ITEMS IN AFP WITH MESH TERM:
ABSTRACT: There are more than one half million cancer deaths in the United States each year, and one third of these deaths are attributed to suboptimal diet and physical activity practices. Maintaining a healthy weight, staying physically active throughout life, and consuming a healthy diet can substantially reduce the lifetime risk of developing cancer, as well as influence overall health and survival after a cancer diagnosis. The American Cancer Society's Nutrition and Physical Activity Guidelines serve as a source document for communication, policy, and community strategies to improve dietary and physical activity patterns among Americans. In 2006, they published updated guidelines for the primary prevention of cancer and guidelines for improving outcomes among cancer survivors through tertiary prevention. These two sets of guidelines have similar recommendations, including: achievement and maintenance of a healthy weight; regular physical activity of at least 30 minutes per day and at least five days per week; a plant-based diet high in fruits, vegetables, and whole grains and low in saturated fats and red meats; and moderate alcohol consumption, if at all. Physicians are encouraged to find teachable moments to impart appropriate nutrition, physical activity, and weight management guidance to their patients, and to support policies and programs that can improve these factors in the community to reduce cancer risk and improve outcomes after cancer.
Cancer Screening in the Older Patient - Article
ABSTRACT: Although there are clear guidelines that advise at what age to begin screening for various cancers, there is less guidance concerning when it may be appropriate to stop screening. The decision to stop screening must take into account patients' age; overall health and life expectancy; the natural history of the disease; and the risks, expense, and convenience of the screening test, and any subsequent testing and treatment. The U.S. Preventive Services Task Force and the American Academy of Family Physicians suggest that Papanicolaou smears can be discontinued in women at 65 years of age, provided they have had adequate recent normal screenings. Evidence suggests that cessation of breast cancer screening at approximately 75 to 80 years of age is appropriate, although American Geriatric Society guidelines recommend cessation at a more advanced age. Studies support continuing colon cancer screening until approximately 75 years of age in men and 80 years of age in women for patients without significant comorbidities. Prostate cancer screening, if conducted at all, may be discontinued at approximately 75 years of age in otherwise healthy men. Ultimately, the decision to screen or to discontinue screening must be made after careful discussion with each patient, using evidence-based guidelines and individual patient preferences.
ABSTRACT: Radiation therapy can be an effective treatment modality for both malignant and benign disease. While radiation can be given as primary treatment, it may also be used pre- or postoperatively, with or without other forms of therapy. Radiation therapy is often curative but is sometimes palliative. There are many methods of delivering radiation effectively. Often, patients tolerate irradiation well without significant complications, and organ function is preserved. To ensure that all patients with cancer have the opportunity to consider all treatment options, family physicians should be aware of the usefulness of radiation therapy.
Evaluation of Dysuria in Men - Article
ABSTRACT: Men with pain or a burning sensation on urination should be evaluated with a thorough history, a focused physical examination and urinalysis (both urine dipstick and microscopic examination of the urine specimen). Although dysuria may be caused by anything that leads to inflammation of the urethal mucosa, it is most often the result of urinary tract infection. In younger patients, the infectious agent is usually a sexually transmitted organism such as Chlamydia trachomatis. In patients over 35 years of age, coliform bacteria predominate. Infection in older men most often occurs as a result of urinary stasis secondary to benign prostatic hyperplasia. Other conditions that may cause dysuria include renal calculus, genitourinary malignancy, spondyloarthropathy and medications. Successful treatment of dysuria depends on correct identification of its cause.
Evaluation of the Acutely Limping Child - Article
ABSTRACT: A limp may be defined as any asymmetric deviation from a normal gait pattern. The differential diagnosis of a limp includes trauma, infection, neoplasia and inflammatory, congenital, neuromuscular or developmental disorders. Initially, a broad differential diagnosis should be considered to avoid overlooking less common conditions such as diskitis or psoas abscess. In any patient with a complaint of knee or thigh pain, an underlying hip condition should be considered. The patient's age can further narrow the differential diagnosis, because certain disease entities are age-specific. Vigilance is warranted in conditions requiring emergent treatment such as septic hip. The challenge to the family physician is to identify the cause of the limp and determine if further observation or immediate diagnostic work-up is indicated.
