Malignancy Flashcards
1
Q
The six most common causes of death from cancer in Australia and the US are cancer of the 1 2 3 4 5 6
A
lung, bowel,
breast, prostate, lymphoma and pancreas
2
Q
The so-called ‘silent’ malignancies that pose a special problem include cancer of the 1 2 3 4 5 6
A
ovary,
pancreas, kidney, caecum and ascending colon, liver
(hepatoma), melanoma and haematological tissue
3
Q
Although uncommon in children under 15 years,
cancer is the _____ most common cause of death
in this age group
A
second
4
Q
The most common cancers in children (in
order) are
- leukaemias, especially ________
- brain tumours, especially _____
- lymphomas, especially_____
- ; neuroblastoma; Wilms tumour;
- soft tissue tumours, especially ______;
- and bone tumours
A
acute lymphocytic leukaemia (34%);
astrocytoma (20%);
non- Hodgkin (13%)
rhabdomyosarcoma
5
Q
Undiffentiated sx of cancer
A
- Tiredness/fatigue/weakness
- Anorexia and nausea
- Weight loss
- Fever
- Thirst (hypercalcaemia)
- Drowsiness (hyponatraemia)
6
Q
The _____ effects or syndromes are very
important clinically because they may provide
an early clue to the presence of a specific type of
cancer, in addition to the possible lethal effect of the
metabolic or toxic effect
A
paraneoplastic
7
Q
Paraneoplastic syndromes and associated
tumours: more common examples
Lung, kidney, adrenal, thymoma,
pancreas
A
Cushing
8
Q
Paraneoplastic syndromes and associated
tumours: more common examples
Lung, kidney, thymoma, thyroid
A
ACTH
9
Q
Paraneoplastic syndromes and associated
tumours: more common examples
Lung, hepatoma, choriocarcinoma
A
Gonadotrophins
10
Q
Paraneoplastic syndromes and associated
tumours: more common examples
Lung, breast, kidney, multiple myeloma,
prostate, pancreas, adrenal, hepatoma
A
Hypercalcaemia
11
Q
Paraneoplastic syndromes and associated
tumours: more common examples
Kidney, hepatoma, lymphoma,
pancreas, thymoma
A
Fever
12
Q
Paraneoplastic syndromes and associated
tumours: more common examples
Lung, breast, thymoma, Hodgkin,
prostate
A
Neurologic
13
Q
Paraneoplastic syndromes and associated
tumours: more common examples
Lung, breast, hepatoma, prostate,
pancreas
A
Coagulopathy
14
Q
Paraneoplastic syndromes and associated
tumours: more common examples
Kidney, pancreas, prostate
A
Thrombophlebitis
15
Q
Paraneoplastic syndromes and associated
tumours: more common examples
Kidney, hepatoma
A
Polycythaemia
16
Q
Paraneoplastic syndromes and associated
tumours: more common examples
Lung, breast, pancreas
A
Dermatomyositis
17
Q
What agent?
Occupation: Chemical industry
Cancer type: Lung, skin, liver
A
Arsenic
18
Q
What agent?
Occupation: Glue worker,
varnisher
Cancer type: Leukaemia
A
Benzene
19
Q
What agent?
Occupation: Chimney sweep
Cancer type: Skin
A
Soot, coal tar
20
Q
What agent?
Occupation: Farmer, sailor, outdoor worker
Cancer type: Skin
A
Ultraviolet light
21
Q
What agent?
Occupation: PVC manufacturing
Cancer type: Liver (angiosarcoma)
A
Vinyl chloride
22
Q
MC familial cancers
1
2
3
A
colorectal, breast and
ovarian cancers.
23
Q
A ______ is an abnormal characteristic that
is specific for a particular type of malignancy
A
tumour marker
24
Q
CEA and AFP are not specific markers but are
elevated in certain tumours and are very useful in
_____
A
monitoring tumour activity
25
Tumour markers have a limited role in diagnosis
of malignant disease because several have low
sensitivity and specificity. The most valuable are
those associated with testis cancer—___ and _____
AFP and beta-
| HCG.
26
What is the tumor marker?
Testicular cancer (non-seminomatous)
Hepatocellular carcinoma
GIT cancers with and without liver
metastases
CA 125
27
What is the tumor marker?
Breast
CA-15-3
28
What is the tumor marker?
Pancreas, colon, ovary
CA-19-9
29
What is the tumor marker?
Colorectal cancer
Pancreatic, breast, lung, small intestine,
stomach, ovaries
CEA
30
What is the tumor marker?
Prostate cancer
PSA*
31
What is the tumor marker?
Choriocarcinoma
Hydatidiform mole
Trophoblastic diseases
hCG
32
What is the tumor marker?
Multiple myeloma, some lymphomas
α-microglobulin
33
Apart from non-melanoma skin cancer, ______ is
the most common cancer in Australia in terms of both
incidence and death, accounting for at least 20% of
cancer deaths
lung cancer
34
Paraneoplastic syndromes associated with lung CA
hypercalcaemia,
Cushing syndrome, carcinoid syndrome,
dermatomyositis, visual loss progressing to blindness
from retinal degeneration, cerebellar degeneration
and encephalitis.
