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MEDS 532 Cancer

Terms in this set (98)

what is cancer?
a group of more than 100 different diseases that are characterized by uncontrolled cellular growth, local tissue invasion and distant metastases
how is cancer thought to develop?
from a cell in which the normal mechanisms for control of growth and proliferation are altered
what treatments are used for cancer?
surgery, radiation, chemotherapy, hormone therapy, immune therapy, and targeted therapy
cancer is the _____ leading cause of death in high income countries?
2nd
cancer is the ___ leading cause of death in low/middle income countries?
3rd
in 2012 according to IARC how many new cancer cases were there?
14.1 million new cancer cases and 8.2 million cancer deaths worldwide
by 2030 what is the global burden expected to grow to
expected to grow to 21.7 million new cancer cases and 13 million cancer deaths
cancer survival rates are affected by what factors?
-type of growth
-type of cancer
-available treatments
-stage of diagnosis
-screenings and treatments
what is the 5 year survival rate for breast cancer in the US
2005-2009 is 89%, compared with 53% in South Africa and 60% in Algeria
what cancers affected by screenings show differences in survival between developed and developing countries
female breast, colorectal, and certain childhood cancers
what cancers without early detection don't show differences in survival between developed and developing countries
esophagus, liver, lung, or pancreatic cancer
what are the top five cancers for males
lung, prostate, colorectal, stomach, liver
what are the top five cancers for women?
breast, colorectal, lung, cervix, stomach
Why is there Geographic Differences in Cancer Prevalence?
-Variations in age structure
-Prevalence of risk factors
-Availability and use of diagnostic tests
-Availability and quality of treatment
almost 1.5 million of the estimated 8 million cancer deaths in the world were caused by ___
smoking
between 1/5th and 1/4th of cancers worldwide are related to
overweight or obesity, physical inactivity, and/or poor nutrition
Many of the cancers related to infectious agents, such as HPV, HBV, HCV, HIV, and H. pylori, could be prevented through ...
vaccines
Many cases of skin cancer could be prevented by protecting skin from..
from excessive sun exposure and avoiding indoor tanning
how is cancer staged?
based on the size or extent of the primary tumor and whether it has spread to nearby lymph nodes or other areas of the body
what do clinicians use as staging system
TMN system
What are the 3 ways TNM system assesses cancer growth and spread
Size of the primary tumor (T), absence or presence of regional lymph node involvement (N), and absence or presence of distant metastases (M)
how are the stages assigned?
stage of 0, I, II, III, or IV is assigned, with stage 0 being in situ, stage I being early, and so on, with stage IV being the most advanced disease
what are the cancer costs?
substancial
direct: care, treatment and indirect costs: childcare, transportation
what is global cancer day
feb 4
what are the 4 broad approaches Who emphasizes to fight cancer
1. prevention
2. early detection
3. diagnosis and treatment
3. palliative care
what are the goals of primary prevention
reduce or eliminate exposure to cancer-causing factors, which include modifiable factors related to tobacco use, nutrition, physical inactivity, occupational exposures, and chronic infections
what are some examples of primary prevention
1. Immunization against, or treatment of, infectious agents that cause certain cancers (HPV, HBV)
2. Application of effective tobacco control measures (Framework Convention on Tobacco Control)
3. Reduction of excessive alcohol consumption
4. Maintenance of healthy body weight and physically active lifestyles
5. Dietary intervention
6. Avoidance of excess sun exposure
7. Reduction in occupational exposure to carcinogens
why is the gol of secondary prevention?
to detect precancerous changes or early stage cancers when they can be treated most effectively
what rank is colorectal cancer in terms of common cancer for men/women?
2nd -men
3rd - women
where are the highest incidence rates for colorectal cancer?
Northern America, Australia, New Zealand, Europe, and South Korea
where are the lowest incidence rates for colorectal cancer?
Africa and South Central Asia
what is the reason for variation in colorectal cancer?
diet
why is the pathophysiology
colon cells become overactive and create bulbs that become polyps
-polyps usually benign but can grow and mutate into cancerous tumors
-tumors grow and burrow into the muscle and get into lymph and blood
what are the potential sites of colorectal cancer?
26% ascending
13% transverse
6% descending
26% sigmoid
27% rectum
what are the signs and symptoms of colorectal cancer?
-A change in bowel habits
-Feeling that the bowel is not completely empty
-Rectal bleeding
-Blood in stool
-Abdominal pain
-Weakness & fatigue
-Unintended weight loss
what are modifiable risk factors for colorectal cancer?
