Introduction to Cancer Flashcards
(58 cards)
1
Q
Cancer statistics
A
1.7million new diagnosis for 2016
39.6% of people will be diagnosed
#1 cause of death worldwide (8.2 million/year)
#2 cause of death by disease in US (after heart)
2
Q
1 cancer diagnosis
A
Lung cancer
3
Q
Survivorship
A
14.5 million adult and ped survivors, survival increasing,
need for resources post-cancer treatment related to therapy and radiation
4
Q
Cancer Disparities
A
- Socioeconomic increases death rates, independent of demographics of race and ethnicity
- Lack of access to preventive health care, early detection, and treatment
- Discrimination
5
Q
Childhood cancers
A
0-14
~16,000 new diagnosis
Leukemia (acute)
overall survival ~90%
6
Q
Adolescent and Young adult cancers
A
15-39
~70,000 new diagnosis, 5% of cancer diagnosis
leading cause of disease related death
unique diagnoses and genetics
18-20 pediatric treatment improves survival (more aggressive care)
7
Q
What is cancer?
A
> 100 related diseases
uncontrolled division of normal cells, invading surrounding tissue and disrupting normal function
8
Q
how does cancer spread?
A
through lymph
9
Q
How is cancer named?
A
primary tissue or organ
10
Q
Cancer spread
A
metastasis
- Cancer cell invades surrounding tissues and blood vessels
- Cancer cells are transported by circulatory system to distant sites
- Cancer cells reinvade and grow at new locations
11
Q
Cancer Etiology
A
Multifactorial:
- Genetic
- Environment
- Lifestyles
- Medical conditions
12
Q
Cancer is genetic disease
A
- Inherited genetics abnormalities/mutations 5-10% of all cancer diagnosis
- Genetic alterations over course of lifetime: errors during cell replication, DNA mutations due to exposure (smoking, UV rays)
13
Q
Cancer Therapy
A
Traditional: Surgery, radiation, chemo Future: Personalized medicine Genetics Targeted Therapy Immunotherapy
14
Q
Cancer Therapy
A
- knowledge of molecular changes
- Tumor DNA sequencing
- Tumors grouped by mutation, not location
- treatment based on mutation
15
Q
Cancer Risk
A
-everyone at risk
-increases with age
-Risk factors
Goal: Prevention
16
Q
Cancer Risk Factors
A
Genetic - inherited vs mutations over lifetime
environmental (radiation)
Lifestyle (tobacco and alcohol)
Medical conditions (HPV)
17
Q
Goal of Prevention
A
Primary health
secondary screening
tertiary treatment
18
Q
Primary Prevention
A
Before cancer
Health and wellness (diet, weight, activity)
Lifestyle modifications
19
Q
Primary prevention: Diet
A
5+ veggies and fruit whole grains limit processed foods limit sugar intake limit processed and red meats
20
Q
Primary Prevention: Weight
A
- balance calorie intake with physical activity
- healthy BMI (obese >30)
- > 60million Americans are obese
21
Q
Obese women increased risk for:
A
breast, endometrial cervical, kidney, GB and ovarian
22
Q
obese men increased risk for:
A
colon, gastric, esophageal
23
Q
Diabetes increases risk
A
2011 study association between diabetes and higher cancer mortality rates
women: 11% increase risk for cancer mortality
men: 17% risk for cancer mortality
overall inc risk for colon, rectum and liver cancer
24
Q
Primary Prevention: Activity
A
Exercise:
- improves energy metabolism
- reduces circulating estrogen
- reduces insulin and insulin-like growth factor
- evidence links to reduced rsk of breast, colon, endometrial, lung and prostate cancer
25
Adult Activity guidelines
Adults
Minimum 20 min x 5 days /wk
goal: 30 min 5x/week
Preferred: 45 - 60 min
Kids and Adolescents
60 min 5 days/week
26
Primary prevention: Lifestyle
Sun safety, sexual health, alcohol, tobacco,
27
Sun Safety
Skin cancer #1 in US
Ultraviolet radiation known carcinogen
-UVA = premature aging
-UVB = sunburn
28
Risk factors for Skin cancer
Caucasian
red or blond hair
family hx
medical conditions (xeroderma pigmentosum)
90% non melanoma and 65% melanoma directly related to UV rays from sun
29
Sun Safety Prevention
Decrease time spent in direct sun 11am - 4pm
sun screen application 30 min prior, repeat 90 to 120 minutes
SLOP, SLIP, SLAP (SPF 40+)
tanning beds 20% increased risk, doubles if start before 35
30
Primary prevention: Sexual health
```
unsafe sex linked to cervical, liver, anal and genital cancers
-Reduce risk:
limit # of partners in lifetime
use condoms
STI testing
note changes and report
HPV vaccine
```
31
HPV vaccine
only known way to prevent cancer with vaccine
HPV 6, 11, 16 and 18
females 9-26
males 9-18
32
Primary Prevention: Alcohol use
increased risk with excessive alcohol intake
men no more than 2.day
women no more than 1/day
avoid binge
33
Primary Prevention: Tobacco use
affects almost every organ
linked to 15 cancers types
30% of all cancer deaths
inhaling causes inflammation, leading to DNA damage, can lead to cancer
34
Tobacco
smoking cessation offered to EVERY patient
behavioral therapy: stressors, coping mechanisms
Pharmacotherapy: NRT, Zyban, Chantix
