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Year 3 ICSM Sofia > Cancer > Flashcards

Cancer Flashcards

1
Q

What is bladder cancer?

A

Malignancy of bladder cells

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2
Q

What is the aetiology of bladder cancer

A
  • Unknown
  • Common genetic abnormalities are chromosome 9 deletions in superficial tumours and p53 mutations and 14q and 17q deletions in more invasive tumours
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3
Q

What are the risk factors of bladder cancer?

A
  • Smoking
  • Exposure to carcinogens in dye, rubber and leather industries
  • Cyclophosphamide treatment
  • Pelvic irradiation (e.g. for cervical carcinoma
  • Chronic UTI
  • Schistosomiasis
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4
Q

What is the epidemiology of bladder cancer?

A
  • 2nd most common cancer of genitourinary system
  • Males 2-3x more commonly affected as woken
  • 50-70 yrs peak incidence
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5
Q

What are the presenting symptoms of bladder cancer?

A
  • Painless macroscopic haematuria
  • Urinary frequency, urgency, nocturia (irritative)
  • Recurrent UTIs
  • Pain due to clot retention
  • Ureteral obstruction
  • Extension to pelvis
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6
Q

What are the signs of bladder cancer on examination?

A
  • Often no signs

- Under anaesthetic, bimanual examination is part of disease staging

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7
Q

What are the investigations for bladder cancer?

A
  • 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
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8
Q

What is breast cancer?

A

Malignancy of breast tissue

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9
Q

What is the aetiology of breast cancer?

A

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

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10
Q

What is the epidemiology of breast cancer?

A
  • Common
  • 1:9 in UK
  • 4-70= peak incidence
  • Rare in men
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11
Q

What are the presenting symptoms of breast cancer?

A
  • Breast lump (usually painless) or changes in breast shape
  • Nipple discharge or axillary lump
  • Symptoms of malignancy: Weight loss, bone pain, paraneoplastic syndromes
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12
Q

What are the signs of breast cancer on examination?

A
  • 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
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13
Q

What are the investigations for breast cancer?

A
  • 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
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14
Q

What is a CNS tumour?

A

Primary tumour arising from brain tissues

- Tumours arising from meninges/CNS have better prognosis than intra-axial tumours

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15
Q

What is a meningioma?

A

Benign

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16
Q

What is an acoustic neuroma?

A

Benign

- Slow, growing, cerebellopontine angle tumour from vestibular part of CN8

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17
Q

What is a fibrilliary astrocytoma?

A

Most common form in cerebrum

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18
Q

What is pilocytic astrocytoma?

A

In brainstem and cerebellum, cystic

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19
Q

What is glioblastoma multiforme?

A

High grade invasive tumours

Poor prognosis

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20
Q

What is haemangioblastoma?

A

Vascular tumour in cerebellum

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21
Q

What is medulloblastoma?

A

Invasive malignant midline cerebellar tumour in children (vermis)

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22
Q

What is ependyoma?

A

In 4th ventricles, spinal cord, benign

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23
Q

What is lymphoma?

A

In immunosuppressed, high malignant

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24
Q

What is craniopharyngioma?

A

Benign, extra-axial, epithelial tumours of CNS

  • Seen in both children and adults
  • Most commonly arise within the sellar/suprasellar space
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25
Q

What is a pituitary adenoma?

A

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
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26
Q

What is the epidemiology of CNS tumours?

A
  • Meningioma most common, esp in women

- Peak in children and elderly

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27
Q

What is the aetiology of CNS tumours?

A
  • Unknown causes in adults

- Children: embryological errors in development

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28
Q

What are the risk factors for CNS tumours?

A
  • 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
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29
Q

What are the presenting symptoms of a meningioma?

A
  • Mostly benign (can be atypical/malignant)
  • Occurs at cranial and spinal sites
  • Mass effects: Headaches, altered speech, personality seizures)
  • Broca’s aphasia
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30
Q

What are the presenting symptoms of an acoustic neuroma?

A
  • Cerebellopontine angle, unilateral sensorineural deafness, facial weakness, unilateral ataxia- walks into things, dizziness, hemifacial sensory impairment
  • Tinnitus, difficulty localising sounds, decreased tears, headache, metallic taste, diplopia on lateral gaze, nystagmus
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31
Q

What are the presenting symptoms of medulloblastoma?

