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| {{Diabetic foot}}
| | ==Overview== |
| | Factors that increase the chance of developing cancer are called risk factors. There are 2 types of risk factors: Modifiable and Non-modifiable. Modifiable risk factors are attitudes or circumstances that people can avoid, for example smoking. Non-modifiable risk factors are conditions that can't be changed, for example genetic predisposition to certain diseases. Factors that decrease the chance of developing cancer are called protective factors. |
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| | Many other factors in our environment, diet, and lifestyle may cause or prevent cancer. This summary reviews only the major cancer risk factors and protective factors that can be controlled or changed to reduce the risk of cancer. Risk factors that are not described in the summary include certain sexual behaviors, the use of estrogen, and being exposed to certain substances or chemicals. |
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| | ==Factors That are Known to Increase the Risk of Cancer== |
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| | ===Tobacco=== |
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| ==Diabetic Foot Infection <small><small><small><small><small>Adapted from ''Diabetes Care. 2013;36(9):2862-71.''<ref name="pmid23970716">{{cite journal| author=Wukich DK, Armstrong DG, Attinger CE, Boulton AJ, Burns PR, Frykberg RG et al.| title=Inpatient management of diabetic foot disorders: a clinical guide. | journal=Diabetes Care | year= 2013 | volume= 36 | issue= 9 | pages= 2862-71 | pmid=23970716 | doi=10.2337/dc12-2712 | pmc=PMC3747877 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23970716 }} </ref> and ''Clin Infect Dis. 2012;54(12):e132-73.''<ref name="pmid22619242">{{cite journal| author=Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG et al.| title=2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. | journal=Clin Infect Dis | year= 2012 | volume= 54 | issue= 12 | pages= e132-73 | pmid=22619242 | doi=10.1093/cid/cis346 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22619242 }} </ref></small></small></small></small></small>==
| | * Tobacco use is strongly linked to an increased risk for many kinds of cancer. Smoking cigarettes is the leading cause of the following types of cancer: |
| | :* [[Acute myelogenous leukemia]] (AML) |
| | :* [[Bladder cancer]] |
| | :* [[Esophageal cancer]] |
| | :* [[Kidney cancer]] |
| | :* [[Lung cancer]] |
| | :* [[Oral cancer]] |
| | :* [[Pancreatic cancer]] |
| | :* [[Stomach cancer]] |
| | * Not smoking or quitting smoking lowers the risk of getting cancer and dying from cancer. |
| | * Cigarette smoking causes about 30% of all cancer deaths in the United States. |
| | * Cigarette smoking causes an estimated 443,000 deaths each year, including approximately 49,000 deaths due to exposure to secondhand smoke. |
| | * Lung cancer is the leading cause of cancer death among both men and women in the United States, and 90 percent of lung cancer deaths among men and approximately 80 percent of lung cancer deaths among women are due to smoking. |
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| ===Principles of Therapy=== | | ===Infections=== |
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| * Diabetic foot infection (DFI) is diagnosed clinically by the presence of <u>at least two</u> signs or symptoms of inflammation:
| | Certain viral and bacterial infections are able to cause cancer. Infection as a cancer cause is more common in developing countries (about 1 in 4 cases of cancer) than in developed countries (less than 1 in 10 cases of cancer). Examples of infection caused cancers: |
| :* Local swelling or induration | | * [[Human papillomavirus]] (HPV): |
| :* Erythema | | :* [[Cervical cancer]] |
| :* Local tenderness or pain | | :* [[Penis cancer]] |
| :* Local warmth | | :* [[Vaginal cancer]] |
| :* Purulent discharge (thick, opaque to white or sanguineous secretion) | | :* [[Anal cancer]] |
| | :* Oropharyngeal cancer |
| | * [[Hepatitis B virus|Hepatitis B]] and [[Hepatitis C virus|hepatitis C]] viruses increase the risk for liver cancer |
| | * [[Epstein-Barr virus]] increases the risk for [[Burkitt lymphoma]] |
| | * [[Helicobacter pylori]] increases the risk for [[gastric cancer]] |
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| * Hospitalization is appropriate for the following conditions:
| | Two vaccines to prevent infection by cancer-causing agents have already been developed and approved by the U.S. Food and Drug Administration (FDA): |
| :* Severe (grade 4) infections
| | * [[Hepatitis B vaccine]] |
| :* Moderate (grade 3) infections with complicating features | | * [[Human papillomavirus prevention#Vaccine|Human papillomavirus vaccine]] |
| ::* Severe peripheral arterial disease or limb ischemia
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| ::* Lack of home support
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| :* Patients unable to comply with the required outpatient treatment regimen for psychological or social reasons
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| :* Patients not responding to outpatient treatment
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| * Properly obtained specimens for culture prior to initiating empiric antibiotic therapy provide useful information for guiding antibiotic therapy, particularly in those with chronic or previously treated infections which are commonly caused by obligate anaerobic organisms.
