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37 Cards in this Set
- Front
- Back
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Name 3 types of cancers caused by infectious agents
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1. Cervical (HPV)
2. Stomach (H. pylorri) 3. Liver (Hepatitis) |
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Stages of cancer from transformation to metastasis
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1. Transformation
2. Angiogenesis 3. Motility and invasion 4. Embolism and circulation 5. Arrest in capillary beds 6. Adherence 7. Extravasation 8. Tumor proliferation 9. Metastasis |
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When should screening be undertaken?
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- effectiveness is proven
- sufficient resources to cover target group - facilities exist for confirming diagnosis - facilities exist for treatment - high enough disease prevalence to justify costs and efforts of screening |
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What 4 cancers do we routinely screen for?
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1. female breast cancer
2. cervical cancer 3. prostate cancer 4. colon and rectal cancer |
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What do we use to screen for female breast cancer?
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mammography
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What do we use to screen for cervical cancer?
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Pap smear
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What do we use to screen for prostate cancer?
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serum PSA
digital rectal exam |
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What do we use to screen for colon and rectal cancer?
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fecal occult blood
colonoscopy |
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What's sensitivity?
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- Probability that given a disease, the pt tests positive
- ability to correctly detect disease - 100% - False Negative rate |
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What's specificity?
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- Probability that given no disease, pt tests negative
- ability to avoid calling normal things disease - 100% - False Positive rate |
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Se = ?
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TN/total with disease
-do not depend on prevalence |
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Sp = ?
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TN/total without disease
-do not depend on prevalence |
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PPV = ?
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TP / # test pos
- depends on the prevalence of the disease |
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NPV = ?
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TN / # test neg
- depends on the prevalence of the disease |
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p = ?
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(# with disease) / total
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Cervical cancer risk factors
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1. smoking
2. failure to get regular pap smears 3. HPV infection (sex at an early age, multiple sex partners) |
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What is used to diagnose cervical cancer?
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Colposcopy + biopsy
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What is used to treat cervical cancer?
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surgery, radiation, chemo
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List some new technologies for cervical cancer
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- liquid based Pap testing
- automated Pap smear screening - HPV testing - HPV vaccine - VIA |
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Cancers for which screening tests are needed
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lung, ovarian
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Controversial screening tests
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serum PSA for prostate cancer
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Ovarian cancer whispers
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- constant feeling of fullness
- pain during intercourse - abnormal bleeding - pelvic/abdominal discomfort |
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3 ways to detect ovarian cancer
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1. pelvic and rectal exam
2. CA-125 3. transvaginal ultrasound |
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How to diagnose ovarian cancer?
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diagnostic laparoscopy
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How to calculate cost per cancer found?
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work through lecture 10 examples
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Risk factors for prostate cancer
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1. age
2. race 3. family history |
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Signs and symptoms of prostate cancer
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- often asymptomatic in early stages
- weak/interrupted urine flow - inability to urinate |
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Treatments for localized prostate cancer
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1. radical prostatectomy
- serious side effects: impotence, incontinence, infertility 2. conservative management (just watch until symptoms develop) |
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Should we screen for prostate cancer?
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YES:
- localized prostate cancer is curable - advanced is fatal - some studies (not RCTs) show decreased mortality in screened pts NO: - false positives lead to unnecessary biopsies - over-detection of latent cancers (pts die of other causes first) - no RCTs showing decreased mortality |
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What is PSA?
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- prostate-specific antigen
- glycoprotein responsible for liquefaction of semen - highly specific for prostate |
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Cost to screen?
Cost per cancer? |
(Screening cost/person)*(people screened) + (biopsy cost/person)*(biopsies performed)
cost per cancer = ^above value on total money spent / TP cases |
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What do cancer screening exams test for?
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- cellular changes (pap)
- serum proteins (CA-125, PSA, Ovacheck) - genetic changes (HPV DNA, mutations in BRCA1/2) |
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What is the goal of cancer screening?
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- detect cancers at an early stage for higher survival rates
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Successful cancer screening examples?
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Pap, colonoscopy, digital rectal exam?
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Can screening hurt more people than it helps?
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Yes, if:
- resources for treatment aren't available - biopsies may cause harm - low prevalence of the disease |
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What are some challenges in cancer screening?
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- detection at an early age
- Se/Sp |
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Is cancer screening a good investment?
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Depends...?
- need to target the correct population |
