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S7- Differential Diagnosis > Week 13- Screening for Cancer > Flashcards

Week 13- Screening for Cancer Flashcards

1
Q

PART 1: OVERVIEW

A

PART 1: OVERVIEW

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2
Q

What are the (2) MOST important risk factors for cancer?

A
  1. ) Advancing age

2. ) Previous Hx of cancer of any kind (RED FLAG)

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3
Q

Overview:

  • Is it often symptomatic or asymptomatic in the early stages?
  • Survival rates increase with __________ and ________.
  • Mortality is decreasing. Why?
A
  • Asymptomatic in early stages
  • early detection and screening
  • Mortality decreasing due to new treatments and early diagnosis.
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4
Q

Red Flags:

  • Age >____.
  • No improvement in symptoms after _______.
  • _______ onset.
  • Previous Hx of ______.
  • No relief with ________.
  • Unexplained weight loss (10% in 2 weeks), fever, thoracic pain.
  • Systematically unwell.
A
  • Age >50
  • 1 month
  • insidious
  • Hx of cancer
  • bedrest
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5
Q

Which of the red flags is considered a “Major Risk” red flag?

A

Hx of Cancer

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6
Q

Cancer prevention begins with risk factor assessment and reduction. The key is to minimize as many __________________ as possible.

A

modifiable risk factors

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7
Q

PTs role in PRIMARY Prevention of Oncology. (4)

A
  • Stopping the processes that lead to the formation of Cancer
  • General Health promotion
  • Risk factor assessment
  • Risk reduction
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8
Q

PTs role in SECONDARY Prevention of Oncology. (2)

A
  • Regular screening for early detection of Cancer.

- Prevention of progression of pre-malignant lesions through early identification.

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9
Q

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

A
  • Age >50
  • Ethnicity (AA)
  • Family Hx (1st generation)
  • Environment and lifestyle (smoking, diet, alcohol, exposure to carcinogens, sedentary lifestyle
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10
Q

Hereditary Cancer Syndrome:

  • Dx of cancer in __ or more relatives in a family.
  • Dx of cancer in family member ___ or younger.
  • Occurrence of _________ of cancer in several family members.
  • Occurrence of ___________ of cancer in one person.
  • Occurrence of a ____ type of cancer in one or more family members.
A
  • 2 or more
  • <50yo
  • same type
  • more than one type
  • rare
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11
Q

Neoplasms are divided into what (3) categories?

A
  • Benign
  • Invasive
  • Metastatic
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12
Q

Name the type of neoplasms described below as either benign, invasive, or metastatic:

  1. ) Malignant cancer that has invaded surrounding tissue.
  2. ) Spread of cancer cells from primary site to secondary site.
  3. ) Non-cancerous tumors that are localized, encapsulated, slow growing, and unable to move or metastasize to other sites.
A
  1. ) Invasive
  2. ) Metastatic
  3. ) Benign
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13
Q

Metastasis:

  • Primary cancers are ____ likely to present with MSK S/Sx.
  • Recurrence of previously treated cancer in metastasized form more often present with _____, _____, or ______ presentation.
  • Metastatic spread can occur as late as ___-___ years after initial diagnosis. What does this mean?
A
  • less likely
  • bone, joint, or muscular presentation
  • 15-20 years, Cancer screening is very important during IE
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14
Q

What are the (5) most common sites of metastasis?

