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Cancer care > Solid malignancy > Flashcards

Solid malignancy Flashcards

1
Q

What are the RF of prostate cancer?

A
  • Increasing age
  • FH
  • African heritage
  • BRCA2 gene mutation
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2
Q

What are the CF of prostate cancer?

A

LUTS
Asymptomatic - raised PSA
Bone pain - mets
Ejaculatory sx eg. blood in semen - rare

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3
Q

What are the ix into prostate cancer?

A

DRE
PSA - poor ix, mets unlikely if <10
MRI prostate/pelvis - often pre biopsy to decide technique, also if no suspicious areas don’t need biopsy
Biopsy - transperineal most commonly, for Gleason grading

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4
Q

What are some common causes of raised PSA?

A

Prostate cancer
UTI - dip
Prostatitis
Enlarged rpostate eg. BPH
Acute urinary retention

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5
Q

What factors influence treatment of prostate cancer?

A

Age
DRE - staging - localised, locally adv or advanced
PSA
Biopsies - Gleason grade
MRI - nodes or mets ? and bone scan

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6
Q

What is the treatment of metastatic prostate cancer?

A

Hormones - enzalutamide = androgen R antagonist, GnRH agonist or bilat orchidectomy
Palliation - single dose RT for bone pain, bisphosphonates

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7
Q

What is the treatment for locally advanced prostate cancer?

A

Radical radiotherapy w adjuvant hormones
External beam RT? Procitis is complication
Brachytherapy - seeds inside ?

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8
Q

What is the treatment for localised prostate cancer?

A

Active surveillance
Curative - radical prostatectomy, RT, incontinence or erectile dysfunc r the complications
Palliative - deferred hormones, watchful waiting

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9
Q

What are the differential diagnosis for haematuria?

A

Cancer - RCC, TCC bladder, prostate cancer
Stones
Infection and inflam
BPH
Glomerular eg. nephritic syndrome

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10
Q

What are the ix into haematuria?

A

Flexible cystoscopy
USS of kidney
Urine cytology

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11
Q

What is the presentation of testicular cancer?

A

Painless lump in the body of the testis - 2WW. Most are germ cell tumours - hx of undescended testis

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12
Q

What are the ix into testicular cancer? How do you treat?

A

Urgent USS of scrotum
Tumour markers - aFP, hCG, LDH
Treat - inguinal orchidectomy

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13
Q

What are the RF of bladder cancer? TCC

A

Smoking
Occupational exposure - rubber or plastics manufacture, handling crude oil, carbon, painting, mechanics, hairdressers
Male more than women

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14
Q

What are the ix into bladder cancer? How is it treated?

A

Cystoscopy - treat w TURBT
Can sometimes give single intravesical dose of chemo eg. mitomycin
High risk - intravesical BCG to create immune response
Mets - cisplatin based chemo
Biologicals

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15
Q

What is the treatment of upper tract TCC?

A

Nephro ureterectomy

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16
Q

What are the RF of RCC

A

Male and white
Smoking
Obesity
Dialysis

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17
Q

What is the presentation of RCC?

A

Haematuria
Incidental finding on imaging
Palpable mass - vv rare

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18
Q

What is the treatment of RCC?

A

Surveillance
Excision - partial or radical nephrectomy
Mets - palliative, biologicals and targeted therapies

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19
Q

What are sx of lung cancer?

A

Unexplained cough >3w
Haemoptysis
SOB
Hoarse, dysphagia
Chest pain, wheeze
B sx

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20
Q

What are some signs of lung cancer?

A

SVC obstruction
DVT
Clubbing
Horner’s syndrome

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21
Q

Where does lung cancer met to most commonly?

A

Other lung or other lung lobe
Liver, brain, bone, adrenal glands

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22
Q

What are the ix into lung cancer?

A

Biopsy + histology
Bloods - FBC (infection, anaemia), U+E (contrast CT), Ca (bone profile, paraneoplastic syndrome), LFTs (tests and mets), INR (tests)
CXR - hilar enlargement, pleural effusion, collapse, opacity
Staging - CT thorax, abdo, pelvis w contrast

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23
Q

What are the options for biopsy in lung cancer?

