Reproductive tract cancers

Question 1

Cancers are the _________ leading cause of death globally

Answer 1

second

Question 2

First leading cause of death globally is ??

Answer 2

CVD

Question 3

Only 1 in ____ LMIC have the necessary data to drive cancer policy

• SDG target ______– to reduce premature NCD mortality by onethird by 2030

Answer 3

5

3.4

Question 4

The interaction between a person’s genetic factors and 3 categories of external agents, including:
• _________ carcinogens, such as ultraviolet and ionizing radiation
• _________ carcinogens, such as asbestos, components of tobacco smoke, aflatoxin (a food
contaminant) and arsenic (a drinking water contaminant)
• _________ carcinogens, such as infections from certain viruses, bacteria or parasites

Answer 4

physical ; chemical

biological

Question 5

Ageing is a fundamental factor for the
development of cancer

T/F

Answer 5

T

Question 6

The incidence of cancer rises dramatically with age:
• due to a build-up of ______ for specific cancers that increase with age
• combined with the tendency for _________ mechanisms to be less effective with ageing

Answer 6

risks

cellular repair

Question 7

Prostate cancer
Background

• _______ most common cancer globally

• Highest rates occur in Western Europe, Australia, and
North America

Answer 7

3rd

Question 8

Risk factors of prostate cancer

Age- Prostate cancer is diagnosed in very few people aged younger than _____ years (<0·1% of all patients).
• Race/ethnicity- The lowest rates are usually in ________ , especially ________ people in Tianjin, China (1·9 per 100 000 per year), the highest are in North America and Scandinavia, African-
Americans especially those in the USA (137 per 100 000 per year).

Answer 8

50 ; Asia

Chinese

Question 9

Lynch syndrome (also known as _____________, or HNPCC), a condition
caused by inherited gene changes, have an increased risk for a number of cancers, including prostate cancer.

Answer 9

hereditary non-
polyposis colorectal cancer

hereditary non-polyposis colorectal cancer

Question 10

Higher concordance for prostate cancer diagnosis between _______zygotic than ______zygotic twins.

Answer 10

monozygotic than dizygotic twins.

Question 11

Protective factors
• High intake of _______ and _______
• Folate: dietary folate vs folic acid
supplementation
5AR inhibitors, still controversial, not yet recommended by FDA
• Finasteride (Proscar, Propecia etc)
• Dutasteride (Avodart etc)

Answer 11

fruits

vegetables

Question 12

Which is protective?
Dietary folate or folate supplement

Question 13

Factors with less clear effect on prostate cancer risk or effect unknown (higher risk)
• Dietary factors
-western lifestyle and in particular, diet that includes a high intake of ______, meat, dairy products (α-linolenic acid) and _________.
-Consumption of _______ or _______ meat; especially the cooking and preparation

Answer 13

fat ; calcium.

red ; processed

Question 14

Factors with less clear effect on prostate cancer risk or
effect unknown (higher risk)

Hormonal factors
-Androgens: ___________ (DHT)
• __________ (Supplement) 1mg/day
• ________ (taken alone)
• Multivitamins
• Some medications like aspirin, statin

Answer 14

dihydrotestosterone (DHT)

Folic Acid ; Vitamin E

Question 15

Vitamin E + _________ = protective

Answer 15

Selenium

Question 16

Unclear factors (protective)
• Frequent intake of __________-based products, particularly _________ sauce (_______)
• _________ (generally processed into soymilk or tofu)
• Fish- mostly attributed to _____________.
• Brassica or Cruciferous vegetables (Cabbage, Broccoli etc.)
• micronutrients selenium and vitamin E in combination (__________)
• green tea ______________ __________

Answer 16

tomato ; tomato

lycopene ; Soybeans

omega-3 fatty acids.

α tocopherol ; epigallocatechin gallate

Question 17

Symptoms & signs of prostrate cancer

• (Slow or Fast?) growing, maybe symptom free
• Urinary symptoms which include frequent urination, nocturia, sudden urge to urinate, difficulty starting and maintaining a steady stream of urine, hematuria, and dysuria.
• Problems with sexual function and
performance, such as difficulty achieving ________ or __________ ejaculation, _______ in the
semen

Answer 17

Slow ; erection

painful ejaculation

blood

Question 18

Symptoms & signs of prostate cancer
• Shortness of breath, feeling very tired, fast heartbeat, dizziness, or pale skin caused by anaemia
Metastasis may lead to;
• _______ pain- vertibrae, pelvis, ribs
• _______ , _______ ________

