Cancer

Question 1

what is the main way cancer develops?

Answer 1

genetic predisposition mixed with environmental factors gives uncontrolled proliferation and a cancer forms

Question 2

what are some systemic features of cancer?

Answer 2

cachexia
ectopic hormone production - PTH hypercalcaemia, or ACTH - cushings disease
parneoplastic syndromes - neurological/dermatomyocitis, venous thromboses

Question 3

techniques for diagnosis of cancer?

Answer 3

imaging - CT/MRI

fibre optic techniques - endoscopy/bronchoscopy/biopsy

Question 4

what are some staging techniques for cancer diagnosis?

Answer 4

TNM - tumour node metastases - clarify prognosis, survival, defines tx
Ann arbor - lymphoma staging
Dukes ABCD - colorectal carcinomas

Question 5

what is the main action of chemotherapy?

Answer 5

interferes with cellular replication by targeting DNA or cell division

Question 6

side effects effect rapid dividing cells such as?

Answer 6

GI or oral mucosa
bone marrow
hair
reproductive cells

Question 7

chemo is often a combination of agents, why is this better?

Answer 7

different modes of action
less chance of resistance
less toxicity

Question 8

how is chemo used combined with or as an adjuvent to surgery?

Answer 8

pre surgery - reduce tumour load

post surgery - reduce sub clinical disease

Question 9

what cancers can a course of chemo cure?

Answer 9

hodgkins lymphoma
testicular teratoma
acute childhood leukemia

Question 10

chemo can be used as a contribution to care and to prolong life expectancy in what cancers?

Answer 10

small cell carcinoma of the lung
breast carcinoma
adult leukemia
ovarian cancer

Question 11

chemo can be used as palliation in what cancers?

Answer 11

GI tract
non small cell lung cancer
cervical carcinoma
squamous carcinomas of the head and neck

Question 12

what are some general short term side effects of chemo?

Answer 12

nausea
vomiting
diarrhea
alopecia

Question 13

what are some short term side effects of chemo caused by bone marrow suppression?

Answer 13

1. neutropenia - high infection risk, least wbc’s 7-9 days after chemo, oral infections
2. thrombocytopenia = bleeding tendancies
3. anaemia

Question 14

what long term side effects can chemo cause?

Answer 14

impaired fertility
teratogenic
cancer - leukemia
organ damage - pulmonary fibrosis, cardiomyopathy, neuropathy

Question 15

how can chemo be used as hormone therapy?

Answer 15

in breast and prostate cancers

non curative

Question 16

how does radiotherapy work?

Answer 16

affects rapidly dividing cells - targeted to specific areas

Question 17

how is radiotherapy delivered?

Answer 17

externally - linear accelerator

internal - implant/systemic - taken up by specific organs e.g strontium by bone, iodine 131 by thyroid

Question 18

what are some short term side effects of radiotherapy?

Answer 18

oral mucositis
diarrhea 
nausea
tired
hair loss
bm suppression
sunburn

Question 19

what are some long term effects of radiotherapy?

Answer 19

osteoradionecrosis
xerostomia
skin ulcers
fibrosis
bowel stenosis
secondary malignancies

Question 20

what are some novel therapies in cancer treatment?

Answer 20

1. immunotherapy -vaccines, cytokines
2. angiogenesis inhibitors
3. signal inhibitors - specific inhibition of mutated proteins
4. gene therapy - insert correct functioning versions of damaged genes
5. phototherapy - tumour takes up dye, killed by laser

Question 21

what is the aetiology of lung cancer?

Answer 21

biggest killer/poor outlool/almost totally avoidable

90% due to smoking, can also be caused by passive smoking

Question 22

local signs of lung cancer?

Answer 22

cough/chest pain/breathless/chest infections

Question 23

where can lung cancer metastasise to?

Answer 23

bones
brain
liver

Question 24

what are some systemic signs of lung cancer?

Answer 24

cachexia

hormonal - high calcium/low sodium

Question 25

how is lung cancer diagnosed? | how is it treated?

Answer 25

CXR/CT/bronchoscopy/sputum cytology | surgery/chemo/radio/laser

Question 26

what is the 5yr survival for lung cancer? | can it be screened for?