A
  • Bone
  • Lymph Nodes
  • Lung
  • Liver
  • Brain
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15
Q

What are the early warning signs of cancer? (Mnemonic= CAUTIONS)

A
  • Changes in B&B habits
  • A sore that doesn’t heal in 6 weeks
  • Unusual bleeding or discharge
  • Thickening or lump in breast or elsewhere
  • Indigestion or difficulty swallowing
  • Obvious change in wart/mole
  • Nagging cough/hoarseness
  • Supplemental S/Sx (rapid weight loss, change in vitals, frequent infections, night pain, pathological fracture, proximal muscle weakness, DTR)
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16
Q

What warning signs are directly related to PT? (3)

A
  • Changes in vital signs
  • Proximal muscle weakness
  • Change in DTRs
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17
Q

PART 2: CLINICAL MANIFESTATIONS

A

PART 2: CLINICAL MANIFESTATIONS

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18
Q

Clinical Manifestations of Malignancy:

Lumps, Lesions, and Lymph Nodes:

  • Should all suspicious lymph nodes be evaluated by the MD?
  • Lymph nodes that are ____, ______, and _______ raise suspicion of cancer.

Proximal Muscle Weakness:

  • Idiopathic proximal muscle weakness may be an _____ sign.
  • Often due to _________.
  • Need to ask about weakness with subjective measures.

Pain:

  • _____ pain that is rated higher than __/10 is a RED FLAG symptom of primary or recurring cancer.
  • Do all people with cancer experience night pain?

DTRs:
-Changes in _____ DTRs, either diminished or hyperreflexive

A

Lumps, Lesions, and Lymph Nodes:

  • Yes
  • hard, immovable, and nontender

Proximal Muscle Weakness:

  • early sign
  • hypercalcemia

Pain:

  • Night pain, >7/10
  • No

DTRs:
-1 or more

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19
Q
  • Clinical manifestations of malignancy are more likely to show up for ________ of cancer, not the primary site.
  • We will most likely observe S/Sx affecting what (5) systems?
A
  • metastasis of cancer

- Integumentary, Pulmonary, Neurologic, MSK, and Hepatic

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20
Q

Integumentary Manifestations:

  • Can internal cancers invade the skin?
  • Metastasis to the skin may be the FIRST sign of malignancy, particularly in what 2 types of cancer?
A
  • Yes

- Breast or Upper Respiratory Tract Cancer

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21
Q

What (3) questions need to be asked when a suspicious skin lesion is present?

A
  1. ) How long have you had this area of skin discoloration/mole/spot?
  2. ) Has it changed in the past 6 weeks to 6 months?
  3. ) Has your physician examined the area?
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22
Q

A ____________ in the presence of a suspicious skin lesion that has not been evaluated requires recommendation to the patient that an evaluation takes place as soon as possible.

A

Hx of Cancer

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23
Q

Skin Cancer Risk Factors. (9)

A
  • Advancing age
  • Personal/Family Hx (particularly melanoma)
  • Moles with any ABCDE features
  • Fair complexion with green/blue/grey eyes
  • Skin that sunburns easily, skin that never tans
  • Hx of painful sunburns w/ blistering during childhood/adolescence
  • Use of tanning beds/lamps
  • Short intense episodes of sun exposure
  • Transplant recipient
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24
Q

What are the (3) types of skin cancer?

A
  • Basal Cell Carcinoma
  • Squamos Cell Carcinoma
  • Malignant Melanoma
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25
Q

1

A

1

26
Q

1

A

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27
Q

1

A

1

28
Q

Which type of skin cancer can appear anywhere on the body not just areas exposed to sun?

A

Malignant Melanoma

29
Q

Describe the ABCDE Criteria for S/Sx of skin cancer.

A 
A = Asymmetry
B = Border
C = Color
D = Diameter (>6mm)
E = Evolving
30
Q

Pulmonary Manifestations:

  • What is the most common of all metastatic tumors?
  • Primary bone tumors metastasize first to the ______.
  • What are the pulmonary symptoms? (2)
  • Primary lung cancer most commonly metastasizes to the ______. Hx of lung cancer calls for neuro screening.
A
  • pulmonary metastasis
  • lungs
  • pleural pain, dyspnea
  • brain
31
Q

Neurological Manifestations:

