General cancer information

General lifetime risk of cancer in the US?

specifically:

Prostate (men only)

Breast

- women

-men

Lung & bronchus (both sexes)

CRC (both sexes)

Uterine

Ovarian

1/3 women

1/2 men

rates: depend on age, race, and geography

Prostate (men only): 1/8

Breast

- women: 1/8

-men: 1/1000

Lung & bronchus (both sexes): 1/16

CRC (both sexes): 1/24

Uterine: 1/32

Ovarian: 1/87

What are the most to the least common cancers for adult men (AMAB)?

Prostate

Lung

CRC

Urinary

What are the most to the least common cancers for adult women (AFAB)?

Breast

Lung

CRC

Uterine

What are the most to the least common cancers for children?

Leukemia

Brain/CNS

Soft tissue

Non-Hodgkin Lymphoma

What ranking is for the leading cause of death (adults & kids)?

2nd leading COD for all ages. 4th for adults and 2nd for kids

Most to least common cancer deaths for adult men (AMAB)?

Lung

Prostate

CRC

Most to least common cancer deaths for adult women (ADAB)?

Lung

Breast

CRC

What are the general five-year survival rates for:

Prostate

Breast

CRC

Lung

Pancreatic

Prostate- 100%

Breast- 89%

CRC- 65%

Lung- 16%

Pancreatic- 4%

What are the median ages of cancer for (should know generally):

NEED TO KNOW:

All

CRC

Uterine

Ovary

Breast

Prostate

Should know:

Lung

Pancreatic

Leukemia

- ALL

-AML

Renal

Cervix

Thyroid

Hodgkin lymphoma

Testis

NEED TO KNOW:

All- 67y

CRC -72y

Uterine- 63y

Ovary- 63y

Breast- 61y

Prostate- 68y

Should know:

Lung- 70y

Pancreatic- 72

Leukemia- 68y

- ALL- 12y

-AML- 68y

Renal- 65y

Cervix - 47y

Thyroid - 46y

Hodgkin lymphoma- 37y

Testis- 34y

What are the recommended cancer screening for population?

Br

CRC

Cervical

Uterine

Prostate

Ovarian

Br:

- 40y or older: Annual mammogram and clinical encounter

- 25-39y: clinical encounter every 1-3y

- Breast density impacts screening: ex. 6-12m/o for clinical encounters, extremely dense recommended MRI)

CRC: starts at 45y

- cscope every 10yrs (if no polyps)

- flexible sigmoidoscopy every 5yrs

methods that cannot remove anything:

- double contrast barium enema every 5 yrs

-CT colography (virtual colonoscopy) every 5yrs

Cervical:

- 21-29y: papsmear every 3 yrs

- 30-65: papsmear and HPV test every 5yrs

- >65y: no screening unless hx of cancer/pre-cancer

Uterine: based on p/fhx

Prostate: individual decision to screen or not. PSA (blood test)/ rectal exam at 50y

Ovarian: no agreed-upon screening

What questions are always important to ask?

current ages

age of dx of ca and age at death

surgical hx of unaffected individuals

laterality of tumors in paired organs like breast

Environmental factors (like geographics w/ skin cancers)

Bonus:

- death/pathology/medical records

- tx modes

- confirm differences in types of cancers like cervical vs uterine

common pedigree pitfalls

history more accurate when patient is affected

br and colon have better accuracy than ov, endometrial, and prostate cancer. ex: "female ca"

not all skin ca are melanomas

Beware of metastatic spread

Truncated family history

What cancer types are common metastatic spread (like a secondary)?

Brain- primary ca usually lung, breast, melanoma, renal-cell, CRC

Lung- primary ca usually renal-cell, CRC, melanoma, breast, sarcoma

Liver- primary ca usually CRC, pancreatic, breast, lung, stomach

Bone- primary ca usually breast, lung, prostate, renal-cell, CRC,

what are some clues to hereditary cancer syndromes?

ca in 2 or more close relatives in same lineage

earlier onset age

multiple primary tumors

tumors types consistent w known syndrome like breast and ovarian or colon and uterine

cancer in every generation

abnormal tumor markers: triple negative breast ca or absence of MSH2 by IHC

What factors impact penetrance?

modifier genes

environmental factors/lifestyle: smoking, EtOH, asbestos

response to DNA damage (b/c of modifier genes)

Reproductive/hormonal factors like HRT

Genotype (what type of mutation)

How does translocation impact cancer? what category of genes is it?

chromosomal translocations can activate a proto-oncogene

most translocations are specific to certain tumors

often occur in hematologic cancers

- Philadelphia chromosome in CML (one of if not the most common)-> 9;22 translocation combines 2 proto-oncogenes

germline mutations that increase cancer tend to be proto-oncogenes or tumor suppressor genes? are there any exceptions

germline oncogene mutations are rare -> could be lethal in development. if all cells grow then causes problems. Missense mutations, amplification, promoter alterations common. nonsense and frameshift not.

EXCEPTIONS:

ALK gene- hereditary neuroblastoma

MET gene- hereditary papillary renal cell cancer

RET gene- multiple endocrine neoplasia

what is a DCIS and what does it mean? vs LCIS?

DCIS: stage 0 "ca", tx: surgery +/- XRT

LCIS: 90% premenopausal women, often multifocal and bilateral (85% & 30% respectively), and a marker of risk b/c risk is 7-18x higher, applies to both breasts, 10-year risk at least 7%, and can get lobular and ductal ca. tx: surgery only

- subsection of Pleomorphic LCIS: which is higher grade, more typical of DCIS, and no provider consensus

What are the common clinical presentations of ut/ov? ca?

suspicious of abdominal/pelvic mass in physical exam

abd bloating and/or distention

Ascites

abd pain

vaginal bleeding (POSTMENOPAUSAL IS HUGE RED FLAG)

incidental findings

screening for ut and/or ov ca?

transvaginal ultrasound w color doppler flow

CA-125-> transducer blood marker test which can INDICATE getting screening. high false +

- CT/MRI/PET

What is cancer grading? how does it work

Determines extent to which tumor resembles normal tissue and indicates likely metastasis rate

Grade doesn't typically change but can(?)

Gx: cant be assessed so undetermined

G1: ca look like normal cells and usually slow growing. low grade/well differentiated

G2: don't resemble normal cells but appear to stick together and grow faster. intermediate/moderate grade or moderately differentiated

G3: irregular shapes, stick together, and fast growing. high grade or poorly differentiated

G4: undifferentiated. little to no similarity to normal tissue.

What is cancer staging? how does it work

predicts the severity of cancer based on: location of tumor, tumor size & extent of tumor, lymph node involvement, presence or absence of metastasis.

Does not change. just get more info added.

TNM system:

T= tumor size & extent of tumor. TX= no eval, T0= in situ, T1=localized, T2 = early locally advanced, T3= Late locally advanced, t4= metastasis.

- T SYSTEM IS DIFFERENT IN HEMATOLOGIC CANCERS

N= nodal involvement. NX, N1-3

M= Metastases. MX, M0= none, M1= yes