Screening, Management, and Effect of Cancer

February 10, 2009

Screening, Management, and Effect of Cancer

Unless the patient reports a specific symptom, most screening procedures are fruitless. Certain rocedures have been found adequate to detect potentially curable cancers in asymptomatic people in a cost-effective manner.
Breast cancer. Although the National Cancer Institute stopped recommending screening mammograms in 1993, the American Cancer Society has continued its recommendations based on updates of national data showing significantly increased survival in large selected subgroups of women. We recommend breast examination by a physician or qualified nurse every 3 years in women between 20 and 40 years of age and annual examination in women older than 40 years of age. Mammography is performed as a single baseline for those from 35 to 39 years of age, every 1 to 2 years for those from 40 to 49 years of age, and every year for women 50 years of age and older.

sexy woman, screening cancer, management cancer, and effect cancer

Uterine cervical cancer. Three consecutive annual smears of the uterine cervix are recommended for sexually active girls younger than 18 years of age and for all women 18 years of age and older, followed by Papanicolaou’s smear every 3 years thereafter. Smears must include cervical aspiration specimens.
Colorectal cancer. Digital rectal examination should be performed with routine physical examinations until 50 years of age. After 50 years of age, annual rectal examination and stool for occult blood should be performed, and biannual proctosigmoidoscopy should be performed in patients with a history of adenomatous polyps.
Prostate cancer. Men older than 50 years of age should have an annual digital rectal examination and PSA blood level determination.
General screening. Yearly complete blood count is recommended to search for tumor-related iron deficiency anemia and other hematologic problems in older patients.
Management
Hearing is the physician’s most important diagnostic tool. Listening is his or her most important skill.
Applied philosophy in oncology
The withholding of technology requires as much skill and judgment as its employment. Do not use chemicals when time and words are indicated.
Oncology is a unique subspecialty because most patients are referred to the oncologist by family physicians who often have a long-standing relationship with the patient, want to be involved with their care, and can provide psychological support for patient and family. On the other hand, oncologists generally have more experience with differential diagnosis in cancer patients and are in a better position to diagnose treatable nononcologic diseases and to provide optimal palliative care for patients when cancer treatment is no longer effective. The coordination of oncologists with referring physicians must be individualized in the best interests of the patient.
Most cancers can involve multiple organ systems. It is essential that the oncologist has a thorough knowledge of the patient by taking a thorough baseline history and physical examination. This process initiates a trusting relationship between the oncologist and the patient, which will be important in implementing future recommendations.
Listen carefully to the patient and family, who usually provide more useful diagnostic and even therapeutic information than any laboratory test.
Recommendations must be individualized, taking into account the clinical data, but also providing patients with enough information and options so that they can make an informed treatment decision. The physician has the training and experience, but the patient is the “boss.” If the patient chooses a course that the physician feels would cause harm, however, the physician should say so frankly and directly.
he physician should never threaten or desert a patient because he or she does not accept the best therapeutic recommendation.
Efficiency can be the worst enemy of meaningful medical care. A hands-on visit communicates caring and engenders confidence. If pressed for time, the physician can take the chart into the patient’s room and interact with the patient while writing.
Most advanced cancers cannot be cured. Because they have the most extensive knowledge of and experience with the behavior of advanced cancer and the use of complex medication regimens, oncologists should be able to provide optimal palliative care. The trend toward separating oncologists into those who treat and those who care is destructive to the fundamental philosophy and art of medical practice.
Effect of cancer
Seizures, cerebral edema
Spinal cord compression
Brain metastases
Pericardial effusion with tamponade
Hypercalcemia
Hyponatremia
Hypoglycemia
Hyperviscosity states
Infection, especially in leukopenic patients
Superior vena cava obstruction
Lymphangitic pulmonary metastases
Pain
Psychosocial problems