Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CSIM > Cancer > Flashcards

Cancer Flashcards

1
Q

Effective screening programme

A

Affordable for the healthcare system
Acceptable to all social groups
Reduce mortality from cancer
Good discriminatory index between benign and malignant lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How do pt with cancer present

A

Screening programmes
Recent change in symptoms ie wt loss, lump, change in bowel habit
Age > 75y/o common to A/E

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Local spread of cancer

A

Nearby tissue often causes compressive/obstructive problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Distant spread of cancer

A

Metastasis from initial to 2ndary site commonly lymph nodes, brain, liver, bones and lung

Lymphatic, haematogenous and transcolemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Lymphatic spread

A

Comment route of metastasis can lead to haematogenous spread as the thoracic duct drains into the IVC. Lymphadenopathy can = pain due to obstruction/swelling

  • ENT = facial/neck lymphadenopathy
  • Gastric, oesophageal and breast to axillary and L supraclavicular
  • Testicular and ovarian to paraaortic
  • Vulval, scrotal and vaginal to femoral/inguinal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Transcolemic spread

A

Spreads throughout the peritoneum in the circulating peritoneal fluid. Passes up the L paracolic gutter, across surface of the liver and diaphragm and down the omentum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Haematogenous spread

A

Via the blood spreads rapidly usually venous flow as narrower walls are easier to penetrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Government targets for cancer

A

2wk wait - Any GP can refer suspicious red flag symptoms for investigation

31 day limit - 1st treatment must start within 31 days of agreement with pt

62 day limit - Treatment must begin within 62 days of referral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Common PC of cancer

A

Ascites - ovarian, gastric, pancreatic, HCC
Change in bowel - CRC, prostate, ovary
Dysphagia - Oesophageal, gastric, lung
#’s = 1 sarcoma, mets from renal,thyroid, lung, prostate and breast
Jaundice - HCC, cholangiocarcinoma,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Cancer of unknown primary

A

Tumor is able to metastasis before the primary site can be identified. Tends to be aggressive, disseminate early and be unpredictable. 5-10% of all cancers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Cause of CUP

A

i) Squamous cancer usually arising from head and neck/lung. Usually respond well
ii) Poorly differentiated or anaplastic - high grade lymphomas or germ cell tumours respond well treatment
iii) Adenocarcinomas poor prognosis usually pancreas or lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

CUP Mx

A

Speak to oncologist. Search for a site! You must rule out potentially curable tumors = germ cell!!

CXR, CT chest abdo pelvis, rectal USS = prostate, mammogram = breast

Use tumor markers, full examination PV and testicular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Poor prognosis of CUP

A 
Adenocarcinoma on histology
Hepatic/renal involvement 
Poor performance status
>10% wt loss
Supraclavicular lymph node involvement
High tumor marker levels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Cytological grading

A 
C1 = inadequate for testing
C2 = normal morphology
C3 = cells abnormal but likely to benign
C4 = highly suspicious of cancer
C5 = Cancer cells present
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Empyema

A

pH <7.2, low glucose, high WCC + present on culture/microscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Transudate vs Exudate

A

Transudate = protein <3g/l = cirrhosis, HF, renal failure and meigs syndrome

Exudate = protein >3g/L due to infection, inflammation (RA,SLE), PE or cancer.
Pleural albumin : serum albumin >0.5
Pleural LDH : Serum LDH >0.6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Hypercalcemia

A

Common complication of malignancy seen in 40% of pt
PC - non specific, renal failure, bone pain, confusion, conspitation

Due to either direct invasion of bones - mets, myeloma or squamous cell producing PTHrp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Confusion in cancer pt

A

Brain mets, hypercalcemia, constipation - bowel obstruction, infection, opiod OD, metabolic disturbance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Mx CUP

A

Curative treatment = survival
Palliative = QoL, secondary objective - duration of life

Factors influencing decision = pt choice, age, performance status, organ impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Smoking