Answer 18

Bone

Urinary, faecal incontinence

Question 19

Detecting prostate cancer
• _________ & _________ (diagnosis)
• ______________________
• Kallikrein Tumor Markers
• Transrectal ultrasound
• Transrectal MRI
• ______________ Exam
• Recently: Prostate Urine Risk test (PUR)

Answer 19

Biopsy & histology

PSA (Prostate specific antigen)

Digital Rectal Exam

Question 20

_______________________ test (PUR)

Answer 20

Prostate Urine Risk

Question 21

Staging of prostate cancer
• The TNM staging system T1, T2, T3, T4
• Histologic Grading: The __________ Score 2-10
• Post-Surgical Evaluation
• Imaging Bone Metastases

Answer 21

Gleason Score

Question 22

Treatment of prostate cancer
• Types of treatment used:
– Watchful waiting/active surveillance
/observation/expectant management
– Surgery
– Radiation therapy and radiopharmaceutical therapy
– Hormone therapy
– Chemotherapy
– Biologic therapy
– Bisphosphonate therap

Answer 22

I agree

Question 23

Bisphosphonate therapy

Works by ??

Answer 23

Slowing down bone resorption

Question 24

Treatment of prostate cancer

• New types of treatment being tested in clinical trials:
– ___________
– High-intensity–focused ________ therapy
– __________ radiation therapy
– __________ therapy

Answer 24

Cryosurgery

ultrasound

Proton beam radiation

Photodynamic

Question 25

Primary prevention of prostate cancer - education on the _________ of modifiable risk factors; diet, behavioral • Secondary- _________; - ——— - ———- Tertiary- treatment of invasive cancer, ________ care

Answer 25

avoidance ; screening PSA ; DRE palliative

Question 26

Palliative care • This is treatment to ______________ caused by cancer • Improved access to __________ is mandatory for the treatment of moderate to severe cancer pain, suffered by over 80% of cancer patients in terminal phase.

Answer 26

relieve symptoms oral morphine

Question 27

Cervical cancer Background (global) • ____ most common cancer among women worldwide • Victims have their lifespan reduced by_____ yrs

Answer 27

4th 18

Question 28

Cervical cancer In Nigeria….. • ______ most common cancer among women in Nigeria

Answer 28

2nd

Question 29

Aetiology of cervical cancer • The primary cause of cervical pre-cancer and cancer is persistent or chronic infection with one or more of the “______-risk” (or oncogenic) types of ___________________ especially ____ & ___

Answer 29

high human papilloma virus (HPV) 16 & 18 •

Question 30

________ is the most common viral infection of the reproductive tract

Answer 30

HPV

Question 31

HPV is mainly transmitted through ___________ and most people are infected with HPV shortly after the onset of sexual activity

Answer 31

sexual contact

Question 32

Aetiology of cervical cancer • Most HPV infections clear up on their own spontaneously within __________ and most pre-cancerous lesions resolve within ________

Answer 32

a few months ; 2 years

Question 33

• Cervical Cancer develops ________ yrs after HPV infection in women with normal immune system and _____ yrs in those with weakened immune system like those with untreated HIV infection.

Answer 33

15- 20 yrs 5-10 yrs

Question 34

Risk factors for cervical cancer • _____ age of sexual debut • ________ sexual partners • _________ use • Immune suppression eg _____ infection • ________ parity (_________ Ca) • _________________ (____ term use)

Answer 34

Early ; Multiple Tobacco ; HIV High ; Sq cell Oral contraceptives ; Long

Question 35

High parity means having ______ or more previous pregnancies where the gestation period reached 20 weeks or more

Answer 35

5

Question 36

Estrogen and progestin in Oral contraceptives can make the Cervical __________ more susceptible to infection and cellular changes

Answer 36

epithelium

Question 37

Clinical features of cervical cancer • ________ vaginal bleeding • ____________ bleeding • ____________ bleeding • ____________ bleeding • Menorrhagia • Vaginal ____________ or ______ vaginal discharge • Back, leg or pelvic pain • Fatigue, weight loss, loss of appetite

Answer 37

Irregular ; Post menopausal Post-coital ; Intermenstrual discomfort ; foul

Question 38

Detecting CA cervix • _________ testing for high-risk HPV types • ______________________ (VIA)/__________________________ (VILI) • Conventional (_____) test and _______________ (LBC) (diagnosis) • Culposcopy

Answer 38

HPV DNA Visual inspection with acetic acid (VIA) Visual inspection with Lugols iodine (VILI) Pap ; liquid-based cytology (LBC)

Question 39

For age 21-29: Pap test every ______ 30-65:pap test every ______, or _____ test every _______ , or pap/HPV co-test every 5 years

