Approach to the Cancer Patient

Approach to the Cancer Patient is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

Risk Factors

  • 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
    SyndromeDefectAssociated Cancer Type
    Ataxia-telangiectasiaATMMultiple; predominantly leukemia and lymphoma
    Birt-Hogg-DubeBHDChromophobe RCC
    Bloom syndromeBLMMultiple
    Cowden syndromePTENMultiple; predominantly breast, thyroid, RCC, endometrial
    Familial adenomatous polyposisAPCColorectal, desmoid
    Fanconi anemiaDNA repair complexMultiple; predominantly MDS and AML
    Hereditary breast–ovarian cancerBRCA1 and BRCA2Multiple; predominantly breast, ovarian
    Hereditary diffuse gastric cancerCDH1Gastric, lobular breast cancer
    Hereditary leiomyomatosis and RCCFHPapillary RCC
    Lynch syndrome (HNPCC)Mismatch repairMultiple; predominantly colorectal
    Hereditary papillary RCCMETPapillary RCC
    Juvenile polyposis syndromeMADH4 (SMAD4), BMPR1ADigestive tract and pancreas
    Li-Fraumeni syndromeTP53Multiple
    MEN type 1MEN1Islet cell tumors
    MEN type 2RETMedullary thyroid cancer
    Neurofibromatosis type 1NF1MPNST, glioma
    Neurofibromatosis type 2NF2Meningioma, glioma, schwannoma
    Nijmegen breakage syndromeNBS1Predominantly lymphoma
    Peutz–Jeghers syndromeLKB1 (STK11)Multiple; predominantly breast, GI, pancreas
    Retinoblastoma, hereditaryRBRetinoblastoma, primitive neuroectodermal tumor
    Rothmund–Thomson syndromeRECQL4Osteosarcoma
    Tuberous sclerosis (TS)TSC1, TSC2RCC, giant cell astrocytoma
    von Hippel-LindauVHLClear cell RCC
    Xeroderma pigmentosumNucleotide excision repairMultiple, 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.

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