A

Linked to 90% of lung cancer. Also increases the incidence of oesophageal, laryngeal, bladder, cervical and breast cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Asbestos

A

Causes malignant mesothelioma, potentiates risk of lung cancer if smoker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Amines in dye/rubber

A

Bladder cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Benzene

A

Myeloid leukaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Ionising radiation

A

BM, breast and thyroid all very sensitive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

BCC vs SCC

A

BCC = shiny, pearly nodule with rolled edge +/- umbilicate centre and telangiectasia

SCC = hyperkeratotic, crusting ulcerated lesion

Both present @ sites of sun exposure - ears, nose corner of mouth. Only definitive diagnosis is to excise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Xeroderma pigmentosum

A

Rare autosomal recessive condition at NER DNA mismatch repair gene, unable to repair DNA damaged by UV light

PC: severe sunburn with minimum sunlight often from 6month to 3yrs. Photosensitivity and dry skin. Premature skin ageing, increased risk of BCC,SCC and melanoma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Viral carcinogens

A

EBV - Burkitt’s and Hodgkins lymphoma craniopharyingoma,
HBV/HCV - HCC
HPV - cervical and oral cancer
HHV-8 = Kaposi and Castlemans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Parasitic carcinogens

A

H.pylori - gastric cancer and gastric lymphoma
Bilihartzia - Bladder cancer
Liver flukes - cholangiocarcinoma
Schitsomasis - Bladder cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Germline vs Somatic

A

Germaine present at embryogenesis so all cells in the body possess the mutation. Can be passed on to offspring

Somatic mutations acquired during life. Only affects cells they arose from and their subsequent descendants. Cannot be passed to offspring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Process of carcinogenesis

A

Proliferation in the absence of growth factors, failure to respond to inhibition to proliferation. Evade apoptosis replicative immunity. Angiogenesis and metastasis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

AD cancer syndromes

A

50% chance of passing to offspring. Lynch syndrome, BRCA I and II, Peutz Jeghers, von hippel lindau, Rb, NF1, MEN1 and 2, Li fraumeni

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Peutz Jeghers

A

Development of multiple haemartous polyps in the GI tract. These are benign and have a low index of malignancy but increase the risk of intussception and CRC

They also have hyperpigmented macules on lips, oral mucosa and palms/soles

Increased risk of liver, lung, ovarian, breast and testicular cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

MEN 1

A

AD mutation in the MEN1 gene which gives risk to pancreatic tumours, parathyroid hyperplasia and pituitary adenoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

MEN 2A and 2B

A

Gain in function mutation in RET gene
2A = medullary thyroid cancer, parathyroid hyperplasia and phaechromocytoma

2B = medullary thyroid cancer, phaechromocytoma, Marfanoid body habitus and multiple mucosal neuromas @ tongue eyelids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Li Fraumeni

A

Gene mutation in p53 guardian of the genome leads to leukaemia + lymphoma, premenopausal breast cancer, childhood sarcoma and brain tumour. Penetrance 50% by 50y/o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Ataxia telengestasia

A

AR mutation in AT gene leading loss of DNA repair. High risk of leukaemia, lymphoma and brain malignancy

PC - ataxia in childhood, slurred speech, telangiectasia over sclera of the eyes, FTT and recurrent URTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Von hippel lindau

A

Phaechromocytoma, RCC and hemangioblastomas. Common to have problems with eye sight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

NF1

A

PC 6+ cafe au last spots, freckling in axilla, multiple dermal neurofibrotomas, Lisch nodules in the iris - optic gliomas. Reduced IQ, scoliosis and risk of leukaemia and plexiform neurofibromas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

NF2

A

Rare hearing loss, few cutaneous signs, VIII problems

100% have CNS lesions - bilateral vestibular schwannomas, meningiomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Sensitivity

A

Ability to pick up all the people that have the disease, i.e. high power to rule out the condition
- True positive = TP - FN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Specificity