35
The most important tumours of the kidney are
| _______ and ______
adenocarcinoma (80% of all kidney tumours) 3 and
| nephroblastoma (Wilms tumour
36
haematuria + loin pain + palpable
| kidney mass
kidney cell cancer
37
________is responsible for 10% of all childhood
| malignancies
Wilms tumour
38
Clinical features of Wilms
* peak incidence ____ years
* general symptoms of neoplasia
* _______ 80%
* _______ 30%
* ________ 25
2–3
palpable mass
abdominal pain
haematuria
39
Wilms:
Early diagnosis with nephrectomy and chemotherapy
leads to a very favourable prognosis_____
(90%
| 5-year survival
40
It is a
tumour of the adrenal medulla (50%) and sympathetic
nervous system, especially _________but also in chest and neck
retroperitoneal neural tissue in abdomen (30%)
41
Dxtics for NB
CT scan, skeletal survey; biopsy required
42
Tx of NB
Treatment is based on surgical resection then
| chemotherapy ± localised radiotherapy
43
______ has the highest mortality rate of all
the gynaecological cancers because the majority
of patients present in the late stage of the disease
Ovarian cancer
44
_____ are the most common
| of malignant ovarian tumours.
Epithelial tumours
45
New test for ovarian CA
A new test is the
OvPlex ™ serum test, which measures five serum
markers.
46
Malignancy in this area is more likely to present with
symptoms of anaemia without the patient noting
obvious blood in the faeces or alteration of bowel
habit
Carcinoma of caecum and
| ascending colon
47
This is another cancer with vague symptoms,
| metastasising early and late presentation
Pancreatic cancer
48
MC typre of pancreatic Ca
ductal adenocarcinoma
49
Presentation of ductal adenoCA of the head of the pancreas?
presents with painless jaundice and if in
the body and/or tail presents with epigastric pain
radiating to the back, relieved by sitting forward
50
jaundice + anorexia + abdominal
| discomfort / pain
pancreatic cancer
51
_______has a rapidly fatal course
if untreated, while _______ has a variable
chronic course with an inevitable fatal outcome
Acute leukaemia
chronic leukaemia
52
The usual age range for acute lymphatic leukaemia
| (ALL) is ______years with a second peak at about ______ years
2–10
40
53
```
The median age of presentation of acute
myeloid leukaemia (AML) is______ years
```
55–60
54
Symptoms due to infiltration of tissues with blast
| cells (e.g. gingival hypertrophy in______
AML)
55
```
Bone pain (notably in children with_____ and
joint pain
```
ALL)
56
Dxtcs for Leukemia
1
2
3
4
1. FBE and film
2. Bone marrow examination
3. PCR studies
4. Cytogenetics
57
As a rule, relapse of acute leukaemia means
| imminent death unless _____
bone marrow transplantation
| is successful.
58
The mean 5-year survival rate for
childhood ALL is about _______, for adult ALL _____
for AML it varies with age with poorer survival, about
____ over 55 years of age
75–80%
30%;
20%,
59
* A disorder of middle age, typically 40–60 years
| * Insidious onset
CML
60
Sx of CML
```
• Constitutional symptoms: malaise, weight loss,
fever, night sweats
• Symptoms of anaemia
• Splenomegaly (very large); abdominal
discomfort
• Priapism
• Gout
```
61
Dxtics of CML
* Markedly elevated _____
* Marked left shift in ___
* Presence of _____
white cell count (granulocytes)
myeloid series
Philadelphia chromosome
62
```
fatigue + fever / night sweats +
abdominal fullness ( splenomegaly )
```
CML
63
• A disorder of late middle age and elderly
• Insidious onset
• Constitutional symptoms: malaise, weight loss,
fever, night swea
Chronic lymphocytic leukaemia
| CLL
64
PE of CLL
1
2
• Lymphadenopathy (large rubbery nodes)—neck,
axilla, groin (80%)
• Moderately enlarged spleen and liver (about 50%)
65
Labs of CLL
* Lymphocytosis >15 × 10 9 /L
* _____ appearance of lymphocytes
* Consider_____
‘Mature’
cytogenetics
66
T or F
in CLL
Most cases require no specific therapy but
observation.
T
67
Clinical features of CLL
• Painless (rubbery) lymphadenopathy, especially
______
• Constitutional symptoms (e.g. malaise, weakness,
weight loss)
• Fever and drenching night sweats—undulant
_____
• Pruritus
• _____ pain in any enlarged lymph
nodes
• Possible enlarged spleen and liver
cervical nodes
(Pel–Ebstein) fever
Alcohol-induced
68
dx of CLL
Diagnosis is by lymph node biopsy with
| histological confirmation
69
Other dxtics for CLL
FBE, CXR,
CT/MRI (to stage), bone marrow biopsy, functional
isotopic scanning.
70
Staging of CLL
Staging is by using Ann Arbor
| nomenclature (IA to IVB).
71
Tx of CLL
Treatment includes
| chemotherapy, immunotherapy and radiotherapy.