| | ===Radiation=== |
| :* Infected wounds should be cultured by obtaining tissue samples during any surgical procedure or by tissue biopsy or wound base curettage.
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| :* Bone cultures are optimal for detecting the pathogen in osteomyelitis, but blood cultures are only necessary for those with a severe (grade 4) infection.
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| :* Cultures may be unnecessary for mild infections in patients who have not recently received antibiotic therapy and who are at low risk for methicillin-resistant ''Staphylococcus aureus'' (MRSA) infection; these infections are predictably caused solely by staphylococci and streptococci.
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| :* Cultures may yield organisms that are commonly considered to be contaminants (eg, coagulase-negative staphylococci, corynebacteria), but these may be true pathogens in DFIs and are often resistant to the empiric antibiotics.
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| * Conditions to request consultation from specialists: | | There are two main types of radiation linked with an increased risk for cancer: |
| :* Urgent surgical intervention should be sought for DFIs accompanied by gas in the deeper tissues, an abscess, or necrotizing fasciitis, and less urgent surgery for DFIs with substantial nonviable tissue or extensive bone or joint involvement. | | * Ultraviolet radiation from sunlight: This is the main cause of nonmelanoma skin cancers. |
| :* Consult a vascular surgeon to consider revascularization if ischemia complicates a DFI. | | * Ionizing radiation including: |
| :* Infectious diseases specialists should be consulted when cultures yield multiple or antibiotic-resistant organisms, the patient has substantial renal impairment, or the infection does not respond to appropriate medical or surgical therapy in a timely manner.
| | :* Medical radiation from tests such as [[x-rays]], [[CT scans]], [[fluoroscopy]], and [[Nuclear medicine#Diagnostic testing|nuclear medicine scans]]. |
| | :* Radon gas found in homes. |
| | * Radiation exposure from diagnostic [[X-rays]] increases the risk of cancer in patients and [[X-ray]] technicians. |
| | * The growing use of CT scans over the last 20 years has increased exposure to ionizing radiation. The risk of cancer also increases with the number of CT scans a patient has and the radiation dose used each time. |
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| * No adjunctive therapy has been proven to improve resolution of infection, but for selected diabetic foot wounds that are slow to heal, clinicians might consider using bioengineered skin equivalents, growth factors, granulocyte colony-stimulating factors, hyperbaric oxygen therapy, or negative pressure wound therapy.
| | Ionizing radiation has been associated with: |
| | * Leukemia |
| | * Thyroid cancer |
| | * Breast cancer in women |
| | * Myeloma |
| | * Lung cancer |
| | * Gastric cancer |
| | * Colon cancer |
| | * Esophagueal cancer |
| | * Bladder cancer |
| | * Ovarian cancer |
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| ===Antibiotic Therapy===
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| * Clinically uninfected wounds should ''not'' be treated with antibiotic therapy. For all infected wounds, antibiotic therapy combined with appropriate wound care is recommended.
| | ===Immunosuppressive Medicines=== |
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| * For clinically infected wounds, consider the questions below:
| | Immunosuppressive medicines are linked to an increased risk of cancer. These medicines lower the body’s ability to stop cancer from forming. For example, immunosuppressive medicines may be used to keep a patient from rejecting an organ transplant. |
| : '''1. Is there high risk of MRSA?'''
