Giwk4- 3-24 Cancer Prevention Dew

Front 1

What is screening considered?

Back 1

secondary prevention

Front 2

Second most common cause of cancer death in US?

Back 2

colorectal cancer

Front 3

What is lifetime risk of dying of colorectal?

What % of pts have regional and distant metastisis at diagnosis?

Back 3

2.6%

60%

Front 4

Most common type of Colorectal cancer?
Common area?
Uncommon type?

Back 4

Adenocarcinoma- 62% distal and 38% proximal from benign adenoma

- Carcinoid arise from enterochromaffin usually appendix or rectum

Front 5

Squamous and Melanoma carcinoma of rectum

Back 5

Squamous cell carcinoma – uncommon form;
located in the anal canal.
• Melanoma – rare; usually presents as pigmented lesion adjacent to dentate line (red to skin color of butt).

Front 6

Five-year surival based on Dukes' classification of colorectal cancer
Stages: 5- year survival
a.
b1.
b2.
C1
C2
D.

Back 6

a. 80%
b1- 65%
b2- 50%
c1- 40%
C2- 10%
D- <5%

Front 7

Benign adenoma takes how long to metastasize?

Back 7

10-15 yrs

Front 8

For right sided Adenocarcinoma give 4 main sign/symptoms of colorectal cancer

Back 8

– Anemia
– Pain and/or mass in right lower quadrant
– Occult blood in stool
– Change in appearance of stool (infrequent)

Front 9

For left sided Adenocarcinoma give 3 main sign/symptoms of colorectal cancer

Back 9

– Change in bowel habits (may be constipation or diarrhea)
– Reduced caliber of stool
– Red blood mixed in stool

Front 10

For adenocarcinoma located in the Rectal adenocarcinoma what are the three main symptoms?

Back 10

Bright red blood
Tenesmus
Mass on digital exam

Front 11

For the following presentations what area is the adenocarcinoma...
1. Bright red rectal bleeding, Tenesmus, Mass on digital exam
2. Change in bowel habits, reduced caliber, red blood mixed in stool
3. anemia, occult blood, pain or mass in RLQ

Back 11

1. Rectal Adenocarcinoma
2. Left sided
3. Right sided

Front 12

Risk factors for Colorectal Cancers...

Back 12

a. Age >50
b. Fam Hx
c. Previous hist
d. Previous endometrial, ovarian, breast
e. UC
f. Familial Polyposis
g. Benign adenomas
H. diet low in fibers

Front 13

5 Screening tests for Colorectal cancer?

Back 13

1. Digital rectal exam- not very good due to size of finger
2. Fecal occult blood test- (blood that can not be seen in blood)
3. Sigmoidoscopy (sigmoid colon only)-
4. Colonoscopy (entire colon)
5. Barium enema- not as frequently used

Front 14

Interpretations of screen tests...
punnet square... (a,b,c,d) labels and Horizontal/vertical squares

Back 14

Horizontal- Condit present, condition absent
Verti- Pos. test, Neg test
a. true pos
b. false pos
c. false neg
d. true neg

Front 15

What is the formula for the following using punnet square from screen tests (a,b,c,d)
Sensitivty
Specificity
Pos. Predictive Value
Neg. Predictive Value

Back 15

sensitivity - A/(A+C)
Specificity- D/(B+D)
Pos. pred value- A/(A+B)
Neg pred value- D/(C+D)

Front 16

Define the following terms in words...
Pos. Predictive Value
Neg. Predictive Value

Back 16

Pos- Proportion of persons with positive test who have condition
Neg- Proportion o fpersons with negative test who do not have condition

Front 17

Define the following terms in words...
Sensitivty
Specificity

Back 17

Sensitivity- Proportion of persons with condition who test positive

Specifity- Proportion of persons without condition who test negative.

Front 18

What are the biases associated with screening?

Back 18

Lead time
Length time
Both biases make the reported "What we should see at this point, or year prognosis" seem better than it actually may be.

Front 19

Lead time bias means?

