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Solid Cancers Flashcards

1
Q

What are some inherited causes of colon cancer?

A

Familial Adenomatous Polyposis (FAP)
Hereditary Nonpolyposis Colorectal cancer
Familial Colorectal cancer

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2
Q

What are some lifestyle factors that increase the risk of colon cancer?

A

Low fibre high fat diet with red/processed meat
Obesity
Cigarette smoking
Alcohol

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3
Q

What can be protective against developing Colon cancer?

A

Exercise

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4
Q

What are some symptoms of a Rt sided Colon cancer?

A

Weight loss
Weakness
Obstruction
Iron Deficiency

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5
Q

What are some symptoms of a Lt sided Colon cancer?

A 
Constipation
Abdominal pain
Reduced stool calibre
Alternating bowel habit
Rectal bleeding
Large Bowel Obstruction
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6
Q

What are some symptoms of a Colon cancer in the rectum?

A

Obstruction
Tenesmus
Bleeding
Palpable PR Mass

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7
Q

When are patients invited for Bowel Cancer screening?

A

60-74y they are invited every 2y

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8
Q

What does Bowel Cancer screening detect?

A

Presence of Fecal Occult Blood via FIT test

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9
Q

If initial Bowel Cancer screening is positive, what is the next step?

A

Patient is referred for Colonoscopy

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10
Q

What are some appropriate investigations for suspected Bowel Cancer?

A

Baseline Bloods
Colonoscopy/Flexible Sigmoidoscopy
CT Colon
Biopsy

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11
Q

Which tumour marker is specific for bowel cancer?

A

Carcinoembryonic antigen (CEA)

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12
Q

Which staging system is used to stage colon cancer?

A

Dukes Staging

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13
Q

What is Dukes stage 0?

A

Cancer cells are only within the mucosa of the colon/rectum

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14
Q

What is Dukes stage A?

A

Cancer has invaded the muscular layer, with no further spread

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15
Q

What is Dukes stage B?

A

The cancer has invaded the muscular layer with localised spread

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16
Q

What is Dukes stage C?

A

The cancer has spread to regional lymph nodes, with no distant metastases

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17
Q

What is Dukes stage D?

A

Cancer has spread to distant metastases

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18
Q

What are some potential surgical procedures performed in Colon cancer?

A

Rt or Lt Hemicolectomy

Anterior resection

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19
Q

Which Chemotherapeutic agents can be used for Colon Cancer?

A

5-Fluororacil

Capecitabine

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20
Q

Which immunotherapy agent is often used in Colon cancer?

A

Cetuximab

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21
Q

What are some risk factors for development of Lung Cancer?

A 
Large number of Pack Years
TB
COPD
Previous Radiotherapy
Pulmonary Fibrosis
HIV
Airflow obstruction
Increasing age
FHx
Carcinogen exposure - Asbestos
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22
Q

What are some symptoms of Lung Cancer?

A 
Cough
Haemoptysis
Dyspnoea
Chest Pain
Recurrent Chest Infections
Weight loss
Anorexia
Fatigue
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23
Q

What are some clinical signs that may be present with Lung Cancer?

A 
Cachexia
Clubbing
Anaemia
Lymphadenopathy
SVCO
Horners
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24
Q

Which investigations are appropriate with suspected Lung Cancer?

