Clinical management
Alistair Burns, Michael A Horan, John E Clague, Gillian McLean in Geriatric Medicine for Old-Age Psychiatrists, 2005
Weight loss is a frequent indication for referral of elderly patients to medical out-patient clinics. Diseases in many systems can lead to weight loss, and review of the systems part of the medical history may pick up potential sources which will then guide investigations. Smoking history and alcohol intake should be determined. In smokers, a history of persistent cough or haemoptysis should be sought, possibly indicating a lung neo- plasm. Upper gastrointestinal symptoms such as dysphagia, vomiting or epigastric pain should be sought and might indicate oesophageal or gastric c�ncer. Persistent diarrhoea might indicate malabsorption. A change in bowel habit or rectal bleeding may occur in colonic carcinoma. Thirst and polyuria might indicate diabetes mellitus. Heat intolerance, tremor and irri- tability may indicate hyperthyroidism. Clinical examination would include looking for signs of anaemia, finger clubbing and lymphadenopathy. In women, breast examination should be performed. Features of hyperthy- - roidism should be sought. Clinical signs suggesting underlying lung malig- nancy such as collapse or pleural effusion may be found. Abdominal examination is performed for palpable masses and hepatomegaly. Rectal examination should be performed to fmd tumours and to assess the prostate gland in men.
Breast cancer
Pat Price, Karol Sikora in Treatment of Cancer, 2014
Women at intermediate or high risk according to the aforementioned factors are offered referral to a specialist risk service, comprising clinical genetics and breast oncology input, and counsellors with close links to a dedicated molecular genetics laboratory.8 There is currently little evidence on which to base reliable guidelines. Women at moderately increased risk (15%–25%) are advised to examine their breasts once a month and asked to attend annual clinical breast examination and annual mammography between the ages of 35 and 50 years. The frequency of screening is commonly reduced above this age but continues until the age of 69 years. Women considered or proved to have BRCA1 mutations are referred for annual pelvic ultrasound, in view of their elevated risk of ovarian cancer. Women at high risk (>25%) of breast cancer may wish to consider further measures, including bilateral prophylactic mastectomies and reconstruction (and oophorectomy in the case of BRCA1 mutation carriers). These interventions are taken only after careful consideration, including psychological counselling.9 Inclusion in ongoing chemical prevention trials may also be considered.
Bannayan–Riley–Ruvalcaba Syndrome
Dongyou Liu in Handbook of Tumor Syndromes, 2020
For CS the current proposal for surveillance protocol includes investigation for breast cancer, endometrial cancer, thyroid cancer, renal carcinoma, and intestinal hamartomas. Eng et al. recommend monthly self-examination and clinical breast examination starting from age 25 and annual mammography beginning at age 30. Breast self-examination is also suggested for men. An annual endometrial examination is recommended from age 35. To screen for abnormalities of the thyroid gland, annual palpation of the thyroid gland from age 18 is recommended. Furthermore, they suggest annual urinalysis to help detect renal carcinoma at an early stage. A baseline colonoscopy is recommended at age 50, with the purpose of detecting hamartomas [36].
Advances in pleural effusion diagnostics
Published in Expert Review of Respiratory Medicine, 2020
Lucía Ferreiro, María E. Toubes, María E. San José, Juan Suárez-Antelo, Antonio Golpe, Luis Valdés
If PF is an exudate, investigate whether the patient has a neoplasm, anorexia, or weight loss. Physical examination should be performed to seek for adenopathies or masses supporting the presence of malignancy. In female patients, breast examination is recommended. The patient may have had an infection, productive cough, pleural pain, fever, or have used antibiotics. These findings are suggestive of IPE. Patients should be asked about their work history to determine potential exposure to asbestos. It is recommended to investigate the presence of a systemic disease (systemic lupus erythematosus, rheumatoid arthritis) and perform a physical examination to identify subcutaneous nodules, joint deformities or skin lesions suggestive of diseases such as systemic lupus erythematosus or yellow nail syndrome. In the presence of a recent risk factor, signs of pulmonary embolism and deep venous thrombosis should be investigated. Finally, the use of medicines that may cause PE should be determined by revising the medical history of the patient (www.pneumotox.com).
Breast health, risk factors, and cancer screening among lesbian, bisexual, and queer/questioning women in China
Published in Health Care for Women International, 2021
Piper Liping Liu, Tien Ee Dominic Yeo
This study seeks to address the lack of knowledge about the breath health and risks of LBQW in China by (a) profiling the risk factors, abnormalities presented, and screening behaviors among a sample of this population and (b) identifying the salient determinants of their behavioral intentions and past behaviors of performing breast examination. The theoretical framework adopted to guide the investigation of salient determinants is the integrated behavioral model, which posits that behavioral intention (a function of attitude, perceived norm, and personal agency) is the primary determinant of behavior plus other factors such as knowledge (Montano & Kasprzyk, 2015). In this study, the pertinent attitude, perceived norm, and personal agency involved are operationalized through a set of health belief constructs and tested alongside knowledge and information exposure for their influence on BSE or CBE intention and behavior.
The cost-effectiveness of sexual and reproductive health and rights interventions in low- and middle-income countries: a scoping review
Published in Sexual and Reproductive Health Matters, 2021
Andrea Hannah Kaiser, Björn Ekman, Madeleine Dimarco, Jesper Sundewall
HPV vaccination against infection with two and four different types of HPV (bivalent and quadrivalent vaccines) of pre-adolescent girls prior to sexual initiation to prevent cervical cancer was cost-effective in nearly all country settings analysed. Vaccinating adolescent boys was not cost-effective. Cervical cancer screening with visual inspection with acetic acid (VIA) and VIA followed by cytology one to three times per lifetime was cost-effective in countries within all WHO regions. Provider-collected HPV-DNA testing one to three times per lifetime was also cost-effective, while the cost-effectiveness of HPV self-collection was inconclusive. Only a few publications reporting on cervical cancer treatment were identified, suggesting lesion removal, radiotherapy, chemotherapy, and radical hysterectomy with pelvic lymph node dissection to be cost-effective. For early breast cancer detection, clinical breast examination was cost-effective in all settings, while the results for mammography screening varied greatly. Similarly, results for evaluated breast cancer chemotherapy regimens differed, rendering a statement on their cost-effectiveness impossible. Treatment with lumpectomy, radiotherapy, mastectomy, adjuvant oophorectomy, and tamoxifen were cost-effective. Regarding other forms of reproductive cancer, neoadjuvant chemotherapy in advanced ovarian patients was not cost-effective, while a population-based prostate cancer screening programme was suggested to be cost-effective.
Related Knowledge Centers
- Breast Disease
- Palpation
- Lymphadenopathy
- Physical Examination
- Mammography
- Informed Consent
- Breast Self-Examination
- Nipple Discharge