A

Ability to rule out the disease in all those without disease. Ie is specific to only those with the disease so high power to rule in

  • True negative = TN + FP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Breast cancer screening

A

All women 50-70 y/o invited for 3yrly mammogram. Suspicious feature such as soft tissue density or micro calcification = recall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Breast cancer screening for susceptible

A

Women with BRCA1/2 yearly MRI from 30y/o
FHx - mammograms from 40y/o
Li-fraumeni - yearly MRI from 20y/o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

CRC screening

A

FOB testing 2 yearly from 60-74y/o. Trial of one off flexisigmoidoscopy @ 55y/o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

CRC screening for susceptible

A 
IBD = 10 yearly flexisigmoidoscopy 
Lynch = 2 yearly colonoscopy from 25y/o or 5 years before age of onset in youngest family member
FAP = yearly colonoscopy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Cervical cancer

A

24-49 = 3yrly, 50-64 = 5yrly. Detection of CIN. Doesn’t detect adenocarcinoma which is responsible for 15% of cervical cancer.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Cancer prevention

A

Vaccination - HBV, HCV and HPV
Dietary measures - increased fibre, low red meat, stop smoking, reduced alcohol public health campaigns
Screening programmes

NSAID’s - protective against cancer approx 7% reduced rate, but no survival benefit due to GI bleed
Tamoxifen - preventing of breast cancer but increases risk of endometrial.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Lung Cancer epidemiology

A

Peak incidence 60-70y/o, smoking and asbestos exposure increase risk, 3x incidence in males, 5x increased risk if +ve FHx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

PC lung cancer

A

Can be asymptomatic and look like a gradual worsening of COPD - crucial to look as these ppl are most @ risk

PC - progressive SOB, chest pain, change in cough - 3wks long = CXR, anorexia, fatigue, wt loss, fever +/- haemoptysis

May have symptoms of extrinsic compression dysphasia, SVC obstruction, hoarseness of voice due to recurrent laryngeal nerve involvement or symptoms of metastasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

O/E lung cancer

A

Hands - clubbing, tar staining,
Cachexia, wt loss, SOB @ rest
Axillar or supraclavicular lymphadenopathy
Pleural effusion or lung collapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Lung cancer spread

A

Spread often along bronchus of origin. Involves lymphatics 1st to ipsilateral peribronchial and hilar nodes then to mediastinal, contralateral hilar and supraclavicular.

Disseminates into blood stream where it often metastases to the brain, bone and liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Pancoasts syndrome

A

Caused by a lung cancer @ apex of the lung. It can grow into the chest wall causing compression of structures

Dependent on the extent of growth can =
Horners syndrome a triad of miosis, ptosis and enopthalmus +/- anhydrosis depend of site. This is due to compression of the sympathetic chain

Severe shoulder pain and atrophy of hand muscles if T1 nerve root is compressed

Can also give phrenic palsys, SVC obstruction and recurrent laryngeal damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Horners syndrome

A

With or without anhydrosis depends on the site of the lesion
i) Central causes - anhydrosis of the face, arm and trunk = MS, brain tumors, syringomyalyia

ii) Preganglionic - anydrosis of face only = Pancoast, thyroid carcinoma, goitre
iii) Post ganglionic = no anhydrosis = carotid artery dissection, cavernous sinus thrombosis, migraine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

PC of pleural effusion

A

Tachypnoea, pleuritic chest pain, SOB

O/E - dull to percussion, reduced expansion and breathe sounds, vocal resonance reduced

Inv = exudative effusion if cancer, CXR = meniscus fluid level present, Lights analysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Types of lung cancer

A

i) Small cell
ii) Non small cell lung cancer (NSCLS)
Adenocarcinoma, Large cell and squamous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Small cell lung cancer

A

20% of lung cancers. Carry the worst prognosis aggressive, low doubling time and metastasize early.

