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Onc Key Conditions Flashcards

(128 cards)

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1
Q

BCC Risk factors

A

Increasing age
UV exposure
Fitzpatrick skin type 1
Immunosupression
Genetic predisposition

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2
Q

What does a BCC look like?

A

Shiny or pearly nodule
Rolled edges
Surface telangiectasia
Rodent ulcer

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3
Q

Types of BCC

A

Nodular (most common)
Superficial
Morphoeic
Basosquamous (more aggressive)

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4
Q

High risk BCC features

A

Young patients
Immunocompromised patients
Recurrent lesions
Site - nose, lips, eyes, ears
Non-Nodular sub type

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5
Q

BCC treatment

A

Excision
MOHs e sic ion for high risk areas
Cryotherapy
Imiqiumod cream

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6
Q

SCC Risk factors

A

Smoking
Chronic skin inflammation
Fitzpatrick skin type 1
UV exposure
Increasing age
Previous history of skin cancer

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7
Q

How is SCC diagnosed

A

Clinical appearance and biopsy results

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8
Q

What is bowens disease / SCC in situ

A

Pre-cancerous change
SCC is present but hasn’t breached the basement membrane.
Irregular scaly plaque on sun exposed area

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9
Q

SCC treatment

A

Excision
MOHs excision
Curettage
Cryotherapy

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10
Q

Malignant melanoma symptoms

A

Mole growth
Irregular edges
Multiple colours
Bleeding
Itching and irritation

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11
Q

Malignant melanoma RF

A

UV exposure
Fitzpatrick skin type 1
FH skin cancer

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12
Q

Malignant melanoma treatment

A

Excision
Radiotherapy
Immunotherapy

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13
Q

Malignant melanoma spread

A

Most likely skin cancer to spread
Bones, brain, lymph nodes

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14
Q

Bladder cancer RF

A

Smoking
Dye exposure (aromatic amines)
Previous cancer treatment eg radiation to pelvis
Schischosomatis (SCC)

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15
Q

Clinical features of bladder cancer

A

Haematuria
Dysuria, frequency, urgency
Suprapubic pain
Weightloss, reduced appetite, back pain

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16
Q

Types of bladder cancer

A

Transitional cell carcinoma (95%)
Squamous cell carcinoma
Muscle invasive
Non muscle invasive

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17
Q

Bladder cancer Ivx

A

Urine dip
FBC, U+E, PSA
USS KUB
Flexible cystoscopy +/- biopsy
CT KUB
Staging CT

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18
Q

Causes of haematuria

A

Bladder cancer
Bladder stones
Cystitis
RCC
Renal stones
Prostatitis
Urethral stricture

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19
Q

Bladder cancer treatment

A

TURBT -Transurethral resection of bladder tumour
Muscle invasive - radical treatment- cystectomy or radical radiotherapy
Superficial- regular cystoscopes 5yrs post treatment
Mitomycin C - left in bladder 1 hour post op - reduces risk of recurrence
BCG - superficial

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20
Q

Renal cancer RF

A

Von hippel lindau
Smoking
HTN
Obesity
Diabetes

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21
Q

RCC Symptoms

A

Triad = haematuria, loin pain, palpable mass
Bone pain, night sweats, fatigue
Left varicoecle
Lower limb oedema

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22
Q

Paraneoplastic syndromes associated with RCC

A

Anaemia (of chronic disease)
Polycythemia (ectopic EPO production)
Hypercalcaemia (Ectopic PTH production)
Cushing syndrome (ectopic ACTH production)

