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Medicine for Finals > Oncology > Flashcards

Oncology Flashcards

1
Q

lung adenocarcinoma: distribution

A

peripheral

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2
Q

lung squamous cell carcinoma: distribution

A

central (perihilar)

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3
Q

lung adenocarcinoma: smoking risk

A

not a risk factor, seen in never-smokers

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4
Q

lung squamous cell carcinoma: smoking risk

A

smoking is a major risk factor

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5
Q

lung cancer: presenting features

A
  • cough
  • haemoptysis
  • dyspnoea
  • chest pain
  • anorexia and weight loss
  • SVC obstruction
  • hoarse voice (Pancoast’s Tumour)
  • cervical and supraclavicular lymphadenopathy
  • clubbing
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6
Q

small cell lung cancer: paraneoplastic features

A
  • hyponatraemia (SIADH)
  • Cushingoid syndrome (ACTH)
  • Lambert-Eaton Myasthenic Syndrome
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7
Q

lung squamous cell carcinoma: paraneoplastic features

A
  • hypercalcaemia (PTHrP)
  • hyperthyroidism (TSH)
  • clubbing
  • hypertrophic pulmonary osteoarthropathy
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8
Q

lung adenocarcinoma: paraneoplastic features

A
  • gynaecomastia
  • hypertrophic pulmonary osteoarthropathy
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9
Q

lung cancer: RED FLAGS

A
  • CXR findings suggestive of lung cancer
  • unexplained haemoptysis in >40yo
  • ≥2 of cough, fatigue, SOB, chest pain, weight loss, anorexia, smoking history in >40yo
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10
Q

lung cancer: imaging modalities

A
  • CXR typically first line
  • CT gold-standard
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11
Q

lung cancer: prognosis

A

small cell cancer carries the worst prognosis

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12
Q

lung cancer: metastatic sites

A
  • liver
  • brain
  • bone
  • adrenals
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13
Q

mesothelioma: risk factors

A

asbestos exposure

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14
Q

mesothelioma: presenting features

A
  • dyspnoea
  • weight loss
  • chest wall pain
  • clubbing
  • pleural effusion or thickening on CXR
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15
Q

mesothelioma: metastatic sites

A
  • contralateral lung
  • peritoneum
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16
Q

mesothelioma: prognosis

A

poor, eligible for industrial compensation

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17
Q

oesophageal adenocarcinoma: distribution

A

lower third of the oesophagus

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18
Q

oesophageal squamous cell carcinoma: distribution

A

middle and upper thirds of the oesophagus

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19
Q

oesophageal adenocarcinoma: risk factors

A
  • GORD +/- Barret’s Oesophagus
  • obesity
  • high fat diet

(most common in the developed world)

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20
Q

oesophageal squamous cell carcinoma: risk factors

A
  • smoking
  • alcohol
  • chronic achalasia
  • low vitamin A
  • iron deficiency
  • HPV
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21
Q

oesophageal and gastric cancer: RED FLAGS

A

Dysphagia
Weight loss + epigastric pain, dyspepsia or reflux in >55yo

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22
Q

oesophageal and gastric cancer: first-line investigation

A
  1. OGD +/- biopsy
  2. CT CAP and staging laparoscopy
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23
Q

oesophageal cancer: presenting features

A
  • PROGRESSIVE dysphagia (solids then liquids) ((cf. achalsia which presents with dysphagia to solids and liquids))
  • weight loss and anorexia
  • odynophgagia
  • hoarse voice
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24
Q

oesophagectomy: risks

A
  • anastomotic leak (8%)
  • pneumonia (30%)
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25
Q

gastrectomy: risks

A
  • anastomotic leak (5-10%)
  • dumping syndrome (high-sugar foods pass quickly)
  • vitamin B12 deficiency
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26
Q

oesophageal and gastric cancer: metastatic sites

A
  • supraclavicular lymph nodes (Virchow’s Node)
  • periumbilical lymph nodes (Sister Mary Joseph Nodule)
  • liver and abdomen (requires staging laparotomy)
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27
Q

lung cancer: histology

A
  • non-small cell cancer: adenocarcinoma, squamous cell carcinoma, large cell carcinoma (anaplastic - poor prognosis)
  • small cell lung cancer (rare, poor prognosis)
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28
Q

oesophageal cancer: histology

A
  • adenocarcinoma
  • squamous cell carcinoma
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29
Q

gastric cancer: histology

A
  • adenocarcinoma (>90%)
  • others: GIST, MALT lymphoma, NET
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30
Q

gastric MALT lymphoma: risks

A
  • H pylori infection
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31
Q

gastric MALT lymphoma: histology

A

a slow-growing non-Hodgkin lymphoma

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32
Q

gastric MALT lymphoma: management

A
  1. H pylori eradication
  2. rituximab (anti-CD20)

