Screening & cancers

Question 1

What is screening?

Answer 1

Identifying apparently healthy people at increased risk of a disease/condition
-never 100% sensitive or specific

Question 2

What are the Wilson and Jungner criteria?

Answer 2

Principles for screening programmes;

• disease sufficiently common
• natural history known
• early treatment beneficial
• diagnostic confirmatory test
• acceptable & affordable

Question 3

How are neonates screened in the UK?

Answer 3

All babies tested between 5-8 days

- 3mm dry blood samples

Question 4

What is included in the current UK programme for screening babies?

Answer 4

PKU
Congenital hypothyroidism
Sickle cell & Hb disorders
CF
MCADD
New; MSUD, IVA, GA1, homocystinuria

Question 5

What does phenylketonuria cause if untreated?

Answer 5

Severe mental retardation
Seizures
Eczema
-prognosis good if treated early

Question 6

What does congenital hypothyroidism cause if untreated?

Answer 6

Severe developmental delay

Question 7

What does sickle cell disease cause if untreated?

Answer 7

20% die within 2 years

-acute infection, stroke, splenic sequestration, etc.

Question 8

What is the treatment if babies are diagnosed with sickle cell disease?

Answer 8

Prophylactic penicillin initiated

Question 9

Who is screened for breast cancer and how often?

Answer 9

50-70 year olds

-3 yearly mammography

Question 10

What is the ‘triple assessment’ for breast cancer screening?

Answer 10

RADIOGRAPHY - mammography, ultrasound, MRI
CLINICAL ASSESSMENT
PATHOLOGY - biopsy

Question 11

What do most breast tumours arise from?

Answer 11

The epithelium

Question 12

What is LCIS?

Breast cancer

Answer 12

Lobular Carcinoma In-Situ

-often picked up accidently

Question 13

What is DCIS?

Breast cancer

Answer 13

Ductal Carcinoma In-Situ

-often calcifies & picked up on x-ray

Question 14

What is the most common type of breast cancer?

Answer 14

Invasive ductal carcinoma

Question 15

How does breast cancer typically spread?

Answer 15

Lymphatic channels

Question 16

What is typically the 1st lymph node bed for breast tumours?

Answer 16

The axilla (sentinel node)

Question 17

Where do soft tissue tumours occur?

Answer 17

Connective tissue, muscle, fat, blood vessels, etc.

Question 18

What are the commonest sites of malignant soft tissue tumours? (2)

Answer 18

Thigh and retroperitoneum

Question 19

What are the clinical clues for soft tissue tumours?

Answer 19

Painful lumps
Deep to fascia
>5cm & enlarging

Question 20

What does “oma” suggest?

Answer 20

Benign tumour

Question 21

What does “sarcoma” suggest?

Answer 21

Malignant tumour

Question 22

What is the possible diagnosis for small round blue cell tumour?

Answer 22

Sarcoma (eg. Ewing’s)
Carcinoma
Germ cell tumour
Lymphoma

Question 23

What are the features of a malignant tumour?

Answer 23

Metastases
Necrosis
Abnormal mitoses
Cytological atypia

Question 24

What is the general prognosis for sarcomas?

Answer 24

50% alive at 5 years

Question 25

What is a GI stromal tumour (GIST)?

Answer 25

Tumour of smooth muscle of bowel wall - involves cell membrane receptor CD117 - treated with Imatinib

Question 26

What is the most fatal malignancy in men?

Answer 26

Lung cancer (8%)

Question 27

How many deaths does lung cancer cause per year?

Answer 27

35,000

Question 28

What are the 2 histological types of lung cancer?

Answer 28

- Non-small cell carcinomas (NSCLC) | - Small cell carcinoma (SCLC)

Question 29

What is the normal bronchus lined with?

Answer 29

Pseudostratified collumnar epithelium. | with ciliated and mucous cells

Question 30

What metaplastic change occurs in the bronchus lining?

Answer 30

Pseudostratified collumnar epithelium >> stratified squamous (METAPLASIA) -may >> irreversible change to neoplastic cell that proliferates more successfully (DYSPLASIA)

Question 31

His lung cancer diagnosed?

Answer 31

- Bronchial brushing - Bronchoscopy - Fine needle aspiration - Sputum - Biopsy

Question 32

What are the main types of non-small cell carcinomas? (3)

Answer 32

- Squamous carcinoma - Adenocarcinoma - Undifferentiated large cell carcinoma

Question 33

What are the main stages of lung cancer development?

Answer 33

Bronchial epithelium >> squamous metaplasia >> dysplasia

Question 34

How does NSCLC squamous carcinoma produce distant metastases?

Answer 34

Neoplastic cells breach basement membrane >>invasive squamous carcinoma >> infiltrates lymphatic and blood vessels >>distant metastases

Question 35

What are the main features of NSCLC squamous carcinoma?

Answer 35

- Resembles squamous epithelium - Desmosomes link cells - ~90% in smokers - More central than peripheral - Hypercalcaemia

Question 36

What causes hypercalcaemia in squamous lung carcinoma?

Answer 36

Parathyroid hormone related peptide.

Question 37

What are the main feature of NSCLC adenocarcinoma?

Answer 37

- Glandular cells - ~80% in smokers - Atypical alveolar cell hyperplasia

Question 38

What are the main features of SCLC?

Answer 38

- Most malignant (lung tumours) - Neurosecretory granules with peptide hormones (e.g. ACTH) - ~99% in smokers - May have metastases before presentation

Question 39

What are paraneoplastic syndromes?

Answer 39

Rare disorders triggered by an altered immune system response to a neoplasm.

Question 40

What are common presenting features linked to primary lung tumours? (4)

Answer 40

- Cough - Haemoptysis - SOB - Chest pain

Question 41

What are common presenting features linked to secondary lung tumours? (4)

Answer 41

- Lumps - Neurological signs - SVCO (sup vena cava obstruction) - Heart failure

Question 42

What are common presenting features linked to systemic lung tumours? (3)

Answer 42

- Weight loss - Hypercalcaemia - Paraneoplastic

Question 43

What investigations are carried out for suspected lung cancer? (5)

Answer 43

- CXR - Blood tests - CT - Bronchoscopy - Biopsy

Question 44

How is lung cancer treated? (4)

Answer 44

- Surgery - Chemotherapy - Radiotherapy - Supportive care

Question 45

What is the prognosis for lung cancer?

Answer 45

Poor prognosis. | -usually inoperable due to late presentation