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Medicine for Finals > Oncology > Flashcards

Oncology Flashcards

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1
Q

lung adenocarcinoma: distribution

A

peripheral

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2
Q

lung squamous cell carcinoma: distribution

A

central (perihilar)

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3
Q

lung adenocarcinoma: smoking risk

A

not a risk factor, seen in never-smokers

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4
Q

lung squamous cell carcinoma: smoking risk

A

smoking is a major risk factor

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5
Q

lung cancer: presenting features

A
  • cough
  • haemoptysis
  • dyspnoea
  • chest pain
  • anorexia and weight loss
  • SVC obstruction
  • hoarse voice (Pancoast’s Tumour)
  • cervical and supraclavicular lymphadenopathy
  • clubbing
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6
Q

small cell lung cancer: paraneoplastic features

A
  • hyponatraemia (SIADH)
  • Cushingoid syndrome (ACTH)
  • Lambert-Eaton Myasthenic Syndrome
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7
Q

lung squamous cell carcinoma: paraneoplastic features

A
  • hypercalcaemia (PTHrP)
  • hyperthyroidism (TSH)
  • clubbing
  • hypertrophic pulmonary osteoarthropathy
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8
Q

lung adenocarcinoma: paraneoplastic features

A
  • gynaecomastia
  • hypertrophic pulmonary osteoarthropathy
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9
Q

lung cancer: RED FLAGS

A
  • CXR findings suggestive of lung cancer
  • unexplained haemoptysis in >40yo
  • ≥2 of cough, fatigue, SOB, chest pain, weight loss, anorexia, smoking history in >40yo
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10
Q

lung cancer: imaging modalities

A
  • CXR typically first line
  • CT gold-standard
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11
Q

lung cancer: prognosis

A

small cell cancer carries the worst prognosis

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12
Q

lung cancer: metastatic sites

A
  • liver
  • brain
  • bone
  • adrenals
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13
Q

mesothelioma: risk factors

A

asbestos exposure

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14
Q

mesothelioma: presenting features

A
  • dyspnoea
  • weight loss
  • chest wall pain
  • clubbing
  • pleural effusion or thickening on CXR
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15
Q

mesothelioma: metastatic sites

A
  • contralateral lung
  • peritoneum
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16
Q

mesothelioma: prognosis

A

poor, eligible for industrial compensation

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17
Q

oesophageal adenocarcinoma: distribution

A

lower third of the oesophagus

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18
Q

oesophageal squamous cell carcinoma: distribution

A

middle and upper thirds of the oesophagus

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19
Q

oesophageal adenocarcinoma: risk factors

A
  • GORD +/- Barret’s Oesophagus
  • obesity
  • high fat diet

(most common in the developed world)

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20
Q

oesophageal squamous cell carcinoma: risk factors

A
  • smoking
  • alcohol
  • chronic achalasia
  • low vitamin A
  • iron deficiency
  • HPV
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21
Q

oesophageal and gastric cancer: RED FLAGS

A

Dysphagia
Weight loss + epigastric pain, dyspepsia or reflux in >55yo

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22
Q

oesophageal and gastric cancer: first-line investigation

A
  1. OGD +/- biopsy
  2. CT CAP and staging laparoscopy
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23
Q

oesophageal cancer: presenting features

A
  • PROGRESSIVE dysphagia (solids then liquids) ((cf. achalsia which presents with dysphagia to solids and liquids))
  • weight loss and anorexia
  • odynophgagia
  • hoarse voice
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24
Q

