KCP: Cancer Flashcards
What are the main features of cancer compared with healthy cells?
- Uncontrolled proliferation
- Self sufficiency in growth signals
- Insensitivity to anti-growth signals
- Avoiding cell death (apoptosis)
- Establish blood flow (for oxygen and nutrients)
- Tissue invasion
- Metastasis i.e. can spread to other parts of the body
A 68 year old woman has three months with a cough. She has hypertension and takes lisinopril.
What additional questions would you like to ask?
Smoking history?
Occupation?
Haemopotysis?
A 68 year old woman has three months with a cough. She has hypertension and takes lisinopril.
You find out 40 pack smoking history
Yellow sputem no blood more tired and breathless walking to shops, dull left sided chest pain. worked in council administration
What investigations should be requested?
Chest X-Ray
Full blood count, urea and electrolytes, calcium
A 58 year old woman visits her GP with six months of increasing tiredness. She has had occasional lower abdominal pain and has lost 5 kg in weight. She is not taking any medication. She works as a teacher.
What additional questions would you ask?
Why are you here today?
Changes in bowel movements? Blood?
Family history?
Where is abdominal pain?
Change in appetite?
Cancer screening?
A 58 year old woman visits her GP with six months of increasing tiredness. She has had occasional lower abdominal pain and has lost 5 kg in weight. She is not taking any medication. She works as a teacher.
You find out pain is lower left side of abdomen and cramping. Loose stool with blood mixed in. Mother has had bowel cancer. Decline bowel screening.
What are the next steps?
Full blood count - aneamia due to blood loss in stool. If aneamia comes back colonoscopy.
Stool sample to rule out infection
Back pain red flags (9)
- Weakness/numbness in both legs
- Saddle anaesthesia
- Urine retention or incontinence, faecal incontinence
- Nocturnal pain
- Weight loss
- Fevers
- Thoracic pain
- Recent trauma
- History of cancer or immunosuppression
The first three may indicate compression of spinal chord or cauda equina
A72 year old man has three months of gradually worsening back pain in his thoracic and lumbar spine. The pain is now keeping him awake at night and he has weakness in his legs. He has lost 4 kg in weight and has also been constipated for the last month. He has had nocturia and urinary urgency for the last 2 years. These have not changed.
He is tender over T4/5 and L3/4 verterbra. He has weakness of ankle dorsiflexion and knee flexion and extension in both legs. He has an enlarged, irregular, firm prostate on rectal examination.
What should you do next?
Urgent same day referal to medical emergency - likely spinal chord compression from tumour. They would then do…
Full blood count, urea, electrolytes, calcium and prostate specific antigen test (PSA test - for prostate cancer as coult metastasised)
MRI of spine
Who gets breast screening and how regularly?
- Women aged 50-70
- Mammogram every 3 years
What is a mammogram?
An X-Ray of the breast to screen for early signs of breast cancer
Where is the abnormality in this mammogram?
What happens after a positive mammogram?
Breast clinic review:
- Examination
- Magnified mammogram-Tomosynthesis
- Breast ultrasound
Why is a positive mammogram not the end of diagnosis?
It is very common to get false positives and over-diagnosis
What is over-diagnosis?
How is it different from a false positive?
This is detecting a cancer that would not have caused harm to person in their lifetime
Estimated that 20% of all breast cancers detected in screening are over-diagnosis
Diagnostic signs of breast cancer that aren’t a positive mammogram?
- Breast mass
- Lymphadenopathy
- Skin changes
- Metastatic disease
Breast cancer histology markers (charicteristics that the cancer cells might have)
- Oestrogen receptor (here oestroge is a growth factor) (ER)
- Progesterone receptor (here progesterone is a growth factor) (PR)
- Human epidermal growth factor receptor 2 (HER2)
- Triple negative has none of these markers (worse prognosis)
- Ki67- marker of proliferation (may respond better to chemotherapy but worse prognosis)
