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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Which type of skin cancer can appear anywhere on the body not just areas exposed to sun?
Malignant Melanoma
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Describe the ABCDE Criteria for S/Sx of skin cancer.
``` A = Asymmetry B = Border C = Color D = Diameter (>6mm) E = Evolving ```
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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.
- pulmonary metastasis - lungs - pleural pain, dyspnea - brain
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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.
- brain - HA, personality changes (both tumor specific) - Nerve/Cord Compression and Cauda Equina Syndrome
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What are the early signs of cord compression? (4)
- Pain - Sensory Loss - Muscle Weakness - Muscle Atrophy
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What are some S/Sx of primary or metastatic tumors causing Cauda Equina? (5)
- abnormal weight loss - hematuria - hemoptysis - melena - constipation
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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?
- 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
What are the the manifestations of back pain associated with cancer? (5)
- New onset with known history of cancer=suggestive of spinal metastases - Insidious onset - Unrelieved with lying - Worse at night - Unexplained weight loss
36
Hepatic Manifestations: - Liver metastasis primary site from what (3) areas? - What are the (5) PT symptoms of Hepatic Manifestations?
-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
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What do we do if we notice a cluster of S/Sx associated with cancer?
Cancer ROS
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PART 3: ONCOLOGIC PATHOLOGIES
PART 3: ONCOLOGIC PATHOLOGIES
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What are the (3) primary subsets of Cancers?
- MSK System - Primary Central Nervous System Tumors - Cancers of the Blood and Lymph System
40
What are the (3) pathologies of the MSK system?
- Soft Tissue Sarcoma - Osteosarcoma - Ewing Sarcoma
41
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?
- Rare - Most common in extremities followed by trunk, but can happen anywhere in the body. - Usually no symptoms in early stages.
42
Soft Tissue Sarcoma S/Sx. (5)
- Persistent swelling/lump in muscle*** - Pain*** - Pathologic Fracture - Local swelling*** - Warmth of overlying skin
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Osteosarcoma: - _____ common type of bone cancer. - Ages ___-___ most common. - What are (2) important risk factors? - Usually occurs in which bones?
- most common - 10-25 years - rapid bone growth, previous Hx of cancer - long bones
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Osteosarcoma S/Sx. (7)
- 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
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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?
- rapidly growing - 5-16 years - boys > girls - long bones and pelvis
46
Ewing's Sarcoma S/Sx. (5)
- Increasing and persistent bone pain.*** - Increasing and persistent swelling over a bone.*** - Limited ROM if extremity involvement.**** - Fever, fatigue, weight loss. - B&B disturbances
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What are the (2) pathologies of the Primary CNS Tumors?
- Brain Tumors | - Spinal Cord Tumors
48
Brain Tumors: - Symptoms are dependent on _______. - Increased incidence in older adults with __________.
- location | - immunodeficiency
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Brain Tumors S/Sx. (13)
- 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
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Spinal Cord Tumors: - Much _____ common than intracranial. - Occur most often in the ______ region. - Symptoms consistent with _______ of lesion.
- less common - thoracic region - cord level
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Spinal Cord Tumors S/Sx. (10)
- 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
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What are the (4) pathologies of Cancers of the Blood/Lymph System?
- Leukemia - Multiple Myeloma - Hodgkin's Disease - Non-Hodgkin's Lymphoma
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Leukemia: - What is it? - Most common malignancy in _______/________.
- Multiplication of immature WBCs, preventing production of mature WBCs. - children/young adults
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Leukemia S/Sx. (8)
- Enlarged lymph nodes*** - Easy bruising*** - Infections, fever - Abnormal bleeding - Pallor fatigue - Anorexia - Anemia - Bone and joint pain
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Multiple Myeloma: - What is it? - Destroys bone tissue and produces ______ lesions.
- Uncontrolled growth of plasma cells in bone marrow. | - osteolytic lesions
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Multiple Myeloma S/Sx. (7)
- 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
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Hodgkin's Disease: - What is it? - Progresses to extralymphatic sites such as ______ and ________. - What is a RED FLAG in Hodgkin's Disease?
- Chronic, progressive, neoplastic disorder of lymphatic tissue. - spleen and liver - Changes in lymph nodes.
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Hodgkin's Disease S/Sx. (4)
-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.
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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.
- Usually more WIDESPREAD and LESS PREDICTABLE. - less systemic symptoms - peripheral lymph node sites
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Non-Hodgkin's Lymphoma S/Sx. (7)
- Enlarged lymph nodes*** - Fever - Night sweats - Weight loss - Bleeding - Infection - Red skin and generalized itching of unknown origi
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Clues to Screening for Cancer:
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Guidelines for Medical Referral:
1