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Flashcards in Cancer Deck (15):
1

Outline the Breast cancer screening program?

  • mammogram for women >35 with risk.
  • US used for women <35 screening occurs from 50-74 (but still available for 70+) every 2 years.

Tripple assessment: 

  • palpation 
  • radiology 
  • FNA cytology

Risk:

moderate <50 FDR, 2 FDR or 2SDR with one <50 and might get mammograms from 40 years

high risk ovarian high, mutation or FDR <40, etc... possible SERMs and individualised screening. 

 

 

2

What are the risk categories for a women presenting with a breast lump concern?

Moderate:

  • >1 FDR <50 with it
  • >2 FDR on same side
  • >2 SDR same side <50

High:

  • ovarian cancer high risk
  • >2 FDR/SDR with ovarian or breast + 1 of:
    • <40 years old when got it
    • Ashkenazi Jew
    • male
    • FHx of established mutation

3

Outline some definitions of the types of cancer?

Non-invasive (any dysplasia):

  • ductal cancer in situ
  • lobular cancer in situ

Invasive:

  • infiltrative ductal cancer
  • medullary
  • papillary
  • tubular
  • mucinous

Other:

  • adenoid
  • secretory
  • apocrine

Remember flow chart from first year.

sporadic to dysplasia

  • if E-cadherin is mutated it becomes lobular
  • if not it becomes ductal
  • sporadic amplification of HER2 - its a HER2 amplified carcinoma (trastuzumab targets it)
  • if its BRCA1/2 mutation thats a TSG and becomes 'basal-like' or 'triple negative'

4

What are some RFs for breast cancer?

  • Family history
  • Oestrogen exposure (nulliparity)
  • Advancing age
  • Alcohol
  • Radiation exposure
  • Obestity
  • Inherited mutation

5

What is the Presentation of a women with Ovarian cancer?

very non-specific:

  • abdominal bloating
  • LOA
  • weight gain or loss
  • fatigue
  • change in bowel habit
  • pelvic pain

6

What are the Investigations for Ovarian cancer?

  • Pelvic US (preferrably transvaginal)
  • ADNEX model
  • CT scan
  • Routine bloods specifically looking for CA125

7

Talk through PSA testing, and how you would counsel a patient?

  • secreted from the prostatic epithelium and secreted into semen
  • Pros:
    • good for recurrent disease
    • might pick up cancer that normally presents late.
  • Cons:
    • overtreatment of indolent cancer
    • non-specific to cancer (BPH, prostate infarcts, instrumentation and ejaculation increase it)
    • reference range changed over the years.

Guidelines say a PSA score of 3 determines further investigation. 

8

Outline the presentation of prostate cancer?

usually assymptomatic

  • mostly affects the peripheral zone, therefore doesn't present with obstruction often.

Symptoms:

  • haematuria
  • LUTS
  • metastatic (bone pain, sciatica)

RFs of:

  • BRCA,
  • FHx of cancer,
  • age,
  • African descent

9

Outline the diagnosis of Prostate cancer?

  • PSA screening MRI - assist in biopsy planning Biopsy (TRUS/transperineal) -
  • Gleason Score (6=low, 7=moderate, 8-10 = high)
  • Staging - TNM (CT CAP, bone scan, PET) 5 grades based on glandular pattern, as most tumours contain multiple patterns a secondary and primary score are assigned.

10

What is the treatment of Prostate cancer?

depends on age (<70 or >70) and whether its metastasised Metastatic: - castration - GNRH analogues (target LH) - agonists - surge stops feedback loop. - antagonists - bilateral orchidectomy if it resists this treatment go chemo (poor prognosis) low risk <70 'active surveillance' - regular review 3-6 monthly for PSA/DRE - 2nd confirmatory biopsy in 1 year - 1/3 progress <70 mod/severe - radiotherapy - prostatectomy - adjunct hormones >70 watchful waiting - follow PSA/DREs - same as young but with no curative intent.

11

What is the Screening program for Colorectal cancer?

FOBT between the ages of 50-75 or <10 years from the age of onset of family

Moderate risk:

  • colonoscopy every 5 years
  • 1 FDR <55
  • 2 FDR or 1FDR + SDR

High risk:

  • 3FDR/SDR same side
  • Syndromes suspected

Known high risk mutation:

  • Lynch - 1-2 years from 25 (low dose aspirin)
  • FAP - every 6 months

12

Cervical Cancer screening program?

  • within 2 years of first sexual intercourse or after the age of 20.

LSIL (low-grade squamous intraepithelial lesions):

  • repeat in 12 months for PAP smear
  • colposcopy >30 years
  • repeat at 6 months or colposcopy

HSIL

  • colposcopy +/- biopsy
  • HPV testing every 12 months

13

What advice would you give to a patient pre-colonoscopy?

  1. bowel preparation 3pm and 7pm day prior fleet or polyethylene glycol 1-3hours the day prior
  2. Anaesthesia - IV benzos (diazepam or midazolam) or propofol
  3. discontinue warfarin, aspirin, NSAIDs and iron supplements days prior.
  4. positioning in the left lateral decubitus position.
  5. Relative Contraindications due to increase risk of perforation:
  • pregnancy
  • suspected colonic perforation
  • toxic megacolon
  • fulminant colitis
  • severe IBD with ulceration

14

What are some risks associated with colonoscopy?

  • risk that an abnormality may not be detected, this is reduced with proper bowel prep. - intolerance to the bowel preparation
  • reaction from the sedatives or anaesthetic
  • perforation
  • major bleeding from the bowel (from polyp removal)

15

What is the Screening for Cervical Cancer? What are some of the changes coming up? 

  • In Dec 2017 it will switch to 25 testing 2 yearly. 
  • At present its at 20 years old or 2 years after first sexual activity. See women's health for Guardisil 

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