Arise from neuroendocrine cells therefore give rise to paraneoplastic syndromes such as SIADH, ectopic ACTH and LEMS

Located centrally often with bulky hilar and mediastinal lymphadenopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Adenocarcinoma

A

40% now the most common lung cancer in UK, lowest smoking link, increased in asbestos exposure.

Originates from mucus secreting glandular cells, originates peripherally in the lung so commonly involves the pleura = pleural effusions

Metastasises to pleura, lymph nodes, brain, bone and adrenals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Squamous cell

A

Central obstructive lesion of the bronchus can cavitate. Grow slowly, spread locally and disseminate late.

Can give paraneoplastic effects of clubbing, PTHrp and HOA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Large cell

A

Often peripheral mass poorly differentiated. Grow rapidly and metastasise early. Derived from mucus cell most linked to asbestos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Malignant mesothelioma

A

Caused by light asbestos exposure. CXR shows tumour arising from serosal cells of the pleura. No cure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Inv Lung caner

A

Stage the extent of the disease - CT thorax, abdo and pelvis
Biopsy is crucial for a tissue diagnosis = define treatment via bronchoscopy
Assess performance status for surgery = pulmonary function tests, echo, vital signs, renal function
Pleural fluid analysis

CXR 1st line, FBC ?anaemia, U+Es, LDH, serum calcium

62
Q

Poor prognostic factors

A

Low performance status, any site metastasis, high LDH

63
Q

SVC obstruction PC

A

PC = facial swelling and fullness worsened on lying down or bending forward, SOB, arm swelling chest pain.

O/E = facial oedema, venous distention of neck veins, cyanosis, plethora of face + oedema of arms

64
Q

Causes of SVC obstruction

A

90% due to bronchogenic carcinoma
Lymphoma of 2ndary lymphadenopathy = compression of SVC
Thrombosis - CVC increased risk

65
Q

Pathophysiology of SVC obstruction

A

Blockage of the SVC which is responsible for drainage of blood from the brain leads to collateral circulation developing from the internal mammary, lateral thoracic and the oesophageal veins. It can lead to cerebral oedema or lifethreatening laryngeal oedema.

66
Q

Inv and Mx of SVC obstruction

A

CXR/CT may show superior mediastinal enlargement, R hilar mass

Mx = steroids to reduce swelling, stenting of SVC if severe. treat cause!

67
Q

Brain mets PC

A

PC new onset headache, confusion, seizures +/- neurological defects parathesia, hemiparesis

68
Q

Causes of brain mets

A

Lung, breast, CUP, prostate and myeloma

69
Q

Mx of Brain mets

A

Supportive - corticosteroid to reduce cerebral oedema - improves survival in 50% - relieve headache and cognitive dysfunction. Anticonvulsants to reduce seizure risk.

Surgery is only favourable if one discrete lesion which is accessible, Chemo doesn’t work due to inability to cross BBB. Radiotherapy may increase survival.

70
Q

Hypercalcemia due to PTHrp

A

PTHrp 100x more potent than PTH acts at the PTH receptor to stimulate increased bone reabsorption and distal tubular Ca2+ reabsorption. Doesnt increase intestinal Ca2+ reabsorption

Produced by NSCLC, RCC, ENT cancer and SCC of oesophagus

71
Q

PC hypercalcemia

A

Confusion, dehydration, constipation, polyuria, polydyspia, muscle weakness and cardiac arrthymias.

High Ca2+ leads to reduced membrane permeability to Na+ ion movement. This leads to hypotonicity of smooth and striated muscle.

72
Q

Inv and Mx hypercalemia

A

Serum calcium, undetectable or low PTH, high urinary Ca2+. Mx = IV bisphosphanates stat, fluid resus

73
Q

Ectopic ACTH PC

A

PC Cushing syndrome truncal obesity, hypertension, fatigue, weakness, hirsutism, high Na+, low K+

74
Q

Causes of ectopic ACTH

A

SCLC, pancreatic islet cell tumours, medullary thyroid ca, phaechromocytoma, carcinoid tumours

75
Q

Inv and Mx ectopic ACTH

A

24hr urinary cortisol, high ACTH, no response to high dose dexamethasone suppression test. CT for site. Chemotherapy to treat.

