1
Q
Role of the PCP in cancer?
A
- prevention
- screening
- dx
- management of sxs:
due to cancer
due to tx
2
Q
How can cancer be prevented?
A
- tobacco cessation
- nutrition
- physical activity
- alcohol consumption
- wt managment
- excess sun exposure
- decrease medical radiation
3
Q
Most common cause of preventable cancer death?
A
- tobacco
- 30% of cancer deaths in US are directly linked to tobacco
- responsible for at least 15 types of cancers:
lung cancer is primary cancer type, 80% of cases of lung cancer occur in smokers
4
Q
How can good nutrition prevent cancer?
A
- diet rich in fruits and veggies lower risk of several GI cancers: esophageal, stomach, colon
- lycopene intake (tomatoes) is inversely assoc with development of prostate cancer
- consumption of low fat dairy products is inversely assoc with development of breast cancer
- high intake of red meat assoc with increased risk of colon cancer
5
Q
Correlation of DM pts and cancer?
A
- pts with DM (primarily 2):
have 2 fold or greater risk of cancers of liver, pancreas, and endometrium - slightly lower but increased risk for cancers of colon, breast, and bladder
- risk of prostate cancer is decreased
6
Q
Physical activity and cancer risk?
A
- sedentary lifestyle is assoc with 5% of cancer deaths
- in pts who don’t smoke - physical activity along with wt control and diet are most impt modifiable risk factors
- increased physical activity can decrease risk of these cancers:
liver
pancreas
stomach
endometrial
prostate - most compelling assoc with breast and colon cancers (24-27% reduction in colon cancer, 15% reduction in colon polyps)
increased activity during adolescence seems to have protective effect against breast cancer
7
Q
How does exercise decrease cancer risk?
A
- decreased insulin levels
- improved immune fxn
- altering levels of:
hormones
growth factors
prostaglandins
bile acid metabolism
8
Q
Excessive ETOH is linked to increase risks of what cancers?
A
- head and neck
- esophageal
- liver
9
Q
Obesity is related to increased risks of what cancers? Est to cause up what % of cancers?
A
- breast
- uterine
- colorectal
- esophageal
- renal
- est to cause up to 20% of all cancers
- 60% reduction in cancer mortality following bari surgery
10
Q
How can radiation cause cancer? Most common cause of radiation assoc cancers?
A
- medical/ionizing
- effects are cumulative
- avg annual radiation dose in US has risen steadily over last 30 yrs
- majority from CT scans - 1 CT = 200 CXRs
- 75% of all CTs are ordered in acute care settings
- CT scan use may account for up to 2% of cancers in the future
11
Q
How does ionizing radiation cause cancer?
A
- causes electrons to detach from subatomic particles forming ions
- free radicals are produced:
interfere with chemical bonds
DNA mutation or cell death
damage to essential cellular enzymes - radiation induced cancers may develop decades after exposure
- any amt of radiation can induce future cancer
- to protect pts: medical imaging studies must be limited and justified
12
Q
What organs have very high and high sensitivity to ionizing radiation?
A
- very high: embryonic, lymphoid organs, bone marrow, blood, testes, ovaries, small intestines
- high: skin, lens and cornea of eye, most GI organs (mouth, esophagus, stomach and rectum), bladder and uterus
13
Q
What organs have medium, low and very low sensitivity to ionizing radiation?
A
- medium: growing cartilage, growing bones, blood vessels
- low: mature cartilage or bone, pituitary gland, lungs, thyroid, pancreas, kidneys, adrenal glands
- very low: brain, spinal cord and muscles
14
Q
What are radiation induced cancers?
A
- myeloma
- leukemia
- lung cancer
- thyroid cancer
- breast cancer
- bone cancer
- skin cancer
15
Q
How does excess sun exposure leave you at increased risk for cancer?
A
- UV radiation causes genetic mutations and interferes with body’s ability to reject abnormal cells:
risk of squamous cell and basal cell cancer appear to correlate with total lifetime sun exposure
repeated blistering sunburns seems to have higher correlation with melanoma - UV radiation from tanning beds:
human carcinogen
75% increase in risk for melanoma in pts who utilized tanning booths b/f 35YO
16
Q
Definition of neoplasia?
A
- (new growth) abnormal proliferation of cells in a tissue or organ
- synonymous to tumor
17
Q
Definition of hyperplasia? Hypertrophy?
A
- prolieration of cells w/in an organ that may result in gross enlargement in response to physiological stimulus
- remains under normal regulatory control mechanisms
- hypertrophy: increase in cell size
18
Q
Definition of dysplasia?
A
- early form of pre-cancerous transformation detected in a bx or pap-smear
- cells are diff from tissue of origin
19
Q
What is carcinoma “in situ’?
A
- cancer in place, cells ahve lost their tissue identity, growth is rapid and w/o regulation
20
Q
What is an invasive carcinoma?
A
- invading beyond original tissue layer or location
- may be able to spread to another part of the body (met)
21
Q
What is metaplasia? Progression of metaplasia?
A
- changes in response to chronic physical or chemical irritation such as cigarette smoking that causes the mucus secreting ciliated epithelium to be replaced by squamous epithelium
- this change is benign and reversible to certain limit
- Cells may progress from 1 stage to the next:
metaplasia to dysplasia to neoplasia
22
Q
Most common cancer in men? Women?
- Who has higher rate of cancer?
A
- men = prostate
- women = breast
- men have always had increased rate of cancer (enviro?)
23
Q
What race has highest incidence of cancer? Lowest?
A
- highest - non-hispanic blacks (men), non-hispanic whites - melanoma, breast, thyroid and lung cancer (women)
- lowest: Asian/Pacific islander (both men and women)
24
Q
Most deaths result from which types of cancer?
A
- men: lung and bronchus (28%), prostate (9%)
- women: lung and bronchus (26%), breast (15%)
25
Even though most cancer death rates are decreasing, what cancer has increasing death rate?
- in both men and women: pancreas and liver has increasing death rate
26
Highest cancer death rates by race?
- highest - non-hispanic blacks (both M&W)
| - lowest - Asian/pacific Islander (M&W)
27
Most common type of cancers among kids (0-14) and adolescents (15-19)?
- kids: leukemia (52%), and then Brain and CNS
| - adolescents: Brain and CNS and leukemia
28
Top 3 causes of cancer death in children and adolescents?
- children:
brain/CNS
leukemia
soft tissue (heart included)
- adolescents:
leukemia
bone and jts
Brain/CNS
29
What cancer has higher 5 yr survival rate in children and adolescents, brain/CNS or leukemia?
- kids: leukemia
| - adolescents: brain/CNS
30
What is palliative care?
- affirms life, sees death as personal and natural process
- many dxs
- appropriate early in course of illness
- combined with disease modifying therapies or may be focus of goals of care
- interdisciplinary care of the pt and family
- psychological, social and spiritual support
- focuses on relieving suffering, improving quality of life
- pain and sx management
- bereavement support
31
Which cancer is the most deadly (has worst survival rate)?
- pancreatic cancer
