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Cancer Symposium (all 3 lectures) Flashcards

(45 cards)

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1
Q

Define cancer?

A
  1. UNCONTROLLED NEW GROWTH of tissue
  2. which is NON-PHYSIOLOGICAL and has the
  3. capacity to INFILTRATE, INVADE AND SPREAD from its point of origin, having a detrimental effect.
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2
Q

What is meant by ‘non-physiological’?

A

Not controlled by normal homeostatic mechanisms

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3
Q

Is thickened skin cancer?

A

Not normal without a stimulus (eg, a guitarist can get callouses)

It is a physiological response (a new growth of tissues) to trauma - if the trauma is stopped, it’ll go away

So no it is not cancer

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4
Q

Is lipoma cancer?

A

Fat tumour under the skin- common in shoulder blades/clavicles
Although not physiological as it isn’t controlled like the rest of the fat in body
BUT does not infiltrate other tissues, therefore is NOT cancer.

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5
Q

Who gets cancer?

A

1 in 2 people
Increases with age (60 years < especially)

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6
Q

How many cancer cases are preventable?

A

40%
Risk factor and screening is important

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7
Q

How do people know they have cancer?

A

Non specific symptoms so need high index of suspicion
Any persistent symptoms need to be taken seriously

Late stage features include:
pain
lumps
weight loss
lymphadenopathy

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8
Q

What are the big 4 cancers?

A

Make up over 50% of new cancer cases:
1. Breast
2. Prostate
3. Lung
4. Bowel / colorectal

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9
Q

What percentage of cancer patients will die?

A

50%

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10
Q

What percentage of cases are preventable?

A

40%

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11
Q

How are cancer outcomes measured (4 points)

A
  1. Survival
  2. Prognosis
  3. Overall survival - may not be that useful bc pt may die of difference cause (old age for example)
  4. Disease free survival - indicator of if/how well treatment works
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12
Q

What kind of graph do we map survival on?

A

Kaplan-Meier survival estimate graphs - can compare treatments and their stages

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13
Q

How does disease stage, survival and quality of life correlate to each other?

A

Higher stage= lower survival = lower quality of life

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14
Q

What type of medical team do cancer patients need?

A

Multidisciplinary team - oncologists, surgeons, pathologists, radiologists, nurses, therapists

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15
Q

What is the process by which cancer patients get help? (cancer diagnosis pathway)

A
  1. GP
  2. Hospital speciality (eg, oral surgery, lung clinic, breast clinic etc) who carry out examinations, biopsies, imaging etc
  3. Multidisciplinary team
  4. Treatment
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16
Q

Why is cancer caught late?

A

Patient may not have symptoms and not feel sick until late stage - patient won’t seek help until cancer is advanced

Leads to poorer survival rates and poorer quality of life

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17
Q

What are the signs and symptoms of breast cancer?

A
  1. Lump in breast
  2. Lump in axilla
  3. Nipple bleeding/discharge
  4. Men can also get breast cancer
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18
Q

What are the signs and symptoms of lung cancer?

A
  • Persistent cough
  • Heamoptysis- coughing up blood from respiratory tract
  • Abnormal Chest x ray
  • Finger clubbing
  • Supraclavicular lymph node
  • Weight loss
  • Fatigue
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19
Q

What are the signs and symptoms of prostate cancer?

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A
  1. Urinary problems including:
    - Frequency
    -Hesitancy
    - Nocturia
    - Urgency
    - Retention
  2. Check PSA - prostate specific antigen released by prostate cells (both normal and cancer cells)
  3. Examine prostate - may find prostatic hypertrophy (most men over 60 have this which makes PSA go up)
20
Q

What are the signs and symptoms of colorectal cancer?

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A
  • Unintentional weight loss
  • Change in bowel habit
  • Rectal bleeding
  • Abdominal pain
  • Positive FIT test - faecal Immunochemical Test to look for tiny traces of blood that may be in faeces
21
Q

What is screening?

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A

Testing a population at risk of a disease (eg, no point testing women for prostate)
Aims to identify asymptomatic cases or those with pre-malignant disease

It helps the patient get into the cancer diagnosis pathways

22
Q

What are the benefits of screening?

Study These Flashcards
A

Increases rate of detection
Improves outcomes, survival and quality of life

23
Q

How do we screen for breast cancer?

Study These Flashcards
A

Mammography every 3 years
50-70 years most at risk

24
Q

How do we screen for colorectal cancer?