A

US guided neck node core for cytology - least invasive
Nothing in the neck - bronchoscopy = EBUS
CT biopsy if peripheral mass
Sputum sample for cytology
Pleural effusion - thoracoscopy

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24
Q

What are the ix into malignant pleural effusion?

A

Bloods - FBC, U+E, CRP, INR, LFT
US guided diagnostic aspirate - protein, LDH, cytology, microbiology
-ve cytology - medical thoracoscopy
If you have pleural effusion in lung cancer normally have non curative treatment.

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25
Q

What is Light’s criteria?

A

Transudate = protein <0.5, LDH <0.6
Causes - congestive HF, hypoalbuminaemia - cirrhosis, nephrotic syndrome
Exudate = protein >0.5, LDH >0.6
Causes - malignancy, PE, infection, autoimmune

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26
Q

What is done w incidental lung nodules?

A

5mm + = follow up
8mm + = active intervention
20mm + = cancer clinic

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27
Q

What are the different types of lung cancer?

A

80% Non small cell lung cancer - SCC, large cell, adenocarcinoma 40%
20% small cell lung cancer - linked with smoking

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28
Q

What is the treatment of hypercalcaemia?

A

> 3 = treat
IV fluids - see if reduces Ca
Pamidronate one off reduces Ca

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29
Q

What is WHO performance status?

A

0 - fully active w/o restriction
1 - restricted in physically strenuous activity, able to carry out light work
2 - capable of self care but can’t work
3 - limited self care, seated/bed >50% time
4 - completely bed bound
5 - dead

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30
Q

Where does prostate cancer most affect?

A

Peripheral zone

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31
Q

What are some risks of prostate biopsy?

A

Pain
False -ve - miss cancerous area
Bleeding in stools, urine and semen
Infection
Urinary retention
Erectile dysfunc

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32
Q

What are the RF of lung cancer?

A

Smoking and second hand smoke
Prev lung disease
Asbesto or radon exposure
FH

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33
Q

What is the management of NSCLC?

A

1st line = surgery = lobectomy, segmentectomy or wedge resection if isolated disease, curative
RT can be curative if early disease
Adjuvant chemo after surgery or palliative

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34
Q

What is the management of SCLC?

A

Chemo (cisplatin based) and RT - much worse prognosis than NSCLC

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35
Q

What are the ix prior to surgery for NSCLC?

A

LFT - determine the type of surgery and can predict post op lung func

36
Q

What are the extrapulm manifestations of lung cancer?

A

RLN palsy
Phrenic nerve palsy = SOB
SVCO
Paraneoplastic syndrome - SIADH and Cushing’s syndrome = SCLC, hypercalcaemia = SCC
Limbic encephalitis
Lambert Easton syndrome
Horner’s = pancoast tumour

37
Q

What is referral guidance for lung cancer?

A

2WW referral:
- Suggestive CXR and unexplained haemoptysis >40
- Recurrent chest infection or clubbing or supraclav LA >40
- >40 and have smoked w sx of lung cancer

38
Q

What staging is used for lung cancer?

A

TMN

39
Q

What is the prognosis for lung cancer?

A

Biggest cause of cancer related death in UK
1 year survival ~40%, 5 year survival ~16%

40
Q

What are some differentials for breast lumps?

A
  • Breast cancer
  • Fibroadenoma
  • Fibrocystic breast changes
  • Breast cysts
  • Fat necrosis
  • Lipoma
  • Galactocele
  • Phyllodes tumour
41
Q

What are the RF of breast cancer?

A
  • Female
  • Increase O exposure eg. COCP, HRT, long time w periods
  • Glandular breast tissue
  • Obesity and smoking
  • FH
42
Q

What hereditary syndromes predispose someone to breast cancer?

A

BRCA 1 - 60-80% risk breast cancer
BRCA 2 - 45-70% risk breast cancer
Also increase risk of breast cancer in men

43
Q

What are the types of breast cancer?