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| :* Methicillin-resistant ''Staphylococcus auerus'' (MRSA) coverage should be considered in the following conditions:
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| ::* Prior history of MRSA infection or colonization within the past year
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| ::* High local prevalence of MRSA infection or colonization (50% for a mild and 30% for a moderate soft tissue infection)
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| ::* Clinically severe diabetic foot infection
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| : '''2. Has patient received antibiotics in the past month?'''
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| :* If so, include agents active against gram-negative bacilli in regimen.
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| :* If not, agents targeted against just aerobic gram-positive cocci may be sufficient.
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| : '''3. Are there risk factors for infection with ''Pseudomonas aeruginosa'' or extended-spectrum β-lactamase (ESBL)–producing organisms?'''
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| :* Anti-pseudomonal agent is usually unnecessary <u>except</u> for patients with risk factors:
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| ::* High local prevalence of ''[[Pseudomonas aeruginosa]]'' infection
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| ::* Frequent exposure of the foot to water
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| ::* Warm climate
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| :* Coverage of ESBL-producing gram-negative organisms should be considered in countries in which they are relatively common.
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| : '''4. What is the infection severity status?'''
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| :* DFI is classified based on its severity according to the Infectious Diseases Society of America (IDSA) guideline or the PEDIS grade developed by International Working Group on the Diabetic Foot (IWGDF). [see Table below]
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| :* Selection of empiric antimicrobial regimen should be determined by the severity of DFI and the likely etiologic agents.
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| ::* '''Mild (grade 2) to moderate (grade 3) DFI without recent antibiotic treatment:'''
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| :::* Highly bioavailable oral antibiotics against aerobic gram-positive cocci may be sufficient.
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| ::* '''Severe (grade 4) DFI:'''
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| :::* Broad-spectrum antibiotics are recommended while culture results and susceptibility data are pending.
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| {|
| | Factors That May Affect the Risk of Cancer |
| | style="width: 15px;"|
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| {| style="border: 2px solid #A8A8A8; font-size: 90%;"
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| ! align="center" style="background: #A8A8A8;" | '''Clinical Manifestation'''
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| ! align="center" style="background: #A8A8A8; padding: 0 10px;" | '''PEDIS Grade'''
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| ! align="center" style="background: #A8A8A8; padding: 0 10px;" | '''IDSA Severity'''
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| |-
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| | style="background: #DCDCDC; padding: 0 10px;" | '''No symptoms or signs of infection'''
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| ! style="background: #DCDCDC; padding: 0 10px;" | 1
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| ! style="background: #DCDCDC; padding: 0 10px;" | Uninfected
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| |-
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| | style="background: #F5F5F5; padding: 0 10px;" | '''Local infection involving only the skin and the subcutaneous tissue''' <u>without</u> involvement of deeper tissues and <u>without</u> signs of SIRS
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| * If erythema, must be >0.5 cm to ≤2 cm around the ulcer.
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| * Exclude other causes of an inflammatory response of the skin (eg, trauma, gout, acute Charcot neuro-osteoarthropathy, fracture, thrombosis, venous stasis).
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| ! style="background: #F5F5F5; padding: 0 10px;" | 2
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| ! style="background: #F5F5F5; padding: 0 10px;" | Mild
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| |-
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| | style="background: #DCDCDC; padding: 0 10px;" | '''Local infection with erythema >2 cm or involving structures deeper than skin and subcutaneous tissues''' (eg, abscess, osteomyelitis, septic arthritis, fasciitis) <u>without</u> signs of SIRS
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| ! style="background: #DCDCDC; padding: 0 10px;" | 3
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| ! style="background: #DCDCDC; padding: 0 10px;" | Moderate
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| |-
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| | style="background: #F5F5F5; padding: 0 10px;" | '''Local infection with the signs of SIRS''', as manifested by ≥2 of the following:
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| * Temperature >38 °C or <36 °C
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| * Heart rate >90 beats/min
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| * Respiratory rate >20 breaths/min or PaCO2 <32 mm Hg
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| * White blood cell count >12,000 or <4,000 cells/μL or ≥10% immature (band) forms
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| ! style="background: #F5F5F5; padding: 0 10px;" | 4
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| ! style="background: #F5F5F5; padding: 0 10px;" | Severe
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| |}
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| |}
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| : '''5. What is the appropriate route, setting, and duration of antibiotic therapy?'''
