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50 Cards in this Set
- Front
- Back
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What is cancer?
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A broad spectrum of disorders. A malignant tumor of potentially unlimited growth that expands locally by invasion and systematically by metastasis which terminates fatally.
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What is the time span from a first atypical cell to a cancer.
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6 years
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What is a carcinoma in-situ?
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A cancer within the lining of the organ in which it starts.
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What is cancer cachexia?
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A series of metabolic events that prevent patients from utilizing nutrition.
Weight loss occurs even in the presence of tube feedings or TPN. No muscle strength or energy. |
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What is the difference between looking at prostate cancer epidemiology in terms of
# of new cases, # of deaths, and # of years of life lost. |
Prostate cancer is very common, so it is #2 in terms of new cases. However it occurs when people are older and it is not fast growing so it drops to #5 in terms of # of deaths. It falls off the top 5 in terms of years of life lost because it occurs when people are older.
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Obesity is a major cause in which three cancers?
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Prostate
Colorectal Breast |
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By what percent do we estimate that diet and exercise (i.e. decreasing obesity) would decrease cancer?
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35%
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What percent of cancer deaths are caused by smoking?
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30%
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True or False: There are dietary supplements that confer the same protective effects against breast cancer as a diet rich in fresh fruits and vegetables and whole grains?
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False
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Name four general categories we have as tools for primary prevention against cancer
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Lifestyle changes
Medications Surgery Vaccination |
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What is the objective of secondary prevention in cancer?
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Reduce mortality (screenings = early detection)
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What is "chemo-reduction"?
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Taking a medication that reduces the risk of cancer.
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Tamoxifen can reduce the risk of breast cancer.
What are some side effects of tamoxifen? |
hot flashes
DVT uterine hyperplasia uterine cancer |
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To which pharmacologic class of drugs does tamoxifen belong?
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SERM (Selective estrogen receptor modulator).
In some tissues (breast) this drug has estrogen-like effects and in other tissues (endometrium) it has estrogen blocking effects. |
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What kind of chemoprevention is available for ovarian cancer?
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Birth control pills.
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What medication helps decrease the rate of colon cancer?
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NSAIDS (especially the COX inhibitors)
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What supplement increases the risk of lung cancer in smokers?
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Beta carotene
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What two drugs were tested in the STAR trial and what was the finding?
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Tamoxifen (standard therapy) was put up against Raloxifene (Evista).
It was found that they had nearly equivalent breast cancer reduction results, but Evista had lower risk of DVT and endometrial cancer. |
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What prophylactic surgeries are offered in HBOC families?
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oopherectomy
mastectomies |
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What prophylactic surgeries are offered in APC/ FAP families?
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colectomy
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Which two virus types of HPV cause 70% of cervical cancer?
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16 & 18
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Which types of HPV cause the most genital warts?
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6 & 11
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Which types of HPV are targeted in the Gardasil immunization?
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16 & 18 (cause 70% of cervical cancer)
6 & 11 (genital warts) |
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How effective is the Gardasil vaccination?
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About 100% against the specific strains.
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How many injections are required for Gardasil?
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3 injections over 6 months.
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For whom is Gardasil approved?
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Girls age 9-26 (recommended around age 11-12)
Boys age 9-18 (for genital warts) |
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When we are tying to detect cancer early in asymptomatic individuals with the goal of increasing cure rates and decreasing morbidity what are we doing?
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Secondary Prevention
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Since the same test can be used for screening and for cancer diagnosis, how do we tell the difference between a screening test and a diagnostic test?
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If you are well you are having the test for the purposes of screening.
If you have symptoms the test is being done for evaluation and possible diagnosis. |
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What six conditions must be present for a screening test to be worthwhile?
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1. The disease has a significant effect on the quality of life.
2. An effective treatment is available. 3. The disease has an asymptomatic period. 4. Treatment is more effective in the early stage (asymptomatic disease). 5. The cost of screening is reasonable. 6. The prevalence of the condition justifies the cost of screening. |
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MRI detects more than 80% of breast cancer. Mammography only detects up to 80%. Why is MRI not used as a screening test for breast cancer?
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Cost. MRI is 15x more expensive
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Distinguish between the terms "incidence" and "prevalence"
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Incidence = # of NEW cases in a specific time frame.
Prevalence = TOTAL # of people with condition at specific point in time. |
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What is the benefit of a highly sensitive test?
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You pick up most of the disease (true positives).
You won't have very many false negatives. |
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What is the draw back of a highly sensitive test?
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You will have more false positives.
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When do you want a highly sensitive test?
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When the cost of missing a disease is high.
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What is specificity
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The probability of testing negative if the diagnosis is absent.
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In cancer screening which would we prefer, sensitivity or specificity?
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Specificity.
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What is the positive predictive value (PPV) of a test?
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The proportion of patients with a positive screening test
who actually have the condition. |
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What is lead time bias?
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A screening test may make it appear that there is longer life by early detection, however it may be that people are not living any longer, they are just aware of the condition for a longer amount of time.
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What is length bias?
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Screening may appear to improve outcomes. However it may be that screenings pick up less aggressive cancers than those that would have been diagnosed due to symptoms. Screenings are more likely to detect slower growing cancers because they are usually done at intervals of a year or longer.
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We find that people who are screened are less likely to die of cancer.
What kind of bias could add to this finding? |
Screening lag time: Screenings are more likely to pick up slow growing cancers.
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How can we overcome screening lag time
when evaluating the effectiveness of screening. |
Look at mortality rates rather than length of time from diagnosis to death.
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What is over-diagnosis bias in screening?
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An indolent tumor that would never have caused clinical disease is diagnosed and treatment. This is an extreme of length bias.
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What is selection bias in screening?
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The group that is studied is not representative of the population as a whole
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What screening is recommended for the general population r/t colon cancer?
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Colonoscopy begin at age 50, then every 10 years if normal.
(less frequently used - flex sig every 5 years, brium enema every 5, fecal occult blood testing) |
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Does fecal occult blood testing detect precancerous lesions?
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No, it detects cancer.
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What is the recommendation for screenings related to breast cancer?
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Yearly mammogram beginning at age 40
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What is the recommendation for screenings related to cervical cancer?
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Begin paps 3 years after first vaginal intercourse or at age 21.
Stop paps at age 70. If reach age 30 with normal paps can go every 2-3 years. |
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What is the recommendation for screenings related to prostate cancer?
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Talk to your doctor at age 50
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True or False?
There can be reduced mortality as a result of screening for ovarian cancer? |
False.
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How many atypical breast cells progress to carcinoma in situ?
How many carcinoma in situ progress to invasive cancer. How many invasive cancers go on to systemic metastses? |
30% abnormal cells progress to carcinoma in situ
20% of carcinoma in situ progress to invasive cancer. Invasive may or may not progress to systemic metastasis |
