Cancer in the Primary Care Setting Theodore Pollock, DO, FACOI June 21,

Leading Causes of Death, 2007 Source: CA Cancer J Clin 60:277, © 2011 Rising Tide

Probability of Developing Cancer Source: CA Cancer J Clin 60:277, © 2011 Rising Tide

©2010 Rising Tide, Kft. All rights reserved. 4 Cancer in the Office Moles Lymph Nodes Weight Loss Fever Leukocytosis

©2010 Rising Tide, Kft. All rights reserved. Definition of Melanoma - A form of cancer that begins in melanocytes (cells that make the pigment melanin). It may begin in a mole (skin melanoma), but can also begin in other pigmented tissues, such as in the eye or in the intestines. Estimated New Cancer Cases & Deaths from Melanoma in the U.S. in 2012 – New Cases: – Deaths: 9,180 5 The Mole

©2010 Rising Tide, Kft. All rights reserved. History – Exposure – Recent Change – Bleeding – Pregnancy 6 The Mole

©2010 Rising Tide, Kft. All rights reserved. Physical Exam – Margins – Ulcer – Lesions in Transit – Lymphadenopathy Biopsy 7 The Mole

©2010 Rising Tide, Kft. All rights reserved. History – Co-Existing Factors – Fever – Weight Loss 8 Lumps

©2010 Rising Tide, Kft. All rights reserved. Physical – Location Matted – Consistency Rubbery Rock Hard – Painful 9 Lumps

©2010 Rising Tide, Kft. All rights reserved. Temporal Factors Coexisting Factors – Diarrhea – Fevers – Diabetes – Meals-on-Wheels 10 Weight Loss

©2010 Rising Tide, Kft. All rights reserved. CDC Definition of Fever – Temperature of 100°F or higher in the absence of antipyretics. Temporal Factors – Infection Rigors 11 Fever

©2010 Rising Tide, Kft. All rights reserved. Infection Inflammatory Disease Leukemia Lymphoma Renal Cell 12 Differential Diagnosis

©2010 Rising Tide, Kft. All rights reserved. CBC Differential Diagnosis – Infection – Leukamoid Reaction – Neoplastic – N/A 13 Leukocytosis

©2010 Rising Tide, Kft. All rights reserved. HGB Platelets Differential 14 Neoplastic

©2010 Rising Tide, Kft. All rights reserved. Differential Diagnosis – CLL – CML – MDS / AML – Leukamoid Reaction 15

Questions 16