Approach to the Cancer Patient
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- The lifetime probability of being diagnosed with cancer is approximately 40% in men and 38% in women.
- Tobacco use is the most common cause of cancer and is associated with lung, head and neck, esophageal, gastric, pancreatic, kidney, and bladder cancers.
- Diet, obesity, inactivity, alcohol abuse, and height have also been shown to be associated with increased risk of developing selected cancers.
- Chronic inflammatory states such as ulcerative colitis and infections such as HIV, hepatitis, Epstein–Barr virus (EBV), human papillomavirus (HPV), and Helicobacter pylori are also associated with increased cancer risk.
- Several familial cancer syndromes have been described and have important implications for cancer screening (Table 22-2).Table 22-2: List of Selected Familial Cancer Syndromes With High Penetrance
Syndrome Defect Associated Cancer Type Ataxia-telangiectasia ATM Multiple; predominantly leukemia and lymphoma Birt-Hogg-Dube BHD Chromophobe RCC Bloom syndrome BLM Multiple Cowden syndrome PTEN Multiple; predominantly breast, thyroid, RCC, endometrial Familial adenomatous polyposis APC Colorectal, desmoid Fanconi anemia DNA repair complex Multiple; predominantly MDS and AML Hereditary breast–ovarian cancer BRCA1 and BRCA2 Multiple; predominantly breast, ovarian Hereditary diffuse gastric cancer CDH1 Gastric, lobular breast cancer Hereditary leiomyomatosis and RCC FH Papillary RCC Lynch syndrome (HNPCC) Mismatch repair Multiple; predominantly colorectal Hereditary papillary RCC MET Papillary RCC Juvenile polyposis syndrome MADH4 (SMAD4), BMPR1A Digestive tract and pancreas Li-Fraumeni syndrome TP53 Multiple MEN type 1 MEN1 Islet cell tumors MEN type 2 RET Medullary thyroid cancer Neurofibromatosis type 1 NF1 MPNST, glioma Neurofibromatosis type 2 NF2 Meningioma, glioma, schwannoma Nijmegen breakage syndrome NBS1 Predominantly lymphoma Peutz–Jeghers syndrome LKB1 (STK11) Multiple; predominantly breast, GI, pancreas Retinoblastoma, hereditary RB Retinoblastoma, primitive neuroectodermal tumor Rothmund–Thomson syndrome RECQL4 Osteosarcoma Tuberous sclerosis (TS) TSC1, TSC2 RCC, giant cell astrocytoma von Hippel-Lindau VHL Clear cell RCC Xeroderma pigmentosum Nucleotide excision repair Multiple, cutaneous
AML, acute myeloid leukemia; GI, gastrointestinal; HNPCC, hereditary nonpolyposis colorectal cancer; MDS, myelodysplastic syndrome; MEN, multiple endocrine neoplasia; MPNST, malignant peripheral nerve sheath tumor; RCC, renal cell carcinoma.
- Prior exposure to cytotoxic chemotherapy or radiation therapy is associated with an increased risk of developing secondary cancers. For instance, exposure to alkylating agents or topoisomerase II inhibitors increases the risk of developing treatment-related leukemia, and exposure to radiation therapy increases risk for developing cancers such as breast cancer, angiosarcoma, and osteosarcoma.