Answer 39

3 years 3 years ; HPV; 5 years

Question 40

Treatment of cervical cancer • For pre-cancer lesions: ________ or _________ and Loop Electrosurgical Excision Procedure (LEEP) • Cancer: Depends on the stage • Surgery • Chemotherapy • Radiotherapy • Palliative

Answer 40

cryotherapy thermal ablation

Question 41

Treatment of cervical cancer(trials) • Recently “________” : an antiviral drug, normally used orally to treat _______ • Has been shown to kill-off the human papilloma virus (HPV) • Self-applied directly to the cervix as a pessary • Long acting injectable form is undergoing clinical trial

Answer 41

Lopinavir HIV

Question 42

Cervical Cancer 5 Year Survival Rates by Stage • Stage 1A- 95 to 99% • Stage 1B- 80 to 95% • Stage 2A- 70-90% • Stage 2B- 60-70% • Stage 3- 30-50% • Stage 4- 20% • Another prognostic factor is ____________(PS)- patient ability to participate in activities of daily life or how well you are overall

Answer 42

Performance Status

Question 43

Prevention of cervical cancer Cervical cancer is a preventable disease, WHO recommends life-course approach to cervical cancer interventions • Primary prevention- girls ______ years • HPV ________ • Education for boys and girls targeted at prevention of risk factors such as sex education on: • high risk sexual behavior, abstinence, provision of barrier methods such as condom; tobacco use

Answer 43

9-14 years vaccination •

Question 44

Prevention of cervical cancer • Secondary prevention- ___ years or older (start at ______ yrs for HIV positive women) • ________ to detect and treat pre-cancerous lesions. Can do _________ testing, _____ test, _____ & _____ at the primary health care level. Regular screening interval of ____ years • immediate treatment of pre-cancerous lesion or as quickly as possible • Tertiary prevention: All women as needed: treatment of invasive cancer, palliative care

Answer 44

30 ; 25 yrs HPV DNA ; pap test VIA ; VILI 3 years

Question 45

Prevention of cervical cancer • Screening is recommended for every woman from aged 30 to 49 at least once in a lifetime • IDEALLY, all sexually active women should have a cervical smear every ____ yrs and _______ after menopause. • Yearly pap smears are also recommended for women with known risk factors such as history of HPV infection, previous positive smear, HIV/AIDS, multiple sexual partners etc.

Answer 45

2 yrs yearly

Question 46

New recommendations of cervical cancer • WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention, second edition • Has a total of ______ recommendations and _____ good practice statements •_________ detection should be used as the primary screening test rather than _____ or _______ in screening and treatment approaches among both the general population of women and women living with HIV

Answer 46

23 ; 7 HPV DNA VIA ; cytology

Question 47

For the general population of women • WHO suggests using either of the following strategies for cervical cancer prevention: • HPV DNA detection in a _______________ approach starting at the age of 30 years with regular screening every _____ to _____ years. • HPV DNA detection in a ____________ approach starting at the age of 30 years with regular screening every 5 to 10 years.

Answer 47

Screen and treat 5:10 screen, triage and treat

Question 48

For women living with HIV • WHO suggests using the following strategy for cervical cancer prevention: • HPV DNA detection in a _______________ approach starting at the age of ____ years with regular screening every ____ to ____ years.

Answer 48

screen, triage and treat 25 years 3 to 5 years.

Question 49

HPV Vaccine • Currently there are _____ licensed HPV vaccines (9-45yrs): • 3 ___valent (________, Cecolin, Walrinvax) • 2 _____valent (________ , ________) • 1 _______valent (_________)

Answer 49

6 3 bivalent (Cevarix • 2 quadrivalent (Gardasil 4, Cervavax) • 1 nonavalent (Gardasil 9)

Question 50

Global Response • World Cancer Day is ______; 2025 theme is : _________

Answer 50

Feb 4th United by unique

Question 51

A WHO global strategy to accelerate the elimination of cervical cancer as a public health problem (73rd WHA 2020): a threshold of ____ per 100 000 women- years for elimination as a public health problem in the next _________

Answer 51

4 century

Question 52

The WHO global strategy The 90-70-90 targets 90% ? 70% ? 90% ?

Answer 52

Of girls vaccinated with the HPV vaccine by age 15 Of women screened with a high performance test by ages 35 and 45 Of women with cervical disease receiving treatment

Question 53

Nigeria • (Slow or fast?) progress in Cancer control in Nigeria • Many factors at play: poor health-seeking behavior, late detection, misdiagnosis, lack of skilled medical manpower, lack of chemotherapy and radiotherapy facilities, high cost of cancer management, poor govt and non-govt funding, • Individuals and communities should take actions to save lives, achieve greater equity in cancer care and make fighting cancer a priority at the highest political level

Answer 53

Slow