Flashcards in General oncology Deck (92):
what are the two ways cancers can metastasise?
via lymphatics and via blood (haematogenous spread)
Why are the lungs, bones and liver very common sites for metastases?
very vascular organs. and so lots of blood supply (haematogenous spread of cancer)
what are some systemic effects of cancer? Think categories
metabolic, hormonal, paraneoplastic
why do cancer patients become cachetic?
what is the most important risk factor for a patient who has cancer?
Hx of cancer
what do we think when we see a cancer patient who presents with infection and has just started chemo?
Febrile neutropenia. Chemotherapy stops high cell turnover such as neutrophils--> neutropenia. These patients are very susceptible to septicaemia. Hence an oncological emergency
what is the empirical antibiotics used for febrile neutropenia?
tazobactam + pipericillin, and gentamicin. If MRSA is suspected, then vancomycin may be administered
what is adenocarcinoma?
cancer derived from gland forming epithelial cell
what is the most important prognostic predictor for patients with colorectal cancer?
what are common initial sites of metastases for carcinoma of the colon?
what are common initial sites of metastases for carcinoma of the rectum?
how do we screen for HNPCC lynch syndrome- we want to know if we should do germline mutation testing
Bethesda criteria, immunohistochemistry on tumour tissue
what is the inheritance pattern for HNPCC?
what are some bad complications of chemotherapy?
death from sepsis, peripheral neuropathy, GI toxicity
what other cancers are at increased risk with HNPCC?
endometrial, ovarian, duodenum cancer
what is the sensitivity and specificity for faecal occult blood testing in colorectal cancer?
sensitivity is about 30%
what are the 4 characteristics of a cancer cell?
1. increased proliferation
2. loss of function of the cell
4. ability to metastasise
what type of leukaemia do we use imatinib? How does it work?
CML. BCR/ABL kinase inhibitor
what are the two types of oesophageal cancer?
1. Squamous cell carcinoma
2. Adenocarcinoma (Barrett's)
what chemicals do germ line tumours secrete?
Alpha feto protein and beta HCG
52 year old male presents with 3 week hx of exquisitely tender ankles and wrists. On examination finger clubbing and toe clubbing are present. What do you think is going on?
HPOA secondary to lung cancer. Periosteal new bone formation
what is paraneoplastic syndrome?
Hormonally mediated responses distant to the tumour
what is GIST?
Gastrointestinal stromal tumours. Slow growing tumours in stomach or small/large intestine that have the cKit mutation. Respond to surgery and imatinib
how do we screen for bowel cancer on a population basis?
faecal occult blood test
what is the inheritance pattern like for FAP?
autosomal dominant inheritance
what is the underlying mutation of FAP?
A single germline mutation in the adenomatous polyposis coli (APC) tumour suppressor gene is responsible for the dominantly inherited syndrome familial adenomatous polyposis.
Clinical expression of the disease is seen when the inherited mutation of one APC allele is followed by a second hit mutation or deletion of the second allele.
what does TMN stand for?
staging system of cancer.
T= Tumour (T0-4)
N= regional lymph nodes (N0-2)
M= distant metastases (M0 or M1)
what ix would you order for colorectal cancer?
• CT thorax, abdomen, pelvis
• Colonoscopy- GOLD STANDARD
• Flexible sigmoidoscopy (alternative to colonscopy)
• FBE- anaemia
• Genetic testing
• Biopsy to confirm diagnosis
CEA tumour marker levels
+/-Ultrasound for peri rectal lymph nodes
what do we mean by 'adenomatous polyps'
dysplastic lesions in the colon which have NOT invaded past the muscularis propria
which 6 cancers are you worried can metastasise to bone?
5. Kidney (RCC)
6. Multiple myeloma
what imaging modality is best suited for ix bony metastases?
MRI. can also do bone scan secondarily, and sometimes a PET scan`
what may indicate status of neutropenia in a chemo patient?
mucositis around the mouth
what do we think when we see a fever + cancer + chemotherapy?
what electrolyte are we worried about in cancer patients?
calcium. Hypercalcemia is a medical emergency
signs of hypercalcemia due to malignancy?
obtundancy, dehydration, constipation, unwell, N and V
How do we manage hypercalcaemia due to malignancy?
bisphosphonate (IV zoledronic acid), treat underlying cancer, dexamethasone/lasix
Why are there less events of chemotherapy related emesis nowadays?
ondanestron is given nowadays
management of chemotherapy related emesis in the hospital?
IV fluids, ondanestron, dexamethasone
what defines the prognosis of colerectal cancer?
Prognosis of CRC is TOTALLY stage dependent. Early detection equates with favourable outcome
how does left sided colon cancer present
alternating constipation and diarrhoea
colicky abdominal pain
MEN type 1 cancer constitutes what?
pituitary, parathyroid and pancreatic tumours
MEN type 2 cancer constitutes what?
medullary cancer of the thyroid
why would you consider a dermatological review for patient who is undergoing induction chemotherapy?
When else would you do a dermatological review?
some skin lesions (e.g. SCC) may progress and metastasise during the immunosuppressive chemotherapy regime so need to do a dermatological review.
also before organ transplant operations
neutropenia + chemotherapy may lead to issues with the oral mucosa.
what sort of management would you prescribe? what are you worried about?