| | Diet |
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| | The foods that you eat on a regular basis make up your diet. Diet is being studied as a risk factor for cancer. It is hard to study the effects of diet on cancer because a person’s diet includes foods that may protect against cancer and foods that may increase the risk of cancer. |
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| {| style="border: 2px solid #A8A8A8; font-size: 90%;"
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| ! align="center" style="background: #A8A8A8; padding: 0 10px;" colspan=2 | '''Site of Infection, by Severity or Extent'''
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| ! align="center" style="background: #A8A8A8; padding: 0 10px;" | '''Route of Administration'''
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| ! align="center" style="background: #A8A8A8; padding: 0 10px;" | '''Setting'''
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| ! align="center" style="background: #A8A8A8; padding: 0 10px;" | '''Duration of Therapy'''
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| |-
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| ! style="background: #DCDCDC; padding: 0 10px;" rowspan=3 | '''Soft-tissue only'''
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| ! style="background: #DCDCDC; padding: 0 10px;" | Mild
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| | style="background: #DCDCDC; padding: 0 10px;" | Oral (or topical for superficial infections)
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| | style="background: #DCDCDC; padding: 0 10px;" | Outpatient
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| | style="background: #DCDCDC; padding: 0 10px;" | 1–2 wk; may extend to 4 wk
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| |-
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| ! style="background: #DCDCDC; padding: 0 10px;" | Moderate
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| | style="background: #DCDCDC; padding: 0 10px;" | Oral (or initial parenteral)
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| | style="background: #DCDCDC; padding: 0 10px;" | Outpatient (or inpatient)
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| | style="background: #DCDCDC; padding: 0 10px;" | 1–3 wk
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| |-
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| ! style="background: #DCDCDC; padding: 0 10px;" | Severe
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| | style="background: #DCDCDC; padding: 0 10px;" | Initial parenteral, switch to oral when possible
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| | style="background: #DCDCDC; padding: 0 10px;" | Inpatient, then outpatient
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| | style="background: #DCDCDC; padding: 0 10px;" | 2–4 wk
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| |-
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| ! style="background: #F5F5F5; padding: 0 10px;" rowspan=4 | '''Bone or joint'''
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| ! style="background: #F5F5F5; padding: 0 10px;" | No residual infected tissue
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| | style="background: #F5F5F5; padding: 0 10px;" | Parenteral or oral
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| | style="background: #F5F5F5; padding: 0 10px;" | Inpatient, then outpatient
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| | style="background: #F5F5F5; padding: 0 10px;" | 2–5 d
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| |-
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| ! style="background: #F5F5F5; padding: 0 10px;" | Residual infected soft tissue
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| | style="background: #F5F5F5; padding: 0 10px;" | Parenteral or oral
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| | style="background: #F5F5F5; padding: 0 10px;" | Inpatient, then outpatient
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| | style="background: #F5F5F5; padding: 0 10px;" | 1–3 wk
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| |-
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| ! style="background: #F5F5F5; padding: 0 10px;" | Residual infected, viable bone
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| | style="background: #F5F5F5; padding: 0 10px;" | Initial parenteral, switch to oral when possible
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| | style="background: #F5F5F5; padding: 0 10px;" | Inpatient, then outpatient
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| | style="background: #F5F5F5; padding: 0 10px;" | 4–6 wk
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| |-
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| ! style="background: #F5F5F5; padding: 0 10px;" | Residual dead bone or no surgery
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| | style="background: #F5F5F5; padding: 0 10px;" | Initial parenteral, switch to oral when possible