A

Ductal or lobular carcinoma in situ - pre cancerous or cancerous cells not breached the BM, can spread
Invasive ductal (most common) or lobular carcinoma
Inflam breast cancer
Paget’s disease of the nipple

44
Q

What is inflam breast cancer?

A

~1-3% of breast cancers
Looks like breast abscess or mastitis - swollen, warm, ternder breast w pitting skin = peau d’orange
Doesn’t respond to abx
Worst prognosis

45
Q

What is Paget’s disease of the nipple?

A

Erythematous scaly rash - looks like eczema of the nipple
Indicates breast cancer involving the nipple

46
Q

What screening is there for breast cancer?

A

50-71 years old women, transmen and transwomen on HRT have a mammogram
Satisfactory - no evidence of breast cancer
Abnormal - need further ix
Unclear - need further ix

47
Q

What are the CF of breast cancer?

A

Asymptomatic
Lump - irregular, hard/firm, fixed
Breast pain
Change to skin appearance, pitting, tethering
Nipple inversion or discharge
Features of mets

48
Q

What is triple assessment in breast cancer?

A
  1. Hx and exam
  2. Imaging - mammogram and US
  3. Biopsy - FNA or core biopsy
49
Q

What are the other ix into breast cancer?

A

CXR
MRI breast
CT chest abdo pelvis w contrast
±CT brain
±Liver USS
±Bone scan
±PET/CT

50
Q

What is the tumour marker for breast cancer?

A

Ca 15-3

51
Q

What receptors are there in breast cancer?

A

Oestrogen
Progesterone
HER2 - can have herceptin, ab that blocks HER2 pathway

52
Q

What is the screening for breast cancer?

A

Normal pt - mammogram every 3 years for women aged 50-70
High risk pt - annual mammogram for high risk pt
Can have chemoprevention, genetic counselling and pre test counselling, bilat mastectomy or oophorectomy also

53
Q

What pt are at high risk of breast cancer?

A

1st degree relative w breast cancer <40 years
1st degree male relative w breast cancer
1st degree relative w bilat breast cancer <50 years
x2 1st degree relatives w breast cancer

54
Q

What chemoprevention is offered for high risk women?

A

Tamoxifen - pre menopausal
Anastrozole - post menopausal

55
Q

What surgery options are there in breast cancer?

A
  • Tumour removal - breast conserving surgery or mastectomy w breast recon
  • Axillary clearance
56
Q

What are the hormone treatments used in breast cancer?

A
  1. Tamoxifen - pre menopausal
  2. Aromatase inhib - post menopausal eg. letrozole

Both block O production, given for 5-10 years in women w O R +ve breast cancer

57
Q

What targeted treatments are used in breast cancer?

A

HER2 R targetters - herceptin, perjeta

58
Q

What are the RF of colorectal cancer?

A

FH
FAP and HNPCC/Lynch syndrome
IBD
Increased age
Diet w lots of red meat, processed meat and not much fibre
Obesity and sedentary lifestyle
Smoke and alcohol

59
Q

What are the red flags for bowel cancer?

A

Change in bowel habit
Unexplained weight loss
Rectal bleeding
Unexplained abdo pain
Fe def anaemia
Mass

60
Q

What is the 2WW criteria for cancer referral?

A

> 40 years w abdo pain and unexplained weight loss
50 years unexplained rectal bleed
60 years w change in bowel habit or Fe def anaemia

61
Q

What is bowel cancer screening?

A

FIT - faecal immunochemical test in 60-74 years every 2 years
Tests for human Hb in stool, +ve - colonoscopy

62
Q

What are the ix into bowel cancer?

A

Colonoscopy - gold standard, can biopsy
Sigmoidoscopy - when only rectal bleeding
CT colonography
CT AP thorax w contrast - staging
CEA = tumour marker

63
Q

What is the management of bowel cancer?

A

Surgical resection - w stoma or anastomosis formation
Chemo
RT
Palliative care

64
Q

What are the different surgeries in bowel cancer?