1. Being overweight or obese
2. Physical inactivity
3. Certain types of diets
4. Smoking
5. Heavy alcohol use
what is the % increase risk for people who smoke for colorectal cancer?
Compared to never-smokers, the risks of colorectal cancer and mortality in smokers were 18% and 25% higher, respectively
what are non modifiable risk factors for colorectal cancer?
1. Age > 50 years old (risk increases with age)
2. A personal or family hx of colorectal polyps or colorectal cancer
3. A personal history of inflammatory bowel disease
4. Genetic predisposition
5.Your racial and ethnic background
6. type 2 diabetes
what are the genetic factors related to colorectal?
Familial Adenomatous Polyposis (FAP) - 0.5% cases
Presence of APC gene mutation increase polyps, 100% risk for colon cancer by ages 40 - 50
what are the racial and ethic backgrounds most at risk for colorectal cancer?
Ashkenazi Jews
African Americans
why are processed meats risk for colorectal cancer?
(which)
-nitrates and carcinogens
-ham, salami, sausages and hot dogs - as a Group 1 carcinogen
at what age do colon cancer screenings start?
50
what tests find polyps and cancer
1. Flexible sigmoidoscopy (FSIG) every 5 years*, or
2. Colonoscopy every 10 years, or
3. Double-contrast barium enema (DCBE) every 5 years*, or
4. CT colonography (virtual colonoscopy) every 5 years*
5. Fecal occult blood test (FOBT yearly)
why are FOBT's used more frequently?
in low income areas, it is inexpensive and easy to perform so is more practical screening option
in what communities are lo screaming rates observed?
1. 50 -64 years old
2. Lower incomes
3. Little or no health care coverage
4. Fewer years of education
what are the prevention methods for colorectal cancer?
1. NSAIDs, aspirin and COX-2 inhibitors
2. Calcium supplementation or calcium rich diet and/or Multi-vitamin with folic acid and Vitamin D
3. Hormone replacement therapy
4. Maintain a healthy diet
5. Stay physically active- achieve and maintain a healthy weight
6. Limit consumption of alcoholic beverages
7. Recommend smoking cessation
how do COX2 inhibitors work?
COX-2 inhibitors (Celecoxib) decrease number of polyps in patients with FAP
what is the treatment for colorectal cancers that have not spread?
surgical removal may be curative
what is the treatment for colorectal patients whose cancer has penetrated bowel wall or spread to lymph nodes?
Chemotherapy alone, or in combination with radiation, is given before (neoadjuvant) or after (adjuvant) surgery
what are the 2 main types of lung cancer?
small and non small cell lung cancer
what are the types of NSCLC?
Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma
what are the % of the different cancers?
NSCLC: About 80% to 85%
SCLC: About 10% to 15%
what are the sign and symptoms for advanced lung cancer?
1. A cough that does not go away or gets worse
2. Coughing up blood or rust-colored sputum
3. Chest pain that is often worse with deep breathing, coughing, or laughing
4. Hoarseness
5. Weight loss and loss of appetite
6. Shortness of breath
7. Feeling tired or weak
8. Infections such as bronchitis and pneumonia that don't go away or keep coming back
9. New onset of wheezing
what are modifiable risk factors for lung cancer?
1. Tobacco Smoke
2. Exposure to radon
3. Exposure to asbestos
4. Other workplace exposures
5. Certain dietary supplements
what are non-modifiable risk factors for lung cancer?
1. Previous radiation therapy to the lungs
2. Air pollution
3. Personal or family history of lung cancer
what are environmental risk factors for lung cancer?
-radon
- asbestos
-diesel exhaust
-air pollution
what is radon?
-the second leading cause of lung cancer, and is the leading cause among non-smokers
-naturally occurring radioactive gas that results from the breakdown of uranium in soil and rocks
what is a lung cancer screening?
low-dose CT (also called low- dose spiral or helical CT) can help lower the risk of dying from lung cancer
what are the criteria for candidates of lung screening?
-55 to 74 years old (yearly)
-In fairly good health
-Have at least a 30 pack-year smoking history
-Are either still smoking or have quit smoking within the last 15 years
what do patients need to know regarding screenings?
-even if you fit all criteria discuss with doctor about getting screened
-what to expect from screenings (harms and benefits)
-cost
-screening doesn't reduce mortality
what is one of the most preventable cancers?
lung cancer
what is the trend of prevalence in tobacco control and cancer?
comprehensive tobacco control programs in many states have markedly decreased smoking rates and accelerated the reduction in lung cancer occurrence
what treatment is used for early stage NSCLC?
surgery is usually the treatment of choice; chemotherapy (sometimes in combination with radiation therapy) may be given as well
what is the treatment for advanced stage NSCLC?
chemotherapy, targeted drugs, or some combination of the two
what is the downfall of chemotherapy alone or combined with radiation is the usual treatment for SCLC
a large percentage of patients experience remission, though the cancer often returns
what is the most lethal cancer?
lung cancer
what is the survival rate of lung cancer?
