Cancer Flashcards
Features
Cancer (malignancy) accounts for;
- 1 in 8 deaths of people <35 yrs
- 1 in every 4 of those >45 yrs.
The six most common causes of death from cancer are;
- lung
- bowel
- breast
- prostate
- lymphoma
- pancreas
Neoplasia, esp. malignancy of the silent areas can present as undifferentiated illness and be a real ‘masquerade’. eg
- ovary
- kidney
- caecum and ascending colon
- liver
- haematological tissue
The clinical manifestations of malignancy are due to:
Pressure effect of the growth (e.g. abdominal pain)
Infiltration or metastases in various organs
Systemic symptoms
- –tiredness, malaise, weakness
- –anorexia and nausea
- –weight loss
Paraneoplastic effects, e.g.
- –hypercalcaemia (causes thirst)
- –hyponatraemia (causes drowsiness)
- –fever and sweats
- –ectopic hormone production
- –haematological disorders (e.g. coagulopathy)
- –neuropathies
Red flag pointers for cancer (adults)
constitutional (systemic) symptoms: tiredness, malaise* , weakness, anorexia, nausea*
fever, night sweats*
unexplained weight loss*
age >50
past history of malignancy
unresolved pain*
unusual lumps or swellings*
family history, e.g. breast, ovary, stomach
unresponsive to treatment*
*also applies to childhood cancer plus white eye, increased swelling or persistent pain in bone
Diagnostic triads/tetrads for specific cancers
(In addition to probable constitutional symptoms, e.g. malaise, tiredness)
Bladder: haematuria + frequency + dysuria
- Diagnosis: urine cytology × 3, cytoscopy
Breast: lump + nipple changes (discharge, distortion)
- Diagnosis: fna/biopsy, excision biopsy, imaging
Cerebral: seizure + cognitive impairment ± headache
- Diagnosis: CT scan/MRI
Cervix: post-coital bleeding, intermenstrual bleeding, vaginal discharge
- Diagnosis: Pap test, biopsy
Diagnostic triads/tetrads for specific cancers
Colorectal: blood in stool + change in bowel habit ± abdominal discomfort
- Diagnosis: colonoscopy, FOBT
Kidney: haematuria (60%) + loin pain (40%) ± palpable kidney mass
- Diagnosis: urine cytology × 3, ultrasound or CT/MRI
Lung: persistent cough + weight loss ± haemoptysis
- Diagnosis: CXR, CT scan, PET scan, bronchoscopy
Oesophagus: dysphagia + chest discomfort + weight loss ± hiccoughs
- Diagnosis: barium swallow, endoscopy
Ovary: abdominal discomfort, distension or bloating ± bowel changes ± menstrual dysfunction
- Diagnosis: pelvic ultrasound, serum CA-125
Pancreas: abdominal discomfort (75%) + jaundice + epigastric/back pain (esp. body of P).
If head of P may → painless jaundice + enlarged gall bladder.
- Diagnosis: CT or MRI (MRCP), CA 19-9
Diagnostic triads/tetrads for specific cancers
Prostate: BOO (70%) + back pain (15%) + haematuria 5%
- Diagnosis: DRE, core biopsy (transrectal US), PSA
Stomach: anorexia + dyspepsia + weight loss
- Diagnosis: gastroscopy + biopsy
Leukaemia: Acute (ALL, AML): pallor + bone pain + bleeding tendency + gingival hypertrophy (AML)
Chronic myeloid L: fever/night sweats + abdominal fullness (splenomegaly) + symptoms of anaemia
Chronic lymphocytic L: fever/night sweats + weight loss + lymphadenopathy
- Diagnosis: FBE/film, bone marrow biopsy, CXR, CT scan, lymph node biopsy
Lymphoma Hodgkin: fever/night sweats + pruritus + cervical lymphadenopathy
Non-Hodgkin: fever/night sweats + lymphadenopathy
- Diagnosis: lymph node excision biopsy, FBE/film, CXR
Multiple myeloma: weakness + unexplained back pain + susceptibility to infection
- Diagnosis: FBE/film, urine Bence-Jones protein, serum paraprotein, skeletal survey
Metastatic tumours
The big three metastasising primaries are;
- lung
- colon
- breast
Common target sites are;
- lymph nodes
- liver
- lung
- mediastinum
- bone
Important sites followed by likely primary sources are:
Liver:
- colon
- pancreas
- stomach
- breast
- lung
- melanoma
Lung and mediastinum:
- breast
- colon
- kidney
- testes
- cervix/uterus
- lymphoma
- melanoma
Bone:
- breast
- prostate
- lung
- kidney
- thyroid
- melanoma
- Hodgkin lymphoma
Brain:
- breast
- lung
- colon
- lymphoma
- kidney
- melanoma
- prostate
