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MC > Malignancy > Flashcards

Malignancy Flashcards

1
Q 
The six most common causes of death from cancer
in Australia and the US are cancer of the
1
2
3
4
5
6
A

lung, bowel,

breast, prostate, lymphoma and pancreas

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2
Q 
The so-called ‘silent’ malignancies
that pose a special problem include cancer of the 
1
2
3
4
5
6
A

ovary,
pancreas, kidney, caecum and ascending colon, liver
(hepatoma), melanoma and haematological tissue

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3
Q

Although uncommon in children under 15 years,
cancer is the _____ most common cause of death
in this age group

A

second

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4
Q

The most common cancers in children (in
order) are

  1. leukaemias, especially ________
  2. brain tumours, especially _____
  3. lymphomas, especially_____
  4. ; neuroblastoma; Wilms tumour;
  5. soft tissue tumours, especially ______;
  6. and bone tumours
A

acute lymphocytic leukaemia (34%);

astrocytoma (20%);

non- Hodgkin (13%)

rhabdomyosarcoma

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5
Q

Undiffentiated sx of cancer

A
  • Tiredness/fatigue/weakness
  • Anorexia and nausea
  • Weight loss
  • Fever
  • Thirst (hypercalcaemia)
  • Drowsiness (hyponatraemia)
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6
Q

The _____ effects or syndromes are very
important clinically because they may provide
an early clue to the presence of a specific type of
cancer, in addition to the possible lethal effect of the
metabolic or toxic effect

A

paraneoplastic

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7
Q

Paraneoplastic syndromes and associated
tumours: more common examples

Lung, kidney, adrenal, thymoma,
pancreas

A

Cushing

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8
Q

Paraneoplastic syndromes and associated
tumours: more common examples

Lung, kidney, thymoma, thyroid

A

ACTH

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9
Q

Paraneoplastic syndromes and associated
tumours: more common examples

Lung, hepatoma, choriocarcinoma

A

Gonadotrophins

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10
Q

Paraneoplastic syndromes and associated
tumours: more common examples

Lung, breast, kidney, multiple myeloma,
prostate, pancreas, adrenal, hepatoma

A

Hypercalcaemia

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11
Q

Paraneoplastic syndromes and associated
tumours: more common examples

Kidney, hepatoma, lymphoma,
pancreas, thymoma

A

Fever

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12
Q

Paraneoplastic syndromes and associated
tumours: more common examples

Lung, breast, thymoma, Hodgkin,
prostate

A

Neurologic

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13
Q

Paraneoplastic syndromes and associated
tumours: more common examples

Lung, breast, hepatoma, prostate,
pancreas

A

Coagulopathy

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14
Q

Paraneoplastic syndromes and associated
tumours: more common examples

Kidney, pancreas, prostate

A

Thrombophlebitis

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15
Q

Paraneoplastic syndromes and associated
tumours: more common examples

Kidney, hepatoma

A

Polycythaemia

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16
Q

Paraneoplastic syndromes and associated
tumours: more common examples

Lung, breast, pancreas

A

Dermatomyositis

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17
Q

What agent?

Occupation: Chemical industry

Cancer type: Lung, skin, liver

A

Arsenic

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18
Q

What agent?

Occupation: Glue worker,
varnisher

Cancer type: Leukaemia

A

Benzene

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19
Q

What agent?

Occupation: Chimney sweep

Cancer type: Skin

A

Soot, coal tar

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20
Q

What agent?

Occupation: Farmer, sailor, outdoor worker

Cancer type: Skin

A

Ultraviolet light

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21
Q

What agent?

Occupation: PVC manufacturing

Cancer type: Liver (angiosarcoma)

A

Vinyl chloride

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22
Q

MC familial cancers
1
2
3

A

colorectal, breast and

ovarian cancers.

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23
Q

A ______ is an abnormal characteristic that

is specific for a particular type of malignancy

A

tumour marker

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24
Q

CEA and AFP are not specific markers but are
elevated in certain tumours and are very useful in
_____

A

monitoring tumour activity

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25
Q

Tumour markers have a limited role in diagnosis
of malignant disease because several have low
sensitivity and specificity. The most valuable are
those associated with testis cancer—___ and _____

A

AFP and beta-

HCG.