A
  • Morning headaches
  • Nausea
  • Vomiting relieves headaches
  • Irritability
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32
Q

What are the presenting symptoms of astrocytoma?

A
  • Gerstmann’s syndrome: dominant parital love
  • Neglect
  • Hypothalamic syndrome
  • Cognitive decline
  • Emotional lability
  • Visual change
  • Motor weakness
  • Speech deficit
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33
Q

What are the presenting symptoms of a craniopharyngioma?

A
  • Diplopia, vision loss, headache, short stature
  • Children: Acute visual loss. Other age groups: gradual vision loss
  • Macrocephaly in infants
  • Growth failure
  • Amenorrhoea, erectile dysfunction, galactorrhoea
  • Headache
  • Raised ICP
  • Optic atrophia
  • Polyuria
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34
Q

What are the signs on examination of an acoustic neuroma?

A
  • Loss of balance
  • Swallowing difficulties
  • Slow blink
  • Gait
  • Papilloedema
  • Raised ICP
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35
Q

What are the signs on examination of medulloblastoma?

A
  • Diplopia-6th nerve palsy
  • Ophthalmoplegia- difficulty in lateral gaze
  • Ataxia
  • Bulging anteria fontanella
  • Papilloedema
  • Nystagmus
  • Head tilt
  • Ataxia
  • Dysmetria
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36
Q

What are the signs of pituitary adenoma on examination?

A
  • Decreased acuity
  • Bitemporal hemianopia
  • Pituitary apoplexy
  • Diplopia
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37
Q

What are the investigations for CNS tumours?

A
  • CT head
  • MRI brain: high sensitivity
  • CXR or CT: Determine whether lesion is secondary or primary
  • Blood: CRP, ESR, consider HIV screen, toxoplasma serology
  • Brain biopsy: Type and grading
  • Lumbar puncture: contraindicated if there is evidence of raised intracranial pressure, may cause coning (herniation)
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38
Q

What is cholangiocarcinoma?

A

Primary adenocarcinoma of the biliary tree

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39
Q

What is the aetiology of cholangiocarcinoma?

A

Largely unknown
- Known associated with ulcerative colitis and primary sclerosing cholangitis, choledochal cysts, Caroli’s disease and parasitic infections of biliary tract

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40
Q

What is the epidemiology of cholangiocarcinoma?

A
  • Rare
  • Slightly more common in males
  • More common in developing world due to parasitic infections
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41
Q

What are the presenting symptoms of cholangiocarcinoma?

A
  • Obstructive jaundice (yellow skin and sclera, pale stools, dark urine, pruritis)
  • Abdominal fullness or pain
  • Symptoms of malignancy: weight loss, malaise
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42
Q

What are the signs of cholangiocarcinoma on examination?

A
  • Jaundice
  • Palpable gallbladder
  • Epigastric or right upper quadrant mass
  • May be hepatomegaly
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43
Q

What are the investigations for cholangiocarcinoma?

A
  • Bloods: FBC, U&Es, LFT (bilirubin, alkphos), clotting, tumour markers (CA19-9 raised and cholangiocarcinoma and pancreatic carcinoma)
  • Endoscopy
  • Ultrasound
  • CT, MRI or MRCP, bone scan: stage and visualise spread
  • Arteriogram
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44
Q

What is Courvoisier’s law?

A

In the presence of jaundice, an enlarged gallbladder is unlikely to be due to gallstones i.e. carcinoma of the pancreas or lower biliary tree more likely

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45
Q

What is colorectal cancer?

A

Malignant adenocarcinoma of the large bowel

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46
Q

What is the aetiology of colorectal cancer?

A
  • Environmental and genetic factors
  • Sequence of epithelial dysplasia -> adenoma -> carcinoma due to genetic changes in oncogenes (e.g. APC, K-ras) and tumour suppressor genes (e.g. p52, DCC)
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47
Q

What are the risk factors for colorectal cancer?

A
  • Western diet (high intake of red meat, alcohol, fat, sugar and reduced vegetable and fibre intake)
  • Presence of colorectal polyps
  • Previous colorectal cancer
  • Family history
  • IBD (particularly longstanding UC)
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48
Q

What is the epidemiology of colorectal cancer?

A
  • 60-65 avg age at dx
  • Rectal carcinomas more common in males
  • Colon carcinomas more common in females
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49
Q

What are the presenting symptoms of colorectal cancer in the left-sided colon and rectum?