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23
Q

Which lymph nodes does RCC spread to

A

Hilar and Para-aortic

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24
Q

RCC IVX

A

Urine dip
FBC,U+E,PSA,LFT,Bone profile
USS KUB
CT Chest, abdo, pelvis
MRI
Biopsy

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25
Lung sign indicative of RCC
Cannonball lesions
26
What is the Leibovich score
Predicts patients risk of developing metastatic cancer following nephrectomy 0-1 low risk 2-5 mod risk 6+ high risk
27
RCC Treatment
Radical nephrectomy Radical partial nephrectomy Surveillance Cryotherapy Immunotherapy (mets) Nephro-ureterectomy (TCC)
28
Testicular cancer tumour markers
AFP LDH bHCG
29
RF testicular cancer
Age 20-45 Cryptochiadism FH testicular cancer Caucasian Hx contralateral testicular cancer HIV
30
Testicular cancer symptoms
Testicular lump/swelling Feeling of fullness in scrotum Scrotum feels firmer
31
Testicular lump differentials
Tumour Haematoma Abscess Hernia Epididymitis
32
Testicular cancer investigations
Scrotal USS CXR (Mets) Bloods Inc tumour markers CT Chest abdo pelvis (ideally post orchidectomy)
33
Testicular cancer treatment
Orchidectomy Sperm banking Chemo
34
Breast cancer causes
Excess oestrogen BRCA1/2 genes
35
Breast cancer symptoms
Breast lump Blood stained nipple discharge Skin changes - peu’d orange Breast asymmetry + indrawing of breast Swollen axilla lymph nodes
36
Breast lump differentials
Cancer - firm, irregular, usually tethered Fat necrosis - often mimics cancer lump Cysts - fluid filled, not fixed Fibroadenoma - firm, non tethered, highly mobile Abcess- painful, red,hot breast Intraductal papilloma - benign warty leison behind areola
37
Breast cancer RF
Obese Late menopause/early menarche/ nuliparity FH Female Increasing age
38
What is ducal carcinoma in situ
Sometimes classed as cancer sometimes classed as pre-cancerous change Arises from epithelial cells and doesn’t breach basement membrane
39
What is lobular carcinoma in situ
Doesn’t breach basement membrane Arises from acini cells
40
What is pagets disease of the nipple?
Rough dry erythmatous skin surrounding nipple Often mistaken for eczema Usually associated with underlying cancer
41
Most common breast cancer
Invasive ducal carcinoma
42
What is triple assessment
History and breast exam Radiology - USS under 40s, mammogram +/- USS over 40s Biopsy if needed
43
Breast cancer management
Wide local excision/ mastectomy depending of cancer + boob size + staging Adjuvant radiotherapy Chemo Tamoxifen, aromatise inhibitors
44
What is tamoxifen
SERM - blocks oestrogen receptors Given to premenopausal women with ER+ cancer
45
Tamoxifen side effects
Vaginal bleeding Endometrial cancer risk
46
What are aromatase inhibitors
Eg// Letrozole Given to post menopausal women with ER+ cancer Stop oestrogen production
47
Aromatase inhibitors side effects
Hot flushes Osteoporosis
48
Colorectal cancer RF
High alcohol intake Poor diet - red meat, low fibre, lots processed foods IBD FH - lynch syndrome Inc age Obesity Vit D deficiency
49
Bowel cancer screening
FIT testing - 60-74 year olds every 2 years Stool sample in post Uses antibodies against haemoglobin to look for blood in stool
50
Who gets enhanced bowel cancer screening
Lynch syndrome Familial adenomatous polyposis FH early bowel cancer IBD
51
Bowel cance 2WW criteria
Rectal mass Positive FIT test
52
Right sided bowel cancer symptoms
Weight loss Iron deficiency anaemia Abdo pain Abdo mass
53
Left sided bowel cancer symptoms
PR Bleed Tenesmus Obstruction Bloating Change in bowel habit - constipation or diarrhoea
54
Bowel cancer emergency presentations
Obstruction Perforation (usually caecal due to Ileo-caecal valve) PR bleed
55
Bowel cancer IVX
Colonoscopy (not if obstruction) Biopsy CT CAP CEA tumour marker Rectal cancer MRI
56
Indicators of high risk bowel cancers
Bigger than 3cm More than 30% bowel circumference involved Poorly differentiated
57
Bowel cancer follow up