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A

Feacal immunochemical test - FIT test every 2 years
60-75 years most at risk

25
How do we screen for lung cancer?
CT scan 50-80 years and smokers/ex-smokers less than 15 years ago most at risk
26
How do we screen for prostate cancer?
PSA test
27
How do we screen for cervical cancer?
Smear test women aged 25-49 years (every 3 years) Women aged 50-64 years ( every 5 years)
28
What are the disadvantages of screening?
1. May miss some cancers providing false reassurance 2. A positive screening result may cause anxiety by diagnosing a slow-growing tumour that may never cause any harm or symptoms.
29
What are the Wilson and Jungner principles for screening?
1. Knowledge of disease: -The condition should be important. -There must be a recognisable latent or early symptomatic stage. -The natural course of the condition, including development from latent to declared disease, should be adequately understood. 2. Knowledge of test: -Suitable test or examination. -Test acceptable to population. -Case finding should be continuous (not just a 'once and for all' project). 3. Treatment for disease: -Accepted treatment for patients with recognised disease. -Facilities for diagnosis and treatment available. -Agreed policy concerning whom to treat as patients. 4. Cost considerations: -Costs of case finding (including diagnosis and treatment of patients diagnosed) economically balanced in relation to possible expenditures on medical care as a whole.
30
How long does it take to get treated?
1. There is a 2 week wait referral (2WW referral)-seen and examined within 2 weeks 2. If diagnosis positive, staging complete and txt plan within 31 days 3. Start treatment within 62 days 14 : 31 : 62 day pathway - audited and published, trusts are fine if dates not met
31
How do we stage cancer?
TNM system 1. Tumour 2. Nodes (regional) 3. Metastases (distant) We then stage the cancer from 1-4 which is an accumulation if all these factors
32
Explain the T section of TNM staging?
Tumour size (primary tumour) T1 to T4 T1: 0-2CM T2: 2-5CM T3: 5
33
Explain the N section of TNM staging?
N0-N3 Check regional lymph nodes- number/ bilateral/unilateral Neck for head&neck cancer Armpits for breast
34
Explain the M section of TNM staging?
M0-M1 Distant metastasis - tested by PET CT scan
35
Explain surgery in cancer management?
COORDINATED BY MDT (MULTIDISCIPLINARY TEAM) 1. Remove primary tumour with a margin of normal tissue around it 2. Remove involved lymph nodes for examination 3. Reconstruction of area if needed.
36
Explain radiotherapy in cancer management?
COORDINATED BY MDT (MULTIDISCIPLINARY TEAM) 1.External beam 2. Implant- brachytherapy: planted in tumour, focused locally (common in cervical and prostate cancer) Can be used in start metastases or lymph nodes
37
Problems with radiotherapy?
1. Limited dose 2. Can only treat once as increased risk of killing normal tissues 3. Radiation reaction 4. Mucositis - ulceration/inflammation of GI tract 5. Osteoradionecrosis if radiated on bone
38
Explain chemotherapy in cancer management?
COORDINATED BY MDT Often in combination with radiotherapy. Side effects include: * Toxicity * Hair loss * Nausea * Weight loss * Fatigue * Effects on blood
39
Who is immunotherapy coordinated by?
MDT (MULTIDISCIPLINARY TEAM)
40
Explain anti-resorptive medication in cancer management?
COORDINATED BY MDT (MULTIDISCIPLINARY TEAM) 1. Bisphosphonates - prevents risk of bone being metastasis 2. RANK-L inhibitors (denosumab) - Reduce bone turnover - MUST BE KEPT DENTALLY FIT so patients can cope with their cancer treatments - MRONJ - EXTRA CAUTION WITH EXTRACTIONS
41
Explain hormone therapy in cancer management?
COORDINATED BY MDT (MULTIDISCIPLINARY TEAM) - Can change growth pattern of their cancer - Used for breast and prostate cancers
42
At what point does follow up and survivorship link flatten out?
5 years (or 5-10 years) - likely to survive further at this point However the compromise between continuing follow ups is the cost VS peace of mind
43
Why might follow ups be important especially for childhood cancers?
The effects can last a lifetime (eg, MRONJ, osteoradionecrosis)
44
What is our role as dentists in the management of cancer patients?
* Champion healthy living * Smoking, alcohol, diet * Be aware of red flag signs * Signpost patients to GP * Champion screening * Oral Health promotion
45
Hannah has a lump in her breast. She has a family history of breast cancer and thinks that her lump is a cancer. What things does Hannah want her treatment to achieve?
*Wants to be cured * Go back to her old life * Minimal impact/side effects: -Cosmetic -Functional -Family/children * Quick diagnosis * Quick treatment * Involvement in her care choices * Doctors and nurses with good communication skills * Access to her cancer team * Minimal pain * Minimal complications * Regular follow up for as long as she needs it * Genetic counselling for her and her family

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