Five-year net survival is generally similar worldwide, ranging from about 10% to 20%
Metastatic (Stage IV NSCLC) has a 5-yr survival rate of about 1%
what is the most commonly diagnosed cancer among women worldwide?
breast cancer
where is the incidence rate for breast cancer highest (1&2)?
-Asian countries have the largest burden of breast cancer, with 39% of new cases, 44% of deaths, and 37% of the world's 5-year survivors
-Northern America accounts for 15% of new cases, 9% of deaths, and 17% of survivors
.
where is the incidence rate for breast cancer a bit lower?
African countries represent 8% of the total new cases and 12% of breast cancer deaths
why re the population differences in terms of breast cancer?
-rates increased due to length of hormones in your body
-distribution of ER+ & ER- BC with distinct age patterns (bad testing)
-quality of tissue preservation and adherence to testing protocols
what are differences in incidence rates between Western and Eastern
higher in Northern and Western European countries than in Eastern Europe
what is another country that has high incidence rate?
Israel least 1.5 times higher than other Asian countries, which may be in part due to the high prevalence of BRCA1 and BRCA2 mutations in the Ashkenazi Jewish population
when do rates increase rapidly?
age 50
why do low risk areas see rising rates of breast cancer?
-economic development and urbanization
-delayed childbearing years
-fewer children
-decreased breast feeding
-screening and awareness
where has mortality been stable/decreasing since 1990 and why?
US, Canada, and many European countries d/t early detection through mammography and improved treatment
where has mortality rates been increasing?
Asia, Africa, Latin America reflecting lack of treatment
-Japan and Korea (lack of mammography)
what is the pathophysiology of breast cancer?
-starts when cells in the breast begin to grow out of control
-can become metastatic
what are the different types of breast cancer?
-carcinomas --> most begin in the ducts the cray milk to the nipple (IDC)
-some start in the glands the make breast milk (ILC)
what is the etiology of breast cancer?
unknown
what may lead to tumor initiation and progression?
-up-regulation of the estrogen receptor known to stimulate breast cell proliferation
what are the genetic risk factors?
5-10% are hereditary
-inherited mutations in BRCA1 and BRCA2
-HER2
how can you detect the earliest sign of abnormality?
mammogram
what is the most common symptom of breast cancer?
lump or mass in the breast, which is usually painless
what are modifiable risk factors for breast cancer?
1.Alcohol consumption
2.Obesity & BMI
3.Physical inactivity
4.Diet (High fat intake)
5.Birth control
6. Hormone therapy after menopause
7.Smoking?
what is heavy drinking
(2-5 drinks/day)
what menopausal status shows association
Postmenopausal women: increased incidence of breast cancer with increasing weight
what are non-modifiable risk factors for breast cancer?
1. Female gender
2. Age (80% diagnosed > 50 years of age)
3. Certain Inherited genes
(BRCA -1, BRCA -2 genes)
4. Family/personal hx
5. Race & ethnicity
6.Dense breast tissue
7. Prolonged estrogen stimulation
8. Radiation to chest
9. Long phases of uninterrupted ovulation
(Nullparity or first pregnancy after age 30)
how does family history influence risk factors?
1. One 1st degree relative = two fold increase
2. Two 1st degree relatives = four fold increase
what ethnicities are at risk for breast cancer?
White > African Americans > Asians
how much do mammographies reduce risk of dying
breast cancer by 15% to 20%
where have they put in place prevention and awareness?
sudan -> females conducting exams
malayasia -> public awareness
when should women do monthly breast exams self
>20 at risk
when should women have screening mammograms?
women age >40
what are current prevention trials ongoing?
LCIS & DCIS
-considering the use of Tamoxifen for 5 years as a preventative measure in LCIS, DCIS (decreases risk 40-60%)
what are other healthy lifestyle modifications
Decrease alcohol intake, maintain healthy weight, engage in regular activity
what are some cultural reasons for late stage diagnoses
1. cancer fatalism
2. cultural acceptance
3. male doctors
what are the survival rates for breast cancer?
Survival rates for breast cancer are 85% or higher in the US, Canada, Australia, Israel, Brazil, and many Northern and Western European countries but are 60% or lower in many developing countries, such as South Africa, Mongolia, Algeria, and India
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