Diagnosing Cancer

Question 1

Average risk breast cancer age 50-74 what’s the screening interval

Answer 1

Mammogram every 2yrs

Question 2

High risk breast cancer age 30-69yrs

Answer 2

Screening yearly with both mammogram and MRI

Question 3

Colorectal cancer screening

Answer 3

50-74yrs no parent or siblings or child with colorectal cancer (average risk) screening every 2yrs with fecal immunichemical test (FIT)

Question 4

Colorectal screening for those at increased risk- parent or siblings or child diagnosed before before 60

Answer 4

Age 50yrs or 10yrs earlier than age relative was diagnosed

Colonoscopy every 5yrs

Question 5

Colorectal cancer screening for those whose relative were diagnosed after 60yrs

Answer 5

Age 50yrs or 10yrs earlier than relative was diagnosed with colorectal cancer

Colonoscopy every 10yrs

Question 6

Lung cancer screening

Answer 6

55-74yrs and have smoked every day for at least 20yrs

Question 7

What is the most common cancer in female

Answer 7

Breast cancer

Question 8

Cancer most common in men

Answer 8

Prostate cancer

Question 9

Cancer most common in children

Answer 9

Leukaemia

Question 10

Which are the most common cancers in Canada

Answer 10

Breast cancer, prostate cancer and colorectal cancer

Question 11

Lung cancer prevalence is what?

Answer 11

Second most common cancer in both men(12.5%) women (13.3%)

Question 12

Lung cancer is number 1 cancer in which age range

Answer 12

79-84yrs

Question 13

What is the basis of diagnosis of cancer?

Answer 13

Manifestation based on site, tumor site and diagnostic testing

Question 14

What are the staging systems for cancer!

Answer 14

Microscopic analysis which is based on presence of metastasis

WHO’s TNM

Question 15

TNM is used in staging what kind of cancer?

Answer 15

Solid cancer

Question 16

Microscopic analysis staging are

Answer 16

Stage I - No metastasis

Stage II - local invasion

Stage III - spread to regional structures

Stage IV - distant metastasis

Question 17

WHO’ TNM

Answer 17

T: primary tumor size and extent

N: node involvement

M: extent of distant metastasis

Question 18

TNM system T is what?

Answer 18

T 1: 0-2 cm

T2: 2-5cm

T3: >5cm

T4: tumor broke through skin or attached to chest wall

Question 19

TNM system N staging includes

Lymph node status

Answer 19

N -0: surgeon can’t feel any node

N-1: surgeon can feel swollen node

N-2: node feel swollen and lumpy

N-3: swollen node located at collerbone

Question 20

M in the TNM staging stand for what?

Answer 20

Metastasis

M-0: Tested node cancer free

M-1: Tested node show cancer cells or micro metastasis

Question 21

What are tumor markers?

Answer 21

Substance produced by cancer cells that are found in tumor cells in blood, CSF or urine

Question 22

Tumor markers could be

Answer 22

Hormone
Enzymes
Genes
Antigens
Antibodies

Question 23

What’s the use of tumor markers?

Answer 23

For screening and identify individuals at high risk for cancer

Diagnose specific types of tumor

Observe clinical course of cancer

Question 24

What are the problem of tumor markers?

Answer 24

False positives and negatives

Question 25

What is the benefit of histology of cancer cells?

Answer 25

It help with molecular characterization to subdivide cancer into therapeutically and prognostic smaller groups

Question 26

What is the definition of histology?

Answer 26

Scientific study of microscopic structures (micro anatomy) of cells and tissue Origin Greek Histos = tissue or columns Logia= study

Question 27

What’s the 4 classification of tissue

Answer 27

Nervous tissue Muscle tissue Epithelial tissue Connective tissue

Question 28

What are the sub categories of tissue?

Answer 28

Epithelium Endothelium Mesothelium Mesenchyme Germ cells Stem cells

Question 29

What are the 3 historic treatment of cancer?

Answer 29

Surgery Radiation Chemotherapy

Question 30

What are the ways surgery is used in cancer

Answer 30

1. Dignosis- surgical excision of suspected area lymph node or mass 2. Treatment - removal of cancerous tumours 3. Palliation: debunking of an area where cancer has invaded surrounding organ or tissue e.g ureter 4 as adjunct treatment to debunking tumours before chemotherapy

Question 31

Can surgical removal of tumor be used as cure?

Answer 31

Yes

Question 32

Immunotherapy

Answer 32

Used recently in cancer management

Question 33

In the treatment of Breast cancer what is used

Answer 33

Surgery, radiation and chemotherapy

Question 34

What are the 2 ways radiation can be used in cancer treatment

Answer 34

Systemic treatment Local treatment

Question 35

Today body radiation (systemic) is used in what cancer treatment

Answer 35

Haematological cancer such as lymphoma as an adjunt

Question 36

Radiation can be used as local treatment or cure in what type of cancer

Answer 36

Prostate cancer- brachytherapy

Question 37

What is brakytherapy

Answer 37

Radiotherapy beads are inserted near the prostate to get rid of the prostate cancer

Question 38

Targeted radiation therapy is used in paillative care True or false

Answer 38

True

Question 39

Immunotherapy

Answer 39

Harnessing immune system in an effort to up regulate immune function and use the bodies own defence to treat cancer

Question 40

What is immunotherapy used for

Answer 40

Hard to treat cancers such as malignant melanoma, lung cancer and myeloma

Question 41

What are the 2 well know treatment in immunotherapy

Answer 41

Immune checkpoint inhibitors CAR T cell therapy

Question 42

What are the adverse effects of immunotherapy?

Answer 42

Relate to stimulation of immune system and hyper immune response example Rashes Inflammation etc

Question 43

What is the name of the adverse events from immunotherapy called

Answer 43

Immune related adverse events IRAEs

Question 44

What is the treatment of Immune related Adverse events (IRAS)

Answer 44

Steroids to dampen the events

Question 45

What are the risk factors for lymphoma of GI

Answer 45

H pylori HIB chronic immunosuppressant therapy IBD celiac disease Autoimmune disease

Question 46

What is the gold test for colorectal cancer

Answer 46

Colonoscopy

Question 47

What are the risk of colonoscopy

Answer 47

Bowel perforation Heavy bleeding Adverse reaction to sedatives Infection Nausea and vomiting

Question 48

What’s the stats of colorectal cancer

Answer 48

1 in 15 diagnosed with the disease 1 in 31 die of it Survival rate average Highest incidence for men and women occurs in Newfoundland Labrador

Question 49

Cervical cancer screening use what

Answer 49

Pap smear Done a 3yrs age 25- 69 yrs >79yrs Pap test negative 3x in past 10yrs stop

Question 50

What is the frequency of diagnosis if colorectal cancer in Canada

Answer 50

3rd most diagnosed cancer

Question 51

Preferred opioid in cancer

Answer 51

Pain not too intense - oxycodone Moderate to severe. - morphine

Question 52

Benefit of opioid rotation

Answer 52

Can minimize adverse event. Stop abruptly and replace with another

Question 53

Opioid to avoid in cancer

Answer 53

Demerol ( toxic metabolite normeperidine can accumulate) Buperenorphine Butorphanol Nalbuphine Pentazocine

Question 54

WHO recommendation

Answer 54

Pain ladder 1-3 use none opioid 4- 10 start opioid

Question 55

First choice of none opioid in cancer

Answer 55

Acetaminophen Benefit - relief pain, suppresses inflammation and reduce fever AE: gastric ulcers, renal failure and bleeding