Treatable, but may recur

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33
Q

neuroendocrine tumour: sites

A

Can affect anywhere
Stomach, lung, appendix and small bowel common

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34
Q

neuroendocrine tumour: presenting features

A

non-functioning tumour → mass effect symptoms (pain, distension, N&V, bowel obstruction

functioning tumour (post-metastasis) → carcinoid syndrome (flushing, palpitations, abdominal pain and diarrhoea)

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35
Q

neuroendocrine tumour: marker(s)

A
  1. chromogranin A
  2. pancreatic polypeptide
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36
Q

GIST: management

A
  • surgical resection (symptomatic relief of mass effect)
  • tyrosine kinase inhibitors (imatinib)
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37
Q

gastric adenocarcinoma: risk factors

A
  • male
  • increasing age
  • H pylori infection
  • smoking
  • alcohol
  • high salt diet
  • family history
  • pernicious anaemia
38
Q

gastric adenocarcinoma: presenting features

A
  • dyspepsia (refractory to PPI)
  • dysphagia
  • early satiety
  • vomiting
  • melena +/- haematemesis
  • weight loss and anorexia
39
Q

colorectal cancer: histology

A

adenocarcinoma

40
Q

colorectal cancer: risk factors

A
  • polyps
  • inflammatory bowel disease (UC > Crohns)
  • genetic syndromes (FAP, HNPCC)
41
Q

colorectal cancer: presenting features

A
  • change in bowel habit
  • weight loss
  • anaemia
  • rectal bleeding (left sided > right sides)
42
Q

colorectal cancer: markers

A

CEA

43
Q

colorectal cancer: screening test

A

faecal occult blood test
offered biannually for 60-75yo

44
Q

colorectal cancer: first-line investigation

A

sigmoidoscopy or colonoscopy +/- biopsy
barium enema
CT abdomen

45
Q

colorectal cancer: Duke’s Staging

A

A) confined to mucosa
B) involves muscular wall
C) involves lymph nodes
D) distant metastases

46
Q

colorectal cancer: metastatic sites

A

liver

47
Q

colorectal cancer: RED FLAGS

A
  • new iron deficiency in >60yo
  • unexplained PR bleed in >50yo
  • unexplained weight loss and abdominal pain in >40yo
48
Q

breast cancer: risk factors

A
  • increasing age
  • alcohol
  • lifetime oestrogen exposure (nulliparity, early menarche, late menopause, HRT, obesity)
  • genetics (in 5-10%)
49
Q

breast cancer: histology

A
  • ductal carcinoma (75%)
  • lobular carcinoma (15%)
  • intraductal papilloma
  • Phyllodes tumour (fibroepithelial tumour, mostly benign)
50
Q

ductal carcinoma: associated conditions

A
  • DCIS is a precursor
  • DCIS with nipple involvement (eczema) → Paget’s Disease of the Nipple
51
Q

lobular carcinoma: associated conditions

A
  • LCIS is a precursor
52
Q

intraductal papilloma: associations and presenting features

A
  • younger women
  • blood-stained discharge
53
Q

breast cancer: investigation

A

triple assessment:
- expert examination
- imaging (mammogram if >35yo, USS if <35yo)
- tissue diagnosis (cytology from FNA or biopsy)

For confirmed cancer, sentinel LN biopsy

54
Q

breast cancer: molecular phenotyping

A

ER
PR
HER2

55
Q

breast cancer: marker(s)

A

CA15-3

56
Q

breast cancer: surgical management

A

Tumours <5cm (T1+2) → lumpectomy/WLE
Tumours >5cm (T3+4) → radical mastectomy +/- axillary LN clearance (risk of lymphoedema)

57
Q

breast cancer: metastatic sites

A
  • axillary lymph nodes (N1 = mobile; N2 = fixed)
  • internal mammary nodes (N3)
  • bones
  • brain
  • liver
  • lungs
58
Q

breast cancer: hormonal management of ER-positive cancer in a pre-menopausal woman

A

Tamoxifen (an ER modulator) 5yrs
Gosrelin (LHRH modulator - induces menopause)

risks: endometrical cancer, VTE

59
Q

breast cancer: hormonal management of ER-positive cancer in a post-menopausal woman

A

Aromatase inhibitors (anastrozole or letrozole)

risks: joint or muscle aches, oestoporosis

60
Q

breast cancer: hormonal management of HER2-positive cancer

A

Trastuzumab (herceptin) with chemotherapy

risks: cardiotoxicity

61
Q

breast cancer: roles of chemo and radiotherapy

A

chemotherapy - (neo)adjuvant in triple negative disease
radiotherapy - external beam radiotherapy for breast-conserving surgery or axillary disease

62
Q

prostate cancer: histology

A

adenocarcinoma, of which:
- acinar subtype (common)
- ductal subtype (faster growing and more aggressive)

