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Flashcards in CSIM solid organ malignancy Deck (140):
1

what is the grading system for cytological samples?

C1 - C5 where 5 is definite malignancy

2

what is icterus?

jaundice in the scelera

3

which abdo organs move on respiration?

basically all of them
not so much bowel

4

cancer patient with confusion- what additional investigations should you always do?

LP - check for cancer cells in the fluid
calcium - bone cancer

5

why do you need to check clotting in cancer patients?

risk of bleeding in biopsy

6

what kind of anaemia in cancer?

normocytic or micro if there is an associated iron deficency

7

what is serum protein electrophoresis? when is it used?

measures specific proteins in the blood to help identify some diseases
looking for diseases that chuck out loads of protein (e.g. anti bodies) like myeloma

8

role of calcium in confusion ? how to investigate?

raised calcium causes confusion
need corrected calcium

9

what is B HCG diagnostic of?

CONTEXT:
germ cell cancer
molar pregnancy

10

what is corrected calcium and ionized calcium?

ionized - unbound 'free' calcium

corrected - takes into account the amount bound to albumin as well as the free atoms

11

what is the advantage of a colonoscopy over non invasive imaging techniques?

can do a biopsy too

12

what is PTT?

AKA APTT
activated partial thromboplastin time - measures the intrinsic clotting pathway

13

what is the tumour marker for colon cancer?

carcinoembryonic antigen

14

effect on MCV in suspected GI malignancy? why

decreased

chronic gi bleed -> iron deficiency

15

what is performance status?

scale from 1 - 5 where 1 is normal and 4 is bed bound (5 is dead)

16

when does breast cancer metastasize?

when grown to 1cm

17

what is transcoelomic spread

a route of tumour metastasis across a body cavity, such as the pleural, pericardial, or peritoneal cavity.

18

modes of cancer spread

lymph
local
transceolomic
blood

19

what nodes do testes / ovarian cancer spread to?

para-aortic

20

what nodes do genital tract cancers spread to?

femoral / inguinal

21

what are the 3 steps in the approach to carcinoma of unknown origin?

1. search for primary site
2. rule out potentially curable / treatable tumours
3. characterise the pathology then treat

22

what is the biggest environmental factor in cancer predisposition?

diet

23

what % of lung cancers are associated with smoking?

90%

adenocarcinomas arent that strongly associated

24

how does smoking affect organs other than the lungs?

absorption of chemicals into other parts of the body leads to chronic inflammation

25

which lung is more likely to be effected by mesothelioma?

the right
right main bronchus is more vertical and these particles follow gravity

26

how does radiation lead to cancer?

high-frequency radiation dislodges electrons therefore damaging molecular structure

27

what % of cancer is caused by ionizing radiation?

5%

28

how does xeroderma pigmentsum predispose you to cancer?

minimal UV exposure will cause mutation

29

what viruses causes HCC?

HBV HCV

30

world wide most common cause of HCC?

HBV

(here it is alcohol and therefore cirrhosis)

31

what causes kaposi sarcoma?

HHV8

32

what hormonal causes of breast cancer are there?

anything that heightens exposure to estrogen:
1. low parity
2. late age of first birth
3. early menarche and late menopause
4. increased breast density

33

effect of post menopause estrogen Tx on endometrial cancer?

increases risk if given without progesterone

34

how do viruses cause cancer?

chronic inflammation

35

what is the difference between a germ line and a somatic mutation?

germ line - mutation that effects every cell in the body including all the gametes

somatic- only in that one cell

36

what characterizes li-fraumeni syndrome?

1. pre-menopausal breast cancer
2. childhood sarcoma
3. brain tumours
4. leukaemia
5. lymphoma
6. adrenocortico carcinoma

37

what is the defect in li-fraumeni syndrome?

germ line mutation in the p53 gene on chromosome 17p

38

clinical sign in the eye for retinoblastoma?

white pupil reflex

39

what are the clinical features of multiple endocrine neoplasia. inheritance?

mucosal nueromas on the tongue
medullary carcinoma of the thyroid
marfanoid features
skin pigmentation

autosomal dominant condition

40

what is lead time bias in relation to cancer screening?

in a screening programme you will detect cancer earlier therefore the survival time from detection is spuriously long in relation to those who didnt undergo screening

41

sens. and spec. of CA125?

high sensitivity
low specificity

42

why is the prevalence of lung cancer less than the incidence?

most people die very quickly after dignosis

43

why do some lung cancer patients get dysphagia?

tumour pressing on the oesophaus

44

why do some lung cancer patients get a hoarse voice?

pressing on the laryngeal nerve

this is very bad for prognosis

45

which lymph nodes does lung cancer typically drain to?

supraclavicular
axilla

46

which vessel can become compressed in lung cancer and constitutes a medical / oncological emergency?

sup. vena cava

47

signs of SVC obstruction

dilated / tortuous vessels of upper chest (nipples)
oedema of the face / neck / arms with distended veins
congested mucous membranes

48

what is Pancoasts syndrome?

apical malignant neoplasm in the lung leads to:
1. Horners syndrome
2. shoulder pain
3. oedema secondary to vessel compression

49

what happens to trachea in pleural effusion?

normally nothing as fluid will be at base of lung
can shift it if MASSIE effusion

50

what is the role of sputum cytology in lung cancer ix?

not very useful but can hep rule out non-cancerous causes

51

what is the role of CT thorax in lung cancer?

used to assess size, spread, invasion and lymph node involvement

52

what further investigations are always done in SCC

CT head
CT upper abdo

to check for spread else where

53

what is the most important factor when considering treatment?

performance status

54

what does LDH tell you about cancer?