A
  • Change in bowel habit
  • Rectal bleeding or blood/mucous mixed in with the stools
  • Rectal masses may also present as tenesmus (sensation of incomplete emptying after defecation)
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50
Q

What are the presenting symptoms of colorectal cancer in the right-sided colon?

A
  • Later presentation
  • Symptoms of anaemia, weight loss and non-specific malaise
  • 20% present as emergency- pain, distension due to large bowel obstruction, peritonitis due to perforation
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51
Q

What are the signs of colorectal cancer on examination?

A
  • Anaemia may be only sign: particularly in right sided lesion
  • Abdominal mass
  • Hepatomegaly
  • Shifting dullness of ascites
  • Low lying rectal tumours may be palpable on rectal examination
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52
Q

What are the investigations for colorectal cancer?

A
  • Blood: FBC (for anaemia), LFT, tumour markers (CEA to monitor treatment response or disease recurrence)
  • Stool: occult or frank blood
  • Endoscopy: Sigmoidoscopy, colonoscopy.
  • Barium contrast studies: ‘Apple core’ stricture on barium enema
  • Contrast CT scan: staging
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53
Q

What is gastric cancer?

A

Gastric malignancy, most commonly adenocarcinoma, more rarely lympphoma, leiomosarcoma or stromal tumours (GIST)

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54
Q

What is the aetiology of gastric cancer?

A
  • Unknown
  • Risk factors: Diet high in smoked and processed foods, smoking, alcohol, H. pylori and atrophic gastritis, blood group A, Pernicious anaemia, Gastric polyps
55
Q

What is the epidemiology of gastric cancer?

A
  • Common
  • Highest incidence in Asia, especially Japan
  • ## Usual age of presentation more than 50 yrs
56
Q

What are the presenting symptoms of gastric cancer?

A
  • Early often asymptomatic
  • Early satiety or epigastric discomfort
  • Weight loss, anorexia, nausea and vomiting
  • Haematemesis, melaena, symptoms of anaemia
  • Dysphagia (tumours of cardia)
  • Symptoms of metastases, particularly abdominal swelling (ascites) or jaundice (liver involvement)
57
Q

What are the signs of gastric cancer on examination?

A
  • Epigastric mass, abdominal tenderness, ascites
  • Signs of anaemia
  • Eponymous signs found in metastatic spread:
  • Virchow’s node or Troisier’s sign
  • Sister Mary Joseph’s node
  • Krukenberg’s tumour: Ovarian metastases
58
Q

What is Sister Mary Joseph’s node?

A

Metastatic nodule on umbilicus

59
Q

What are the investigations for gastric cancer?

A
  • Upper GI endoscopy
  • Bloods: FBC (for anaemia), LFT
  • CT/MRI: Staging of tumour and planning for surgery
  • Bone scan: Staging of tumour
  • Endoscopic USS: Assess depth of gastric invasion and local lymph node involvement
  • Laparoscopy may be needed to determine if tumour is resectable
60
Q

What is hepatocellular carcinoma?

A

Primary malignancy of the liver parenchyma

61
Q

What is the aetiology of hepatocellular carcinoma?

A
  • Associated with chronic liver damage (alcoholic liver disease, hep C, autoimmune disease), metabolic disease (haemochromatosis) and aflatoxins
62
Q

What is the epidemiology of hepatocellular carcinoma?

A
  • Common

- Increased incidence in regions where hep B and C are endemic (e.g. southern Mediterranean, Far East)

63
Q

What are the presenting symptoms of hepatocellular carcinoma?

A
  • History of malignancy: weight loss, malaise, loss of appetite
  • History of exposure to carcinogens: High alcohol intake, hep B or C, aflatoxins
  • Fullness in abdomen and jaundice
64
Q

What are the signs of hepatocellular carcinoma on examination?

A
  • Signs of malignancy: Cachexia, lymphadenopathy
  • Hepatomegaly: Nodular (but may be smooth). Deep palpation may elicit tenderness
  • Jaundice, ascites
  • May be bruit heard over the liver
65
Q

What are the investigations for hepatocellular carcinoma?

A
  • Bloods: FBC, ESR, LFT, clotting, a-feroprotein, hepatitis serology
  • Imaging: Abdominal ultrasound may identify a fixed lesion within a cirrhotic liver. CT scan or MRI is gold standard for staging
  • Angiography
  • Histology
  • Staging: chest, abdo and pelvic CT scans. Consider bone scan
66
Q

What is non small cell lung cancer?