Answer 26

10% | screening under investigation

Question 27

what is the aetiology of colorectal cancer?

Answer 27

disease of western lifestyle, 2nd most common cause of death, partially preventable

Question 28

risk factors in lifestyle that contribute to colorectal cancer development?

Answer 28

diet high in fat and low in fibre familial - genes inflammatory bowel disease

Question 29

what are local signs of colorectal cancer?

Answer 29

anaemia altered bowel habits acute abdomen

Question 30

where can colorectal cancer metastasise to?

Answer 30

liver lungs ascites

Question 31

what is a systemic sign of colorectal cancer?

Answer 31

cachexia

Question 32

how is colorectal cancer diagnosed? | how is it treated?

Answer 32

sigmoid/colonoscopy, barium swallow | surgery, radiotherapy, chemotherapy

Question 33

what is the survival like for colorectal cancer? | can it be screened for?

Answer 33

90% 5 yr survival stage I,

Question 34

what is the aetiology of breast cancer?

Answer 34

1 in 12 women no 1-2 in women relatively young pts

Question 35

risk factors of breast cancer?

Answer 35

familial - genes | hormonal - no children/early periods/late menopause/no breastfeeding/HRT

Question 36

what are local signs of breast cancer?

Answer 36

puckering, pain, discharge, lump

Question 37

where can breast cancer metastasise to?

Answer 37

bone brain liver

Question 38

what are some systemic signs of breast cancer?

Answer 38

cachexia | hypercalcaemia

Question 39

how is breast cancer diagnosed? | how is it treated?

Answer 39

mammogram/tissue diagnosis - fine needle aspiration/biopsy | surgery/chemo/radio/hormonal - osetrogen inhibition

Question 40

how is breast cancer screened for?

Answer 40

mammograms every 3 years for women 50-70yrs | self exams promoted

Question 41

aetiology of prostate cancer?

Answer 41

1 in 3 men | 80% of 80 + yr olds

Question 42

local signs of prostate cancer?

Answer 42

detected on pr exam confused with normal urinary changes in elderly found at operation for urinary symptoms

Question 43

where can prostate cancer metastasise to?

Answer 43

bone | lungs

Question 44

how is prostate cancer diagnosed? | how is it treated?

Answer 44

biopsy/prostate specific antigen | surgery/radio/hormonal - inhibit testosterone

Question 45

how to screen for prostate cancer?

Answer 45

look for prostate specific antigen

Question 46

aetiology of oseophageal cancer? | risk factors?

Answer 46

increasing frequency poor outlook - smoking/alcohol/reflux

Question 47

local signs of oseophageal cancer?

Answer 47

dysphagia pain anaemia

Question 48

where can oseophageal cancer metastasise to?

Answer 48

lymphadenopathy | liver

Question 49

systemic signs of oseophageal cancer?

Answer 49

cachexia

Question 50

how is oseophageal cancer diagnosed? | how is it treated?

Answer 50

endoscopy/barium swallow | surgery/radio/laser/endoscopic dilation

Question 51

survival rate of oseophageal cancer? | can it be screened for?

Question 52

aetiology of stomach cancer?

Answer 52

reducing frequency | risks with Hpylori, prev gastrectomy, age, smoking

Question 53

what are local signs of stomach cancer?

Answer 53

local fullness, vomitting, pain, anaemia

Question 54

where can stomach cancer metastasise to?

Answer 54

lymph nodes, liver, ascites

Question 55

how is stomach cancer diagnosed? | how is it treated?

Answer 55

endoscopy | surgery/radiotherapy/chemotherapy

Question 56

what is the survival rate of stomach cancer? | how can it be screened for?

Question 57

aetiology of cerebral cancers?

Answer 57

10% of all tumours - 60% primary, 40% secondary

Question 58

what are some local signs of a cerebral cancer?

Answer 58

focal defecit - limb weakness, cranial nerve palsy impaired co ordination headache - raised intracranial pressure, local invasion seizures endocrine effects

Question 59

how are cerebral cancers diagnosed? | how are they treated?

Answer 59

CT, MRI | surgery, radiotherapy, steroids, anti epileptics, hormone blocking medications

Question 60

prognosis of cerebral tumours?

Answer 60

prognosis depends on site