NOT an indication of cancer risk but high LDH suggests rapid growth of cancer cells so is a prognostic factor

55

why does LDH increase with cancer growth

cancer cells need increased glycolysis
cancer cells use anaerobic method of metabolism even when oxygen is sufficient

56

most common presentaion of brain mets?

headaches

(also get cognitive dysfunction, neuro deficit and seizures)

57

which lung cancer can present with large amounts of pink frothy sputum?

bronchoalveolar carcinoma

58

what supportive treatment is useful in brain mets?

steroids to reduce oedema
anti convulsants

59

why can you get a raised calcium in cancer?

tumour producing PTH-rP leads to increased calcium

60

presentation of hypercalcaemia

rapid onset confusion, nausea / vomming, dehydration

61

why is gynecomastia a feature of cancer?

in germ cell cancers (testes, ovaries) the tumour can produce gonadatrophins

62

which lung cancer can cavitate?

squamous cell - can get a fluid level

63

which lung cancer gets multiple bilateral pulmonary nodules?

bronchoalveolar carcinoma

64

how does SCC look on CXR?

large, bulky central mass with hilar and mediastinal adenopathy

65

what type of cancer is a biopsy often not necessary in ?

germ cell cancers

66

what is the most common cancer in teenagers / young adults?

testicular germ cell in men

germ cell cancers are generally very rare

67

what happens to testicularsize in germ cell cancer?

noramlly gets larger
can get smaller

68

where is there pain in testicualr cancer?

testes (20%)
back (10%) due to para aortic lymphadenopathy

69

why get gynaecomastia in germ cell cancer?

beta - HCG

70

what tumour markers do you want to look for in testicular cancer?

AFP
B-HCG
LDH

71

why raised LDH in tumour growth?

it is an intra cellular enzyme that is released on tumour necrosis so goes up with chemotherapy

72

what imaging in testicular cancer?

USS
CT

73

what three things combine to be diagnostic for testicular cancer

testicular mass
raised B-HCG
AFP

this is one scenario where tumour markers are diagnostic of cancer

74

what drug can give a false positive in B-HCG test?

regular cannabis use

75

what gives false positive in AFP?

alcohol abuse

76

what imaging is done after the histological diagnosis in germ cell cancer?

contrast CT chest, abdo and pelvis within 3 weeks

77

what would prompt you to do CT head in germ cell cancer?

multiple lung mets
very high HCG (>10,000)

78

how can HCG tell you about brain mets?

if CSF HCG > serum HCG then must be cancer in brain
if CSF HCG < serum HCG then it is seeping in from the blood

79

what is tumour lysis syndrome? why does it happen

oncological emergency -> AKI, DIC, cardiac arrest

hyperuraemia
hyperkalaemia
hypOcalcaemia
hyperphosphataemia

when there is a large amount of tumour cell death (due to treatment) the products of this can be toxic to the liver

80

when is tumour lysis syndrome often seen and why?

large volume and sensitive tumours:
germ cell
sarcoma
burketts lymphoma
leukaemia

81

when should contralateral teste be biopsied?

if < 30 yo
if small

82

how are suspected residual masses investigated?

PET at least 2 weeks after end of chemo

83

what must considered before biopsy of testes?

sperm banking

84

effect of multiple pregnancies on ovarian cancer?

reduced

85

effect of taking the mini pill on ovarian cancer?

none,

taking the COC for 10 years reduces it though

86

why do animal fats increase ovarian cancer?

animals are fed oestrogen to make them fatter

87

in a somatic mutation which cells have a mutation?

only the tumour cells

88

why do 2/3 of ovarian cancer patients present late (stage 3 or 4)

early stage is asymptomatic

89

signs symptoms of ovarian cancer?

bowel - distention, bloating, constipation, pain, loss of appetite

kidney - recurrent UTI, hydronephrosis secondary to ureteric obstruction, loin pain, renal failure

pleural effusion

constitutional

90

what tumour markers are you looking for in ovarian cancer?

CEA
CA-125

in younger women:
AFP
B-HCG
LDH

91

why can throtoxicosis be confused with ovarian cancer

non-specific symptoms
raised CA-125 in BOTH

ALWAYS BIOPSY

92

how is ovarian cancer diagnosed?

histopathological study following exploratory laparotomy

93

what is the first line imaging in ovarian cancer?

