Cancer Flashcards

Question

What are the signs of hepatocellular carcinoma?

Answer 1

Inc age, lymphadenopathy, Abdo distension, suites, oesophageal bleeding, WL, RUQ pain, leg oedema, palmar erythema, cachexia, spider naevi, captured medusae, splenomegaly, asterixis, diarrhoea, bony pain, bruit, retro hepaticus, obstructive jaundice

Answer 2

FBC - microcytic anaemia / thrombocytopenia INR/PT - Inc AST ALT BILI ALP GGT - all increased. Albumin LOW LOW LOW Alpha fetoprotein - Raised Us Liver - irregular borders / coarse internal echos Contrast CT - increased vascularity Biopsy - grading CT chest/bone scan - metastasis

Answer 3

A metabolic and electrolyte abnormality that occurs in cancer patients as a result of cytotoxic treatment initiation (and sporadically rarely). Usually associated with haematological malignancies. Results with cell lysis and ensuing hyperkalaemia, hyperuricaemia, hyperphosphataemia and hyPOcalcaemia

Answer 4

Haematological malignancies, large tumour burden, initiation of cytotoxic Rx, renal impairment, dehydration, increased age,

Answer 5

Parasthesias, muscle cramps, weakness, diarrhoea, N+V, anorexia, chvosteks, trousseaus, LNs, tetany, peripheral oedema

Answer 6

U+Es - hyperkalaemia, hyperphosphataemia, hyperuricaemia, hypocalcaemia FBC - WCC up up up LDH - INCREASED with malignancy - large tumour burden RFT - may show increased urea Urine ph - <5 ECG - possible arrhythmia

Answer 7

Cancer of the testes. Most common malignancy in young males (20-34) and highly curable when diagnosed early.

Answer 8

20-34, white, gonadal dysgenesis, gonadal atrophy, Fhx, PMHx, decreased sperm count, rural residence, inguinal hernia

Answer 9

55% r sided, 2% bilateral. Supraclavicular LNs, 85% PAINLESS, lumbar pain, bone pain, gynaecomastia Location, irregular, hard

Answer 10

``` Blood tests - serum AFP, GGT, B-HCg, LDH, fetal ALP increased Imagery - colour flow doppler If inconclusive -> CT CTabdopelvis for LNs/involvement CxR - mediastinal involvement MRI - staging ``` Histology post orchidectomy

Answer 11

An aggressive epithelial tumour predominantly arising from the pleura of the lung. It can also arise from the abdominal, pericardia or tunica vaginalis lining. Strong association with asbestos exposure.

Answer 12

Strong = asbestos exposure, 60-85 (20yrs to develop), radiation, simian virus 40, bap1 mutation

Answer 13

Signs - dec lung volume, dull percussion at bases, dec breath sounds Symptoms - chest pain, dry non productive cough, fever, night sweats, SOB, abdo pain/distension

Answer 14

CxR - lower zone fibrosis, dec lung volume, possible LN, pleural thickening, pleural effusion Chest CT - same but better LN evaluation VATS/MRI/PET - used for staging Pleural aspiration - cytology suggest malignancy FBC - Normal in early stages, dec Hb, increased plts and WCC in late Metabolic panel - normal Can do pleural biopsy

Answer 15

Mucosal neoplasm arising from the epithelial cells that line the oesophagus

Answer 16

Smoking, hot beverages, GORD, achalasia, alcohol intake, hiatus hernia, dec socio, dec fruit and veg, obesity, HPV, Drugs - GTN, B blockers, anticholinergics, bentos

Answer 17

Oydonophagia, dysphagia, WL, hiccups, hoarseness, post prandial cough

Answer 18

OGD + BIOPSY - visualisation and histology Endoscopic USS with FNA - cytology CT/MRI/PET - spread PFT - N/Red Met panel - advanced = hypokalaemia, inc Urea and Creat

Answer 19

Pancreatic ductal adenocarcinoma - PDAC Follows a linear progression from intraductal papillary mucinous neoplasm (IPMN) or mucinous cystic neoplasm (MCN) to invasive ductal carcinoma

Answer 20

Smoking - primary FHx, other inherited cancer syndromes Obesity, DM, inc alcohol, dec folate, sporadic pancreatitis

Answer 21

Non specific epigastric pain/discomfort + jaundice (ob) + WL and anaemia N+V Courvoisiers sign - palpable painless gallbladder + jaundice Steatorrhoea DM new onset symptoms - nocturia, polyuria, polydipsia Petechaie and bruising Epigastric mass

Answer 22

Abdo USS - mass, dilated ducts, liver mets LFTs - ob jaundice pattern - increased bili, ALP AST ALT GGT markedly MRI/CT/PET - staging Ca19-9 FBC - dec in DIC

Answer 23

A malignant tumour of glandular origin, situated in the prostate and most common in older men. More men die with prostate cancer than of it.

Answer 24

Age > 50, high fat diet, FHx, Black

Answer 25

Dysuria, nocturia, dribbling, incr hesitancy, inc frequency, back pain, lethargy, WL, ABNORMAL DRE, LNs

Answer 26

PSA >4 = suggestive but there are other causes Testosterone, FBC, RF, LFTs - All normal Prostate biopsy Bone scan / MRI - stage/LNs

Answer 27

Tumour arising from the renal parenchyma / cortex.

Answer 28

Smoking, 55-84, black, obese, polycyclic, HTN, FHx, Asbestos, oestrogen exposure

Answer 29

50% asymptomatic Flank pain, haematuria (G/M), palpable mass Constitutional symptoms - WL, fever, LN, mononeuropathy, cachexia Scrotal varicocele, hepatic dysfunction, lower limb oedema

Answer 30

