OncoBreastObsGyn Flashcards
(32 cards)
What are the types of non small cell lung cancer?
- Squamous cell
- Adenocarcinoma
- Large cell carcinoma
- Carcinoid
What is squamous cell carcinoma?
- Most common
- Typically occurs centrally around main bronchus
- Linked strongly with smoking
- Associated with hypercalcaemia, clubbing, hypertrophic pulmonary osteoarthropathy, hyperthyroidism due to ectopic TSH
What is adenocarcinoma?
- Typically occurs peripherally
- Most common type of lung cancer in non-smokers
- Associated with gynaecomastia, HPOA
- Many are associated with EGFR mutations - responds to TKI inhibitors (gefitinib)
What is large cell carcinoma?
- Anaplastic, poorly differentiated tumour
- Carries a poor prognosis
- Typically peripheral
- May secrete B-HCG
What is carcinoid lung cancer?
- Neuroendocrine tumour (5-HIAA found in urine)
- Presents with symptoms of hypotension, bronchospasm and flushing
What is small cell lung cancer?
- Usually central
- Not usually curative, poor survival
- Anti-Hu Ab
- Associated with paraneoplastic syndromes:
1. SIADH: hyponatremia, excessive water retention
2. ACTH: presents with HTN, hyperglycaemia, muscle weakness
3. Lamberton Eaton syndrome: presents with limb girdle weakness, repeated muscle contractions, hyporeflexia, dry mouth
What are the investigations for lung cancer?
- CXR
- Bloods: thrombocytopenia, raised calcium
- CT scan
- Bronchoscopy with endobronchial US
What are key features of lung cancer?
- Persistent cough
- Haemoptysis
- SOB
- Weight loss/night sweats
- Hoarse voice - Pancoast tumour, pressing on RLN
- Stridor/difficulty swallowing
- Clubbing
- Fixed, monophonic wheeze
- Supraclavicular lymphadenopathy
- Hepatomegaly - metastases
What are blood results for colorectal cancer?
- FBC - raised platelets, microcytic anaemia
- U&E - urea raised in GI bleed
- LFT - metastatic spread
- Calcium - often raised in malignancies
- TFT - can cause change in bowel habits
What investigations are done in colorectal cancer?
- Stool cultures (rule out infection)
- Faecal calprotectin (used to identify bowel inflammation - IBD)
- Faecal immunochemical test (FIT)
- Colonoscopy + biopsies/CT colonograohy if unable to tolerate
- CT for staging
- MRI
What resection would be done for location of cancer?
- Caecum, ascending and proximal transverse colon: right hemicolectomy
- Distal transverse and descending colon: left hemicolectomy
- Sigmoid colon: high anterior resection
- Rectum: anterior resection
- Anal verge: abdomino-perineal excision of rectum
What is the presentation of pancreatic cancer?
- Painless obstructive jaundice
- Unintentional weight loss
- Palpable mass in epigastric region
- N&V
- New onset diabetes or worsening of T2DM
- Over 40 with jaundice - referred on 2WW
- Over 60 with weight loss + diarrhoea, N+V, constipation, new onset diabetes, back + abdo pain - refer for CT abdomen
What are investigations and management for pancreatic cancer?
- Staging CT scan
- CA19-9
- Biopsy
- Management: surgery, but usually ERCP (stents to relieve biliary obstruction), surgery to improve symptoms, palliative chemo and radiotherapy
What is the presentation of endometrial cancer?
- Post menopausal bleeding
- Premenopausal intermenstrual bleeding/PCB
- Pain/discharge/anaemia/haematuria/thrombocytopenia
What are the investigations and management for endometrial cancer?
Investigations:
- 1st line - trans animal USS (>4/5mm is concerning)
- Hysterectomy with pipeline endometrial biopsy
Management:
- Total abdominal hysterectomy with bilateral salpingo-oophorectomy
- +/- radiotherapy
What are the risk factors for endometrial cancer?
- Unopposed oestrogen
- Age
- Obesity
- Nulliparity
- Early menarche
- Late menopause
- PCOS
- Tamoxifen
- Diabetes
- Lynch syndrome
What is the presentation of cervical cancer?
- Discharge
- PCB/IMB/PMB
- Pelvic pain
What is the screening for cervical cancer?
HPV first system
- 3 yrly smears for all women aged >25 yrs
- 5 yrs smears for women aged 50-64yrs
- Women with HIV screened annually
- Over 65 can request smears
- Immunocompromised or previous CIN women may have additional screening
- Pregnant women should wait 12 weeks postpartum
What is the management for cervical cancer?
CIN: LLETZ or cone biopsy
Stage 1B-2A: radical hysterectomy and removal of local lymph nodes with chemo/RT
Stage 2B-4A: chemo/RT
Stage 4B: combo of surgery, RT, chemo and palliative care
What is the presentation of ovarian cancer?
- Abdominal distension
- Bloating
- Abdo pain
- Urinary symptoms
- Early satiety
- Weight loss
- Change in bowel habit
What are the investigations for ovarian cancer?
- Ca125
- USS
- Diagnostic laparotomy
How does myeloma present?
- Hypercalcaemia
- Renal impairment
- Anaemia
- Bone pain
What are the symptoms for breast cancer?
- Discharge
- Nipple changes
- Skin tethering
- Ulceration
- Erythema
What are the types of breast cancer?
- Invasive dictaphone carcinoma
- Invasive lobular carcinoma
- Ductal carcinoma in situ
- Lobular carcinoma in situ
- Inflammatory
- Rarer cancers = medullary, mucinous tubular etc.