72
malaise + f ever/ night s weats + p ruritus
Hodgkin
73
In Hodgkins Lymphoma
```
• Painless lymphadenopathy—localised or
widespread
• Constitutional symptoms possible, especially
_____
• _____is uncommon
```
sweating
Pruritus
74
In Hodgkins Lymphoma
* Extra nodal sites of disease ______
* Possible enlarged liver and spleen
* Possible nodular infiltration of skin_____
(e.g. CNS, bone, skin, GIT)
(e.g. mycosis
fungoides)
75
malaise + fever / night sweats +
| lymphadenopathy
non - Hodgkin lymphoma
76
_______ is a clonal malignancy of the
| differentiated β lymphocyte—the plasma cell.
Multiple myeloma
77
MM
It is
regarded as a disease of the elderly, the mean age
of presentation being_____ years.
65
78
MM
It is asymptomatic in_____ of patients.
20%
79
The classic presenting triad in
an older person is anaemia, back pain and elevated
ESR which helps to differentiate it from ____
monoclonal
| gammopathy of uncertain significance (MGUS
80
weakness + unexplained back pain +
| susceptibility to infection
MM
81
Features of MM
Replacement of bone marrow by malignant
_____
Kidney failure
Associated with______
plasma cell
amyloidosis
82
Dx criteria of MM
* _____ in serum (on electrophoresis)
* _____ protein in urine
* bony_____ on skeletal survey
paraprotein
Bence–Jones
lytic lesions
83
Tx of MM
Treatment is with chemotherapy including
| thalidomide or lenalidomide: 5-year median survival
84
_____ involves the production of
paraprotein (M protein) by non-cancerous cells in the
absence of other clinical manifestations of multiple
myeloma.
Monoclonal gammopathy of undetermined
| significance (MGUS)
85
MGUS is usually asymptomatic but _______ can occur. No chemotherapy treatment is
recommended.
peripheral
| neuropathy
86
Classic triad: skin flushing (especially face),
diarrhoea (with abdominal cramps), valvular
heart disease
Carcinoid syndrome
87
Site of tumors for carcinoid
appendix/ileum, stomach,
| bronchi
88
Dx labs of carcinoid
1
2
* 24 hour urine 5-hydroxyindoleacetic acid
| * plasma chromogranin A/hepatic ultrasound
89
This is a malignant proliferation of RBCs and also
| WBCs and platelets.
PV
90
Investigations for PV
1
2
3
* FBE and haematocrit
* Bone marrow biopsy
* Genetic mutations—JAK2 mutation
91
Potentially curable malignant tumours
Haematological tumours
1
2
3
* Hodgkin lymphoma
* Acute lymphatic leukaemia
* Acute myeloid leukaemia
92
Potentially curable malignant tumours
Solid tumours
```
1
2
3
4
5
6
```
* Choriocarcinoma
* Testicular teratoma
* Neuroblastoma
* Wilms tumour (nephroblastoma)
* Burkitt tumour
* Embryonal rhabdomyosarcoma
93
Tumours curable by adjuvant chemotherapy
1
2
3
4
* Breast cancer
* Osteogenic cancer
* Soft tissue cancer
* Colorectal cancer
94
```
Common sites of metastatic presentation are the
1
2
3
4
5
```
lymph nodes, liver, lung, mediastinum and bone
95
Impt site of mets
Breast, prostate, lung, Hodgkin lymphoma,
kidney, thyroid, melanoma
Bone
96
Impt site of mets
Breast, lung, colon, lymphoma, kidney,
melanoma, prostate
Brain
97
Impt site of mets
Colon, pancreas, liver, stomach, breast,
lung, melanoma
Liver
98
Impt site of mets:
Breast, lung, colon,
kidney, testes, cervix/uterus, Hodgkin
lymphoma, melanoma
Lung and mediastinum
99
Impt site of mets:
Hodgkin lymphoma, lymphoma,
squamous cell carcinoma, oropharynx,
nasopharynx
High cervical
100
Impt site of mets:
Lung, stomach, lymphoma,
Hodgkin lymphoma, oropharynx, larynx,
skin, tongue
Low cervical
101
Impt site of mets:
Breast, lung, lymphoma
Axillary
102
Impt site of mets:
Lymphoma, ovary, uterus, vulva,
prostate, skin
Inguinal
103
Impt site of mets:
Lymphoma, Hodgkin
lymphoma, ovary, uterus, testes, prostate
Retroperitoneum
104
Impt site of mets:
Lung, colon, melanoma, Kaposi sarcoma
Skin
105
Cancer without a clear primary source is present in
| about ______of all cases
5%
106
The mean
survival time in patients with an unknown primary
is____
6 months
107
anorexia + weight loss + jaundice
| ± epigastric pain
pancreatic cancer
108
fatigue + dysphagia + weight loss
oesophageal cancer
109
HIV is a retrovirus with two known strains that
cause a similar spectrum of syndromes: HIV-1 and
HIV-2 (mainly confined to West Africa). It infects
_____ cells bearing the _____receptor
T-helper
CD 4