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26
Q

What is the tumor marker?

Testicular cancer (non-seminomatous)
Hepatocellular carcinoma
GIT cancers with and without liver
metastases

A

CA 125

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27
Q

What is the tumor marker?

Breast

A

CA-15-3

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28
Q

What is the tumor marker?

Pancreas, colon, ovary

A

CA-19-9

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29
Q

What is the tumor marker?

Colorectal cancer
Pancreatic, breast, lung, small intestine,
stomach, ovaries

A

CEA

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30
Q

What is the tumor marker?

Prostate cancer

A

PSA*

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31
Q

What is the tumor marker?

Choriocarcinoma
Hydatidiform mole
Trophoblastic diseases

A

hCG

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32
Q

What is the tumor marker?

Multiple myeloma, some lymphomas

A

α-microglobulin

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33
Q

Apart from non-melanoma skin cancer, ______ is
the most common cancer in Australia in terms of both
incidence and death, accounting for at least 20% of
cancer deaths

A

lung cancer

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34
Q

Paraneoplastic syndromes associated with lung CA

A

hypercalcaemia,
Cushing syndrome, carcinoid syndrome,
dermatomyositis, visual loss progressing to blindness
from retinal degeneration, cerebellar degeneration
and encephalitis.

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35
Q

The most important tumours of the kidney are

_______ and ______

A

adenocarcinoma (80% of all kidney tumours) 3 and

nephroblastoma (Wilms tumour

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36
Q

haematuria + loin pain + palpable

kidney mass

A

kidney cell cancer

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37
Q

________is responsible for 10% of all childhood

malignancies

A

Wilms tumour

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38
Q

Clinical features of Wilms

  • peak incidence ____ years
  • general symptoms of neoplasia
  • _______ 80%
  • _______ 30%
  • ________ 25
A

2–3

palpable mass

abdominal pain

haematuria

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39
Q

Wilms:

Early diagnosis with nephrectomy and chemotherapy
leads to a very favourable prognosis_____

A

(90%

5-year survival

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40
Q

It is a
tumour of the adrenal medulla (50%) and sympathetic
nervous system, especially _________but also in chest and neck

A

retroperitoneal neural tissue in abdomen (30%)

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41
Q

Dxtics for NB

A

CT scan, skeletal survey; biopsy required

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42
Q

Tx of NB

A

Treatment is based on surgical resection then

chemotherapy ± localised radiotherapy

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43
Q

______ has the highest mortality rate of all
the gynaecological cancers because the majority
of patients present in the late stage of the disease

A

Ovarian cancer

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44
Q

_____ are the most common

of malignant ovarian tumours.

A

Epithelial tumours

45
Q

New test for ovarian CA

A

A new test is the
OvPlex ™ serum test, which measures five serum
markers.

46
Q

Malignancy in this area is more likely to present with
symptoms of anaemia without the patient noting
obvious blood in the faeces or alteration of bowel
habit

A

Carcinoma of caecum and

ascending colon

47
Q

This is another cancer with vague symptoms,

metastasising early and late presentation

A

Pancreatic cancer

48
Q

MC typre of pancreatic Ca

A

ductal adenocarcinoma

49
Q

Presentation of ductal adenoCA of the head of the pancreas?

A

presents with painless jaundice and if in
the body and/or tail presents with epigastric pain
radiating to the back, relieved by sitting forward

50
Q

jaundice + anorexia + abdominal

discomfort / pain

A

pancreatic cancer

51
Q

_______has a rapidly fatal course
if untreated, while _______ has a variable
chronic course with an inevitable fatal outcome

A

Acute leukaemia

chronic leukaemia

52
Q

The usual age range for acute lymphatic leukaemia

(ALL) is ______years with a second peak at about ______ years

A

2–10

40

53
Q 
The median age of presentation of acute
myeloid leukaemia (AML) is\_\_\_\_\_\_ years
A

55–60

54
Q

Symptoms due to infiltration of tissues with blast

cells (e.g. gingival hypertrophy in______

A

AML)

55
Q 
Bone pain (notably in children with\_\_\_\_\_ and
joint pain
A

ALL)

56
Q

Dxtcs for Leukemia

1
2
3
4

A
  1. FBE and film
  2. Bone marrow examination
  3. PCR studies
  4. Cytogenetics
57
Q

As a rule, relapse of acute leukaemia means

imminent death unless _____

A

bone marrow transplantation

is successful.

