Topic 3: Screening and early detection of cancer Flashcards
Topic 3: Screening and early detection of cancer
Explain the following terms:
1) Primary prevention
2) Secondary prevention
3) Mass screening
4) Targeted screening
5) Self screening
1) Aims to reduce the incidence of disease (interventions applied before there is any evidence of disease or injury).
2) Aims to reduce the impact of a disease or injury that has already occurred.
Screening program..
3) ..directed at large groups within the population
4) ..only directed at high-risk groups (e.g.: age groups, hereditary abnorm., areas or work)
5) Patients screen them self (achieved through raising awareness and providing health education for e.g.: breast cc., testiluar cc.)
Topic 3: Screening and early detection of cancer
Give examples of opportunities for primary prevention of cancer related to:
1) Lifestyle
2) Environmental pollution
3) Vaccination
1) Smoking, alcohol consumption, eating habits, personal hygiene
2) Water, pesticides, fuels, soil
3) Vaccinations:
- HBV (Hungarian program: at birth if +ve mother, & school-based vaccination in 7th grade)
- HPV (Hungarian program: school-based vaccination in 7th grade for girls - only recommendation)
Topic 3: Screening and early detection of cancer
Which screening programs are available in Hungary and how are they organized?
Cervical cancer:
- Either cytology (Pap) or HPV testing.
- If cytology: starting age 25-30y, then every 3-5 years
- If HPV: starting age 35y, then every 5y
- Both are continued until age of 60-65 and continued beyond this age in case of recent abnormal results.
Breast cancer: Biannual mammography screening for women ageing 45 to 65 years.
Colorectal cancer: Occult bleeding fecal test will be implemented in 2018 for men and women ageing 50 to 70 years
Note that two methods are possible (debate on methodology), both have starting age 50-60y:
- biannual guaiac-based fecal occult blood test (gFOBT) or fecal immunochemical test (FIT)
- flexible sigmoidoscopy or colonoscopy every 10 years
Topic 3: Screening and early detection of cancer
What are the screening recommendations from WHO and the Union for International Cancer Control?
- Cervical cancer: ages 25-65, cytology every 2-3 years
- Breast cancer: ages 45-65, mammography every 2 years
- Colorectal cancer: detecting occult intestinal bleeding in both genders, ages 50-70
Topic 3: Screening and early detection of cancer
What are the WHO and the Union for International Cancer Control recommendations regarding prostate cancer screening?
Perform opportunistic screening for men aged 50+ annually, using digital rectal examination (DRE) and prostate-specific antigen (PSA) test.
Topic 3: Screening and early detection of cancer
What is the current situation for lung cancer screening in Hungary?
Due to markedly high incidence and mortality rates of lung cancer in Hungary, annual low-dose CT should be considered for the high-risk lung cancer group (age 50+, heavy smokers).
Topic 3: Screening and early detection of cancer
What are the results of the breast cancer screening started in Hungary in 2002?
- Participation rate 46% (expected 60%)
- Of 1503 patients who underwent surgery, 75% had breast cancer (49% of which were impalpable tumors <15 mm in diameter, while 12% had DCIS)
- In majority of cases, early diagnosis means that the patient may be fully cured, and treatment requires less radical, breast conserving, surgery.
Topic 4: Imaging methods and their role in the treatment of tumors
Describe the steps in Onco-radio-diagnostics
- Detection of the tumour.
- Establish diagnosis.
- Staging (TNM):
- T: size of the primary tumor and its relationship with its surroundings
- N: detecting any lymph node metastasis
- M: detecting distant metastases.
- Evaluate efficacy of the therapy by changes in: tumor volume, circulation, cell contents, metabolism
- Medical imaging is also used to quickly detect: recurrent tumors, distant metastases, and for restaging.
Topic 4: Imaging methods and their role in the treatment of tumors
How can we broadly classify imaging methods in terms of the information they provide?
Anatomical imaging:
- gives information on anatomical relationships of pathological conditions.
- can be used in image guidance during procedures.
Functional imaging: (isotope marker methods, various MR scans, contrast-enhanced studies):
- gives information on metabolic function and molecular level processes in the tissue.
Topic 4: Imaging methods and their role in the treatment of tumors
X-ray
1) Advantages?
2) Disadvantages?
3) Onco-clinical applications?
1) Easy access, cheap
2) Little information
3) Onco-clinical applications:
- Mainly: Bone, lung, breast
- Also: Abdomen, GI-tract
Topic 4: Imaging methods and their role in the treatment of tumors
Ultrasonography
1) Advantages?
2) Disadvantages?
3) Onco-clinical applications?
1) Advantages:
- Easy access, cheap
- Excellent soft tissue resolution
- Non-invasive, -ionising
- Real time information
2) Disadvantages:
- Subjective and technician dependent
- Lack of complex information
- Difficulties in the evaluation of deep structures and large lesions
3) Onco-clinical applications:
- Not a standard tool for tumor evaluation
- Transcutan: abdominal, pelvic, neck, breast, extremities
- Endocavital: rectal, esophageal, bronchial
- Guidance of biopsy and drainage
Topic 4: Imaging methods and their role in the treatment of tumors
(Multi detector) Computed tomography (CT):
1) Advantages?
2) Disadvantages?
3) Onco-clinical applications?
1) Advantages
- Quick, high spatial resolution
- Volumetric measurement, 3D information
- With the use of a contrast agent:
- Good soft tissue information
- Excellent temporal resolution (in constrast enhanced dynamic phases)
2) Disadvantages:
* Ionizing radiation
3) Onco-clinical applications:
- CT is the universal examination method for tumours.
- Gives (≥1mm thick) slices with excellent anatomical resolution and 3-D visualisation (helps w/both planning and guiding surgeries).
- Contrast administration makes parenchymal lesions easier to detect, and provides visualization of vascularisation lesions and perfusion abnormalities.
Topic 4: Imaging methods and their role in the treatment of tumors
MRI:
1) Advantages?
2) Disadvantages?
3) Onco-clinical applications?