``` FBC - N/paraneoplastic - low hb/highRBC Urinalysis - inc protein / blood LFTs - N LDH - increased in advanced disease Creatinine - inc CT/MRI/Abdopelv USS - lesion on kidney ``` Bone scan/MRI/CT - for staging/metastatic spread Biopsy possible

Answer 31

Defined as a fever >38 with an absolute neutrophil count ANC of <500cells/micL or an ANC of <1000cells/micL with a projected NADIR of <500. 50% chemo related deaths, 50% mortality if untreated, 75% deaths in acute leukaemia

Answer 32

Age >65, albumin <35, low first NADIR, low hb before Rx, advanced disease, prior organ dysfunction, full dose chemo, prior chemo, haem malignancies

Answer 33

``` All related to infection Tachycardia, Fever >38, hypotension GI - NV, diarrhoea, stomach pain Resp - pneumonia signs - SOB cough etc Soft tissue - erythema, warmth, pain, swelling Mucosal/oral ulcers UTI - dysuria, pain, inc freq, clouding BOSH BOSH BOSH ```

Answer 34

ANC < 500 / 1000 + nadir <500 Urea and creatinine - N/R with Renal dysfunction LFTs - LOW albumin <35, possible liver damage = increased bili and transferases Cultures from the infection sites - +ve CxR - infiltrates with pneumonia

Answer 35

Localised + surgical candidate: Endoscopic mucosal resection (EMR) Total gastrectomy is usually recommended for proximal tumours. Patients with distal gastric cancers have had no survival benefit for total gastrectomy compared with subtotal gastrectomy. For all patients with T2 or higher and any N, perioperative treatment should be given. Perioperative chemotherapy (ECF) Epirubicin, cisplatin, fluorouracil OR (FLOT4) docetaxel, oxaliplatin, fluorouracil, calcium folinate +/- post operative chemo 5daysx5weeks + fluorouracil Patients with localised disease who are not surgical candidates should be offered chemoradiation, which consists of radiotherapy and fluorouracil (or fluorouracil and a taxane such as paclitaxel). Calcium folinate is often administered with fluorouracil as it potentiates its effects. ``` ADVANCED METASTATIC Trastuzumab - HER2/neu receptor) should be added to cytotoxic chemotherapy. Pembrolizumab - PD1 Ramucirumab - VEGF +/- Palliative gastrectomy ```

Answer 36

``` Malnutrition Gastric obstruction GI bleed Perforation SBO Post-op gastroparesis Post-op dumping syndrome Anasomotic leak Wound infetion MI post-op Post-op pneumonia Chemotherapy related complications - febrile neutropenia, thrombocytopenia, and nausea. Radio complications - febrile neutropenia, thrombocytopenia, and nausea. ```

Answer 37

The 5-year relative survival rates (excluding deaths from other causes) for patients with gastric cancer vary by stage. According to the 1997 report from the American College of Surgeons National Cancer Data Base, the rates are 71% for patients with stage IA cancer, 56% for stage IB, 37% for stage II, 18% for stage IIIA, 11% for stage IIIB, and 5% for stage IV.

