
The camera relays images to a monitor and can also be used to take biopsies, where a small tissue sample is removed for further analysis.
What are the tests associated with bowel cancer?
Flexible sigmoidoscopy
Colonoscopy
CT colonography
CT scan of chest and abdomen
MRI scan
To see if it has spread elsewhere
What are the stages of bowel cancer using the TNM system?
T – indicates the size of the tumour
N – indicates whether the cancer has spread to nearby lymph nodes
M – indicates whether the cancer has spread to other parts of the body (metastasis)
What are the stages of bowel cancer?
Stage 1 – the cancer is still contained within the lining of the bowel or rectum
Stage 2 – the cancer has spread beyond the layer of muscle surrounding the bowel and may have penetrated the surface covering the bowel or nearby organs
Stage 3 – the cancer has spread into nearby lymph nodes
Stage 4 – the cancer has spread beyond the bowel into another part of the body, such as the liver or lungs through blood or lymph nodes
What are the treatments for bowel cancer?
Surgery – the cancerous section of bowel is removed; it is the most effective way of curing bowel cancer
Chemotherapy – where medication is used to kill cancer cells
Radiotherapy– where radiation is used to kill cancer cells
Immunotherapy- new treatment to boost patient immune reaction to kill cancer cells
biological treatments – a newer type of medication that increases the effectiveness of chemotherapy and prevents the cancer spreading e.g. cetuximab
What is the ‘2 week wait’?
Became a legal right that patients with any symptoms that GPs believe might indicate cancer to be seen by a specialist within 2 weeks of referral. If not possible - NHS must do everything they can to find an appropriate alternative appointment.
The majority of people referred in this way do not have cancer but it is important to be seen quickly in order to fully investigate their condition.
What are the red flags for colorectal cancer?
Aged over 40 – unexplained weight loss and abdominal pain or
Aged over 50 – with unexplained rectal bleeding or
Aged over 60 – with iron deficiency anaemia or changes in bowel habit or tests show occult blood in faeces
In adults with rectal or abdominal mass
In adults aged under 50 with rectal bleeding and any of the following unexplained: Abdominal pain Changes in bowel habit Weight loss Iron-deficiency anaemia
What is ‘urgent direct access’ in the context of cancer?
A test is performed within 2 weeks and primary care retain clinical responsibility throughout, including acting on the result which may then involve following suspected cancer pathway referral guidelines.
Also very urgent referral and very urgent direct access (within 48 hours).
What is rectal bleeding?
AKA hematochezia. Passage of bright red blood from the anus, often mixed with stool and/or blood clots.
Most rectal bleeding comes from colon, rectum or anus.
Colour of the blood can indicate the location of the bleed within the gastrointestinal tract.
Bleeding from the anus, rectum or sigmoid colon therefore tends to appear a brighter red. Whereas bleeding from transverse colon and the ascending colon tends to be dark red or maroon coloured.