2x CT CAP in first 3 years 6 monthly CEA tests
58
Oesophageal cancer 2ww criteria for endoscopy
Dysphagia or age >55 + weightloss + 1 of upper abdo pain, reflux or dyspepsia
59
Causes of dysphagia
GORD, Oesophageal cancer, oesophageal stricture, Stroke, MS, MND, Oesophagitis
60
Oesophageal cancer Ivx
Endoscopy /OGD Bloods X-ray Barium swallow Biopsy
61
Types of oesophageal cancer
Adenocarcinoma - bottom 1/3 most common SCC - African population, top 2/3rds
62
Oesophageal cancer RF
Smoking Alcohol Hot drinks Barrett’s oesophagus GORD FH
63
Surgical management of oesophageal cancer
Mckeown oesophagectomy - higher lesions, 3 incisions Ivor-Lewis oesophagectomy - lower leisons, 2 incisions
64
Oesophageal cancer symptoms
Dysphagia (usually progressive) Dyspepsia Reflux Weightloss Upper abdo pain
65
Gastric cancer symptoms
Early satiety Haematemesis Upper abdo pain Weightloss Anorexia Dyspepsia
66
Gastric cancer signs
Virchows node, Acanthodii’s nigricans, epigastric mass, jaundice
67
Gastric cancer RF
Inc age Male H.pylori Smoking Pernicious anaemia High salt diet FH
68
Gastric cancer 2WW criteria
Upper abdo mass consistent with stomach cancer. Endoscopy- dysphagia or age > 55 with weightloss + one of reflux, dyspepsia, upper abdo pain
69
Gastric cancer management
Surgical- total gastrectomy, roux en y reconstruction Nutrition support Chemo
70
What is covossias law?
Painless jaundice + RUQ mass = likely to be Ca
71
Causes of pre-hepatic jaundice
Haemolytic anaemia - sickle cell, hereditary spherocytosis, G6PD deficiency, thalessemia Malaria Gilbert syndrome
72
Causes of hepatic jaundice
Liver cirrhosis Hepatitis- alcoholic, autoimmune, ABCDE Non alcoholic fatty liver disease Wilson’s disease Hereditary haemochromatosis Hepatocellular carcinoma
73
Post hepatic causes of jaundice
Obstruction- pancreatic cancer, strictures Gallstones, ascending cholangitis
74
Pancreatic cancer 2WW Criteria
Age >40 jaundice Age >60 diarrhoea, abdo pain, back pain, N+V, constipation New onset diabetes
75
Pancreatic cancer symptoms
Steatorrhea Back pain, epigastric pain Dark urine Jaundice
76
Pancreatic cancer RF
Increased age Male Smoking Obesity Chronic pancreatitis FH
77
Pancreatic cancer treatment
If ressectable - surgery - whipples procedure Adjuvant chemo or if unressectable
78
Pancreatic cancer tumour marker
CA19-9
79
Most common type + area of prostate cancer
Adenocarcinoma Peripheral zone
80
Causes of prostate cancer
Driven by prolonged exposure to testosterone
81
Prostate cancer symptoms
LUTS - nocturia, hesitancy, weak stream, polyuria, post micturion dribbling, double voiding Back pain common in mets
82
Causes of raised PSA
Prostate cancer BPH Prostatitis DRE Recent ejaculation
83
Prostate cancer Ivx
MP MRI Prostate biopsy - US guided transrectal or transperineal Bone scan CT CAP
84
Prostate cancer treatment
Active surveillance Radiotherapy Prostatectomy Anti-androgen therapy TURP
85
MSCC symptoms
Back pain/ back ache is most common Neurological changes - motor weakness, parathesia Urinary retention or incontinence
86
MSCC on examination
Increased tone Increased plantars Hypereflexia Leg weakness Loss of sensation Changes in anal tone
87
MSCC treatment
16mg Dexamethasone ASAP bed rest PPI LMWH Some patients will have surgery Radiotherapy
88
Most common cancers to cause MSCC
Breast Prostate Lung Myeloma
89
What is SVCO
Obstruction to the flow of blood through the superior vena cava secondary to a cancer
90
Causes of SVCO
Non small cell lung cancer Small cell lung cancer Non Hodgkin’s lymphoma Non malignant causes - syphilis
91
SVCO symptoms
Dyspnoea Facial swelling Cough Head fullness Dysphagia Symptoms exacerbated by bending forwards or lying down
92
SVCO Signs
Facial swelling Distended neck + chest wall veins Upper limb oedema Cyanosis Cognitive dysfunction
93
What is pembertons sign
Test for SVCO elevate both arms above head for 1-2 mins If it cause’s congestive, cyanosis or resp distress = positive Due to increased venous return exacerbating obstruction