Answer 38

gastric cancer Weight loss and abdominal pain are two of the most common presenting symptoms in patients with gastric cancer. [3] Dysphagia is more common in patients who present with proximal or gastro-oesophageal junction tumours. In patients with advanced stomach cancer, physical examination may show a left supraclavicular node (Virchow's node), periumbilical nodule (Sister Mary Joseph's nodule), or left axillary node (Irish node). Metastatic disease to the ovaries can present with ovarian masses (Krukenberg's tumour) in women.

Answer 39

NON INVASIVE = Transurethral resection + immediate post-op intra-vesical chemotherapy - MITOMYCIN or doxorubicin NON INVASIVE BUT - Intermediate risk = SAME PLUS delated BCG immunotherapy HIGH RISK BUT NOT INVASIVE Same +/- radical cystectomy LOCALLY INVASIVE 1. Radical or partial cystectomy +/- LN dissection, with Pre+post op chemo/chemoradio 2. Immunotherapies (e.g., atezolizumab, pembrolizumab, nivolumab, durvalumab, avelumab) may be used as second-line treatments Metastatic or T4a/b = Chemo-radio, immunotherapy __________ Complete transurethral resection is the treatment of choice for tumours that have not invaded the detrusor muscle, but recurrence is high. Seeding after surgery is reduced by intravesical instillation of chemotherapy. High-grade disease is potentially lethal and requires aggressive treatment and close follow-up. Treatment of choice for carcinoma in situ and high-grade tumours not invading muscle is immunotherapy using tuberculosis vaccine bacille Calmette-Guérin. Muscle-invasive tumours are treated with neoadjuvant chemotherapy, cystoprostatectomy, and extended pelvic lymphadenectomy. Neoadjuvant chemotherapy and thorough pelvic node dissection both significantly increase 5-year survival. Precautions should be taken to prevent wound seeding during cystoprostatectomy. Combination cisplatinum-based chemotherapy such as methotrexate, vinblastine, doxorubicin, and cisplatin produces response in ≥50% of cases. Less toxic combinations, such as cisplatin with either gemcitabine or taxol, have similar efficacy and less toxicity, and all 3 together appear to have better efficacy than cisplatin and gemcitabine. New immunotherapies have created great excitement with the promise to bring the benefit of immunotherapy to patients with advanced disease.

Answer 40

Prostatic urothelial carcinoma Upper tract TCC Hydronephosis Urinary retention

Answer 41

Low-risk bladder cancer Low-grade, solitary, non-invasive bladder cancer has a 15-year recurrence risk of 65%, but progression occurs in <5% of patients. Intermediate-risk bladder cancer Large, multifocal, or recurrent low-grade Ta bladder cancer poses increased risk for both recurrence and progression. Without treatment, the risk of recurrence by 15 years approaches 90%. Intravesical chemotherapy reduces recurrence by up to 20% in the short term, but has little effect on long-term recurrence and has not been found to reduce progression. Bacille Calmette-Guérin (BCG)munotherapy using 3-week maintenance, while more toxic than chemotherapy, significantly reduced recurrence, metastasis, and death from bladder cancer in a large RCT High risk - These patients are at about 50% risk for treatment failure and 15% risk of progression

Answer 42

Bladder cancer Although bladder cancer is 3 times more frequent in men, vigilance and proper investigation for this disease in women is especially important because survival in women is reduced, perhaps due to delay in diagnosis. Microhaematuria may be the only presenting symptom. Carcinoma in situ commonly presents with dysuria and frequency and can easily be confused with prostatitis. Rare presentations include the new onset of frequency, pelvic discomfort, malodourous urine, lower extremity oedema from lymphatic metastasis, and abdominal mass.

