Oncology Flashcards
(26 cards)
What are the types of breast cancers?
80% ductal (invasive, in-situ)
15% lobular (invasive, in-situ)
5% other (medullary, mucinous, papillary)
How do you classify breast cancers by histology?
Oestrogen
Progesterone
HER2 (human epidermal growth factor receptor 2) - poorer breast cancer prognosis
Triple negative (none of the above fuel the cancer)
What are some proliferation markers in breast cancer?
Ki67 - useful marker for high levels of proliferation p21 p27 cyclin E cyclin D1
What is treatment for oestrogen receptor positive breast cancer?
Tamoxifen (selective oestrogen receptor modulator) if premenopausal
Aromatase inhibitors if postmenopausal - anastrozole/letrozole
How would you treat HER2 receptor positive breast cancer?
Trastuzumab (Herceptin)
What would a Ki67 + triple negative breast cancer indicate?
Aggressive but sensitive to chemo as Ki67 positive
Whats the staging for breast cancer?
TNM
Tis - in situ carcinoma T1 - tumour <2cm T2 - >2cm <5cm T3 - >5cm T4 of any size with direct extension to chest wall or skin or inflammatory (includes peau d'orange)
N0 - no regional lymph nodes metastasis
N1 - metastasis to ipsilateral axillary nodes
N2 - metastasis to ipsilareral axillary node fixed to one another or to other structures
N3 - metastasis to ipsilateral internal mammary lymph node
M0 - no distant mestast
M1 - metastases present
What is the Nottingham prognostic index?
tumour grade + lymph node status + 0.2 x tumour size (cm)
result between 0 and 7
less than 2.4 = same survival
> 5.4 less than 20% 5 year survival
What’s TNM for lung cancer?
T1 - 3cm surrounded by lung/visceral pleura and not involving main bronchus
T2 - >3cm to 5cm or involvement of main bronchus without carina
T3 - >5 to 7cm
T4 - >7cm
N1 - ipsi peribronchial and/or hilar nodes
N2 - ipsi mediastinal and/or subcarinal
N3 - contralateral mediastinal or hilar
M1 - distant mets
What is tumour lysis syndrome? What is the electrolyte affects?
abrupt release of large quantities of cellular components into the blood following rapid lysis of malignant cells
Proteins released - hyperuricaemia
Electrolytes more concentrated in cells are released - Phos and Potassium increase
Hypocalcaemia
*causes acute renal failure
Who is at risk of tumour lysis?
Large tumour bulk
More chemosensitive cancers
Leukaemias and lymphomas
Poor renal function
Presentation of tumour lysis syndrome?
Weakness
Paralytic ileus - constip, vomiting abdo pain
Arrythmias - palpitations, chest pain , collapse
Acute kidney injury - reduced urine output, lethargy, nausea
Prevention for tumour lysis?
Treatment?
IV fluids
Rasburicase - oxidation of uric acid
Allopurional - blocks conversion of xanthines to uric acid
Vigorous hydration
Correct hyperkalaemia
- calcium gluconate
- insulin and glucose
- salbutamol nebPhosphate binders
IF above fails dialyse
What is neutropenic sepsis?
Neutropenia and a fever of >38 OR sign or symptoms suggestive of sepsis
Neutropenia - neuts <1
Nice guidance <0.5
Who’s at risk of neutropenic sepsis?
current or recent anticancer treatment
most commonly chemo for blood cancers
but also lung, breast, ovarian, colorectal
Management of neutropenic sepsis?
FBC
Identify source or pathogen - CXR, urine MC+S, blood culture
Treatment of neutropenic sepsis?
ABCDE
Sepsis six
Immediate commencement - piperacillin with tazobactam
some will add gentamicin
*fluroquinolone could be used as prophylaxis
Presentation of spinal cord compression ?
radicular pain
difficulty walking
bowel or bladder dysfunction
LMN signs at level of lesion, UMN signs below the level
Management of SCC because of malignancy?
Analgesia + High dose corticosteroids
urgent surgical decompression
radiotherapy
chemotherapy
hormone deprivation (prostate)
VTE prophylaxis
Pressure sore prevention
bisphos
looking after bowel and bladder
What can cause SVC obstruction? presentation?
bronchogenic carcinoma
lymphoma
dyspnoea, chest pain, neck, face and arm swelling, stuffiness, dizziness, syncope
-oedema of upper body, face and extremities, severe repiratory distress, engorged conjunctiva
Management of SVC obstruction?
Head up, oxygen, corticosteroids
radiotherapy or chemo
anticoag
surgical stenting
What screening programmes are there?
Breast
Colon
Cervical
What is the breast cancer screening programme?
mammography
47-73 - every 3 years
Aims to identify calcified ductal carcinoma in-situ
IF POSITIVE - triple assessment including radiologically guided biopsy, clinical exam, USS ( if younger than 35, cos breast too dense)
What is the colon cancer screening programme?
Faecal occult blood now called faecal immunochemical test
age 50 - 74 every 2 years
if positive send for colonoscopy
