Cancer Flashcards
Bladder cancers are what kind of cancers?
Most bladder cancers are transitional cell carcinomas
Rarely, bladder cancers may be squamous cell carcinomas associated with chronic inflammation (e.g. schistosomiasis)
What are the risk factors for bowel cancer?
Smoking
Dye stuffs (naphthylamines and benzidine)
Cyclophosphamide treatment
Pelvic irradiation
Chronic UTIs
Schistosomiasis
Being Male
What are the presenting symptoms of bladder cancer?
Painless macroscopic haematuria
Irritative/storage symptoms
Frequency
Urgency
Nocturia
Recurrent UTIs
- occassionaly ureteral obstruction
What are the signs of bladder cancer on examination?
- Commonly NO SIGNS
- bimanual exam can be used for staging
What are the appropriate investigations for bladder cancer?
Cystoscopy - allows visualisation, biopsy or removal
Ultrasound
Intravenous urography
CT/MRI for staging
What is the most common type of breast cancer?
invasive ductal carcinoma
What are the risk factors for breast cancer?
- genetics (BRCA genes)
- age
- oestrogen exposure
- family history
What are the presenting symptoms of breast cancer?
Breast lump (usually painless)
Changes in breast shape
Nipple discharge (may be bloody)
Axillary lump
Symptoms of malignancy: weight loss, bone pain, paraneoplastic syndromes
What are the signs of breast cancer on examination?
Breast lump - firm, irregular, fixed to surrounding structures
Peau d’orange
Skin tethering
Fixed to chest wall
Skin ulceration
Nipple inversion
Paget’s disease of the nipple - eczema-like hardening of the skin on the nipple -> usually caused by ductal carcinoma in situ infiltrating the nipple
What are the appropriate investigations for breast cancer?
- TRIPLE ASSESSMENT = clinical examination, imaging (ultrasound (< 35 yrs) or mammogram (> 35 yrs) ), tissue Diagnosis
- Sentinel Lymph Node Biopsy
- Staging - via CXR, liver ultrasound, CT (brain/thorax)
- Bloods: FBC, U&Es, calcium, bone profile, LFTs, ESR
What are the risk factors for cholangiocarcinoma?
Ulcerative colitis + primary sclerosing cholangitis
Choledochal cyst (congenital conditions involving cystic dilatations of bile ducts)
Caroli disease (rare genetic condition in which you get dilatation of intrahepatic bile ducts)
Parasitic infection of biliary tract
What are the presenting symptoms of cholangiocarcinoma?
Obstructive jaundice symptoms = yellow sclera, pale stools, dark urine, pruritus
Abdominal pain or fullness
Systemic symptoms of malignancy = weight loss, malaise, anorexia
What are the signs of cholangiocarcinoma on examination?
Jaundice
Palpable gallbladder
Epigastric/RUQ mass
There may be hepatomegaly
What are the appropriate investigations for cholangiocarcinoma?
- Bloods = FBC, U&Es, LFTs (high ALP + GGT), clotting screen, tumour markers
- Endoscopy
- Ultrasound
- Staging - via CT, MRI, Bone Scan
What marker is used for pancreatic and cholangiocarcinoma diagnosis?
- CA19-9
What are the risk factors for CNS tumours?
Ionising radiation
Immunosuppression (e.g. HIV)
Inherited syndromes (e.g. neurofibromatosis, tuberous sclerosis)
What are the presenting symptoms of CNS tumours?
o Presentation depends on the size and location of the tumour
Headache (worse in the morning and when lying down)
Nausea and vomiting
Seizures
Progressive focal neurological deficits
Cognitive and behavioural symptoms
Papilloedema
What are the appropriate investigations for CNS tumours?
Bloods - check CRP/ESR to eliminate other causes (e.g. temporal arteritis)
CT/MRI
Biopsy and tumour removal
Magnetic resonance angiography - define changing size and blood supply of the tumour
PET - distant mets are rare with primary CNS tumours
What is the most common type of colorectal cancer?
adenocarcinoma
Describe the distribution of colorectal cancer.
60% - rectum and sigmoid
30% - descending colon
10% - rest of colon
What are the risk factors for colorectal cancer?
Western diet (e.g. red meat, alcohol)
Colorectal polyps
Previous colorectal cancer
Family history
IBD
Genetics (HNPCC or FAP)
What are the presenting symptoms of colorectal cancer?
o Left-Sided Colon and Rectum
- change in bowel habit
- rectal bleeding (blood or mucus mixed with the stools)
- tenesmus (recurrent inclination to evacuate the bowels) due to a space-occupying tumour in the rectum
o Right-Sided Colon (presents later)
- anaemia symptoms (lethargy)
- weight loss
- non-specific malaise
- lower abdominal pain (rare)
o 20% of tumours will present as an EMERGENCY with pain and distension due to large bowel obstruction, haemorrhage or peritonitis due to perforation
What are the signs of colorectal cancer on examination?
Signs of Anaemia
Abdominal mass
Hepatomegaly and Ascites if metastatic
Low-lying rectal tumours may be palpable on DRE
What are the appropriate investigations for colorectal cancer?
o Bloods = FBC - anaemia, LFTs, Tumour markers (CEA)
o Stools = FOBT - used as a screening test
o Endoscopy = sigmoidoscopy or colonoscopy
o Double-Contrast Barium Enema
o Contrast CT for staging (Duke’s staging)