A
  • Primary malignant neoplasm of lung

- Histological types: squamous cell carcinoma, adenocarcinoma, large cell carcinoma and adenosquamous carcinoma

67
Q

What is the aetiology of non small cell lung cancer?

A
  • Factors such as smoking (active or passive though to cause genetic alterations that result in neoplastic transformation
  • Risk factors: occuational exposures (asbestos, nickel, chromium, cadmium, radon), atmospheric pollution
  • Tumours generally arise in main or lobar bronchi. Adenocarcinomas tend to occur more peripherally
68
Q

What is the epidemiology of non small cell lung cancer?

A
  • Most common fatal malignancy in the West

- 3x more common in men (but increasing in women)

69
Q

What are the presenting symptoms of non-small cell lung cancer due to primary?

A
  • May be asymptomatic with radiographic abnormality found

- Due to primary: Cough, haemoptysis, chest pain, recurrent pneumonia

70
Q

What are the presenting symptoms of non-small cell lung cancer due to local invasion?

A
  • Brachial plexus (Pancoast tumur, in apex of lung) causing pain in shoulder or arm
  • Left recurrent laryngeal nerve (hoarseness and bovine cough)
  • Oesophagus (dysphagia)
  • Heart (palpitations/arrhythmias)
71
Q

What are the presenting symptoms of non-small cell lung cancer due to metastatic disease or paraneoplastic phenomena?

A
  • Weight loss
  • Fatigue
  • Fits
  • Bone pain or fractures
  • Neuromyopathies
72
Q

What are the signs of non-small cell lung cancer due to local invasion on examination?

A
  • Superior vena cava compression (facial congestion, distension of neck veins, upper limb oedema)
  • Brachial plexus: wasting of small muscles of the hand
  • Sympathetic chain: Horner’s syndrome- pupillary miosis and facial anhydrosis
73
Q

What are the signs of non-small cell lung cancer on examination?

A
  • May be no signs
  • Fixed monophonic wheeze
  • Signs of collapse, consolidation or pleural effusion
74
Q

What are the signs of non-small cell lung cancer due to paraneoplastic phenomena on examination?

A
  • Hypertrophic osteoarthropathy: clubbing, painful swollen wrists/ankles (periosteal new bone formation)
  • Dermatological signs
75
Q

What are the signs of non-small cell lung cancer due to metastases on examination?

A
  • Supraclavicular lymphadenopathy

- Hepatomegaly

76
Q

What are the investigations for non-small cell lung cancer?

A
  • Diagnosis: CXR, sputum, bronchoscopy, with brushings or biopsy, CT, lymph node biopsy
  • TNM staging: CT chest, CT or MRI head and abdo, bone scan, PET scan
  • Bloods: FBC, U&E’s, Ca++ (hypercalcaemia is common), AlkPhos (increased in bone mets), LFT
  • Pre-Op: ABG, Pulmonary function tests, V/Q scan, ECG, echo
77
Q

What are the signs of non-small cell lung cancer on a CXR?

A
  • Coin lesions
  • Lobar collapse
  • Pleural effusion
  • Features of lymphagitis carcinomatosis
78
Q

What is small cell lung cancer?

A
  • Malignant neoplasm of neuroendocrine Kulchitsky cells of the lung with early dissemination
  • Also knows as oat cell carcinoma
79
Q

What is aetiology of small cell lung cancer?

A
  • Smoking

- Occupational and environmental exposures

80
Q

What is the epidemiology of small cell lung cancer?

A

Accounts for 20% of lung cancer

81
Q

What are the presenting symptoms of small cell lung cancer?

A

May be asymptomatic with radiological abnormality found

  • Due to primary tumour: Cough, haemoptysis, dyspnoea, chest pain
  • Due to metastatic disease: Weight loss, fatigue, bone pain
  • Due to paraneoplastic syndrome: Weakness, lethargy, seizures, muscle fatiguability
82
Q

What are the signs of small cell lung cancer on examination?

A
  • May be no signs or a fixed wheeze on auscultation of the chest
  • Signs of lobar collapse or pleural effusion
  • Signs of metastases e.g. supraclavicular lymphadenopathy or hepatomegaly
  • Signs of paraneoplastic syndrome
83
Q

What are the investigations for small cell lung cancer?