75% arise in the peripheral zone

63
Q

prostate cancer: risk factors

A
  • increasing age
  • Black African or Caribbean ethnicity
  • family history
  • BRCA1 or 2
  • obesity, DM, smoking, inactivity
64
Q

prostate cancer: presenting features

A
  • LUTS with poor stream
  • haematuria
  • dysuria
  • incontinence
  • suprapubic, loin or rectal pain
  • bone pain
  • weight loss and anorexia
65
Q

factors causing an increase in PSA

A
  • BPH
  • prostatitis (1mo) or UTI (1mo)
  • recent urological surgery
  • urinary retention
  • vigorous exercise (48hrs)
  • sexual intercourse (48hrs)
  • recent DRE (1wk)

** use age-adjusted cut-offs**

66
Q

prostate cancer: investigations

A
  • DRE (most sensitive for peripheral zone tumours)
  • PSA
  • MRI prostate
  • Transperineal or transrectal biopsy
  • CT CAP for staging
67
Q

prostate cancer: risk stratification

A
  • Gleason grade (based off histological analysis)
  • T stage
  • PSA level
68
Q

prostate cancer: management of low-risk cancer

A

active surveillance
- 3mo PSA
- 6mo DRE
- 1-3yr biopsy

69
Q

prostate cancer: management of intermediate and high-risk cancer

A

surgery or radiotherapy + hormone therapy are equivocal

70
Q

prostate cancer: complications of prostatectomy

A
  • erectile dysfunction
  • stress incontinence
  • bladder neck stenosis
71
Q

prostate cancer: complications of radiotherapy

A
  • cystitis
  • proctitis
  • small increased risk of bladder cancer

*equivocal for external beam therapy or brachytherapy (bead)

72
Q

prostate cancer: hormonal therapy

A

Neoadjuvant alongside radiotherapy or surgery

IM GnRH agonist (Zoladex) given monthly, causes tumour flair in first month (bone pain, bladder obstruction)

PO anti-androgen (bicalutamide) given for first month to counteract initial tumour flair (bone pain, bladder obstruction)

73
Q

prostate cancer: side effects of hormonal therapy

A
  • reduced libido
  • erectile dysfunction
  • nausea and diarrhoea
  • breast tenderness
  • hot flushes
74
Q

prostate cancer: metastasis

A
  • pelvic LN
  • bone
  • liver
  • lung
  • brain
75
Q

hepatocellular carcinoma: risk factors

A
  • chronic liver disease (alcoholic, Hep B or C, autoimmune)
  • metabolic disease (haemochromatosis)
  • aflatoxins (Aspergillus)
  • primary biliary cirrhosis
76
Q

hepatocellular carcinoma: presenting features

A
  • abdominal distension
  • ascites
  • jaundice
  • systemic upset (malaise, weight loss, anorexia)
77
Q

hepatocellular carcinoma: tumour marker(s)

A

alpha fetoprotein

78
Q

hepatocellular carcinoma: first-line investigation

A

Liver USS +/- duplex

79
Q

hepatocellular carcinoma: management

A
  • 10% amenable to surgery
  • consider chemotherapy +/- biologics (bevacizumab) +/- tyrosine kinase inhibitors
80
Q

hepatocellular carcinoma: complications

A
  • biliary tree compression
  • liver decompensation
  • pain
  • rupture and intraperitoneal bleed
  • paraneoplastic syndromes
81
Q

cholangiocarcinoma: risk factors

A
  • primary sclerosing cholangitis (inflammation of the bile ducts and cholestasis)
82
Q

cholangiocarcinoma: presenting features

A
  • obstructive jaundice
  • abdominal fullness or pain
  • palpable gallbladder (Courvoisier’s Law)
  • systemic upset (weight loss, fatigue, malaise)
83
Q

cholangiocarcinoma: tumour marker(s)

A

CA19-9, occasionally CEA

84
Q

cholangiocarcinoma: first-line investigations

A

ERCP +/- biopsy
(percutaneous transhepatic cholangiography if difficult bile duct access)

85
Q

cholangiocarcinoma: management

A
  • 15% amenable to surgery
  • poorly responsive to chemotherapy
  • consider palliative stenting
86
Q

pancreatic cancer: histology

A

80% adenocarcinoma

87
Q

pancreatic cancer: risk factors

A
  • increasing age
  • smoking
  • diabetes
  • chronic pancreatitis
  • HNPCC (Lynch Syndrome), MEN, BRCA2, KRAS
88
Q

pancreatic cancer: presenting features

A
  • painless jaundice
  • cholestatic LFT
  • palpable gallbladder (Courvoisier’s Law)
  • systemic upset (weight loss, anorexia)
  • occasionally epigastric +/- back pain
  • migratory thrombophlebitis
89
Q

pancreatic cancer and cholangiocarcinoma: red flags

A

painless jaundice

90
Q

pancreatic cancer: first-line investigation

A

USS
CT (double duct sign)

91
Q

pancreatic cancer: management

A

20% amenable to surgery (Whipple’s)
Adjuvant chemotherapy
Consider ERCP stenting for symptomatic relief

Medicine for Finals (10 decks)

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