Answer 43

``` The management of breast cancer depends on the staging, tumour type and patient background. It may involve any of the following: surgery radiotherapy hormone therapy biological therapy chemotherapy ``` Surgery The vast majority of patients who have breast cancer diagnosed will be offered surgery. An exception may be a very frail, elderly lady with metastatic disease who may be better managed with hormonal therapy. Prior to surgery, the presence/absence of axillary lymphadenopathy determines management: women with no palpable axillary lymphadenopathy at presentation should have a pre-operative axillary ultrasound before their primary surgery if positive then they should have a sentinel node biopsy to assess the nodal burden in patients with breast cancer who present with clinically palpable lymphadenopathy, axillary node clearance is indicated at primary surgery this may lead to arm lymphedema and functional arm impairment ``` Mastectomy for: Multifocal tumour Central tumour Large lesion in small breast DCIS > 4cm ``` ``` Wide Local Excision for: Solitary lesion Peripheral tumour Small lesion in large breast DCIS < 4cm ``` Women should be offered breast reconstruction to achieve a cosmetically suitable result regardless of the type of operation they have. For women who've had a mastectomy this may be done at the initial operation or at a later date. Radiotherapy Whole breast radiotherapy is recommended after a woman has had a wide-local excision as this may reduce the risk of recurrence by around two-thirds. For women who've had a mastectomy radiotherapy is offered for T3-T4 tumours and for those with four or more positive axillary nodes Hormonal therapy Adjuvant hormonal therapy is offered if tumours are positive for hormone receptors. For many years this was done using tamoxifen for 5 years after diagnosis. Tamoxifen is still used in pre- and peri-menopausal women. In post-menopausal women, aromatase inhibitors such as anastrozole are used for this purpose*. This is important as aromatisation accounts for the majority of oestrogen production in post-menopausal women and therefore anastrozole is used for ER +ve breast cancer in this group. Important side-effects of tamoxifen include an increased risk of endometrial cancer, venous thromboembolism and menopausal symptoms. Biological therapy The most common type of biological therapy used for breast cancer is trastuzumab (Herceptin). It is only useful in the 20-25% of tumours that are HER2 positive. Trastuzumab cannot be used in patients with a history of heart disorders. Chemotherapy Cytotoxic therapy may be used either prior to surgery ('neoadjuvanant' chemotherapy) to downstage a primary lesion or after surgery depending on the stage of the tumour, for example, if there is axillary node disease - FEC-D is used in this situation.

Answer 44

Notting prognosi index is indication of survival Tumour Size x 0.2 + Lymph node score(From table below)+Grade score(From table below). Grade 3 if >3 nodes Grade 1 if 0 nodes

Answer 45

Recurrence Infection Swelling due to lymphatic damage Metastasis to SPINE (most common), LNs, Liver, Brain

Answer 46

Unlike stage I to III breast cancer, the primary goal of treatment in metastatic breast cancer (stage IV) is often to improve quality of life, with extending life a secondary goal.

Answer 47

``` Management options early disease: surgical resection liver transplantation radiofrequency ablation transarterial chemoembolisation sorafenib: a multikinase inhibitor ``` Regorafenib, nivolumab, pembrolizumab, and cabozantinib provide survival benefit when prescribed second-line for patients who progress on sorafenib

Answer 48

The 5-year survival for patients with symptomatic HCC is 0% to 10%. The 4-year and 5-year survival rates after liver transplantation are 75% and 70%, respectively, with a tumour recurrence rate of <15%

