L07: Diagnosis And Treatment Of Cancer

Question 1

What are the 3 diagnostic pathway for diagnosing cancer

Answer 1

Symptomatic e.g weight
Screening test
Incidental of a different symptom

Question 2

What are the 4 methods to diagnose cancer

Answer 2

History taking
Imaging
Blood test
Tissue biopsy

Question 3

List the common symptoms that might suggest the types of cancer

Answer 3

• Change in bowel or bladder habits (for stomach, colon, pancreatic cancer)
• a sore that does not heal with unusual shape and fail smelling discharge (skin cancer)
• unusual bleeding when passing urine (bladder, kidney cancer)
• breast lump or thickening (breast cancer)
• indigestion or difficulty in swallowing (throat or oesophageal cancer)
• extreme fever with night sweat (lymphoma)
• persistent cough or hoarseness (lung cancer)

Question 4

What are the common symptoms of lung cancer

Answer 4

Cough 
Breathlessness 
Pain 
Loss of appetite 
Coughing up blood

Question 5

If someone has these symptoms what also should be explored

Answer 5

Smoking status
Occupational exposure to chromium, arsenic and asbestos
Characteristic of symptom i.e has anything changed

Question 6

What are the signs of local spread in lung cancer

Answer 6

Obstruction to superior vena cava
Horners syndrome: pupil is small, droopy eyelid
Pancoast syndrome

Question 7

If there is ectopic hormone production what can it present as

Answer 7

Cushing’s syndrome

Question 8

What are the major symptoms of colon cancer

Answer 8

Change in bowel habits 
Red blood dark, red or black 
Discomfort in abdomen 
Weight loss 
Anaemia

Question 9

After an clincal examination what sort of imaging can be done

Answer 9

Ultrasound
Ct scan
MRI scan
Radio isotope scans

Question 10

Which imaging is 3D

Answer 10

Ct scan

MRI scan

Question 11

Name some example of radio isotope scans

Answer 11

Bone scans
Pet scan
MIBG scan

Question 12

What is radio-isotope scans for

Answer 12

Metastatic cancer

Question 13

If there is a mass upon imaging what is done next

Answer 13

Tissue biopsy

Question 14

When we do blood tests for patients with cancer what do we look for

Answer 14

Tumour markers

Question 15

Give an example of tumour marker for prostate cancer

Answer 15

Prostate specific antigen (PSA) cancer

Question 16

What is the NICE guideline for rapid referral

Answer 16

If you have symptoms of cancer you should be seen in 2 week wait referral for further investigation

Question 17

Before giving treatment to a patient with cancer what do we have to do

Answer 17

Stage

Question 18

What is staging based on

Answer 18

Size and location and spread of the cancer

Question 19

What system do we use to stage cancer

Answer 19

TNM

Question 20

What does TNM stand for

Answer 20

T= tumour Size 
n= lymph nodes
M= metastases

Question 21

How many T stages are there

Answer 21

4

Question 22

What does t1 mean

Answer 22

Invades the mucosa

Question 23

What does t2 mean

Answer 23

Invades the muscularis propria

Question 24

What does t3 mean

Answer 24

Invades to subserosa

Question 25

What does t4 mean

Answer 25

Invades other organs

Question 26

How many stages of N are there

Answer 26

3

Question 27

What is N0

Answer 27

No node metastasis

Question 28

What is n1

Answer 28

1 or 3 pericolic nodes

Question 29

What is N2

Answer 29

More than pericolic nodes

Question 30

What is N3

Answer 30

Vascular trunk nodes

Question 31

What are the stages of m

Answer 31

M0- no metastasis | M1= distant metastasis

Question 32

What are the treatment modalities of cancer

Answer 32

Surgery Radiotherapy Chemotherapy

Question 33

What is neo adjuvant chemotherapy

Answer 33

Chemotherapy that your start prior to surgery so you shrink the tumour

Question 34

Why is adjuvant chemotherapy

Answer 34

Chemotherapy that is deliver after the primary treatment to destroy the remaining cancer cells

Question 35

What does chemotherapy involve

Answer 35

Cytotoxic drugs Small molecule targeted drugs Immunotherapeutics

Question 36

How do cytotoxic drugs work

Answer 36

Toxic drugs that are for rapidly diving cells they also target normal cells

Question 37

What are small molecule targeted drugs

Answer 37

Specific agents that target small molecules such as receptors e.g receptor tyrosine kinase inhibitors

Question 38

What does immunotherapy involve

Answer 38

Monoclonal antibodies Checkpoint inhibitors Oncolytic vaccines Car-t-cell therapy

Question 39

What is the 2nd most commonest bone tumour in childhood

Answer 39

Ewing sarcoma

Question 40

What is the treatment for Ewing sarcoma

Answer 40

Surgery Chemotherapy Radiotherapy

Question 41

What are the chemotherapy drugs given for Ewing sarcoma

Answer 41

``` Vincristine Actinmycin D Andriamycin Alkalayting agents Etoposide ```

Question 42

What other treatments are available to treat cancer

Answer 42

Personalised medicine

Question 43

What is palliative care about

Answer 43

Adding days to life and improve quality