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| | style="background: #F5F5F5; padding: 0 10px;" | Inpatient, then outpatient
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| | style="background: #F5F5F5; padding: 0 10px;" | ≥3 mo
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| |}
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| |}
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| ===Empiric Therapy===
| | It is also hard for people who take part in the studies to keep track of what they eat over a long period of time. This may explain why studies have different results about how diet affects the risk of cancer. |
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| <SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL>
| | Some studies show that fruits and nonstarchy vegetables may protect against cancers of the mouth,esophagus, and stomach. Fruits may also protect against lung cancer. |
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| | Some studies have shown that a diet high in fat, proteins, calories, and red meat increases the risk ofcolorectal cancer, but other studies have not shown this. |
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| '''Mild'''
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| <div class="mw-customtoggle-table01" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
| | It is not known if a diet low in fat and high in fiber, fruits, and vegetables lowers the risk of colorectal cancer. |
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| '''''High suspicion of MRSA'''''
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| <div class="mw-customtoggle-table02" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
| | See the following PDQ summaries for more information: |
| <font color="#FFF">
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| ▸ '''''Low suspicion of MRSA'''''
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| | Breast Cancer Prevention |
| <font color="#FFF">
| | Colorectal Cancer Prevention |
| '''Moderate'''
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| </font>
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| <div class="mw-customtoggle-table03" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
| | Alcohol |
| <font color="#FFF">
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| ▸ '''''High suspicion of MRSA'''''
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| </font>
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| <div class="mw-customtoggle-table04" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
| | Studies have shown that drinking alcohol is linked to an increased risk of the following types of cancers: |
| <font color="#FFF">
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| ▸ '''''Low suspicion of MRSA'''''
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| <div class="mw-customtoggle-table04" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
| | Oral cancer. |
| <font color="#FFF">
| | Esophageal cancer. |
| ▸ '''''High suspicion of P. aureuginosa'''''
| | Breast cancer. |
| </font>
| | Colorectal cancer (in men). |
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| <div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #A1BCDD; text-align: center;">
| | Drinking alcohol may also increase the risk of liver cancer and female colorectal cancer. |
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| '''Severe'''
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| <div class="mw-customtoggle-table06" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
| | See the following PDQ summaries for more information: |
| <font color="#FFF">
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| ▸ '''''Broad-spectrum regimen'''''
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| </font>
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| | Breast Cancer Prevention |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table01" style="background: #FFFFFF;"
| | Colorectal Cancer Prevention |
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| | Esophageal Cancer Prevention |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| | Oral Cancer Prevention |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''High suspicion of MRSA''}}
| | Liver (Hepatocellular) Cancer Prevention |
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Doxycycline]] 100 mg PO q12h'''''<br> OR <br> ▸ '''''[[TMP/SMZ]]'''''
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| | Physical Activity |
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Low suspicion of MRSA''}}
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Dicloxacillin]] 250 mg PO q6h'''''<br> OR <br> ▸ '''''[[Cephalexin]] 500mg PO q12h '''''<br> OR <br> ▸ '''''[[Amoxicillin-clavulanic acid]] 850/125 mg PO q12h''''' <br> OR <br> ▸ '''''[[Clindamycin]] 300-450 mg PO q6h'''''
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| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table03" style="background: #FFFFFF;"
| | Studies show that people who are physically active have a lower risk of certain cancers than those who are not. It is not known if physical activity itself is the reason for this. |