A

R hemicolectomy - caecum, ascending and proximal transverse colon
L hemicolectomy - distal transverse and descending colon
High ant resection - remove simoid colon
Low ant resection - remove sigmoid colon and upper rectum
APR - removes rectum and anus
Hartmann’s - emergency, remove recto sigmoid colon and colostomy formation

65
Q

What are the complications of bowel cancer surgery?

A

Bleed, infection, pain, VTE
Damage to neighbouring structures
Post op ileus
Anaesthetic risks
Failure of anastomosis, need stoma
Failure to remove tumour
Adhesions
Incisional hernias

66
Q

What is low ant resection syndrome?

A

Urgency and freq of bowel movements
Faecal incontinence
Difficulty controlling flatulence

67
Q

What are some tumour markers?

A

CEA - bowel cancer
Ca 125 - ovarian cancer
Ca 19-9 - pancreatic cancer
Ca 15-3 - breast cancer
AFP - hepatocellular and testicular
PSA - prostate

68
Q

What is the most common type of head and neck cancer and where is it?

A

SCC
Nasal cavity
Paranasal sinuses
Mouth
Salivary glands
Pharynx
Larynx

69
Q

What are the RF of head and neck cancer?

A

Smoke
Chewing tobacco or betel leaves
Alcohol
HPV
EBV

70
Q

What are the red flags of head and neck cancer?

A

Lump in mouth or lip
Unexplained ulceration of mouth >3 weeks
Erythroplakia
Erythroleukoplakia
Persistent neck lump
Unexplained hoarse voice
Unexplained thyroid lump

71
Q

What is the treatment of head and neck cancer?

A

Chemo, RT, surgery, palliation
Cetuximab

72
Q

What are the RF of BCC?

A

Long term UV exposure
Prev BCC
UVA therapy for psoriasis
Skin type 1
Immunosuppression
Genetic syndromes - xeroderma pigmentosa

73
Q

What are the CF of BCC?

A

In areas of the body that get lots of sunlight - head, neck, hands, ears
Small slow growing lesions
Raised pearly edges
Telangiectasia
ASymptomatic

74
Q

What are the ix into SCC and BCC?

A

Dermatoscope examination
Excision biopsy

75
Q

What is the management of BCC?

A

Imiquimod cream
5 flurouracil cream
Cryotherapy, curettage
Excision - margins 3-5 mm ±skin graft
Can do Mohs’ micrographic surgery

76
Q

What prevention advice is given for skin cancer?

A

Avoid sunbeds
Use SPF50 all year
Protective clothing - hats etc, sit in shade

77
Q

What are the RF of SCC?

A

Prolonged UV exposure
Chronic wounds and inflam
Immunosuppression
Pre malignant conditions eg. AK, Bowen’s disease
Smoking

78
Q

What are the CF of SCC?

A

Nodular, indurate, keratinised
Ulcerated
Bleeding/itchy
Growing quickly
Sun exposed sites

79
Q

What is Bowen’s disease?

A

Growth of cancerous cells confined to outer layer of skin - SCC in situ
Small red scaly lesion, normally flat and treated w topicals

80
Q

What is the management of SCC?

A

Excision
Low risk - 4mm margin
High risk - 6mm
v high risk - 10mm

81
Q

Which areas are most commonly affected by melanoma and where does it met to?

A

Trunk and legs
Mets - every tissue and organ in body ! can met to anywhere

82
Q

What are the RF of melanoma?

A

UV exposure
Genetic mutations
Premalignant lesions
Prev melanoma
Age
Caucasian
>50 naevi
Sunbeds
Type 1 and 2 skin

83
Q

What are the CF of melanoma?

A

New naevus or change to existing mole
Bleed/ulcer
Asymmetrical
Irreg border
Uneven colour
Diameter >6mm
Evolving lesion
LN involvement

84
Q

What are the ix into melanoma?

A

Excision biopsy to diagnose
Staging CT CAP - TNM

85
Q

What can help to determine met risk in melanoma?

A

Breslow thickness

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