76
Q

SIADH PC

A

PC confusion, lethargy, HTN, tremor, hyponatremia, cerebral oedema. Increased ADH leads to water retention and low Na+. This causes a low serum osmolality due to dilution of the extracellular space and a high urine osmolality as high levels of Na+ are excreted

77
Q

Causes of SIADH

A

SCLC, prostate, pancreatic

78
Q

Inv and Mx SIADH

A

hyponatremia < 130, high urine Na+,
urine osmolality > serum osmolality
non surpressed ADH

Mx = fluid restrict, demoxycycline

79
Q

Lambert eaton myaesthenic syndrome

A

AI reaction with autoantibodies forming against presynaptic voltage gates Ca2+ channels. This leads to reduced influx of Ca2+ to the nerve ending reducing act release. 60% due to underlying malignancy = SCLC/breast

PC = proximal weakness of arms and legs. No affect on bulbar muscles. Constipation, blurred vision, dry mouth

O/E = increased strength with use. Lambert sign is increased power on grip

80
Q

Gonadotrophins

A

Secreted by pituitary tumors, germ cell and gestationaltrophoblastic tumors. Can = gynecomastia in males

High BhcG (can cross react causing hyperthyroidism)

81
Q

Medullary thyroid cancer

A

Calcitonin secreting tumors can lead to hypocalcemia. Calcitonin is a polypeptide produced by C-cells of the thyroid prevents Ca2+ release from the bone and increases renal excretion

PC = tetany, diarrhoea, twitches and spasms

82
Q

Hypertrophic pulmonary osteodystrophy

A

Combination of clubbing and thickening of periostum and long bones. This classicaly presents with joint stiffness, pain @ wrists and ankles. Linked to squamous cell cancer

83
Q

Encephalomyopathies

A

Perivascular inflammation and selective neuronal degeneration can affect the limbic system, brainstem and spinal cord. Autoantibodies present on the tumor surface cross react with other tissues

PC - slow progressive onset, loss of STM, personality, hallucinations and fits

Inv - high IgG in CSF, autoantibody in serum

84
Q

Neutropenic sepsis definition

A

Pyrexia one off reading >38.3 or >38 for 1hr
Symptoms of rigors, unexplained hypotension or tachycardia

Neutrophil count <1.0x106

85
Q

PC neutropenic sepsis

A

Have low suspicion, this is deadly in cancer its
PC = vomiting, drowsiness, fatigue, diarrhoea, fever may not always be present

O/E - hypotension, oliguria, tachycardia

86
Q

Mx neutropenic sepsis

A

Sepsis six. Broad spectrum Abx IV within 1hr !

Keep platelets >20x109

87
Q

Radiation pneumonitis

A

Acute manifestation of radiation induced lung disease
PC = 4-12 wks post radiation exposure
cough oedema and pleuritic pain

CXR = ground glass opacities

88
Q

Pathology of radiation pneumonitis

A

Degenerative - loss of type 1 pneumocytes, deposition of fibrin in aveoli leading to increased permeability can interstitial and pulmonary oedema

Regenerative - proliferation of connective tissue in parenchyma

89
Q

Breast cancer epidemiology

A

100x more likely in females, lifetime risk of 1/9

10% = familial breast cancer, 3% due to BRCA and p53

90
Q

Risk factors for breast cancer

A

Non modifable - age, female gender, FHx, BRCA/p53 mutations, early menarche late menopause,

Modifiable - nulliparity, late 1st child, HRT, smoking, obesity, breast tissue irradiation

91
Q

Familial breast cancer

A

Relative risk with one 1st degree family relative = 1.7x, if premenopausal onset = 3x, bilateral disease = 5x

92
Q

BRCA 2

A

lower risk of breast cancer (40-70%) and ovarian (15%)
Increased risk of prostate cancer and pancreatic (7%)

Male breast cancer

93
Q

BRCA 2

A

lower risk of breast cancer (40-70%) and ovarian (15%)
Increased risk of prostate cancer and pancreatic (7%)

Male breast cancer

94
Q

PC breast cancer

A

80% of women detect a lump
Breast enlargement, pain, nipple retraction and discharge are rare. Wt loss, fatigue and malaise.

