Flashcards in Cancer Deck (134)
What is bladder cancer?
Malignancy of bladder cells
What is the aetiology of bladder cancer
- Common genetic abnormalities are chromosome 9 deletions in superficial tumours and p53 mutations and 14q and 17q deletions in more invasive tumours
What are the risk factors of bladder cancer?
- Exposure to carcinogens in dye, rubber and leather industries
- Cyclophosphamide treatment
- Pelvic irradiation (e.g. for cervical carcinoma
- Chronic UTI
What is the epidemiology of bladder cancer?
- 2nd most common cancer of genitourinary system
- Males 2-3x more commonly affected as woken
- 50-70 yrs peak incidence
What are the presenting symptoms of bladder cancer?
- Painless macroscopic haematuria
- Urinary frequency, urgency, nocturia (irritative)
- Recurrent UTIs
- Pain due to clot retention
- Ureteral obstruction
- Extension to pelvis
What are the signs of bladder cancer on examination?
- Often no signs
- Under anaesthetic, bimanual examination is part of disease staging
What are the investigations for bladder cancer?
- Cytoscopy: allows visualisation of tumour, biopsy or removal
- USS, IVU: To assess upper and lower urinary tract, as tumours can be multifocal
- CR or MRI: For staging
- Urine cytology
What is breast cancer?
Malignancy of breast tissue
What is the aetiology of breast cancer?
Combination of genetic and environmental factors. BRCA-1 and BCRA-2
- Risk factors: Age, prolonged exposure to female sex hormones (particularly oestrogen), nulliparity, early menarche, late menopause and obesity. Fhx
What is the epidemiology of breast cancer?
- 1:9 in UK
- 4-70= peak incidence
- Rare in men
What are the presenting symptoms of breast cancer?
- Breast lump (usually painless) or changes in breast shape
- Nipple discharge or axillary lump
- Symptoms of malignancy: Weight loss, bone pain, paraneoplastic syndromes
What are the signs of breast cancer on examination?
- Breast lump (usually hard, irregular, may be fixed)
- Peau d'orange appearance of skin, skin tethering, fixed to chest wall
- Skin ulceration, nipple inversion
- Examine axillary nodes for lymphatic spread
- Paget's disease of the nipple: Eczematous, ulcerated, discharging nipple. This is ductal carcinoma in situ infiltrating the nipple
What are the investigations for breast cancer?
- Triple assessment: Standardised approach to investigating breast lump. Consists of clinical examination, imaging (mammography or ultrasound) and tissue diagnosis (cytology or biopsy)
- Sentinal lymph node biopsy
- Staging: CXR, liver ultrasound. Consider isotope bone scan
- Bloods, FBC, U&E's Ca, bone profile, LFT, ESR
What is a CNS tumour?
Primary tumour arising from brain tissues
- Tumours arising from meninges/CNS have better prognosis than intra-axial tumours
What is a meningioma?
What is an acoustic neuroma?
- Slow, growing, cerebellopontine angle tumour from vestibular part of CN8
What is a fibrilliary astrocytoma?
Most common form in cerebrum
What is pilocytic astrocytoma?
In brainstem and cerebellum, cystic
What is glioblastoma multiforme?
High grade invasive tumours
What is haemangioblastoma?
Vascular tumour in cerebellum
What is medulloblastoma?
Invasive malignant midline cerebellar tumour in children (vermis)
What is ependyoma?
In 4th ventricles, spinal cord, benign
What is lymphoma?
In immunosuppressed, high malignant
What is craniopharyngioma?
Benign, extra-axial, epithelial tumours of CNS
- Seen in both children and adults
- Most commonly arise within the sellar/suprasellar space
What is a pituitary adenoma?
Space occupying/endocrine effects. Benign
- Prolactinoma: secrete prolactin
- Somatotroph adenoma: secrete GH
- Corticotroph adenoma: secrete ACTH
- Gonadotroph adenoma: Secrete FSH, LH, alpha and beta subunits
- Null cell adenoma: secrete no hormones
- Thyrotroph adenoma: secrete TSH
What is the epidemiology of CNS tumours?
- Meningioma most common, esp in women
- Peak in children and elderly
What is the aetiology of CNS tumours?
- Unknown causes in adults
- Children: embryological errors in development
What are the risk factors for CNS tumours?
- Meningioma: FH brain tumour, NF2, breast cancer, radiation
- Acoustic neuroma: NF2
- Medulloblastoma: age, male, familial syndromes (ataxia-telangectasia, Rubinstein-Taybi syndrome, Gorlin's syndrome)
- Astrocytic: industrial countries, white males, NF1, tuberous sclerosis, Li-Farumeni
- Lymphoma: HIV
- Pituitary adenomas: MEN1, familial isolated pituitary adenomas
What are the presenting symptoms of a meningioma?
- Mostly benign (can be atypical/malignant)
- Occurs at cranial and spinal sites
- Mass effects: Headaches, altered speech, personality seizures)
- Broca's aphasia