ABSTRACT: Although cancer has an annual incidence of only about 150 new cases per 1 million U.S. children, it is the second leading cause of childhood deaths. Early detection and prompt therapy have the potential to reduce mortality. Leukemias, lymphomas and central nervous system tumors account for more than one half of new cancer cases in children. Early in the disease, leukemia may cause nonspecific symptoms similar to those of a viral infection. Leukemia should be suspected if persistent vague symptoms are accompanied by evidence of abnormal bleeding, bone pain, lymphadenopathy or hepatosplenomegaly. The presenting symptoms of a brain tumor may include elevated intracranial pressure, nerve abnormalities and seizures. A spinal tumor often presents with signs and symptoms of spinal cord compression. In children, lymphoma may present as one or more painless masses, often in the neck, accompanied by signs and symptoms resulting from local compression, as well as signs and symptoms of systemic disturbances, such as fever and weight loss. A neuroblastoma may arise from sympathetic nervous tissue anywhere in the body, but this tumor most often develops in the abdomen. The presentation depends on the local effects of the solid tumor and any metastases. An abdominal mass in a child may also be due to Wilms' tumor. This neoplasm may present with renal signs and symptoms, such as hypertension, hematuria and abdominal pain. A tumor of the musculoskeletal system is often first detected when trauma appears to cause pain and dysfunction out of proportion to the injury. Primary care physicians should be alert for possible presenting signs and symptoms of childhood malignancy, particularly in patients with Down syndrome or other congenital and familial conditions associated with an increased risk of cancer.
ABSTRACT: Many patients expect to undergo screening tests for cancer. In evaluating screening procedures, physicians must take into account the known effects of lead time, length and screening biases, all of which can result in an overestimation of the benefits of screening. The gold standard by which a screening test is evaluated remains the prospective, randomized controlled trial, demonstrating reduced morbidity and mortality. The magnitude of benefit from screening is best expressed in terms of the number of patients needed to screen. This value ranges from approximately 500 to 1,100 for proven screening interventions. These concepts are illustrated by controversies in current screening recommendations for cancers of the cervix, lung, colon, breast and prostate, which together account for more than 50 percent of cancer deaths in the United States.
Cancer Screening Guidelines - Article
ABSTRACT: Numerous medical organizations have developed cancer screening guidelines. Faced with the broad, and sometimes conflicting, range of recommendations for cancer screening, family physicians must determine the most reasonable and up-to-date method of screening. Major medical organizations have generally achieved consensus on screening guidelines for breast, cervical and colorectal cancer. For breast cancer screening in women ages 50 to 70, clinical breast examination and mammography are generally recommended every one or two years, depending on the medical organization. For cervical cancer screening, most organizations recommend a Papanicolaou test and pelvic examination at least every three years in patients between 20 and 65 years of age. Annual fecal occult blood testing along with flexible sigmoidoscopy at five-year to 10-year intervals is the standard recommendation for colorectal cancer screening in patients older than 50 years. Screening for prostate cancer remains a matter of debate. Some organizations recommend digital rectal examination and a serum prostate-specific antigen test for men older than 50 years, while others do not. In the absence of compelling evidence to indicate a high risk of endometrial cancer, lung cancer, oral cancer and ovarian cancer, almost no medical organizations have developed cancer screening guidelines for these types of cancer.
ABSTRACT: Procedures performed by an interventional radiology specialist are becoming increasingly important in the management of patients with cancer. Although general interventional radiology procedures such as angiography and angioplasty are used in patients with and without cancer, certain procedures are reserved for the diagnosis and treatment of cancer or cancer-related complications. Interventional radiology procedures include imaging-guided biopsies to obtain samples for cytologic or pathologic testing without affecting adjacent structures. Transjugular liver biopsy is used to diagnose hepatic parenchymal abnormalities without traversing Glisson's capsule. This biopsy procedure is particularly useful in patients with coagulopathies. Because the transjugular liver biopsy obtains random samples, it is not recommended for biopsy of discrete hepatic masses. Fluid collections can also be sampled or drained using interventional radiology techniques. Transcatheter chemoembolization is a procedure that delivers a chemotherapeutic agent to a tumor along with sponge particles that have an ischemic effect on the mass. Tumor ablation, gene therapy and access of central veins for treatment are performed effectively under radiographic guidance. Cancer complications can also be treated with interventional radiology techniques. Examples include pain control procedures, vertebroplasty and drainage of obstructed organs. Interventional radiology techniques typically represent the least invasive definitive diagnostic or therapeutic options available for patients with cancer. They can often be performed at a lower cost and with less associated morbidity than other interventions.
The Era of Targeted Therapies - Editorials