Cancer Types, Risk Factors, Screening & Treatment Overview video 2

Breast Cancer

• Surgical Management
  • Mastectomy (partial or total)
  • Lumpectomy ± radiation when tumor diameter >5\,\text{cm}
• Radiation Therapy
  • External-beam; indicated for tumors >5\,\text{cm} or positive margins
• Chemotherapy
  • Specific regimens not testable for this exam
• Hormone (Endocrine) Therapy
  • Tamoxifen (selective-estrogen-receptor modulator)
  • Used only when tumor expresses estrogen receptors (ER+)
  • Mechanism: competitively blocks ER → slows proliferation
  • Major adverse effects: vasomotor instability (hot flashes), risk of thromboembolism, endometrial hyperplasia/cancer
• Targeted / Biologic Agents
  • Mentioned but details not required for exam

Lung Cancer

• Categories
  • Small-cell lung carcinoma (SCLC)
  • Non-small-cell lung carcinoma (NSCLC) – sub-types not testable
• Risk Factors
  • Active smoking, second-hand smoke
  • Environmental carcinogens: asbestos, air pollution, industrial chemicals, radon gas
• Clinical Presentation
  • New/worsening cough, hemoptysis, dyspnea, unexplained weight loss
  • Persistent wheeze or hoarseness unrelated to infection
• Diagnostics
  • Annual low-dose CT (LDCT) screening beginning at age 50 for current or former smokers
  • Sputum cytology (adjunct)
  • Tissue biopsy needed for definitive diagnosis
• Treatment Options
  • Surgery — wedge resection, lobectomy, or pneumonectomy + peri-operative \text{O}_2 as needed
  • Chemotherapy, radiation, targeted biologics

Prostate Cancer

• Pathophysiology / Growth Pattern
  • Typically indolent, but can invade bladder, testes, abdominal organs if undetected
• Risk Factors
  • Age >50, family history, smoking, obesity
• Clinical Manifestations resemble BPH
  • Increased urinary frequency/urgency, UTIs, hematuria/hematospermia, erectile dysfunction
• Screening & Diagnostics
  • PSA (prostate-specific antigen): annual test starting at age 50
  • Digital rectal exam (DRE) now rarely performed due to risk of inflammation/infection; reserved for high suspicion
  • Elevated PSA or symptoms → trans-rectal ultrasound, MRI, needle biopsy
• Treatment
  • Radical prostatectomy ⇒ indwelling Foley catheter 2–3 weeks (patient teaching on catheter care)
  • Radiation: external-beam most common; brachytherapy (internal seeds) uses same radiation-safety rules (flush \times2–3, no pregnant visitors, disposable utensils)
  • Hormone therapy: androgen-deprivation (testosterone blockade) mirrors tamoxifen concept in breast cancer
  • Chemo / immunotherapy for advanced disease

Colorectal Cancer

• Originates from adenomatous polyps that can transform from benign → malignant
• Risk Factors
  • Obesity, sedentary lifestyle, smoking
  • Diet low in fiber/vegetables & high in fat
  • Inflammatory bowel disease (ulcerative colitis, Crohn’s) and type 2 diabetes
• Red-Flag Symptom
  • Change in bowel habits (constipation → diarrhea or vice-versa)
• Additional Manifestations
  • Occult or frank blood in stool, iron-deficiency anemia, abdominal pain, unexplained weight loss, fatigue
• Screening Tools
  • Annual fecal occult blood test (FOBT)
  • CEA (carcino-embryonic antigen) — tumor marker; not diagnostic but aids monitoring
  • Colonoscopy every 10 years beginning at age 50 (earlier if high-risk); biopsies obtained during procedure
  • Cologuard® stool DNA kit mailed to patient ("dancing box") q3yrs; requires UPS drop-off
  • Blood-based assay in development (q3yrs)
• Treatment
  • Surgical resection of affected bowel ± temporary colostomy; reversal after healing
  • Chemotherapy, external radiation, immunotherapy, radio-frequency ablation

