Cancers Flashcards
Risk factors of lung cancer
asbestos scarring from eg. tb smoking air polution radon gas arsenic
Presentation of lung cancer
- haemoptysis, pleuritic chest pain, SOB, unexplained cough for 3 weeks
- 10% weight loss in 6 months, night sweats, fevers, fatigue, anaemia (iron def)
- recurrent chest infections, not better with antibiotics
- hoarse voice = recurrent laryngeal nerve
- cachexia, clubbing, lymphadenopathy
Investigations for lung cancer
- 1st line CXR (mass + raised hemidiaphragm from phrenic nerve)
- Endobronchial US guided bronchcoscpy for biopsy
- Serum calcium (raised if PTHrP from squamous)
- U&Es (na for siadh in small cell)
- FBC = anaemia
- LFTs
- pulse ox and ecg
- Contrast CT CAP (adrenals + liver for mets!)
- spirometry
When would you refer suspected lung cancer? + areas of spread
Liver, adrenals, bone, brain spread
2ww cxr if >= 40 and 2 of the following (1 if ever smoked)…
cough/fatigue/sob/chest pain/anorexia/weight loss
OR >40 and 1 of the following…
recurrent chest infections/ finger clubbing/ >6 week lymphadenopathy/ chest signs consistent with lung cancer/ thrombocytosis
2ww cancer pathway if
- > = 40 and unexplained haemoptysis
- suspicious cxr
Management of non small cell lung cancer
stage 1-3
- lobectomy (or wedge resection in reduced lung function)
- neo-adjuvant chemo
- adjuvant chemo and radio for stage 2 and 3
- or can use stereotactic ablative radiotherapy as curative therapy
stage 4
- immunotherapy, targeted therapy, chemotherapy
- palliative = chemo and radiotherapy for mets and symptoms
Management of small cell lung cancer
surgery if it is local but most present as mets
so do palliative chemo
do prophylaxis cranial irradiation
Complications of small cell lung cancer
- siadh
- lambert eaton syndrome
- cushings
Complications of non-small cell lung cancer
- hypertrophic pulmonary osteoarthropathy = squamous and adeno
- PTHrP from squamous (hypercalcaemia)
most pancoast are non small cell
- horners if sympathetic compression
- hoarseness if recurrent laryngeal nerve compression
- svco
- arm pain from brachial plexus compression
- vagus nerve compression
Risk factors for breast cancer (male too)
Male = gynaecomastia, klinefelters, BRCA1/2, fhx prostate cancer, cirrhosis, radiation
Female =
- nulliparity, never breastfed
- increased exposure to oestrogen (early menarche, late menopause, hrt (combined), cocp, obesity or high fat diet, first baby >30)
- fhx of relative <50 years old
- older age
- BRCA1,2
- p53 mutation
- chest radiation
Presentation of breast cancer and some other differentials of breast lumps
- painless fixed hard lump in the breast
- skin changes like dimpling
- nipple discharge or bleeding
- nipple changes or inversion
- Pagets disease of the nipple (ductal carcinoma in situ)
- oedema or erythema or colour changes
- Ulceration is a late sign
- lump in the axilla
fibroadenomas, lipomas, phillodes tumours, fat necrosis
When would your refer suspected breast lump?
> =30 2ww
unexplained lump in the breast or axilla
> =50 2ww
unexplained skin or unilateral nipple changes suggestive of malignancy (discharge, retraction, etc)
<= 30 Not urgent
unexplained breast lump
What is the breast screening available?
47-73 every 3 years
Mammogram
also for those with brca1/2, fhx of first degree relative <50 years old, previous cancer
How would you investigate breast cancer?
Triple assessment
- mammogram (<35 do US as there is thicker breast tissue)
- breast examination
- fine needle aspiration (cytology) or core needle biopsy (histology)
- CTCAP
- TNM staging
- Receptor status (her, oestrogen, progesterone)
- LFTs, U&Es, FBC
- bone scan
What are the types of breast cancer?
Ductal carcinoma in situ
- microcalcifications on mammogram
- associated with pagets disease
Invasive ductal carcinoma
- invaded through basement membrane
Lobular carcinoma in situ
- may be no lump or discharge, hard to detect
- often multifocal and bilateral
Invasive lobular carcinoma
How would you manage breast cancer?
Wide local excision or mastectomy
- can do neoadjuvant chemo to reduce tissue
- adjuvant chest wall radiation afterwards
- can do sentinel node biopsy or axillary node clearance if indicated
- adjuvant chemo improves survival
Advanced breast cancer
- chemo and radiotherapy +/- targeted therapies
- HER2 +ve = herceptin (tratuzumab)
- Oestrogen +ve = SERM tamoxifen for premenopausal, Aromatase inhibitor letrozole or anostrozole for post menopausal
- If triple negative = chemo with platinum and anthracycline
Where does breast cancer spread?
lungs, liver, bones
What are some risk factors for colorectal cancer?
- low fibre
- high processed meat, high fats, alcohol, smoking
- IBD
- diabetes
- old, male
- familial adenomatous polyposis, HNPCC
How does colorectal cancer present? (L,R,Rectal)
Sister Mary Joseph Nodule = lymphadenopathy
R = caecal
- faecal occult bleeding
- iron def anaemia/ fatigue
- appendicitis
- RIF mass and abdo pain
L = sigmoid
- colicky pain
- LIF mass
- tenesmus
- bowel changes (diarrhoea, mucus), obstruction etc
Rectal
- rectal mass
- tenesmus then persistent pain
- rectal bleeding
- if invades anal sphincter = incontinence
- can invade into sacral plexus = back pain