Behavioral and Pharmacotherapy: success 40-60%, <10% on own
35
Secondary Prevention: Screening
early detection = discovery at earlier stage
Cancer check ups:
-health counseling
-medical and family hx
-age and gender specific exams
-referral for age and gender specific screenings
36
Screening for early detection
- must be available earlier than if the cancer were detected as a result of symptom development
- evidence must show that treatment initiated earlier as a consequence of screening will improve outcome
37
Effective screening test (4)
Sensitivity
Specificity
Positive Predictive value
Negative predictive value
38
Sensitivity
test correctly identifies those with the disease (true positive)
39
Specificity
test correctly identifies those without the disease (true negative)
40
Positive predictive value
probability that subjects with a positive screening test truly have the disease
41
Negative predictive value
probability that subjects with a negative screening test truly don't have the disease
42
Screening: Testicular cancer
- most common in men 15-34
- annual testicular exam clinically
- monthly testicular self-exam
- U/S for abnormal
43
Testicular: when to seek help
new lumps/bumps
| feeling of heaviness
44
Screening: Breast cancer
most common in women
Guidelines:
-monthly self breast exam starting at 20
- Clinical breast exam (3yrs for 20-30s, annually for >40)
-mammogram starting at 40 yearly and continuing as long as in good health
-women with high risk (>20% lifetime risk) should discuss for screening plan (strong family hx, BRCA)
45
Screening: Prostate cancer
Annual starting at age 50 (to men w/ 10 yr life expectancy)
- PSA blood test (not anymore)
- DRE (digital rectal exam)
- discuss benefits, limitations and harms of early detection and treatment of prostate cancer with HCP
- expect elevated PSA with age
46
Screening: Colorectal cancer
```
screening at age 50 standard
colonoscopy every 10 years for CRC screening
Alt screening methods
-flex. sigmoidoscopy q5yrs
-double contrast barium enema q5yrs
-CT colonography q5yrs
*colonoscopy if abnormal
```
47
Colorectal high risk patients
- personal hx or CRC or adenomatous polyps
- personal hx of chronic inflammatory bowel disease (crohns or ulcerative colitis)
- strong fam hx CRC or polyps: cancer or polyps in first degree relative younger than 60 or in 2+ first degree at any age
- known family hx of CRC syndrome (FAP or HNPCC)
48
Screening: Cervical cancer
- All women should begin screening at age 21
- Between 21-29: pap every 3 yrs, no HPV testing unless abn PAP result
- 30-65: PAP and HPV test every 5, alternate PAP every 3
49
Screening: Cervical cancer 2
- women over 65 who had regular screenings with normal results should not be screened
- women diagnosed with cervical pre-cancer should continue screening
- women who've had uterus and cervix removed and no hx of cervical precancer should not be screened
- women who have had HPV vaccine should still follow screening rec for age group
- women at high risk may need more frequent screening
50
women at high risk for cervical cancer
HIV coinfection
organ transplant
exposure to DES
51
Screening: Skin cancer
once a month, check for abnormal/changes
| yearly clinical exam
52
ABCDs of skin cancer
A- asymmetry
B - border irregularity
C - Color changes
D - Diameter, larger than 6mm or growing
53
screening: Lung cancer
High risk: 55-74 with >30 pack year hx, or >50 + 20 year hx plus other risk factors
Screening with low-dose CT (LDCT)
54
Tertiary prevention
pt already diagnosed with cancer
monitoring for recurrence
Monitoring for second malignancy
55
Childhood cancers: etiology
no known external causes
limited factors: radiation, exposures, more studies needed
most not caused by inherited DNA mutations
not preventable
*ex. chernobyl (radiation --> ALL)
56
Childhood cancers: Screening
not recommended for those not at high risk
increased risk bc of hereditary cancers: careful, regular check ups, special tests to look for early signs
usually found early by doctor or parents
hard to diagnose right away bc early symptoms often like common illnesses
57
Childhood cancer: Symptoms
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unusual S&S that do not resolve:
lumps or swelling
unexplained paleness or dec energy
easy bruising, generalized bruising, petechial rash
ongoing localized pain
limping without injury
unexplained prolonged fever
frequent illnesses, prolonged
frequent headaches, often with vomitting
sudden eye or vision changes
sudden unexplained wt loss
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58
APRN role
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education of patients and public
focus on health promotion and disease
ONS encourages "screening to prevent illness and PROMOTE wellness"
care for patients
develop EBP
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