O/E supraclavicular or axillary lymphadenopathy, discolouration of skin, puckering, peau d’orange, skin thickening or ulceration

Comparison of breasts is crucial

95
Q

Paget’s disease of the breast

A

Linked to intraducal carcinoma involving the terminal ducts of the breast.

PC eczematous erythematous keratotic patch over areolar area +/- discharge or mass

96
Q

Breast cancer metastasis

A

Bone, lung, liver and brain

97
Q

Triple assessment

A

2wk wait involves radiologist, surgeon and oncologist. Clinical exam, imaging -mammogram/MRI, biopsy - FNA/core

98
Q

Breast cancer tumour marker

A

CA15.3

99
Q

Mammogram findings suggestive of maligancy

A

asymmetrical mass, microcalification, distorted architecture

100
Q

Cystic mass

A

USS to determine if cystic. FNA to drain cyst. Biopsy if need if bloody aspirate, incomplete resolution or recurrence

101
Q

Solid mass

A

Mammogram and core biopsy. +ve gives architectural and cellular characteristics

102
Q

Non palpable mass

A

Breast MRI + wire guided or excision biopsy

103
Q

Receptors in breast cancer

A

All breast cancers are tested for oestrogen, progesterone and herceptin receptors. Triple -ve = poorer prognosis

ER - tamoxifen oestrogen antagonist or aromatase inhibitors
HER2 - monoclonal Ab - trastuzumab

104
Q

Bone metastasis

A

5 main causes = breast, lung, renal, thyroid, prostate and myeloma. Average survival is 2 yrs from 1st lesion discovered

105
Q

PC bone metastasis and Mx

A

Severe boring bone pain, pathological #, hypercalcemia, MSCC, reduced mobility and QoL

Mx = bisphosphanates - zolendronate, pain relief

106
Q

MSCC

A

Needs rapid diagnosis to prevent permeant paralysis

PC = bilateral UMN, paralysis of limbs and reduced sensation below level of lesion. +/- incontience

Inv = MRI stat 
Mx = IV steroids stat - may need surgery or chemo. Call oncologist
107
Q

Mx breast cancer

A

Staging by TMN. Anyone with tumor >5cm, >3 lymph nodes effected or clinical suspicion should have a CXR and a bone scan to hunt for mets

Senital node biopsy and radioactive labelled isotope to stage lymphocytic spread

108
Q

Surgery breast cancer

A

Partial mastectomy = tumor and surrounding tissue removed with some lymph nodes removed to check for spread

Modified radial mastectomy = Whole breast and underarm lymph nodes removed. Chest wall left intact

109
Q

Adjuvant to surgery

A

Radiotherapy - mandatory for those with lumpectomy, wide local excision, >5cm tumor or 4+ lymph nodes. Reduces risk of local recurrence

Endocrine therapy - only in those ER,PR or HER2 +ve
- Tamoxifen or Aromatase inhibitor (Only in post-menopausal otherwise causes ovarian failure)

Trastuzumab for HER2. HER2 causes cellular growth and division in the absence of growth factors

110
Q

Tamoxifen

A

Reduced risk = DCIS and invasive cancer

Increased risk of DVT, PE, endometrial cancer

111
Q

Ovarian Cancer epidemiology

A

White female, developed country, increased risk in BRCA1/2, Lynch syndrome and ashkanazi jews