Answer 49

``` Biliary obstruction Cachexia Hypoglycaemia (non DM) Hepatic failure Watery diarrhoea Hypercalcaemia Intraperitoneal bleeding due to tumour rupture ```

Answer 50

HCC A significant number of patients may be asymptomatic and may have well-compensated liver disease with cirrhosis. HCC can also present in patients without any known chronic liver disease. In these patients it usually presents as right upper quadrant abdominal pain.

Answer 51

HCC A significant number of patients may be asymptomatic and may have well-compensated liver disease with cirrhosis. HCC can also present in patients without any known chronic liver disease. In these patients it usually presents as right upper quadrant abdominal pain.

Answer 52

Tumour lysis syndrome

Answer 53

Regular monitoring and assessment Phosphate binders - aluminium hydroxide/magnesium hydroxide Uric acid binders - allopurinol Loop diuretic IV hydration

Answer 54

There are no data on prognosis of TLS following successful treatment or prevention. Since the introduction of rasburicase, acute renal failure requiring dialysis has been significantly reduced.[35] Increased understanding of the pathophysiology and awareness of TLS among physicians has led to better management and better outcomes. Official management guidelines have yet to be formulated, but efforts are in progress.[16][23] The outcome and duration of inpatient stay may vary if complications such as cardiac arrhythmias, seizures, or acute renal failure develop. Most of these complications can be managed successfully in large specialist centres.

Answer 55

Acute renal failure Cardiac arrythmias Seizures Lactic acidosis

Answer 56

tumour lysis syndrome TLS is usually associated with initiation of chemotherapy in highly proliferative, bulky, chemosensitive malignancies, most commonly lymphomas and leukaemias. It rarely presents spontaneously. The appearance of TLS with solid malignancies is uncommon.

Answer 57

tumour lysis syndrome TLS is usually associated with initiation of chemotherapy in highly proliferative, bulky, chemosensitive malignancies, most commonly lymphomas and leukaemias. It rarely presents spontaneously. The appearance of TLS with solid malignancies is uncommon.

Answer 58

Orchidectomy External beam radiation Carboplatin chemotherapy May need retroperitoneal LN resection

Answer 59

With appropriate treatment, the vast majority of seminoma or non-seminoma cases will be cured. If relapse occurs, there is still an opportunity for cure from chemotherapy. If there is metastatic disease at presentation, combination chemotherapy offers a significant chance at eradicating the cancer with response rates of approximately 90% noted in good-risk patients.[76] Even in patients resistant to prior chemotherapy treatments - a poor prognostic group - around 25% may achieve long-term remission and potential cure with ifosfamide-containing combination chemotherapy.[77] Because curative treatment options exist for recurrent disease, a strict surveillance programme must be followed to detect recurrent disease early. During chemotherapy, the kinetics of tumour marker levels should be followed with the understanding that they may be prognostic.[

Answer 60

Rx related - nausea, pulmonary toxicity, renal failure, secondary cancer, neutropenia Infertility

Answer 61

testicular cancer Symptom onset is usually more than 2 weeks. Up to 20% of men present with painful swelling of sudden onset (due to associated haemorrhage or infection). In rare cases, changes in testicular volume and/or consistency may be early indicators of malignancy. Patients with seminoma tend to have a longer history of testicular abnormality than those with non-seminomas. In up to 10% of cases patients present with metastatic disease with or without a clinically palpable testicular mass.[4] Some of the most common metastatic manifestations include a neck mass from a supraclavicular lymph node, pulmonary metastases with respiratory symptoms, non-specific gastrointestinal symptoms, and lumbar back pain due to massive retroperitoneal disease. Other presenting symptoms of metastatic disease are bone pain, nervous system abnormalities due to mechanical nerve root involvement, lower extremity swelling, and symptoms and/or signs of hyperthyroidism.[5] Gynaecomastia can be the presenting sign of testicular cancer in 5% of cases.[6]

Answer 62

Stages 1+2 = resectable + pre and post op radio/chemo Stage 3 = stent and palliative surgery + radio/chemo Stage 4 = Stenting, radio = pointless The most widely used procedures are the proximal pancreaticoduodenectomy with antrectomy (Kausch-Whipple procedure) or the pylorus-preserving pancreaticoduodenectomy (Traverso-Longmire procedure) for tumours in the head of the pancreas. Dumping syndrome + PUD = SE of whipples Extended lymphadenectomy is associated with increases in adverse effects compared with standard lymphadenectomy, without conferring any survival benefit

Answer 63

At the time of diagnosis, 15% to 20% of patients have resectable disease. However, even in patients who have undergone radical pancreatic resection, median survival ranges from 15 to 19 months, with a 5-year survival rate of about 20%. The strongest prognostic indicators for long-term patient survival include negative resection margins, tumour DNA content, tumour size, and absence of lymph node metastases. Patients with metastatic disease (50% to 55%) have a limited survival of only 3 to 6 months. Survival is dependent on tumour burden and performance status at presentation.

Answer 64

``` Pancreatic leaks + fistula Early delayed gastric emptying Duodenal obstruction Cholangitis DVT + PE Bleeding ```