oesophagectomy: risks

A
  • anastomotic leak (8%)
  • pneumonia (30%)
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25
gastrectomy: risks
- anastomotic leak (5-10%) - dumping syndrome (high-sugar foods pass quickly) - vitamin B12 deficiency
26
oesophageal and gastric cancer: metastatic sites
- supraclavicular lymph nodes (Virchow's Node) - periumbilical lymph nodes (Sister Mary Joseph Nodule) - liver and abdomen (requires staging laparotomy)
27
lung cancer: histology
- non-small cell cancer: adenocarcinoma, squamous cell carcinoma, large cell carcinoma (anaplastic - poor prognosis) - small cell lung cancer (rare, poor prognosis)
28
oesophageal cancer: histology
- adenocarcinoma - squamous cell carcinoma
29
gastric cancer: histology
- adenocarcinoma (>90%) - others: GIST, MALT lymphoma, NET
30
gastric MALT lymphoma: risks
- H pylori infection
31
gastric MALT lymphoma: histology
a slow-growing non-Hodgkin lymphoma
32
gastric MALT lymphoma: management
1. H pylori eradication 2. rituximab (anti-CD20) Treatable, but may recur
33
neuroendocrine tumour: sites
Can affect anywhere Stomach, lung, appendix and small bowel common
34
neuroendocrine tumour: presenting features
non-functioning tumour → mass effect symptoms (pain, distension, N&V, bowel obstruction functioning tumour (post-metastasis) → carcinoid syndrome (flushing, palpitations, abdominal pain and diarrhoea)
35
neuroendocrine tumour: marker(s)
1. chromogranin A 2. pancreatic polypeptide
36
GIST: management
- surgical resection (symptomatic relief of mass effect) - tyrosine kinase inhibitors (imatinib)
37
gastric adenocarcinoma: risk factors
- male - increasing age - H pylori infection - smoking - alcohol - high salt diet - family history - pernicious anaemia
38
gastric adenocarcinoma: presenting features
- dyspepsia (refractory to PPI) - dysphagia - early satiety - vomiting - melena +/- haematemesis - weight loss and anorexia
39
colorectal cancer: histology
adenocarcinoma
40
colorectal cancer: risk factors
- polyps - inflammatory bowel disease (UC > Crohns) - genetic syndromes (FAP, HNPCC)
41
colorectal cancer: presenting features
- change in bowel habit - weight loss - anaemia - rectal bleeding (left sided > right sides)
42
colorectal cancer: markers
CEA
43
colorectal cancer: screening test
faecal occult blood test offered biannually for 60-75yo
44
colorectal cancer: first-line investigation
sigmoidoscopy or colonoscopy +/- biopsy barium enema CT abdomen
45
colorectal cancer: Duke's Staging
A) confined to mucosa B) involves muscular wall C) involves lymph nodes D) distant metastases
46
colorectal cancer: metastatic sites
liver
47
colorectal cancer: RED FLAGS
- new iron deficiency in >60yo - unexplained PR bleed in >50yo - unexplained weight loss and abdominal pain in >40yo
48
breast cancer: risk factors
- increasing age - alcohol - lifetime oestrogen exposure (nulliparity, early menarche, late menopause, HRT, obesity) - genetics (in 5-10%)
49
breast cancer: histology
- ductal carcinoma (75%) - lobular carcinoma (15%) - intraductal papilloma - Phyllodes tumour (fibroepithelial tumour, mostly benign)
50
ductal carcinoma: associated conditions
- DCIS is a precursor - DCIS with nipple involvement (eczema) → Paget's Disease of the Nipple
51
lobular carcinoma: associated conditions
- LCIS is a precursor
52
intraductal papilloma: associations and presenting features
- younger women - blood-stained discharge
53
breast cancer: investigation
triple assessment: - expert examination - imaging (mammogram if >35yo, USS if <35yo) - tissue diagnosis (cytology from FNA or biopsy) For confirmed cancer, sentinel LN biopsy
54
breast cancer: molecular phenotyping
ER PR HER2
55
breast cancer: marker(s)
CA15-3
56
breast cancer: surgical management
Tumours <5cm (T1+2) → lumpectomy/WLE Tumours >5cm (T3+4) → radical mastectomy +/- axillary LN clearance (risk of lymphoedema)
57
breast cancer: metastatic sites
- axillary lymph nodes (N1 = mobile; N2 = fixed) - internal mammary nodes (N3) - bones - brain - liver - lungs
58
breast cancer: hormonal management of ER-positive cancer in a pre-menopausal woman
Tamoxifen (an ER modulator) 5yrs Gosrelin (LHRH modulator - induces menopause) risks: endometrical cancer, VTE
59
breast cancer: hormonal management of ER-positive cancer in a post-menopausal woman
Aromatase inhibitors (anastrozole or letrozole) risks: joint or muscle aches, oestoporosis
60
breast cancer: hormonal management of HER2-positive cancer