Amphotericin B anti-fungal lozenges
regular inspection of the mouth on ward rounds
Worried about the candida infection, mouth pain, compromised nutrition
Tumor marker associated with ovarian cancer?
where is virchow's node? what is the clinical significance?
virchow's node refers to enlargement of a lymph node in the left supraclavicular node. Often this indicates metastatic disease or malignancy in general, and was originally described in the context of gastric cancer.
the left supraclavicular node drains lymph via the thoracic duct from the rest of the body
classification of lymphadenopathy
reactive vs neoplastic
(infectious vs non infectious)
lymphoma vs metastases
Non hodgkin lymphoma histology?
similar size and shape cells
with nuclear atypia
melanoma metastatic histology?
Bi nuclear cells
sarcoma histology from core biopsy
clumps of spindle cells
what do we mean by fragmented cores on histology?
fragmented germinal centres (so be careful before dx lymphoma)
Which type of biopsy is the best for lymphoma assessment and why?
What are some downfalls of this type of biopsy?
Architecture well seen. Plenty of tissue for special studies
Patients require GA and theatre time
tumour cells present in the blood, they often originate from the bone marrow haemopoietic cells
tell me about the concept of monoclonality
A polyclonal process is benign but a monoclonal process is MALIGNANT.
Neoplastic lymphoid cells make only one type of light chain (light chain restriction
2 types of light chains: kappa and lambda
Ratio of more than 16 to1 indicates monoclonality
What are the CD markers for CLL?
CD20. CD5, CD23
what are the surface markers of tumour cells called?
what are the classifications of NHL
small, intermediate, or large cell type
B, T NK or null cell type
characteristic histology of Burkitt Lymphoma
STARRY SKY PATTERN
characteristic histological cell type for hodgkin lymphoma?
reed sternberg cells
(bi nucleate cell)
what special staining do we need for histology of Hodgkin lymphoma?
Tell me about flow cytometry for ix lymphoma type/. What type of lymphoma is flow cytometry good for?
-FRESH tissue made into cell suspension
-pass through light beam
-light scatter from the cells captured by sensors and analysed by computer
-markers can be added
-can determine proportion of cell types, cell size and monoclonality
best for B cell lymphomas
would you do a flow cytometry for Hodgkin lymphomas?
what are some B cell markers we are looking for on immunohistochemistry?
CD20, CD79a, PAX-five
which type of cancers can present as nodal metastases?
carcinomas, melanomas, rarely from sarcomas
Where is the most common site for nodal metastases?
in the hilum where the afferent lymphatics first enter into the nodal tissue
other than breast cancer, what other type of cancer requires sentinel node biopsy?
what is the difference between neoadjuvant and adjuvant therapy?
neoadjuvant- reduces tumour size
adjuvant- helps to eradicate cancer
a fifty six year old woman with past hx of breast carcinoma, treated by excision and local radiotherapy complains of neck pain. What imaging tests are appropriate if she has no neurologicalk signs?
what is gardener's syndrome and what cancer is it associated with?
gardener's syndrome= desmoid tumours + lots of skin tags. Often associated with FAP colorectal cancer
what are some other extra colonic cancers associated with HNPCC
endometrial cancers, brain tumours, skin tumours, urothelial carcinomas, small bowel carcinomas.
3 most common places for colorectal cancer to?
what sort of imaging do we order to ix?
colon of course
CT IV contrast or PET scan
when would a PET scan be NOT useful?
in the bladder
how might a patient with colorectal cancer present?
changed bowel habit
signs of obstruction
signs of perforation
Fe deficiency anaemia
constitutional signs-fatigue, weight loss, night sweats
what imaging do we request for rectal cancer
what is the difference between rectal and colon cancer?
we can use neoadjuvant radiotherapy on the rectal tumour prior to resection
what type of cancer are bowel cancers?
vast majority of bowel cancer is familial or sporadic?
two types of renal carcinoma?
clear cell and papillary
risk factors for transitional cell carcinoma?
• Aniline dye
Cyclophosphamide (long term use)
what is the hallmark symptom of TCC
two types of TCC?
papillary or flat
Who gets a faecal occult test as part of the bowel cancer screening program? How often do you get it done?
People aged 50 years and over and recommended to have a FOB test every 2 years
where does lung cancer metastasise to?
order of prognosis for adenocarcinoma small cell carcinoma and squamous cell carcinoma (lung cancers)
in order of worsening prognosis
what do you think if you have persistent consolidation in the lung?
underlying lung malignancy (adenocarcinoma in situ)
what is the most common type of pancreatic cancer?
duct cell carcinomas
hallmark clinical features of glucagonoma?
skin rash and mild diabetes
which ethnicity is predisposed to cholangiocarcinoma?
israel and japan
What type of cancer is cholangiocarcinoma?
can we make a diagnosis of invasive breast carcinoma from FNA?
no. need a core biopsy to assess tissue architecture
What are the hallmark features of carcinoid syndrome?
flushing, diarrhoea, heart failure