Pancreatic Cancer

• Anatomy review: head, neck, body, tail — presentation varies by location
• Dual Function Organ (endocrine + exocrine) → tumors affect digestion & glucose regulation
• Risk Factors
  • Overlap with other GI cancers: smoking, obesity, type 2 diabetes, chronic pancreatitis
• Screening
  • No routine population screening — cancers often found incidentally during imaging for unrelated issues (e.g., hernia work-up, back pain)
• Clinical Manifestations (often late-stage)
  • Obstructive jaundice (common bile duct compression)
  • Pruritus, dark urine, clay-colored stools
  • Nausea, vomiting, anorexia, weight loss
• Diagnostics
  • LFTs: AST and ALT elevation
  • Tumor markers (CA 19-9) — not emphasized in transcript but commonly used
  • CT abdomen, abdominal ultrasound
  • ERCP with brush/forceps biopsy when direct percutaneous biopsy not feasible
• Treatment
  • Surgical resection (e.g., pancreaticoduodenectomy/Whipple or partial pancreatectomy)
  • Post-op concern: new or worsened diabetes due to reduced insulin output → adjust glycemic management
  • Radiation and chemotherapy adjuncts

Skin Cancer

• Sub-types & Layers
  • Basal-cell carcinoma (BCC) — basal epidermis; slowest growth
  • Squamous-cell carcinoma (SCC) — epidermal layer; more aggressive than BCC
  • Malignant melanoma — originates in melanocytes (cutaneous layer); highest metastatic potential
• Risk Factors
  • UV exposure (sunlight & tanning beds), family history, numerous dysplastic nevi, immunosuppression
• Clinical Assessment (ABCDE + additional teaching)
  • Asymmetry, Border irregularity, Color variation, Diameter >6\,\text{mm}, Evolving lesion
  • Anything scraped off that "grows back" warrants biopsy
• Diagnostics
  • Dermatologic shave or punch biopsy depending on size/depth
• Treatment Modalities
  • Surgical excision, Mohs procedure
  • Chemical peels, photodynamic therapy
  • Topical chemo (5-FU) or immunotherapy (imiquimod)
  • External radiation for select lesions

Brain & Central Nervous System Tumors

• Include primary brain tumors and spinal cord neoplasms; nomenclature reflects location (e.g., astrocytoma, meningioma, ependymoma)
• Risk Factors
  • Environmental exposures, Epstein–Barr virus (EBV)
• Clinical Manifestations
  • Headache, seizures, nausea/vomiting, ataxia or balance changes, focal deficits
• Work-up
  • MRI brain/spine, CT, PET, stereotactic biopsy
• Management
  • Watchful waiting for small, indolent lesions
  • Surgical resection, chemotherapy, radiation (stereotactic radiosurgery)

Hematologic Malignancies

Lymphomas

• Hodgkin vs. Non-Hodgkin (NHL); NHL more prevalent
• Symptoms
  • Single enlarged lymph node, "B-symptoms" (fever, night sweats, weight loss), fatigue, SOB
• Diagnostics
  • Lymph-node excisional biopsy, bone marrow biopsy, CT/PET staging

Multiple Myeloma

• Plasma-cell malignancy within bone marrow
• Manifestations: anemia, bone pain/lytic lesions, fatigue, weight loss, hypercalcemia
• Tests: serum protein electrophoresis (M-spike), bone marrow aspiration

Leukemias

• Acute Lymphoblastic Leukemia (ALL)
  • Overproduction of immature lymphocytes → immune incompetence
  • Most common childhood cancer; acute course = higher mortality risk
  • Risk factors: prior radiation/chemo exposure, environmental toxins
  • S/S: fever, bone pain, bruising, recurrent infections
• Chronic Myelogenous Leukemia (CML)
  • Philadelphia chromosome translocation post-birth
  • Indolent until accelerated/blast phase later in life
  • S/S: marked fatigue, splenomegaly (pain below left ribs), night sweats
• Diagnostics for ALL & CML
  • CBC w/ differential (leukocytosis w/ blasts), bone marrow biopsy, cytogenetics

Radiation-Safety Refresher (applies to prostate brachytherapy & others)

• No prolonged close contact with pregnant women or children
• Use separate bathroom; flush 2–3 times
• Disposable/plastic utensils & separate laundry

Exam Emphasis Recap (per Instructor)

• Know screening guidelines:
  • Breast: mammogram start 45–50, annual
  • Prostate: PSA start 50, annual
  • Lung: LDCT start 50 for smokers, annual
  • Colorectal: colonoscopy start 50 (q10yrs) + annual FOBT
• Understand presentations & common treatments for listed cancers
• Be prepared on other hematology topics: anemias, clot management & side-effects (content not fully covered in this transcript)
• ATI exam window: opens 24^{th} (00{:}00–23{:}59); open-notes, not proctored, two attempts — highest score counts