USS

94

generally speaking, which advanced imaging techniques are good for the pelvis / abdo?

MRI good for pelvis
CT good for the abdo

95

how is CT used in ovarian cancer?

in advanced disease it is used to assess extent of spread

96

how is the Risk of Malignancy calculated for pelvic masses?

uss x menopause status x CA-125

97

what are the most likely sources of malignant cells in the ascites?

any visceral site of carcinoma but most likely to be epithelial

98

what three things cause CA-125 to be raised?

inflammation
infection
infarction

99

how does draining ascites reduce CA-125?

extra cellular fluid acts as a reservoir

100

what kind of investigation is best for diagnosing cancer/

anything that allows a biopsy

101

how is CA-125 useful in ovarian cancer?

a rise of 25% indicates progression of the cancer
doubling almost confirms a relapse

102

what is the origin or most ovarian cancers?

90% epithelial

103

what are the complications of local invasion in ovarian cancer?

lymphoedema
vaginal discharge
bowel obstruction
ascites

104

what are the non-metastatic complications of ovarian cancer?

pulmonary emboli
dermatomyositis

105

what is dermatomyositis? how does it present?

inflammation of the skin and underlying muscle tissue

proximal myopathy
skin changes
systemic:
cardio-pulmonary
retinopathy
arthralgias

106

how is malignant hypertension treated?

usually with paracentesis

tx revolving around reducing Na retention DO NOT work e.g. loop diuretics, salt restriction etc

107

three blood tests that indicate dermatomyositis

aldolase
LDH
CK

all raised

108

how is imaging used in malignant ascites?

USS, CT or MRI used to guid drainage

109

what is the most common site for breast cancer?

left breast
upper out quadrant or retro areolar region

110

what are the risk factors for breast cancer associated with oestrogen?

early menarche / late menopause
nulliparous / late (>35) pregnancy
OCP
HRT

111

how often is a hereditary predisposition indicated in breast cancer?

10% of cases

112

what re the three most common breast cancer genes?

BRCA 1
BRCA 2
p53 (Li Fraumeni)

113

what are the characteristics associated with BRCA breast cancer?

worse histology
early onset
more likely to be bi-lateral

114

most common ways breast cancer presents?

lump in up to 75%
Pagets disease
mammograpic findings on screening

115

what is Pagets disease?

associated with intraductal carcinoma
involves terminal ductuals of the breast (may be invasive)

116

how does pagets disease present?

eczematoid change in nipple

117

where might there be lymphadenopathy in breast cancer?

neck and axilla

118

3 most common distant mets in breast cancer?

bone lung liver

119

recommendation for self breast check?

monthly from 20 yo

120

how is a cystic mass investigated?

fine needle aspiration- this should result in full resolution
USS - to determine weather it is solid or cystic
biopsy - only if the fluid is bloody or is not resolved after FNA

121

how common is cystic carcinoma of the breast?

rare - < 1% of breast cancer

122

investigations in solid mass in breast?

mammography - of both breasts
FNA
core biopsy

123

what is the disadvantage of FNA in breast cancer?

small chance of false positive findings
up to 25% chance of false negative findings

124

advantage of core biopsy in breast cancer?

can assess architecture as well as cytology

125

4 ways to investigate a non palpable breast lump?

MRI
wire excision
US guided core biopsy
stereotactic guided core biopsy

stereotactic = precisely positioning patient

126

is CA 15.3 used in breast cancer screening? why?

no, low sensitivity for early disease

127

what is the use of CA 15.3 in breast cancer?

rising levels in follow up are associated with relapse

128

most common type of breast cancer?

70% are invasive ductal carcinoma

129

what are the three components of breast cancer triple assessment?

exam
imaging
needle biopsy

130

4 things on a mammogram that indicate malignancy?

microcalcification
mass
distorted architecture
asymmetry

131

non metastatic complication of breast cancer?

hypercalaemia

132

what are the complications of local invasion in breast cancer?

ascites / pleural effusion
lymphoedema

133

most common distant mets in breast cancer

bone liver lung brain
spinal cord compression

134

best investigation for suspected spinal cord compression?

MRI

will see compression but not the associated bone destruction

bone is invisible to MRI

135

what clinical finding indicates cord compression?

bi lateral UMN signs

136

who gets further investigations into mets in breast cancer? and what are these?

t > 5cm
n > 3
clinical suspicion

CXR
bone scan
USS

137

when are CT / MRI used in looking for mets in breast cancer?

if there is still clinical suspicion AFTER CXR, bone scan and USS

138

which type of breast cancer does tamoxifen reduce the risk of?

oestrogen receptive+ tumours

139

disadvantages of tamoxifen?

increased DVT and PE risk
increased incidence of endometrial cancer

no over all increase in survival

140

what do aromatase inhibitors do and how are they used in cancer?

stop production of oestrogen in post menopausal women
used to treat early stage of ER+ breast cancer