Trastuzumab (herceptin) with chemotherapy risks: cardiotoxicity
61
breast cancer: roles of chemo and radiotherapy
chemotherapy - (neo)adjuvant in triple negative disease radiotherapy - external beam radiotherapy for breast-conserving surgery or axillary disease
62
prostate cancer: histology
adenocarcinoma, of which: - acinar subtype (common) - ductal subtype (faster growing and more aggressive) 75% arise in the peripheral zone
63
prostate cancer: risk factors
- increasing age - Black African or Caribbean ethnicity - family history - BRCA1 or 2 - obesity, DM, smoking, inactivity
64
prostate cancer: presenting features
- LUTS with poor stream - haematuria - dysuria - incontinence - suprapubic, loin or rectal pain - bone pain - weight loss and anorexia
65
factors causing an increase in PSA
- BPH - prostatitis (1mo) or UTI (1mo) - recent urological surgery - urinary retention - vigorous exercise (48hrs) - sexual intercourse (48hrs) - recent DRE (1wk) ** use age-adjusted cut-offs**
66
prostate cancer: investigations
- DRE (most sensitive for peripheral zone tumours) - PSA - MRI prostate - Transperineal or transrectal biopsy - CT CAP for staging
67
prostate cancer: risk stratification
- Gleason grade (based off histological analysis) - T stage - PSA level
68
prostate cancer: management of low-risk cancer
active surveillance - 3mo PSA - 6mo DRE - 1-3yr biopsy
69
prostate cancer: management of intermediate and high-risk cancer
surgery or radiotherapy + hormone therapy are equivocal
70
prostate cancer: complications of prostatectomy
- erectile dysfunction - stress incontinence - bladder neck stenosis
71
prostate cancer: complications of radiotherapy
- cystitis - proctitis - small increased risk of bladder cancer *equivocal for external beam therapy or brachytherapy (bead)
72
prostate cancer: hormonal therapy
Neoadjuvant alongside radiotherapy or surgery IM GnRH agonist (Zoladex) given monthly, causes tumour flair in first month (bone pain, bladder obstruction) PO anti-androgen (bicalutamide) given for first month to counteract initial tumour flair (bone pain, bladder obstruction)
73
prostate cancer: side effects of hormonal therapy
- reduced libido - erectile dysfunction - nausea and diarrhoea - breast tenderness - hot flushes
74
prostate cancer: metastasis
- pelvic LN - bone - liver - lung - brain
75
hepatocellular carcinoma: risk factors
- chronic liver disease (alcoholic, Hep B or C, autoimmune) - metabolic disease (haemochromatosis) - aflatoxins (Aspergillus) - primary biliary cirrhosis
76
hepatocellular carcinoma: presenting features
- abdominal distension - ascites - jaundice - systemic upset (malaise, weight loss, anorexia)
77
hepatocellular carcinoma: tumour marker(s)
alpha fetoprotein
78
hepatocellular carcinoma: first-line investigation
Liver USS +/- duplex
79
hepatocellular carcinoma: management
- 10% amenable to surgery - consider chemotherapy +/- biologics (bevacizumab) +/- tyrosine kinase inhibitors
80
hepatocellular carcinoma: complications
- biliary tree compression - liver decompensation - pain - rupture and intraperitoneal bleed - paraneoplastic syndromes
81
cholangiocarcinoma: risk factors
- primary sclerosing cholangitis (inflammation of the bile ducts and cholestasis)
82
cholangiocarcinoma: presenting features
- obstructive jaundice - abdominal fullness or pain - palpable gallbladder (Courvoisier's Law) - systemic upset (weight loss, fatigue, malaise)
83
cholangiocarcinoma: tumour marker(s)
CA19-9, occasionally CEA
84
cholangiocarcinoma: first-line investigations
ERCP +/- biopsy (percutaneous transhepatic cholangiography if difficult bile duct access)
85
cholangiocarcinoma: management
- 15% amenable to surgery - poorly responsive to chemotherapy - consider palliative stenting
86
pancreatic cancer: histology
80% adenocarcinoma
87
pancreatic cancer: risk factors
- increasing age - smoking - diabetes - chronic pancreatitis - HNPCC (Lynch Syndrome), MEN, BRCA2, KRAS
88
pancreatic cancer: presenting features
- painless jaundice - cholestatic LFT - palpable gallbladder (Courvoisier's Law) - systemic upset (weight loss, anorexia) - occasionally epigastric +/- back pain - migratory thrombophlebitis
89
pancreatic cancer and cholangiocarcinoma: red flags
painless jaundice
90
pancreatic cancer: first-line investigation
USS CT (double duct sign)
91
pancreatic cancer: management
20% amenable to surgery (Whipple's) Adjuvant chemotherapy Consider ERCP stenting for symptomatic relief

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