Answer 65

``` Papillary = 70% Follicular = 20% Medullary = 5% Anaplastic = 1% Lymphoma = rare ``` Features of hyperthyroidism or hypothyroidism are not commonly seen in patients with thyroid malignancies as they rarely secrete thyroid hormones

Answer 66

Management of papillary and follicular cancer total thyroidectomy followed by radioiodine (I-131) to kill residual cells yearly thyroglobulin levels to detect early recurrent disease

Answer 67

Renal cell cancer is also known as hypernephroma and accounts for 85% of primary renal neoplasms. It arises from proximal renal tubular epithelium. The most common histological subtype is clear cell (75 to 85 percent of tumours).

Answer 68

Features classical triad: haematuria, loin pain, abdominal mass pyrexia of unknown origin left varicocele (due to occlusion of left testicular vein) endocrine effects: may secrete erythropoietin (polycythaemia), parathyroid hormone (hypercalcaemia), renin, ACTH 25% have metastases at presentation paraneoplastic hepatic dysfunction syndrome. Also known as Stauffer syndrome. Typically presents as cholestasis/hepatosplenomegaly. It is thought to be secondary to increased levels of IL-6

Answer 69

Management for confined disease a partial or total nephrectomy depending on the tumour size alpha-interferon and interleukin-2 have been used to reduce tumour size and also treat patients with metatases receptor tyrosine kinase inhibitors (e.g. sorafenib, sunitinib) have been shown to have superior efficacy compared to interferon-alpha

Answer 70

RCC in general has a variable natural history. The overall 5-year survival is more than 68% Early-stage disease in general has excellent prognosis, with greater than 90% cancer-specific survival at 5 years Surgical morbidity and mortality continue to fall with advancing techniques. However, up to 30% of patients will relapse with distant metastatic disease.

Answer 71

``` Anaemia Hypercalcaemia Erythrocytosis SIADH Hepatic dysfunction ```

Answer 72

Localised prostate cancer (T1/T2) Treatment depends on life expectancy and patient choice. Options include: conservative: active monitoring & watchful waiting radical prostatectomy radiotherapy: external beam and brachytherapy Localised advanced prostate cancer (T3/T4) Options include: hormonal therapy: see below radical prostatectomy: erectile dysfunction is a common complication radiotherapy: external beam and brachytherapy. Patients are at increased risk of bladder, colon, and rectal cancer following radiotherapy for prostate cancer Metastatic prostate cancer disease - hormonal therapy Synthetic GnRH agonist e.g. Goserelin (Zoladex) cover initially with anti-androgen to prevent rise in testosterone Anti-androgen cyproterone acetate prevents DHT binding from intracytoplasmic protein complexes Orchidectomy

Answer 73

Radiotherapy complications = diarrhoea, nocturia, rectal bleeding, urinary stricture, urgency, incontinence, dysuria, ED, retention, proctitis Hormone induced - gynaecomastia, hot flushes Haematuria

Answer 74

Men with: T1/T2 tumours and a Gleason score of 6 or less had a 10-year disease-specific survival of 86% T1/T2 tumours and Gleason score 7 or T3/N1 tumours with Gleason score of 6 or less had a 10-year disease-specific survival of 75% A Gleason score of 8 to 10 or T3/N1 tumours with a Gleason score of 7 had a 10-year disease-specific survival of 62% The highest-risk features (i.e., Gleason score 8 to 10 and T3 or N1 disease) had a 10-year disease-specific survival rate of 34%.

Answer 75

``` 50-60 = 3 60-70 = 4 70+ = 5 ```

Answer 76

The Gleason score is used to grade prostate tumours obtained from biopsy. A biopsy-positive specimen is given a score from 1 to 5 based on the degree of architectural differentiation of the tumour. The Gleason score is obtained by assigning a primary grade to the predominant grade present and a secondary grade to the second most prevalent grade; for example, a tumour with grade 3 and grade 2 cells equates to a Gleason score of 5. Gleason scores under 6 are rarely recorded in contemporary cases. Low-grade tumour: Gleason score ≤6 Intermediate-grade tumour: Gleason score 7 High-grade tumour: Gleason score 8 to 10

Answer 77

The Gleason score is used to grade prostate tumours obtained from biopsy. A biopsy-positive specimen is given a score from 1 to 5 based on the degree of architectural differentiation of the tumour. The Gleason score is obtained by assigning a primary grade to the predominant grade present and a secondary grade to the second most prevalent grade; for example, a tumour with grade 3 and grade 2 cells equates to a Gleason score of 5. Gleason scores under 6 are rarely recorded in contemporary cases. Low-grade tumour: Gleason score ≤6 Intermediate-grade tumour: Gleason score 7 High-grade tumour: Gleason score 8 to 10

Cancer Flashcards

(101 cards)