A
  • Diagnosis: sputum cytology, bronchoscopy with brushing and biopsy or percutaneous biopsy, thoracoscopy
  • Staging: CT of chest, abdomen, head. Isotope bone scan
  • Other: LFT, FBC, U&E, Ca++, AlkPhos, LFT
84
Q

What is mesothelioma?

A

Aggressive epithelial neoplasm arising from lining of lung, abdomen, pericardium or tunica vaginalis

85
Q

What is the aetiology of mesothelioma?

A
  • Exposure to asbestos principle risk factor
  • Also could be prior exposure to radiotherapy, genetic predisposition (BAP1 gene)
  • Family history
86
Q

What is the epidemiology of mesothelioma?

A
  • More common in men and white people

- Typically occurs in older adults (60-85)

87
Q

What are the presenting symptoms of mesothelioma?

A
  • Shortness of breath
  • Chest pain
  • Cough
88
Q

What are the signs of mesothelioma on examination?

A
  • Diminished breath sounds
  • Dullness to percussion
  • Constitutional symptoms: fatigue, fever, sweats, weight loss
89
Q

What are the investigations fro mesothelioma?

A
  • CXR: unilateral pleural effusion, irregular pleural thickening, reduced lung volumes, and/or parenchymal changes related to asbestos exposure (lower zone linear interstitial fibrosis)
  • Chest CT scan: pleural thickening and/or discrete pleural plaques, pleural/pericardial effusions, enlarged hilar, chest wall invasion
90
Q

What is neutropenic sepsis?

A

Defined as a fever over 38 degrees for 1 hour, with an absolute neutrophil count (ANC) of less than 500 cells/microlitre

91
Q

What is the aetiology of neutropenic sepsis?

A
  • Common complication of many chemotherapeutic regimens for all types of cancers
  • Risk is greatest with first treatment but is cumulative with ongoing cycles of therapy
92
Q

What is the epidemiology of neutropenic sepsis?

A

Most common life threatening complication of cancer therapy

93
Q

What are the presenting symptoms of neutropenic sepsis?

A
  • Recent chemotherapy
  • Fever
  • Age over 65
  • Shortness of breath
  • Abdominal pain
  • Diarrhoea
  • Dysuria
  • Skin erythema, warmth, tenderness
  • Mucositis or oral ulcers
  • Infection, inflammation or ulceration of genital and anal area
94
Q

What are the signs of neutropenic sepsis on examination?

A
  • Tachycardia
  • Hypotension
  • Prior episodes of neutropenia following chemotherapy
  • Haematological malignancies
  • Prior antibiotic regimens
95
Q

What are the investigations for neutropenic sepsis?

A
  • FBC and differential: ANC
  • Urea and creatinine: normal or elevated
  • LFTs: albumin less than 35g
  • LFTs: Albumin less than 35g/L, total bilirubin and aminotransferases elevated
  • Blood cultures for bacteria: peripheral and central lines: positive for a pathogen; differential time to positivity of >120 minutes between central line and peripheral cultures is diagnostic of a line infection
  • CXR: infiltrates in pneumonia
96
Q

What is oesophageal cancer?

A

Malignant tumour arising in the oesophagus.

Two major histological types: squamous cell carcinoma and adenocarcinoma

97
Q

What is the aetiology of squamous oesophageal cancer?

A
  • Alcohol
  • Tobacco
  • Paterson-Kelly syndrome (also knows as Plummer-Vinson syndrome)
  • Tylosis
  • Achalasia
  • Scleroderma
  • Coeliac disease
  • Certain nutritional deficiencies (vit A and C, trace elements)
  • Dietary toxins (nitrosamines) also implicated
98
Q

What is oesophageal cancer?

A

Malignant tumour arising in the oesophagus.

Two major histological types: squamous cell carcinoma and adenocarcinoma

99
Q

What is the aetiology of squamous oesophageal cancer?

A
  • Alcohol
  • Tobacco
  • Paterson-Kelly syndrome (also knows as Plummer-Vinson syndrome)
  • Tylosis
  • Achalasia
  • Scleroderma
  • Coeliac disease
  • Certain nutritional deficiencies (vit A and C, trace elements)
  • Dietary toxins (nitrosamines) also implicated
100
Q

What is the aetiology of oesophageal adenocarcinoma?