  • Metastasis to the _____ occurs in 20-25% of cases of primary sites outside CNS. (lung, colon, kidney, breast, and melanoma)
  • What are the (2) main clinical S/Sx?
  • Nerve/cord _________ and ________ Syndrome of concern.
A
  • brain
  • HA, personality changes (both tumor specific)
  • Nerve/Cord Compression and Cauda Equina Syndrome
32
Q

What are the early signs of cord compression? (4)

A
  • Pain
  • Sensory Loss
  • Muscle Weakness
  • Muscle Atrophy
33
Q

What are some S/Sx of primary or metastatic tumors causing Cauda Equina? (5)

A
  • abnormal weight loss
  • hematuria
  • hemoptysis
  • melena
  • constipation
34
Q

MSK Manifestations:

  • Reported most commonly as _____ or _____ pain.
  • Is primary or metastatic bone cancer more common? Where does it most often occur in the bone?
  • What are the (2) main S/Sx of bone pain indicating bone cancer?
A
  • bone or back pain
  • Most commonly metastatic, occurs at the most heavily vascularized regions of bone.
  • Unrelieved by rest or position change, nonresponsive to PT treatment
35
Q

What are the the manifestations of back pain associated with cancer? (5)

A
  • New onset with known history of cancer=suggestive of spinal metastases
  • Insidious onset
  • Unrelieved with lying
  • Worse at night
  • Unexplained weight loss
36
Q

Hepatic Manifestations:

  • Liver metastasis primary site from what (3) areas?
  • What are the (5) PT symptoms of Hepatic Manifestations?
A

-stomach, colorectum, pancreas

  1. ) Bilateral carpal tunnel syndrome
  2. ) Abdominal pain and tenderness
  3. ) General malaise and fatigue
  4. ) RUQ pain, Right shoulder pain
  5. ) Jaundice
37
Q

What do we do if we notice a cluster of S/Sx associated with cancer?

A

Cancer ROS

38
Q

PART 3: ONCOLOGIC PATHOLOGIES

A

PART 3: ONCOLOGIC PATHOLOGIES

39
Q

What are the (3) primary subsets of Cancers?

A
  • MSK System
  • Primary Central Nervous System Tumors
  • Cancers of the Blood and Lymph System
40
Q

What are the (3) pathologies of the MSK system?

A
  • Soft Tissue Sarcoma
  • Osteosarcoma
  • Ewing Sarcoma
41
Q

Soft Tissue Sarcoma:

  • Is it a common or rare malignancy?
  • Where does it most commonly occur? Can it occur anywhere else?
  • Does it cause symptoms in the early stages?
A
  • Rare
  • Most common in extremities followed by trunk, but can happen anywhere in the body.
  • Usually no symptoms in early stages.
42
Q

Soft Tissue Sarcoma S/Sx. (5)

A
  • Persistent swelling/lump in muscle***
  • Pain***
  • Pathologic Fracture
  • Local swelling***
  • Warmth of overlying skin
43
Q

Osteosarcoma:

  • _____ common type of bone cancer.
  • Ages ___-___ most common.
  • What are (2) important risk factors?
  • Usually occurs in which bones?
A
  • most common
  • 10-25 years
  • rapid bone growth, previous Hx of cancer
  • long bones
44
Q

Osteosarcoma S/Sx. (7)

A
  • Pain/swelling of involved region***
  • Loss of motion/functional movement of adjacent joints***
  • Tender lump may develop
  • Pathological fracture
  • Weight loss
  • Malaise/fatigue
  • Warmth of overlying skin
45
Q

Ewing’s Sarcoma:

  • ______ growing tumor that erodes bone cortex.
  • Ages __-__ most common.
  • Is it more common in boys or girls?
  • Usually occurs in which bones?
A
  • rapidly growing
  • 5-16 years
  • boys > girls
  • long bones and pelvis
46
Q

Ewing’s Sarcoma S/Sx. (5)

A
  • Increasing and persistent bone pain.***
  • Increasing and persistent swelling over a bone.***
  • Limited ROM if extremity involvement.**
  • Fever, fatigue, weight loss.
  • B&B disturbances
47
Q

What are the (2) pathologies of the Primary CNS Tumors?

