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Dan 4th year > Blue book - cancer > Flashcards

Blue book - cancer Flashcards

1
Q

What current screening programmes for cancer are there? Give brief details for each

A
  1. Breast cancer
    50-70yo women
    mammography every 3 years
  2. Cervical cancer
    25-65yo women
    cervical smear every 3 years (when 49 every 5 years)
  3. Colorectal cancer
    60-69 (stretched to 74)
    Faecal occult blood every 2 years
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2
Q

What cancer does is tumour marker CEA used in?

A

Coloectal cancer

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3
Q

What cancer is CA125 raised in?

A

Ovarian cancer

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4
Q

What cancer is alpha fetoprotien rasied in?

A

Hepatocellular carcinoma

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5
Q

What cancer/s is hCG raised in?

A
  1. Hydatiform moles/trophobastic disease
  2. Testicular cancer
  3. Some seminomas
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6
Q

What cancer is Bence Jones protein found in urine?

A

Myeloma

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7
Q

What is the definition of neutropenic sepsis?

A

Neutrophil count less than 1x10^9 per litre and a temperature of >38 or other signs/symptoms of infection

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8
Q

What investigations shoud you do in neutropenic sesis

A

SEPTIC SCREEN

  1. FBC, U&E, LFT, CRP, Lactate
  2. Blood cultures - 2x anerobes and anaerobes (and any line central or peripheral)
  3. Swabs as indicated
  4. Urinary MCS

If symptoms suggest
a. CXR
b stool test

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9
Q

What score can you calculate for patients with neutropenic sepsis?

A

MASCC - looks at risk of complications during neurtopenic febrile episode and burden of infection, co morbidities etc

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10
Q

When should you give G-CSF (colony stimulating factors)? (3)

A
  1. if neutrophils <0.1
  2. predict >10 days
  3. severe sepis/multi organ failure/co - morbidities

They promote stem cell proliferation and shorten duration of neutropenia

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11
Q

What is the usual management of neutropenic sepsis?

A

Broad spectrum abx (Tazocin) within 1hr

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12
Q

Describe the body’s response to low calcium in the blood?

A

Parathyroid releases PTH
In bone - promotes osteocasts to release calcium from bone
In kidney: stimulates kidney to absorb calcium and activates vit D
In bowel: activated vit D leads to increased absorption of calcium
= increases calcium

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13
Q

Describe the body’s response to high calcium levels?

A

Thyroid releases calcitonin
In bone - promototes osteobasts to deposit calcium in bones
In Kidneys - reduces absorption of calcium

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14
Q

What are the 2 ways tumours lead to hypercalcaemia?

A
  1. Produce PTH related peptide
  2. Transforming growth factor alpha (TGFa) - which is a powerful stimulator of bone resorption (promotes osteoclast activity)
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15
Q

What are the most common cancer causes of hypercalcaemia? (6)

A
  1. Squamous cell carcinoma of the lung
  2. Head and neck cancer
  3. Renal carcinoma
  4. Blood cancers - Myleoma and lymphoma
  5. Breast cancer
  6. Prostate cancer
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16
Q

What are the symptoms of hypercalcaemia (work head to toe)

A
  1. CNS - confusion, seizures, proximal neuropathy, HYPOreflexia, coma
  2. Cardiac - arrythmia and arrest (short QT, bradycardia, wide T wave, prolonged bundle branch block)
  3. GI - constipation, abdo pain, n+v
  4. Urinary - polyuria and polydipsia
  5. General - dehydration, weakness, fatgiue, bone pain

Bones (bone pain) , moans (weird mental state), stones (kidney) and groans (constipation)

17
Q

Investigation for suspected hypercalcium?

A

Serum calcium

18
Q

What is the management for hypercalcaemia?

A 
FLUIDS
1L saline 4 hourly over 24h
1L saline 6 hourly over next 48-72h
With adequate K+
Consider Furosemide if at risk of fluid overload

BISPHOSPHONATES- IV pamidronate or Zoledronic acid

CALITONIN + CORTICOSTEROIDS - if arrythmias/seizures

19
Q

Define MSCC

A

Tumour or mets in vertebral body or paraspinal region pressing on the spinal cord

(2/3 in thoracic region)

20
Q

What are the red flags for MSCC? (6)

A
  1. Leg weakness
  2. Sensory loss
  3. Thoracic back pain
  4. Constant pain at night and rest
  5. Urinary retention/faecal incontinence
  6. Saddle anaaesthesia - loss of anal tone
21
Q

Management for suspected MSCC

A
  1. 16mg dexamethasone + PPI cover
  2. MRI scan within 24h
  3. Radiotherapy within 24h of diagnosis
22
Q

What is the prognosis of MSCC?

A

Bad. Only 57% regain motor function

23
Q

What cancers most commonly cause MSCC? (4)

A
  1. Breast
  2. Prostate
  3. Lung
  4. myeloma and lymphona
24
Q

Define SVCO

A

Extrinsic comperession, thrombosis or invasion or the invasion of the wall of SVC

25
Q

In terms of cancer what is the most common mechanism of SVCO?

A

Extensive lymphadeonpthy in the upper mediatistnum caused by lung cancer of lymphoma

26
Q

What are the sympmtoms and signs of SVCO?

A
  1. breathlessness
  2. headache worse on coughing
  3. Swelling - face/neck/arm
  4. Distended neck and chest veins
  5. Visual disturbances
  6. Hoarse voice
  7. Cyanosis
27
Q

What is the management for SVCO?

A
  1. 16mg Dexamethasone (+PPI)
  2. Vascular stent = normal choice followed by radiotherapy or
    chemotherapy depending on cancer type

LMWH if thrombus confirmed

28
Q

How would you investigate the cause of SVCO if this was the initial presentation?

A
  1. Biopsy is important

2. If germ cell tumour possible then tumour markers (AFP, βhCG, LDH) may be useful.

29
Q

What is the management of a major hemorrhage? (in context of palliative care)

A

Symptom control mus be fast and effective

  1. Green towels to absorb and reduce visual impact of blood loss
  2. Midazolam IV/SC
30
Q

What are the malignant causes of SVCO? (7)

A
  1. Lung cancer
  2. Lymphoma
  3. Mediastinal lymphadenopathy
  4. Germ cell tumours
  5. Thymoma
  6. Oesophageal cancer
  7. Tumour associated thrombus
31
Q

What are the benign causes of SVCO? (5)

A
  1. Non malignant tumours eg goitre
  2. Mediastinal fibrosis (idiopathic or post radiation)
  3. Infection - TB
  4. Aoritc anuerysm
  5. Thrombus associated within indwelling catheters
32
Q

What is von-Hippel Lindau syndrome?

A

Hereditray condition leading to tumours arising in multiple organs

33
Q

What is Li-fraumeni syndrome?

A

Inherited familial predisposition to a wide range of certain, often rare, cancers. This is due to a change (mutation) in a tumor suppressor gene known as TP53.

34
Q

Which chemicals are associated with cancer? (5)

A
  1. Cigarette smoke - cause specific mutations in the p53 tumour supressor gene
  2. Aromatic amines -bladder cancer
  3. Benzene - Leukaemia
  4. Wood dust - nasal adenocarcinoma
  5. Vinyl chloride - angiosarcomas
35
Q

Characteristic translocations may be induced by the topoisomerase inhibitors (type of drug) and cause what cancer?

A

Acute leukaemia

Dan 4th year (8 decks)

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