A
  • GORD

- Barrett’s oesophagus (intestinal metaplasia of the distal oesophageal mucosa

101
Q

What is the pathology of oesophageal cancer?

A
  • Squamous cell carcinomas are more common in the mid-upper oesophagus
  • Adenocarcinoma usually develops in the lower oesophagus, or, increasingly, in the gastro-oesophageal junction.
  • Barrett’s intestinal metaplasia can progress to low grade dysplasia, high-grade dysplasia and invasive carcinoma
  • Spread is typically indirect (oesophagus has no serosa) and longitudinal via an extensive network of submucosal lymphatics to tracheobronchial, mediastinal, coeliac, gastric or cervical nodes
102
Q

What is the epidemiology of oesophageal cancer?

A
  • 8th most common malignancy
  • 4:1= male:female
  • Peak incidence 50-70 yrs
103
Q

What are the presenting symptoms of oesophageal cancer?

A
  • Early: Symptomatic/symptoms of reflex
  • Later: Dysphagia, initially worse for solids, regurgitation, cough or choking after food, pain (odynophagia), weight loss, fatigue, voice hoarseness (may indicate laryngeal nerve palsy)
104
Q

What are the signs of oesophageal cancer on examination?

A
  • No physical signs evidence
  • Signs of weight loss
  • With metastatic disease, there may be supraclavicular lymphadenopathy, hepatomegaly.
  • Respiratory signs may be due to aspiration or direct tracheobronchial involvement
105
Q

What are the investigations for oesophageal cancer?

A
  • Endoscopy: Tumour location and biopsy.
  • Imaging: Barium swallow, CT (chest, abdo, pelvis), PET can detect previously occult distant metastases
  • Other: Bronchoscopy, bone scan. Laparoscopy and peritoneal washings, thoracoscopy
106
Q

What is pancreatic cancer?

A

Malignancy arising from the exocrine or endocrine tissues of the pancreas

107
Q

What is the aetiology of pancreatic cancer?

A
  • Unknown
  • 5-10% have familial component, hereditary syndromes include BRCA2 mutation, familial atypical mole melanoma, Peutz-Heghers, hereditary pancreatitis, MEN, HNPCC, FAP, Gardner, von-Hippel-Lindau syndromes
108
Q

What is the epidemiology of pancreatic cancer?

A
  • Increasing in incidence
  • 2x more in males
  • Peak age 60-80 yrs
109
Q

What are the signs of pancreatic cancer on examination?

A
  • Signs of weight loss, epigastric tenderness or mass
  • Jaundice and palpable gallbladder (Courvoisier’s law)
  • In pts with metastatic spread, there may be hepatomegaly
  • Troussaeu’s sign is an associated superficial thrombophlebitis
110
Q

What are the investigations for pancreatic cancer?

A
  • Bloods: Tumour markers CA19-9 and CEA can be elevated. If causing obstructive jaundice, increased bilirubin, ALP, clotting may be deranged
  • Imaging: Ultrasound, endoscopic ultrasound and FNA, CT, MRI, PET and laparoscopy are all useful in staging the disease
  • Other: Staging laparoscopy or intraoperative ultrasound
111
Q

What is prostate cancer?

A

Primary malignant neoplasm of the prostate gland

112
Q

What are the risk factors of prostate cancer?

A
  • Age
  • Race (Afro Carribean more than Caucasian, former also present at younger age with more progressive disease)
  • Geographic distribution (higher in North America, low in far East)
  • Family history
  • Dietary factors (high fat, meat and alcohol consumption)
113
Q

What is the epidemiology of prostate cancer?

A
  • Common

- 2nd most common cause of male cancer deaths

114
Q

What are the presenting symptoms of prostate cancer?

A
  • Often asymptomatic and detected on PSA testing
  • Lower urinary tract obstruction: Frequency, hesitancy, poor stream, nocturia and terminal dribble
  • Metastatic spread: Bone pain or spinal cord compression from the bone metastases
  • General symptoms of malignancy ( malaise, anorexia and weight loss)
  • Paraneoplastic syndromes (e.g. hypercalcaemia)
115
Q

What are the signs of prostate cancer on examination?

A
  • Asymmetrical hard nodular prostate gland with loss of the midline sulcus on rectal examination
116
Q

What are the investigations for prostate cancer?

