Week 13- Screening for Cancer Flashcards
PART 1: OVERVIEW
PART 1: OVERVIEW
What are the (2) MOST important risk factors for cancer?
- ) Advancing age
2. ) Previous Hx of cancer of any kind (RED FLAG)
Overview:
- Is it often symptomatic or asymptomatic in the early stages?
- Survival rates increase with __________ and ________.
- Mortality is decreasing. Why?
- Asymptomatic in early stages
- early detection and screening
- Mortality decreasing due to new treatments and early diagnosis.
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.
- Age >50
- 1 month
- insidious
- Hx of cancer
- bedrest
Which of the red flags is considered a “Major Risk” red flag?
Hx of Cancer
Cancer prevention begins with risk factor assessment and reduction. The key is to minimize as many __________________ as possible.
modifiable risk factors
PTs role in PRIMARY Prevention of Oncology. (4)
- Stopping the processes that lead to the formation of Cancer
- General Health promotion
- Risk factor assessment
- Risk reduction
PTs role in SECONDARY Prevention of Oncology. (2)
- Regular screening for early detection of Cancer.
- Prevention of progression of pre-malignant lesions through early identification.
What are the (4) most common cancer risk factors?
- Age >50
- Ethnicity (AA)
- Family Hx (1st generation)
- Environment and lifestyle (smoking, diet, alcohol, exposure to carcinogens, sedentary lifestyle
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.
- 2 or more
- <50yo
- same type
- more than one type
- rare
Neoplasms are divided into what (3) categories?
- Benign
- Invasive
- Metastatic
Name the type of neoplasms described below as either benign, invasive, or metastatic:
- ) Malignant cancer that has invaded surrounding tissue.
- ) Spread of cancer cells from primary site to secondary site.
- ) Non-cancerous tumors that are localized, encapsulated, slow growing, and unable to move or metastasize to other sites.
- ) Invasive
- ) Metastatic
- ) Benign
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?
- less likely
- bone, joint, or muscular presentation
- 15-20 years, Cancer screening is very important during IE
What are the (5) most common sites of metastasis?
- Bone
- Lymph Nodes
- Lung
- Liver
- Brain
What are the early warning signs of cancer? (Mnemonic= CAUTIONS)
- 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)
What warning signs are directly related to PT? (3)
- Changes in vital signs
- Proximal muscle weakness
- Change in DTRs
PART 2: CLINICAL MANIFESTATIONS
PART 2: CLINICAL MANIFESTATIONS
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
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
- 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?
- metastasis of cancer
- Integumentary, Pulmonary, Neurologic, MSK, and Hepatic
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?
- Yes
- Breast or Upper Respiratory Tract Cancer
What (3) questions need to be asked when a suspicious skin lesion is present?
- ) 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 the area?
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.
Hx of Cancer
Skin Cancer Risk Factors. (9)
- 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
What are the (3) types of skin cancer?
- Basal Cell Carcinoma
- Squamos Cell Carcinoma
- Malignant Melanoma
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1
1
1
1
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Which type of skin cancer can appear anywhere on the body not just areas exposed to sun?
Malignant Melanoma
Describe the ABCDE Criteria for S/Sx of skin cancer.
A = Asymmetry B = Border C = Color D = Diameter (>6mm) E = Evolving
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
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
What are the early signs of cord compression? (4)
- Pain
- Sensory Loss
- Muscle Weakness
- Muscle Atrophy
What are some S/Sx of primary or metastatic tumors causing Cauda Equina? (5)
- abnormal weight loss
- hematuria
- hemoptysis
- melena
- constipation
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
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
Hepatic Manifestations:
- Liver metastasis primary site from what (3) areas?
- What are the (5) PT symptoms of Hepatic Manifestations?
-stomach, colorectum, pancreas
- ) Bilateral carpal tunnel syndrome
- ) Abdominal pain and tenderness
- ) General malaise and fatigue
- ) RUQ pain, Right shoulder pain
- ) Jaundice
What do we do if we notice a cluster of S/Sx associated with cancer?
Cancer ROS
PART 3: ONCOLOGIC PATHOLOGIES
PART 3: ONCOLOGIC PATHOLOGIES
What are the (3) primary subsets of Cancers?
- MSK System
- Primary Central Nervous System Tumors
- Cancers of the Blood and Lymph System
What are the (3) pathologies of the MSK system?
- Soft Tissue Sarcoma
- Osteosarcoma
- Ewing Sarcoma
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.
Soft Tissue Sarcoma S/Sx. (5)
- Persistent swelling/lump in muscle***
- Pain***
- Pathologic Fracture
- Local swelling***
- Warmth of overlying skin
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
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
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
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
What are the (2) pathologies of the Primary CNS Tumors?
- Brain Tumors
- Spinal Cord Tumors
Brain Tumors:
- Symptoms are dependent on _______.
- Increased incidence in older adults with __________.
- location
- immunodeficiency
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
Spinal Cord Tumors:
- Much _____ common than intracranial.
- Occur most often in the ______ region.
- Symptoms consistent with _______ of lesion.
- less common
- thoracic region
- cord level
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
What are the (4) pathologies of Cancers of the Blood/Lymph System?
- Leukemia
- Multiple Myeloma
- Hodgkin’s Disease
- Non-Hodgkin’s Lymphoma
Leukemia:
- What is it?
- Most common malignancy in _______/________.
- Multiplication of immature WBCs, preventing production of mature WBCs.
- children/young adults
Leukemia S/Sx. (8)
- Enlarged lymph nodes***
- Easy bruising***
- Infections, fever
- Abnormal bleeding
- Pallor fatigue
- Anorexia
- Anemia
- Bone and joint pain
Multiple Myeloma:
- What is it?
- Destroys bone tissue and produces ______ lesions.
- Uncontrolled growth of plasma cells in bone marrow.
- osteolytic lesions
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
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.
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.
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
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
Clues to Screening for Cancer:
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Guidelines for Medical Referral:
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