58
Q

The mean 5-year survival rate for
childhood ALL is about _______, for adult ALL _____
for AML it varies with age with poorer survival, about
____ over 55 years of age

A

75–80%

30%;

20%,

59
Q
  • A disorder of middle age, typically 40–60 years

* Insidious onset

A

CML

60
Q

Sx of CML

A 
• Constitutional symptoms: malaise, weight loss,
fever, night sweats
• Symptoms of anaemia
• Splenomegaly (very large); abdominal
discomfort
• Priapism
• Gout
61
Q

Dxtics of CML

  • Markedly elevated _____
  • Marked left shift in ___
  • Presence of _____
A

white cell count (granulocytes)

myeloid series

Philadelphia chromosome

62
Q 
fatigue + fever / night sweats +
abdominal fullness ( splenomegaly )
A

CML

63
Q

• A disorder of late middle age and elderly
• Insidious onset
• Constitutional symptoms: malaise, weight loss,
fever, night swea

A

Chronic lymphocytic leukaemia

CLL

64
Q

PE of CLL

1
2

A

• Lymphadenopathy (large rubbery nodes)—neck,
axilla, groin (80%)
• Moderately enlarged spleen and liver (about 50%)

65
Q

Labs of CLL

  • Lymphocytosis >15 × 10 9 /L
  • _____ appearance of lymphocytes
  • Consider_____
A

‘Mature’

cytogenetics

66
Q

T or F

in CLL

Most cases require no specific therapy but
observation.

A

T

67
Q

Clinical features of CLL

• Painless (rubbery) lymphadenopathy, especially
______
• Constitutional symptoms (e.g. malaise, weakness,
weight loss)
• Fever and drenching night sweats—undulant
_____
• Pruritus
• _____ pain in any enlarged lymph
nodes
• Possible enlarged spleen and liver

A

cervical nodes

(Pel–Ebstein) fever

Alcohol-induced

68
Q

dx of CLL

A

Diagnosis is by lymph node biopsy with

histological confirmation

69
Q

Other dxtics for CLL

A

FBE, CXR,
CT/MRI (to stage), bone marrow biopsy, functional
isotopic scanning.

70
Q

Staging of CLL

A

Staging is by using Ann Arbor

nomenclature (IA to IVB).

71
Q

Tx of CLL

A

Treatment includes

chemotherapy, immunotherapy and radiotherapy.

72
Q

malaise + f ever/ night s weats + p ruritus

A

Hodgkin

73
Q

In Hodgkins Lymphoma

• Painless lymphadenopathy—localised or
widespread
• Constitutional symptoms possible, especially
\_\_\_\_\_
• \_\_\_\_\_is uncommon
A

sweating

Pruritus

74
Q

In Hodgkins Lymphoma

  • Extra nodal sites of disease ______
  • Possible enlarged liver and spleen
  • Possible nodular infiltration of skin_____
A

(e.g. CNS, bone, skin, GIT)

(e.g. mycosis
fungoides)

75
Q

malaise + fever / night sweats +

lymphadenopathy

A

non - Hodgkin lymphoma

76
Q

_______ is a clonal malignancy of the

differentiated β lymphocyte—the plasma cell.

A

Multiple myeloma

77
Q

MM

It is
regarded as a disease of the elderly, the mean age
of presentation being_____ years.

A

65

78
Q

MM

It is asymptomatic in_____ of patients.