A
  • Bloods: FBC, U&Es, PSA, acid phosphatase, LFT, bone profile
  • Prostate-specific antigen: Values may be age-related and increased in BPH, prostatitis, following catheterisation
  • CT/MRI: Assesses extent of local invasion and lymph node involvement
  • TRUS and needle biopsy: for histological diagnosis
  • Isotope bone scan: for bone metastases
117
Q

What is renal cell carcinoma?

A

Renal malignancy arising from renal parenchyma/cortex and accounts for 85% of renal cancers

118
Q

What is the aetiology of renal cell carcinoma?

A
  • Smoking
  • Obesity and hypertension
  • Renal transplantation and dialysis
  • Positive family syndrome
  • von Hippel Lindau syndrome
119
Q

What is the epidemiology of renal cell carcinoma?

A
  • Median age of presentation= 64 tears

- Men 2x more likely

120
Q

What are the presenting symptoms of renal cell carcinoma?

A
  • Asymptomatic (incidental finding)
  • Haematuria
  • Flank pain
121
Q

What are the signs of renal cell carcinoma on examination?

A

Palpable abdominal mass

- Lower limb oedema

122
Q

What are the investigations for renal cell carcinoma?

A
  • FBC: paraneoplastic syndrome, reduced Hb, or elevated RBC
  • LDH: advanced RCC
  • Corrected calcium
  • LFTs
  • Coagulation profile
  • Creatinine
  • Urinalysis: haematuria and/or proteinuria
  • Abdo USS
  • CT abdo
123
Q

What is testicular cancer?

A

Malignant tumour of the testes

124
Q

What are the risk factors for testicular cancer?

A
  • Testicular maldescent or ectopic testis, increases risk 40x
  • Contralateral testicular tumour and atrophic testis
125
Q

What is the epidemiology of testicular cancer?

A
  • Uncommon
  • 1% of male malignancies
  • Most common malignancy in 18-35 yrs
126
Q

What are the presenting symptoms of testicular cancer?

A
  • Swelling or discomfort in the testes
  • Backache due to para-aortic lymph node enlargement
  • Respiratory symptoms, shortness of breath or haemoptysis from lung metastases
127
Q

What are the investigations for testicular cancer?

A
  • Painless hard testicular mass (may be secondary hydrocele)
  • Lymphadenopathy (e.g. supraclavicular, para-aortic) signs of pleural effusion
  • Gynaecomastia (resulting form tumour HCG production)
128
Q

What are the investigations for testicular cancer?

A
  • Bloods: FBC, U&E’s, LFTs, tumour markers should be sent
  • Urine pregnancy test: Often will be positive if tumour produced beta-HCG
  • CXR: Demonstrates lung metastases or pleural effusion
  • Testicular ultrasound: Tumours seen within testicle, hydrocele may be associated
  • CT scan (abdo, thorax): disease staging
129
Q

What is tumour lysis syndrome?

A

Combination of metabolic and electrolyte abnormalities that occurs in pts with cancer, usually after the initiation of cytotoxic treatment but also spontaneously

130
Q

What is the aetiology of tumour lysis syndrome?

A
  • Appears in haematological malignancies characterised by high proliferating rate, especially Hodgkin’s lymphoma, acute lymphocytic leukaemia, AML
  • Risk of developing TLS increases if tumour consists of rapidly dividing cells, if bulk of disease is high and if response to treatment is good
131
Q

What is the epidemiology of tumour lysis syndrome?

A
  • Unknown incidence
  • It is more prevalent in malignancies with high proliferating rates, tumour burden, and chemosensitivity
  • Advanced age may increase risk
132
Q

What are the presenting symptoms of tumour lysis syndrome?

A
  • History of haematological malignancy
  • Pre-existing renal compromise
  • Nausea and vomiting
  • Diarrhoea
  • Muscle cramps
  • Lethargy
133
Q

What are the signs of tumour lysis syndrome on examination?

A
  • Muscle weakness
  • Paraesthesia
  • Lymphadenopathy
  • Splenomegaly
  • Hypertension/hypotension
  • Oliguria/anuria/haematuria
134
Q

What are the investigations for tumour lysis syndrome?

A
  • Serum uric acid
  • Serum phosphate
  • Serum potassium
  • FBC: elevated WBC count
  • Lactate dehydrogenase: elevated

Year 3 ICSM Sofia (16 decks)

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