Back 19

Bias due to diagnosing before disease actually occurs
Bias that occurs when screening detects disease earlier in its natural history than would otherwise have happened, so that the time from diagnosis to death is lengthened. Having additional lead time does not alter the natural history of the disease and, therefore, does not extend the length of life.

Front 20

length time bias?

Back 20

Length bias is when only lesser diseases length to death reported making it seem that disease path is longer, but more problematic diseases would result in death early and therefore would not go reported.

Front 21

U.S. Preventive Services Task Force concerning screening for gastro‐intestinal tumors (secondary prevention)

Back 21

1. >50 yrs screened with fecal occult blood test (FOBT) annually, and/ or sigmoidoscopy 5-10 yrs
2. Family hx screened earlier
3.

Front 22

What is recommended primary prevention for colorectal cancers?

Back 22

1. healthy diet- no excessive meat intake
2. weight
3. Avoid fat, saturated fat, and cholesterol
4. sugar and salt moderation
5. smoking initiation (BAD), cessation
6. NSAID, COx inhib, calcium and selenium (lower incidence of cancer)

Front 23

Fifth leading cause of cancer death in US

Back 23

pancreatic cancer
- more black and Hawaiians
Male- 62
Female- 67

Front 24

At time of diagnosis for pancreatic cancer what are the most higher percentage of symptoms... top 5

Back 24

1. weight loss
2. malnutrition
3. pain
4. jaundice
5. hepatomegaly

Front 25

Task force Screening Tests for pancreatic tests

Back 25

no recommended test or marker for prevention
- tobacco use counseling, fat and cholesterol, and food recommendations

Front 26

Oral cancers include
- Screening available

Back 26

lip, tongue, pharynx, and oral
Inspection and palpation of the oral cavity (includes careful visual examination using a dental mirror and digital palpation using a gloved hand
for masses)

Front 27

Causes of oral cancer...

Back 27

1. Tobacco
2. Snuff
3. Alcohol
4. UV light exposure
5. Riboflain or iron def. and plummer-viinson syndrom
6. Betel nut or leaf chewing

Front 28

What are the two main types of liver cancers?

prevalence?
amoung cirrhotics?
More prevalent in?

Back 28

• Hepatocellular carcinoma
• Cholangiocarcinoma

1-5 new cases per 100,000 population per year
2-5/100 per year
Asians

Front 29

Three s/s most common in Liver cancers...

Back 29

1. Abdominal pain (80%)- Right upper quadrant, dull ache to severe, aggravated by jolting
2. Hepatomegaly (80-90%)- Irregular, nodular, firm to hard, tender
3. Weight Loss (30%)

Front 30

Risk Factors for liver cancer

Back 30

1. Primary Liver Disease – cirrhosis, chronic active hepatitis
2. HBsAg positivity, (age when first infected most important)- Hep B
3. Presence of anti-HCV antibodies
4. Chronic use of oral contraceptives
5. Hemachromatosis
6. Alpha-1-antitrypsin deficiency
7. Primary biliary cirrhosis

Front 31

What are the main primary prevention for Liver cancers?

Back 31

AVOID GETTING HEPatitis by getting vaccine!
Also- safe sex, careful with blood, screen all pregos for hepB, post-exposure prophylaxis, moderate alcohol

Front 32

What type of screening is available for Liver cancer?
Task force recommendation?

Back 32

1. AFP- (alpha-fetoprotein),
2. Ultrasound
3. CT
Not recommended for routine

Front 33

In the last 60 yrs which cancer has decreased markedly in incidence and mortality?
More prevalently seen in?

Back 33

Stomach Cancer- Gastric cancer rates greater among persons of lower socioeconomic status

Front 34

Stomach Cancer.. risk factors?

Back 34

1. Long term ingestion of high concentrations of nitrates in dried, smoked and salted foods (through transformation to carcinogenic nitrites)
2. Role of Helicobacter pylori
3. Achlorhydria, atrophic gastritis and pernicious anemia in the elderly
4. Individuals with blood group A

Front 35

Screening tools for stomach cancer?

Back 35

not recommended for asymptomatic
- Barium meal for radiographic with epigastric complaints
- Gastroscopic biopsy for patients with gastric ulcer