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''High suspicion of MRSA''}}
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
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| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | High suspicion of MRSA
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Linezolid]]''''' <br> OR <br> ▸ '''''[[Daptomycin]]''''' <br> OR <br> ▸ '''''[[Vancomycin]]'''''
| |
| |-
| |
| |}
| |
| |}
| |
|
| |
|
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table04" style="background: #FFFFFF;"
| | Studies show a strong link between physical activity and a lower risk of colorectal cancer. Some studies show that physical activity protects against postmenopausal breast cancer and endometrial cancer. |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Low suspicion of MRSA''}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Levofloxacin]]'''' <br> OR <br>▸ '''''[[Moxifloxacin]]'''''<br> OR <br> ▸ '''''[[cefoxitin]]''''' <br> OR <br> ▸ '''''[[Ceftriaxone]]'''''<br> OR <br> ▸ '''''[[Tigecylin]]''''' <br> OR <br> ▸ '''''[[Imipenem-cilastatin]]'''''
| |
| |}
| |
| |}
| |
|
| |
|
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table05" style="background: #FFFFFF;"
| | See the following PDQ summaries for more information: |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''High suspicion of P. aureuginosa''}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Piperacilin-tazobactam]]'''''
| |
| |}
| |
| |}
| |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table06" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''''Broad-spectrum regimen}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]]'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftazidime]]''''' <br> OR <br>▸ '''''[[Cefepime]]''''' <br> OR <br>▸ '''''[[Piperacillin-Tazobactam]]''''' <br> OR <br>▸ '''''[[Aztreonam]]''''' <br> OR <br>▸ '''''[['''''
| |
| |-
| |
| |}
| |
| |}
| |
| |}
| |
|
| |
|
| ==References==
| | Breast Cancer Prevention |
| | Colorectal Cancer Prevention |
| | Endometrial Cancer Prevention |
|
| |
|
| {{reflist|2}}
| | Obesity |
| | |
| | Studies show that obesity is linked to a higher risk of the following types of cancer: |
| | |
| | Postmenopausal breast cancer. |
| | Colorectal cancer. |
| | Endometrial cancer. |
| | Esophageal cancer. |
| | Kidney cancer. |
| | Pancreatic cancer. |
| | |
| | Some studies show that obesity is also a risk factor for cancer of the gallbladder. |
| | |
| | It is not known if losing weight lowers the risk of cancers that have been linked to obesity. |
| | |
| | See the following PDQ summaries for more information: |
| | |
| | Breast Cancer Prevention |
| | Colorectal Cancer Prevention |
| | Endometrial Cancer Prevention |
| | Lung Cancer Prevention |
| | |
| | Environmental Risk Factors |
| | |
| | Being exposed to chemicals and other substances in the environment has been linked to some cancers: |
| | |
| | Links between air pollution and cancer risk have been found. These include links between lung cancer and secondhand tobacco smoke, outdoor air pollution, and asbestos. |
| | Drinking water that contains a large amount of arsenic has been linked to skin, bladder, and lung cancers. |
| | |
| | Studies have been done to see if pesticides and other pollutants increase the risk of cancer. The results of those studies have been unclear because other factors can change the results of the studies. |
Overview
Factors that increase the chance of developing cancer are called risk factors. There are 2 types of risk factors: Modifiable and Non-modifiable. Modifiable risk factors are attitudes or circumstances that people can avoid, for example smoking. Non-modifiable risk factors are conditions that can't be changed, for example genetic predisposition to certain diseases. Factors that decrease the chance of developing cancer are called protective factors.
Many other factors in our environment, diet, and lifestyle may cause or prevent cancer. This summary reviews only the major cancer risk factors and protective factors that can be controlled or changed to reduce the risk of cancer. Risk factors that are not described in the summary include certain sexual behaviors, the use of estrogen, and being exposed to certain substances or chemicals.
Factors That are Known to Increase the Risk of Cancer
Tobacco
- Tobacco use is strongly linked to an increased risk for many kinds of cancer. Smoking cigarettes is the leading cause of the following types of cancer:
- Not smoking or quitting smoking lowers the risk of getting cancer and dying from cancer.
- Cigarette smoking causes about 30% of all cancer deaths in the United States.
- Cigarette smoking causes an estimated 443,000 deaths each year, including approximately 49,000 deaths due to exposure to secondhand smoke.
- Lung cancer is the leading cause of cancer death among both men and women in the United States, and 90 percent of lung cancer deaths among men and approximately 80 percent of lung cancer deaths among women are due to smoking.