112
Q

PC ovarian cancer

A

Asymptomatic, abdo bloating and pain, change in bowel habit, frequency and urge urination due to mass effect compressing bladder/colon

In advanced disease = ascites, ovarian torsion, PV/PR bleeding, hydronephrosis 2ndary to uteric obstruction, pleural effusion

113
Q

Sister mary nodules

A

Ovarian cancer metastasis to umbilicus

114
Q

Risk factors for ovarian cancer

A

Non modifable = BRCA1/2, age, early menarche + late menopause, Lynch syndrome

Modifiable = nulliparity, IVF, obesity, PCOS

115
Q

Protective for ovarian cancer

A

COCP, multiparity, breast feeding

116
Q

Risk of malignancy index

A

CA125 x menopausal status x USS score

premenopausal = -1, postmenopausal = 3
USS score = 1+ for ascites, bilateral, mulitlocular, metastasis

> 200 = stat referral to specialist centre

117
Q

CA125

A

Ovarian cancer. Raised in SLE,IBD, endometriosis, pregnancy, fibroids and menstruation

Serial rise >25% accurate method in predicting progression. 2x increase from upper limit 100% specificity for relapse of disease

118
Q

AFP

A

HCC and germ cell

119
Q

CA19.9

A

Cholangiocarcioma and pancreatic cancer. Chronic inflammatory conditions such as PSC, PBC, and gallstones will raise.

120
Q

Calcitonin

A

Medullary thyroid cancer

121
Q

PSA

A

Prostate cancer

122
Q

CEA

A

CRC, lung, ovarian, breast

123
Q

Inv of ovarian cancer

A

Explorative laparotomy is crucial aim to reduce tumour size, obtain histological sample and stage the disease
- FNA not done due to risk of seeding tumour through abdominal wall

124
Q

Pathology of ovarian cancer

A

90% epithelial in origin

  • Serous begin in fallopian tubes, fluid filled cysts
  • Mucinous large multiloculated mucus filled cyst derived from GI or endocervical epithelium
  • Endometrial - blood filled chocolate cysts
  • Transitional cell found on bladder rare !

Germ cell

Sex cord stromal - highly aggressive and unilateral lead to increased oestrogen production due to follicle cell development PC = pv bleed, breast tenderness

125
Q

Thyroglobulin

A

Follicular and papillary thyroid cancer

126
Q

Miegs syndrome

A

Benign ovarian fibroma, ascites and pleural effusion often R sided

127
Q

Malignant ascites

A

Collection of intraperitoneal fluid may be due to serial implants in the peritoneal membrane. 10% of ascites are due to malignancy

128
Q

Lymphedema

A

Collection of lymphatic fluid due to obstruction in lymphatic vessels. If not removed inflammatory reaction from high levels of protein and debris will lead to fibrosis of tissue in effected limb. Can be a complication of treatment

129
Q

Inflammatory myopathies

A

Polymyositis = Pain @ neck, torso and hips due to inflammatory breakdown of muscle, low grade pyrexia
- Endomysium of muscles

Dermatomyositis = skin involvement gottrans papules = erythematous heliotrope rash over extensor tendons, proximal muscle weakness, arthralgia

Both are heavily linked to malignancy 40%. NSCLC, SCLC, breast, ovary and upper 1/3rd GI tract

130
Q

Inv and Mx polymyositis and dermatomyositis

A

high CK, LDH
EMG = erratic, high frequency signals
Anti-Jo abs, ANA +ve
Muscle biopsy = diagnostic

Mx = look for cancer!! If found often will remit if cancer treated. Steriods

131
Q

Trousseau’s sign of malignancy

A

Episodes of vessel inflammation due to blood clots. Hyper coagulability leads to increased risk of DVT/PE

132
Q

Mx ovarian cancer

A

Surgery to reduce tumour bulk - if post menopausal bilateral oophoro salpingohysterectomy

Adjuvant carboplatin and paxitel chemo = increased survival

If cancer recurs it is considered platinum resistant based on the length of time it was in remission

133
Q

Germ cell cancer

A

Testicular germ cell most common cancer in males 18-35y/o. Only account for 2% of total cancers. Rapid doubling time, highly sensitive to chemotherapy

5yr survival of 98.5%

134
Q

PC of testicular germ cell cancer

A

Testicular enlargement, painless solid unilateral mass, 10% back pain due to paraaortic lymphadenopathy, gynecomastia if tumor BhcG secreting.