A
  • Brain Tumors

- Spinal Cord Tumors

48
Q

Brain Tumors:

  • Symptoms are dependent on _______.
  • Increased incidence in older adults with __________.
A
  • location

- immunodeficiency

49
Q

Brain Tumors S/Sx. (13)

A
  • Headache (sometimes worse upon awaking then improves during the day)
  • Vomiting
  • Visual changes
  • Changes in mentation
  • Personality change, irritability
  • Unusual drowsiness, increased sleeping
  • Seizures
  • Sensory changes muscle weakens
  • Bladder dysfunction
  • Increased lower extremity reflexes compared with upper extremity
  • Decreased coordination, gait changes, ataxia
  • Clonus
  • Vertigo
50
Q

Spinal Cord Tumors:

  • Much _____ common than intracranial.
  • Occur most often in the ______ region.
  • Symptoms consistent with _______ of lesion.
A
  • less common
  • thoracic region
  • cord level
51
Q

Spinal Cord Tumors S/Sx. (10)

A
  • 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
52
Q

What are the (4) pathologies of Cancers of the Blood/Lymph System?

A
  • Leukemia
  • Multiple Myeloma
  • Hodgkin’s Disease
  • Non-Hodgkin’s Lymphoma
53
Q

Leukemia:

  • What is it?
  • Most common malignancy in _______/________.
A
  • Multiplication of immature WBCs, preventing production of mature WBCs.
  • children/young adults
54
Q

Leukemia S/Sx. (8)

A
  • Enlarged lymph nodes***
  • Easy bruising***
  • Infections, fever
  • Abnormal bleeding
  • Pallor fatigue
  • Anorexia
  • Anemia
  • Bone and joint pain
55
Q

Multiple Myeloma:

  • What is it?
  • Destroys bone tissue and produces ______ lesions.
A
  • Uncontrolled growth of plasma cells in bone marrow.

- osteolytic lesions

56
Q

Multiple Myeloma S/Sx. (7)

A
  • Skeletal/bone pain (pelvis, spine and ribs)***
  • Recurrent bacterial infections
  • Anemia with weakness
  • Bleeding tendencies
  • Spontaneous fracture
  • Osteoporosis
  • Also associated with renal involvement and can cause neurologic abnormalities
57
Q

Hodgkin’s Disease:

  • What is it?
  • Progresses to extralymphatic sites such as ______ and ________.
  • What is a RED FLAG in Hodgkin’s Disease?
A
  • Chronic, progressive, neoplastic disorder of lymphatic tissue.
  • spleen and liver
  • Changes in lymph nodes.
58
Q

Hodgkin’s Disease S/Sx. (4)

A

-PAINLESS, PROGRESSIVE ENLARGEMENT of UNILATERAL LYMPH NODES, often in the neck.

Other early symptoms:

  • Pruritis over entire body.
  • Unexplained fever, night sweats.
  • Anorexia, weight loss.
59
Q

Non-Hodgkin’s Lymphoma:

  • What is the difference between Hodgkin’s Disease and Non-Hodgkin’s Lymphoma?
  • ______ symptomatic symptoms.
  • Painless enlargement of one or more _______ lymph node sites.
A
  • Usually more WIDESPREAD and LESS PREDICTABLE.
  • less systemic symptoms
  • peripheral lymph node sites
60
Q

Non-Hodgkin’s Lymphoma S/Sx. (7)

A
  • Enlarged lymph nodes***
  • Fever
  • Night sweats
  • Weight loss
  • Bleeding
  • Infection
  • Red skin and generalized itching of unknown origi
61
Q

Clues to Screening for Cancer:

A

1

62
Q

Guidelines for Medical Referral:

A

1

S7- Differential Diagnosis (15 decks)

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