Infections
Certain viral and bacterial infections are able to cause cancer. Infection as a cancer cause is more common in developing countries (about 1 in 4 cases of cancer) than in developed countries (less than 1 in 10 cases of cancer). Examples of infection caused cancers:
Two vaccines to prevent infection by cancer-causing agents have already been developed and approved by the U.S. Food and Drug Administration (FDA):
Radiation
There are two main types of radiation linked with an increased risk for cancer:
- Ultraviolet radiation from sunlight: This is the main cause of nonmelanoma skin cancers.
- Ionizing radiation including:
- Radiation exposure from diagnostic X-rays increases the risk of cancer in patients and X-ray technicians.
- The growing use of CT scans over the last 20 years has increased exposure to ionizing radiation. The risk of cancer also increases with the number of CT scans a patient has and the radiation dose used each time.
Ionizing radiation has been associated with:
- Leukemia
- Thyroid cancer
- Breast cancer in women
- Myeloma
- Lung cancer
- Gastric cancer
- Colon cancer
- Esophagueal cancer
- Bladder cancer
- Ovarian cancer
Immunosuppressive Medicines
Immunosuppressive medicines are linked to an increased risk of cancer. These medicines lower the body’s ability to stop cancer from forming. For example, immunosuppressive medicines may be used to keep a patient from rejecting an organ transplant.
Factors That May Affect the Risk of Cancer
Diet
The foods that you eat on a regular basis make up your diet. Diet is being studied as a risk factor for cancer. It is hard to study the effects of diet on cancer because a person’s diet includes foods that may protect against cancer and foods that may increase the risk of cancer.
It is also hard for people who take part in the studies to keep track of what they eat over a long period of time. This may explain why studies have different results about how diet affects the risk of cancer.
Some studies show that fruits and nonstarchy vegetables may protect against cancers of the mouth,esophagus, and stomach. Fruits may also protect against lung cancer.
Some studies have shown that a diet high in fat, proteins, calories, and red meat increases the risk ofcolorectal cancer, but other studies have not shown this.
It is not known if a diet low in fat and high in fiber, fruits, and vegetables lowers the risk of colorectal cancer.
See the following PDQ summaries for more information:
Breast Cancer Prevention
Colorectal Cancer Prevention
Alcohol
Studies have shown that drinking alcohol is linked to an increased risk of the following types of cancers:
Oral cancer.
Esophageal cancer.
Breast cancer.
Colorectal cancer (in men).
Drinking alcohol may also increase the risk of liver cancer and female colorectal cancer.
See the following PDQ summaries for more information:
Breast Cancer Prevention
Colorectal Cancer Prevention
Esophageal Cancer Prevention
Oral Cancer Prevention
Liver (Hepatocellular) Cancer Prevention
Physical Activity
Studies show that people who are physically active have a lower risk of certain cancers than those who are not. It is not known if physical activity itself is the reason for this.
Studies show a strong link between physical activity and a lower risk of colorectal cancer. Some studies show that physical activity protects against postmenopausal breast cancer and endometrial cancer.
See the following PDQ summaries for more information:
Breast Cancer Prevention
Colorectal Cancer Prevention
Endometrial Cancer Prevention
Obesity
Studies show that obesity is linked to a higher risk of the following types of cancer:
Postmenopausal breast cancer.
Colorectal cancer.
Endometrial cancer.
Esophageal cancer.
Kidney cancer.
Pancreatic cancer.
Some studies show that obesity is also a risk factor for cancer of the gallbladder.
It is not known if losing weight lowers the risk of cancers that have been linked to obesity.
See the following PDQ summaries for more information:
Breast Cancer Prevention
Colorectal Cancer Prevention
Endometrial Cancer Prevention
Lung Cancer Prevention
Environmental Risk Factors
Being exposed to chemicals and other substances in the environment has been linked to some cancers:
Links between air pollution and cancer risk have been found. These include links between lung cancer and secondhand tobacco smoke, outdoor air pollution, and asbestos.
Drinking water that contains a large amount of arsenic has been linked to skin, bladder, and lung cancers.
Studies have been done to see if pesticides and other pollutants increase the risk of cancer. The results of those studies have been unclear because other factors can change the results of the studies.