135
Q

Invx of germ cell cancer

A

aFP and LDH both hugely elevated

BhcG - glycoprotein found in syncytitrophoblast of placenta found grossly elevated in trophoblastic disease and germ cell cancer. May = thyrotoxicosis due to cross reaction

USS of ovary/testicles. CXR and CT for staging

136
Q

Risk factors for testicular germ cell cancer

A

FHx = 10x, testicular maldescent, Downs and Kleinfelters

137
Q

Differential diagnosis of cannonball metastasis

A

RCC, thyroid cancer, melanoma, osteosarcoma, testicular cancer

138
Q

Poor prognosis testicular cancer

A

AFP>10,000 BhcG >500,000
Mediastenial or non pulmonary mets

Only NSGCT have poor prognosis 48% @ 5yrs

139
Q

Seminomas

A

Metastasis via para aortic lymph nodes to pelvic to mediastinal. Locally invades the rete testis. Very radio and chemosensitive

140
Q

NSGCT

A

Commonly metastasises to lung via blood, rarely to brain and bones. Variable lymphatic spread with skip node functions

141
Q

Tumour lysis syndrome PC

A

PC hyperkalemia, hyperphosphatemia, hyperuremia and secondary hypocalcemia due to high phosphate levels.

Occurs due to break down of large tumour bulk over short period of time. AKI due to urate nephropathy, cardiac arrhythmias from high K+ and low Ca2+, DIC

142
Q

Risks of tumour lysis syndrome

A

Male <25y/o, renal impairment, large volume sensitive tumour i.e. lymphoma, leukaemia or germ cell

143
Q

Prevention of tumour lysis

A

Hydration, allopurinol a xanthine oxidase inhibitor to reduce urate levels,

Stop ACEi and NSAID’s

If serious/high risk = Rasburicase and dialysis on standby

144
Q

Mx germ cell cancer

A

Orchidectomy - sperm banking and prosthesis offered

Seminoma = surveillance with BhcG and aFP monitoring, adjuvant radiotherapy of para-aortic strip, single dose carboplatin if rate testis > 4cm

NSGCT - surveillance relapse rate 30%, increased if lymph/blood involvement

145
Q

Surveillance of germ cell

A

Months clinic appt, exam and tumour markers for 1st year,

CT @ 3,12 and 24 months

146
Q

Mx of metastasis germ cell

A

High intensity chemotherapy
i) Bleomycin - 10% fibrosis so crucial to do pul function tests, TLCO and KCO before each cycle

ii) Cisplatin = 18% have reduction in eGFR permanently, loss of high range hearing, neuropathy. Small risk of severe vascular toxicity

147
Q

Complications of Mx

A

Tumor lysis syndrome
CVD and fibrosis risk
Psychosexual issues - depression, anxiety
Infertility

148
Q

ALP (Especially with high Ca2+ and low PTH)

A

Represents osteoblast activity. Osteosarcoma, bone mets.

Myeloma presents with high Ca2+, low PTH and a low ALP due to IL-1 and IL-6 acting as strong osteoclast stimulating factors

149
Q

PSA

A

Prostate cancer

150
Q

Ca-15-3

A

Breast

151
Q

Tumour markers aren’t used for diagnosis

A

Low sensitivity and specificity

152
Q

Change in Bowel habit >60

A

Urgent 2wk wait colonoscopy to exclude malignancy

CSIM (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions