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Year 4 Cancer Studies > Peer Share > Flashcards

Peer Share Flashcards

1
Q

ca125

A

ovarian

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2
Q

ca19-9

A

pancreatic

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3
Q

ca15-3

A

breast

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4
Q

PSA

A

prostate

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5
Q

CEA

A

bowel

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6
Q

AFP

A

NSGCT (yolk sac/teratocarcinoma)
hepatocellular

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7
Q

HCG

A

germ celltumours (seminomas, NSGCT)

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8
Q

calcitonin

A

medullary thyroid cancer

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9
Q

tumour markers

A

CA125 = ovarian
CA19-9 = pancreatic
CA15-3 = breast
PSA = prostate
CEA = bowel
AFP = NSCGT (yolk-sac/teratocarcinoma) and hepatocellular
HCG = germ cell tumours (seminomas?NSCGT)
calcitonin = medullary thyroid cancer

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10
Q

def: radical

A

curative

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11
Q

def: neoadjuvant

A

before primary treatment to shrink tumour

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12
Q

def: adjuvant

A

after treatment to destroy remaining cells and reduce liklihood of recurrence

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13
Q

def: palliative

A

aims to extend life and control pain but will not cure

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14
Q

ECOG performance scoring

A

0 = fully active, able to carry on all pre-disease performance without restriction
1 = restricted in physcially strenuous activity but ambulatory and able to carry out work of light or sedentary nature (e.g light house work/office work)
2 = ambulatory and capable of all selfcare but anuable to carry out any work activities; up and about more than 50% of waking hours
3 = capable of only limited selfcare; confined to bed or chair more than 50% of waking hours
4 = completely disabled; cannot carry on any selfcare; totally confined to bef or chair
5 = dead

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15
Q

def: radiotherapy

A
  • ionising radiation daages DNA
  • cancer cells have poorer repair mechanisms than healthy cells
  • results in increased cancer cell death
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16
Q

uses: radiotherapy

A

radical
neo-adjuvant
adjuvant
palliative

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17
Q

types: radiotherapy

A

extrenal beam = traditional rtx
brachytherapy = radioactive beads placed into tumour e/g prostate cancer
SABR = stereotactic ablative rtx (CT guided) giving higher doses in fewer fractions

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18
Q

def: Gy rtx

A

gray = the dose

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19
Q

def: Fr rtx

A

fraction = number of sessions dose is delivered over

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20
Q

advantages and disadvantages compared to surgery: rtx

A

adv:
1. no GA
2. less painful
3. treat tumour margin

dis:
1. less staging information
2. greater risk secondary mallignancy
3. less psychological benefit

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21
Q

short term SEs: rtx

A

SHORT TERM INFALMMATION
* fatigue
* nausea
* heair loss
* hoarseness
* pain/discomfort
* skin reactions: dry desquamation (skin not boken) and wet (skin broken - infection risk)
* mucositis: dysphagia/weight loss/altered bowel habit/urinary symptoms

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22
Q

late/long-term SEs rtx

A

LONG TERM FIBROSIS/SCARRING
* fatigue
* pain
* altered bowel habit
* urinary discomfort/cystitis
* dry mouth
* dry cough (pneumonitis)
* infertility
* seconday cancers
* cardiac toxicity
* skin reactions: pigmentation/talangectasia/atrophy/ulceration/permanent hair loss)

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23
Q

def: SACT

A

systemic anti-cancer therapy
1. chemotherapy
2. hormonal
3. targeted
4. biologic

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24
Q

def: chemotheraoy (cytotoxic)

A

targets DNA of cells

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25
Q

def: hormonal therapy

A

exploits oestrogen/androgen involvement

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26
Q

def: targeted therapy

A

inibits molecular pathways needed for tumour growth e.g herceptin (breast cancer)

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27
Q

def: biologic therapy

A

stimulates host response to aid tumour cell destruction

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28
Q

hormonal therapy: examples

A

tamoxifen (breast cancer)
LHRHs e.g goserelin (prostate cancer)

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29
Q

SEs: targeted therapy

A

menstrual distrubance, hot flushes, VTE and endometrial cancer

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30
Q

NB: lines for chemo treatment

A

PICC lines cannot be inserted on same side as mastectomy with lymph node clearance
if bilateral mastectomy must have centrally inserted CVC

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31
Q

def: chemotherapy

A

targets rapidly dividing cells DNA

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32
Q

reducing toxicity: chemotherapy

A

using different chemos with different MOAs reduces toxicity

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33
Q

SEs: chemotherapy

A

targets other rapidly diving cells: hair follicles/GIT cells causing change in bowel habit/ bone marrow cells (anaemia/thrombocytopenia/pancytopenia

  • general fatigue
  • N+V
  • thrombosis
  • peripheral neuropathy
  • infertility
  • hypersensitivity reactions
  • organ toxicity
  • palmar-plantar erythema (emollients rx)
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34
Q

extravasation: chemotherapy

A

leakage of fluids/medication from vein can causer tissure damage and necrosis
PICC line reduces risk

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35
Q

breast: screening

A

3 yearly mammogram from 50-70

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36
Q

RFs: breast

A

lifestyle - sedentary, high fat diet, smoking, BMI
genetic - BRCA1/2, fhx breast/ovarian ca
hormonal - nulliparity/ early menarche/ late menopause/ HRT (increased unopposed oestrogen)
ionising radiation

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37
Q

red flag 2 week referral criteria: breast

A

> =30 with unexplained breast lump
=50 unilateral nipple discharge or retraction

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38
Q

consider red flag: breast

A

skin changes suggesting breast cancer
>=30 unexplained axillary lump

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39
Q

non-urgent referral: breast

A

<30 uneplained breast lump

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40
Q

triple assessment: breast

A
  1. examination
  2. imaging (mammogram +/- USS)
  3. biopsy (FNA/core)
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41
Q

mammograms in younger patients

A

not as useful in younger women due to increased fibrous tissue and less fat

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42
Q

TNM staging: breast

A

T:
T1 - <2cm
T2 - 3-5cm
T3 - >5cm
T4a - chest wall
T4b - skin
T4c - both chest wall and skin
T4d - inflammatory

N:
N0 = no nodes
N1 = 1-3 nodes
N2 = 4-9 nodes
N3 = >10 nodes

M:
M0 = no mets
M1 - mets

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43
Q

staging scans: breast

A

isotope bone scan and CT abdo/thorax

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44
Q

primary surgical management: breast

A

1st line in breast cancer
CI’d - M1, T4 and unfit for surgery pts
WLE: solitary, peripheral, small lesion
mastectomy: multifocal, central, large lesion
axillary node clearance: palpable/USS +ve, SLNB indicated
if >1 node +ve on SLNB or N1-3 clinically

45
Q

indication for WLE v mastectomy: breast

A

WLE - solitary, peripheral, small lesion
mastectomy - multifocal, large, central lesion

46
Q

SE axillary node clearance: breast

A
  • lymphadenopathy
  • functional arm impairment
47
Q

adjuvant radiotherapy: breast

A
  • almost always indicated
  • whole breat RT after WLE
  • tumur bed boost: >=50, triple -ve, high grade, close margins
  • chest wall RT after mastectomy and T>=3 or N>=2
  • supraclavicular fossa >=N2
48
Q

indications chest wall RT: breast

A

after mastectomy and T>=3 or N>=2

49
Q

chemotherapy: breast

A
  • neoadjuvant to shrink tumour
  • adjuvant -ve, 2-5% risk: oncotype DX analysis
  • node -ve, >5% risk = FEC chemo
  • node +ve = FEC-docetaxel chemo
50
Q

adjuvant SACT: breast

A

hormonal in ER or PR +ve for 5-10 years
pre-menopausal/perimenopausal = tamoxifen
postmenopausal = anastrazole (risk of OP)

targeted in HER2 +ve for 1 year
node -ve = trastuzumab (herceptin)
node +ve trastuzumad and pertuzumab

51
Q

ER or PR +ve breast:

A

hormonal SACT pre/perimenopausal = tamoxifen
postmenopausal = anastrazole
for 5-10 years

52
Q

HER 2 +ve: breast

A

targeted SACT
node -ve = trastuzumab (herceptin)
node +ve = trastuzumab (herceptin) and pertuzumab
for 1 year

53
Q

primary SACT: breast

A

only if surgery CI’d
hormonal/targeted/chemotherapy

54
Q

RFs: colorectal cancer

A
  • age
  • genetics/fhx - lynch syndrome (HPCC), FAP
  • lifestyle - obesity, diet/smoking/alcohol/sedentary
  • large polyp
  • pelvic RT
55
Q

red flag 2 week wait referral criteria: colorectal

A

> = 40 with weight loss + abdo pain
= 50 with rectal bleeding
=60 with iron deficiency anaemia or altered bowel habit
positive FOB/qFIT

56
Q

consider red flag criteria: colorectal

A

rectal or abdominal mass
<50 with rectal bleeding AND
* abdo pain
* altered bowel habit
* weight loss
* iron-deficiency anaemia

57
Q

offer QFIT: colorectal cancer

A

> =50 abdominal pain or weight loss
<60 changes to bowel habit or iron deficiency anaemia
>=60+ no iron deficiency

58
Q

investigations: colorectal

A

1st line = colonoscopy (CT colonogram if frail/intolerant/co-morbidities)
CEA: NOT for screening - only used after diagnosis

59
Q

ix mets: colorectal

A

CT
CT PET
if rectal: MRI rectum and endoanal USS

60
Q

TNM: colorectal

A

T:
T1 - through mucosa into submucosa
T2 - through submucosa into muscularis proproa
T3 - through muscularis propria to subserosa
T4 - through intestinal wall and into adjacent organs

N:
N0 - no nodes
N1 - 1-3 nodes
N2 - 4+ nodes

M:
M0 - no mets
M1 - mets

61
Q

staging: colorectal

A

stage 1 - <=T2 + N0 + M0
stage 2 - T3 or T4 + N0 + M0
stage 3 - any T + N1 or N2 + M0
stage 4 - M1

62
Q

management: colorectal

A

stage 1 - surery alone
stage 2 - surgery + clinical trial
stage 3 - surgery + chemo
stage 4 - palliative surgery/chemo

63
Q

referral criteria: prostate

A
  • raised PSA >4
  • abnormal prostate on DRE
64
Q

ix: prostate cancer

A
  1. multiparametric MRI - results using 5-point LIKERT scale influence decision to biopsy
  2. biopsy (for Gleason) if LIKERT 3+ TRUS or transperineal biopsy if LIKERT 1 or 2 (low risk)
  3. isotope bone scan
65
Q

Gleason score: prostate

A

1 = undifferentiated cells (not cancerous)
3 = cells turn cancerous
5 = undifferntiated cells

2 numbers used and most dominant cell comes first
6 = benign, 10 = highly malignant
group 1 <=6
group 2 3+4 = 7
group 3 4+3 = 7
group 4 = 8
group 5 9+

https://www.youtube.com/watch?v=T19xd3AalPs

66
Q

T stage: prostate

A

T1 - invisible
T2 - confined to prostate (a - <1/2 lobe, b >1/2 lobe, c both)
T3 - extends through capsule
T4 - extends to other structures (excluding seminal vesicles)

67
Q

prognosis and management: prostate

A

see table

68
Q

prognosis and management: prostate

A

see table

69
Q

adv and dis: prostate management

A

surgery:
ad = psych benefit and histology
dis = GA, incontinence, ED, bowel perforation

brachytherapy:
ad = fast recovery, further rx, less ED
dis = urinary obstruction and GA

external RT
ad = no GA, less ED/urinary SE
dis = proctitis and secondary malignancy

70
Q

metastatic management: prostate

A

hormonal therapy:
LHRH (GnRH agonists) - gosereline and deslorelin
anti-androgens - abiraterone and bicalutamide

chemo - docetaxel

bone targeted therapy - zolendronic acid/radium

RT/SABR for mets

71
Q

signs: spinal cord compression

A

LOCAL BACK PAIN AND TENDERNESS
* exacerbated by coughing/sneezing/straining/lying flat
* uncontrolled by analgesia

NEUROLOGICAL PROBLEMS (ADVANCING)
* bladder dysfunction (retention/dribbling/incontinence)
* bowel dysfx (incontinence/constipation)
* weakness i arms/legs
* hypothesia (numbness)

CAUDA EQUINA (below L1/2)
* sciatic pain (usulally bilateral)
* impotence
* baldder dysfx
* sacral aesthesia
* loss of sphincter tone
* weakness/wasting of gluteal muscles

BILATERAL MOTOR NEURONE SIGNS

GIBBUS - swelling sue to spinal angulation caused by vertebral collapse

72
Q

bony mets: SCC

A

breast
lung
prostate
multiple myeloma

73
Q

ix: SCC

A

neurological exam
MRI whole spine gold standard
can do XR spine

74
Q

rx: SCC

A
  • medical emergency
  • IMMEDIATE DEXAMETHASONE 8m PO/IV BD
  • PPI and aanalgesia

definitive management:
1. surgical decompression - gold standard (CI: unfit or complete paraplegia for >24hrs + pain well controlled)
2. radiotherapy in radiosensitive tumours - can make worse before better so give prophylactic dexamethasone
3. bisphosphonates if breast, prostate or myeloma

75
Q

outcomes: SCC

A

strongly dependent on level of neruological dysfunction
approx 30% survive for 1 year
may have irreversible paraplegia/quadriplegia or loss of bladder/bowel fx if late diagnosis

76
Q

symptoms: SVCO

A

gradual onset with symptoms worsening with bending over or lying down
* dyspnoea
* swelling of face/neck/arms
* cough
* headache
* visual disturbance
* dizziness
* syncope
* chest pain
* hoarseness
* nasal congestion
* epistacis
* haemoptysis

77
Q

pembertons test: SVCO

A

raising arms over head for 1 minute will cause
facial plethora and cyanosis

78
Q

signs: SVCO

A
  • dyspnoea
  • orthopnoea
  • facial plethora
  • dilated/engorged veins
    Pemberton’s test- where lifting the arms over the head for more than 1 minute will precipitate facial plethora and cyanosis.
79
Q

causes: SVCO

A

usually lung cancers
ymphoma 2nd most common

80
Q

ix: SVCO

A
  • CXR - right para-tracheal mass, mediastinal lymphadenopathy

CT chest gold standard diagnosis (contrast enhanced)
defines level and degree of venous blockage
identifies cause and staging

81
Q

rx: SVCO

A
  • ABCDE, high flow oxygen
  • dexamethasone 8mg PO/IV BD with PPI
  • tissue diagnosis
  • stenting - indicated for thrombua and is bridge to chemo/radiotherapy while awaiting histo
  • chemotherapy (small cell/lymphoma/germ cell)
  • radiotherapy - poor performance status, previous chemo or relapse)
82
Q

oucome: SVCO

A

prognosis dependent on underlying condition and extent of obstruction

  • if untreated survival time = 30 days
  • XRT tx - at least 30 months in 45% lymphoma and 10% lung
83
Q

causes: raised ICP

A

SOL - primary brain tumour/brain mets/abscess/haematoma
hydrocephalus - CSF obstruction
benign IC hypertension

84
Q

ix: raised ICP

A
  • full clinical examination
  • FBC, U+E, LFT and tumour markers
  • contrast enhanced CT
  • MRI if CT still ?
85
Q

common tumours that met to brain: raised ICP

A
  • lung cancer most common
  • breast cancer
  • melanoma
86
Q

symptoms and signs: brain mets

A

PAPILLOEDEMA
* headache (early symptoms - worse in AM and when coughing/sneezing)
* nausea and vomiting (AM)
* cognitive impairment
* drowsiness
* seizures
* behavioural changes
* focal neurological changes
* altered gait

87
Q

rx: brain mets

A

DEXAMETHASONE 8mg PO/IV BD with PPI
further - surgery or whole brain RT

PATIENTS CANNOT DRIVE AND MUST INFORM DVLA

88
Q

outcomes: brain mets

A
  • high morbidity
  • dependent on primary tumour
  • median survival without treatment is 1 month
89
Q

most common cancers: hypercalcaemia

A
  • breast
  • lung
  • head and neck
  • renal
  • lymphoma
  • multiple myeloma
90
Q

symptoms: hypercalcaemia

A

dehydration is most common finding
usually when >3.0mmol/L
bones, stones, thrones, abdominal groans and psychaitric moans
* bone pain
* stones
* polyuria and polydipsia
* N+V
* fatigue, malaise and weakness
* confusion

above 3.5mmol/Lconfusion, drowsiness and death

91
Q

causes: hypercalcaemia

A
  • bone metastases
  • increased PTH protein - occurs in SCC, breast, porstate, renal, kmelanoma and neuroendocrine cancers (80%)
  • calcitriol secretion from tumour
92
Q

ix: hypercalcaemia

A

bloods - FBC, U+E, LFT, CRP, glucose, PTH, alk phos
12 lead ECG - shortened qT, severe hypercalcaemia = widerend T waves
CXR if underlying cause unknown

93
Q

rx: hypercalcaemia

A
  • immediate rehydration (IV 0.9% NaCL) - 4 to 6L in 24 hours
  • IV bisphosphonate - zolendronic acid 4mg IV given after 24 hrs (moves calcium back into bones)
  • discontinue thiazide diuretics/Ca/vit D supplements
94
Q

outcomes: hypercalcaemia

A

poor prognosis if severe

95
Q

def: thrombocytopenia

A

when chemo suppresses bone marrow
spontaneous bleeding likely when platelets <20x10^9L-1

96
Q

symtpoms: thrombocytopenia

A
  • malaise
  • fatigue
  • general weakness
  • unexplained bleeding - epistaxis, gum bleeding
97
Q

signs: thrombocytopenia

A

bruising
purpura
petechial rash

98
Q

ix: thrombocytopenia

A

FBC (low plt, ?anaemia)
LFT, U+E (high urea ?upper GI bleed), coag screen
vit B12 and folic acid

99
Q

rx: thrombocytopenia

A
  • group and crossmatch
  • arrange platelet Plt <10x10^9 or Plt <20x10^9 if active sepsis/bleeding
100
Q

clinical triad: PE

A

SOB, pleuritic chest pain and haemoptysis

101
Q

symptoms: PE

A
  • triad - SOB, pleuritic chest pain and haemoptysis
  • tachycardia - most common
  • cough
  • raised JVP
  • cyanosis
  • check for DVT
102
Q

ix: PE

A
  • 2-level wells score
  • rotuine bloods, D-dmier, ABG, troponin, BNP
  • CTPA
  • CXR, ECG
103
Q

rx: PE

A

A-E
anticoagulation - DOAC or LMWH if on chemo
thrombolysis if SBP <90mmHg

104
Q

complications: PE

A

development of chronic thromboembolic HTN can lead to RSHF

105
Q

def: TLS

A

caused by destruction of lage number of cancer cells
results in electrolyte abnormalities and renal failure
most common in leukaemia and lymphoma
hyperkalaemia
hyperphosphataemia
hypocalcaemia
high uric acid

106
Q

symptoms: TLS

A
  • fatigue
  • N+V
  • SOB
  • myalgia
  • syncope
  • tetany
  • seizures
  • dark urine
  • arrhythmias
  • HF
107
Q

ix: TLS

A
  • hyperphosphataemia
  • hyperkalaemia
  • hyperuricaemia
  • hypocalcaemia
  • lactic acidosis
  • raised serum LDH
108
Q

rx: TLS

A
  • A-E assesssment
  • IV fluids
  • rasburicase - clears uric acid from blood
  • hyperkalaemia kit
  • haemodialysis if required
109
Q

prophylaxis: TLS

A

allopurinol
adequate hydration

Year 4 Cancer Studies (1 decks)

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