94
SVCO IVX
CXR - mediastinal widening and pleural effusion CT CAP Duplex USS
95
SVCO treatment
Dexamethasone Endovascular stenting Radiotherapy Chemo Elevate head + neck O2
96
What is neutropenic sepsis
Fever>38 or features of sepsis in patients with a neutrophil count of less than 0.5
97
Neutropenic sepsis symptoms
Often very vague - feel generally unwell Fever Confusion Tachycardia Tachypnoea Low BP
98
Neutropenic sepsis management
Sepsis 6 Broad spectrum abx - tazocin / meropenem ASAP IV fluids O2 ABG/VBG - Lactate Blood cultures Catheter - urine output
99
What is DIC
serious disorder in response to illness or disease which results in dysregulated blood clotting Can have simultaneous bleeding and thrombosis
100
DIC causes
Shock Sepsis Major trauma or burns Eclampsia + HELLP
101
DIC symptoms
Bleeding from ears, nose, GI tract, respiratory (3 unrelated sites = v indicative) New onset confusion Widespread bruising
102
DIC Signs
Petechiae Live do reticularis Localised infarction or gangrene eg didgits Oliguria Hypotension Tachycardia
103
DIC Ivx
FBC - thrombocytopenia Coagulation screen - PT / APTT often prolonged Fibrinogen - decreased D-diner - typically raised
104
DIC management
Treat underlying disorder Platelet transfusion- try and keep above 50 FFP or cryoprecipitate transfusion
105
DIC complications
Multi-organ failure Life-threatening haemorrhage Cardiac tampon are Haemothorax Digit loss
106
Hypercalcaemia causes
Excess or ectopic PTH release - RCC, 1 or 3 hyperparathyoidism Malignancy - myeloma, bone mets Excess Vit D or Ca intake Severe AKI Thiazide diuretics
107
How to tell the difference between hypercalcaemia due to malignancy and hyperparathyroidism
PTH is raised in hyperparathyroidism and suppressed in malignancy
108
Hypercalcaemia symptoms
Confusion/hallucinations Abdo pain Renal stones - loin pain, haematuria Constipation Bone pain
109
Hypercalcaemia management
IV fluids IV bisphosphonates (zoledronic acid)
110
Most common head and neck cancer
Tongue
111
H+N cancer RF
Smoking Alcohol HPV Older, male Betal nut chewing Southern china Poor dental hygiene
112
What is erythroplakia
Red, velvety patch on oral mucosa Between 70-90% are precancerous
113
Typical form of H+N cancer
SCC
114
Radiotherapy side effects - skin
Skin soreness Change in colour Dry and itchiness Blistering
115
Radiotherapy side effects
Fatigue Mucositis Hair loss in treatment area N+V Diarrhoea Stiff joints Erectile dysfunction Infertility
116
Small cell lung cancer development
From neuroendocrine cells Develop centrally Quickly grow and metastasise
117
Lung cancer RF
Smoking Asbestos exposure (mesothelioma) Air pollution Ionising radiation
118
Lung cancer features
Cough Haemoptysis SoB Weightloss Fatigue
119
Pancoast tumour features
Apical lung cancer, compress on brachial plexus - upper limb weakness/parathesia or on sympathetic chain - horners
120
SIADH + Small cell lung cancer
Small cell lung cancer may produce ADH causing SIADH - Hyponatraemia
121
Paraneoplastic syndrome associated with small cell lung cancer
SIADH Cushing syndrome - Inc ACTH SVCO Eaton-lambert syndrome
122
Lung Adenocarcinoma Paraneoplastic syndrome
Pulmonary osteoarthropathy
123
Ovarian cancer RF
Previous breast cancer Smoking Obesity + diabetes FH Previous ovarian disease Pelvic radiotherapy
124
Ovarian cancer symptoms
Non specific GI symptoms- bloating, indigestion Abdo, pelvic or back pain Abnormal vaginal bleeding Altered bowel habit Leg swelling Systemic symptoms
125
Ovarian cancer tumour marker
Ca-125
126
Endometrial cancer RF
Prolonged exposure to unopposed oestrogen Early menarche or late menopause PCOS Tamoxifen use Older age
127
Endometrial cancer features
Post menopausal bleeding Clear/white vaginal discharge Weightloss Abdo pain
128
Endometrial cancer IVX
Transvaginal USS -Endometrial thickness >5mm Endometrial biopsy

Cancer Care (4 decks)

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