A

20%

79
Q

The classic presenting triad in
an older person is anaemia, back pain and elevated
ESR which helps to differentiate it from ____

A

monoclonal

gammopathy of uncertain significance (MGUS

80
Q

weakness + unexplained back pain +

susceptibility to infection

A

MM

81
Q

Features of MM

Replacement of bone marrow by malignant
_____

Kidney failure

Associated with______

A

plasma cell

amyloidosis

82
Q

Dx criteria of MM

  • _____ in serum (on electrophoresis)
  • _____ protein in urine
  • bony_____ on skeletal survey
A

paraprotein

Bence–Jones

lytic lesions

83
Q

Tx of MM

A

Treatment is with chemotherapy including

thalidomide or lenalidomide: 5-year median survival

84
Q

_____ involves the production of
paraprotein (M protein) by non-cancerous cells in the
absence of other clinical manifestations of multiple
myeloma.

A

Monoclonal gammopathy of undetermined

significance (MGUS)

85
Q

MGUS is usually asymptomatic but _______ can occur. No chemotherapy treatment is
recommended.

A

peripheral

neuropathy

86
Q

Classic triad: skin flushing (especially face),
diarrhoea (with abdominal cramps), valvular
heart disease

A

Carcinoid syndrome

87
Q

Site of tumors for carcinoid

A

appendix/ileum, stomach,

bronchi

88
Q

Dx labs of carcinoid

1
2

A
  • 24 hour urine 5-hydroxyindoleacetic acid

* plasma chromogranin A/hepatic ultrasound

89
Q

This is a malignant proliferation of RBCs and also

WBCs and platelets.

A

PV

90
Q

Investigations for PV

1
2
3

A
  • FBE and haematocrit
  • Bone marrow biopsy
  • Genetic mutations—JAK2 mutation
91
Q

Potentially curable malignant tumours

Haematological tumours
1
2
3

A
  • Hodgkin lymphoma
  • Acute lymphatic leukaemia
  • Acute myeloid leukaemia
92
Q

Potentially curable malignant tumours

Solid tumours

1
2
3
4
5
6
A
  • Choriocarcinoma
  • Testicular teratoma
  • Neuroblastoma
  • Wilms tumour (nephroblastoma)
  • Burkitt tumour
  • Embryonal rhabdomyosarcoma
93
Q

Tumours curable by adjuvant chemotherapy

1
2
3
4

A
  • Breast cancer
  • Osteogenic cancer
  • Soft tissue cancer
  • Colorectal cancer
94
Q 
Common sites of metastatic presentation are the
1
2
3
4
5
A

lymph nodes, liver, lung, mediastinum and bone

95
Q

Impt site of mets

Breast, prostate, lung, Hodgkin lymphoma,
kidney, thyroid, melanoma

A

Bone

96
Q

Impt site of mets

Breast, lung, colon, lymphoma, kidney,
melanoma, prostate

A

Brain

97
Q

Impt site of mets

Colon, pancreas, liver, stomach, breast,
lung, melanoma

A

Liver

98
Q

Impt site of mets:

Breast, lung, colon,
kidney, testes, cervix/uterus, Hodgkin
lymphoma, melanoma

A

Lung and mediastinum

99
Q

Impt site of mets:

Hodgkin lymphoma, lymphoma,
squamous cell carcinoma, oropharynx,
nasopharynx

A

High cervical

100
Q

Impt site of mets:

Lung, stomach, lymphoma,
Hodgkin lymphoma, oropharynx, larynx,
skin, tongue

A

Low cervical

101
Q

Impt site of mets:

Breast, lung, lymphoma

A

Axillary

102
Q

Impt site of mets:

Lymphoma, ovary, uterus, vulva,
prostate, skin

A

Inguinal

103
Q

Impt site of mets:

Lymphoma, Hodgkin
lymphoma, ovary, uterus, testes, prostate

A

Retroperitoneum

104
Q

Impt site of mets:

Lung, colon, melanoma, Kaposi sarcoma

A

Skin

105
Q

Cancer without a clear primary source is present in

about ______of all cases

A

5%

106
Q

The mean
survival time in patients with an unknown primary
is____

A

6 months

107
Q

anorexia + weight loss + jaundice

± epigastric pain

A

pancreatic cancer

108
Q

fatigue + dysphagia + weight loss

A

oesophageal cancer

109
Q

HIV is a retrovirus with two known strains that
cause a similar spectrum of syndromes: HIV-1 and
HIV-2 (mainly confined to West Africa). It infects
_____ cells bearing the _____receptor

A

T-helper

CD 4

MC (90 decks)

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