A

Bloods - FBC, U&E, Calcium, LFTs, INR
CXR and Staging CT
PET
Histology + Biopsy

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25
Which tumour markers may be present with a lung cancer?
``` CEA Ca19.9 Ca125 PSA Alpha-Fetoprotein Beta-hCG ```
26
When should a patient be referred for investigations via 2WW for suspected lung cancer?
CXR Findings suggestive of Lung Ca or Age >40 with Haemoptysis
27
How is Lung Cancer staged?
TNM
28
Grossly, how is lung cancer classified?
Small Cell | Non-Small Cell
29
What are some subtypes of Non-Small Cell lung cancer?
Adenocarcinoma Squamous cell Large Cell +/- neuroendocrine features Adenosquamous
30
Which Lung Cancer is particularly chemosensitive?
Small Cell
31
Which Chemotherapeutic agents are often used with Lugn Cancers?
Cisplatin Gemcitabine Docetaxel
32
Which Biological agent can be used with Lung Cancer?
Pembrolizumab
33
Which performance scale can be used to quantify patient function with lung cancer?
WHO Performance Scale
34
How would a patient present if they are WHO Performance Scale 0?
Normal, fully active without any restriction of activities
35
How would a patient present if they are WHO Performance Scale 1?
Restricted in physically strenuous activity, but ambulatory and able to carry out light work
36
How would a patient present if they are WHO Performance Scale 2?
Ambulatory and Capable of self-care, unable to carry out any work. Up and about for more than 50% of the day
37
How would a patient present if they are WHO Performance Scale 3?
Capable of limited self-care, confined to bed/chair more than 50% of the time.
38
How would a patient present if they are WHO Performance Scale 4?
Completely disabled, cannot self-care
39
How would a patient present if they are WHO Performance Scale 5?
Dead
40
When are men commonly affected by Prostate Cancer?
>65Y
41
Which cell type are the majority of Prostate cancers?
Adenocarcinoma
42
Where in the Prostate do Prostate Cancers originate?
``` Peripheral Zone (75%) Transitional Zone (20%) Central Zone (5%) ```
43
Histologically, how can Prostate Cancer be defined?
Acinar Adenocarcinoma | Ductal Adenocarcinoma
44
In Prostate Cancer, where do Acinar Adenocarcinomas originate?
Glandular cells within the Prostate gland
45
In Prostate Cancer, where do Ductal Adenocarcinomas originate?
Cells lining the duct of the Prostate
46
What are some risk factors for development of Prostate Cancer?
``` Age Ethnicity - Black African/Carribean FHx BRCA1/2 Mutations Obesity DM Smoking ```
47
What are some clinical features suggestive of Prostate Cancer?
LUTS - Weak Stream, Increased Frequency, Urgency
48
What are some clinical features suggestive of advanced Prostate Cancer?
``` Haematuria Dysuria Incontinence Haematospermia Suprapubic Pain Loin Pain Rectal Tenderness ```
49
What are some clinical features suggestive of metastatic Prostate Cancer?
Bone Pain Lethargy Anorexia Unexplained weight loss
50
Which blood marker can be used to monitor Prostate Cancer?
PSA
51
Other than cancer, which other conditions can lead to elevations of PSA?
``` BPH Prostatitis Vigorous Exercise Ejaculation Recent DRE ```
52
Which Biopsies can be performed for suspected Prostate Cancer?
Transperineal Biopsy - Under GA, low infection risk | Transrectal US Biopsy (TRUS) - Under local
53
How is Prostate Cancer graded?
Gleason Grading
54
How does Gleason Grading for Prostate Cancer work?
Macroscopic examination of differentiation of cells from 2 different samples are then assigned a score
55
Which Gleason Score is associated with the best outcome?
Gleason 3+3 = Gleason 6
56
How can Low-Risk Prostate Cancer (Gleason 6) be managed?
Active Surveillance
57
How can intermediate/high-risk Prostate Cancer (Gleason 7 or higher) be managed?
Radical Treatment
58
How should metastatic Prostate Cancer be managed?
Chemotherapy +/- Hormonal Agents
59
What surgical options are available for Prostate Cancer management?
Radical Prostatectomy | Brachytherapy
60
What is Brachytherapy?
Transperineal implantation of radioactive seeds into the prostate
61
What is Watchful Waiting in relation to Prostate Cancer?
A symptom-guided approach to Prostate Ca management - Focus on symptom control and QoL. Reserved for older patients with lower life expectancy
62
What is Active Surveillance for Prostate cancer?
Monitoring of disease offered to select patients with low/intermediate risk disease
63
Which monitoring is appropriate for active surveillance of Prostate Cancer?
3/12 PSA 6-12/12 DRE Frequent Biopsy
64
How can invasive carcinomas of Breast be classified?
Invasive Ductal Carcinoma - Most common Invasive Lobular Carcinoma - More common in older women Others
65
What are some risk factors for development of Breast Cancer?
``` Female Sex Age BRCA1/2 Mutations FHx in first degree relative Previous Benign Disease Obesity Alcohol consumption Exposure to Unopposed Oestrogen ```
66
How may Breast Cancer present?
``` Asymptomatic - Detected via screening Symptomatic: Breast Lumps Asymmetry Swelling Abnormal Nipple Discharge Nipple Retraction Skin Changes - Peau d'orange Mastalgia Palpable Axillary Lump ```
67
With suspected Breast Cancer, what assessments does a Triple Assessment involve?
Examination Imaging Histology or Cytology
68
How is prognosis predicted with confirmed Breast Cancer?
Nottingham Prognostic Index
69
When are women offered screening for Breast Cancer?
Every 3y between ages of 50-70
70
What is Pagets disease of the Nipple?
Roughening, reddening and ulceration of the nipple usually secondary to Neoplasm
71
What are some clinical features of Pagets disease of the Nipple?
Itching/Redness of Areola +/- Nipple Flaking and Thickened Skin on/around Nipple Pain Sensitivity
72
How can Pagets disease of the Nipple be managed?
Surgical removal of nipple and areola | Radiotherapy if underlying malignancy
73
What is Breast Carcinoma in Situ?
A malignancy that is contained within the basement membrane, and is a pre-malignant condition
74
What is a Ductal Carcinoma in Situ?
Malignancy of ductal tissue that is contained within the basement membrane of the breast
75
How should DCIS be managed?
Wide-local excision | Mastectomy if widespread
76
What is Lobular Carcinoma in Situ?
Malignancy of secretory lobules of the breast, usually a pre-menopausal diagnosis
77
What are some surgical options for treatment of breast malignancy?
Wide-Local excision for breast conservation with localised disease Mastectomy - Indicated in multifocal disease Axillary Surgery - To assess for nodal involvement
78
What happens in a Sentinal Node Biopsy?
Removal of the first lymph node a tumour drains into
79
What happens in Axillary Node Clearance?
Removal of all the nodes within the Axilla
80
How does Tamoxifen work?
Blockade of Oestrogen receptors within the tumour
81
What are some example Aromatase Inhibitors?
Anastrazole | Letrozole
82
How do Aromatase inhibitors work?
Bind to oestrogen receptors inhibiting further growth. Advised for adjuvant therapy in Post-Menopausal patients
83
When is immunotherapy used for Breast Cancer?
When cancers express specific growth factors
84
What is a common growth factor expressed by Breast Cancer, and which immunotherapy is used to treat it?
HER2 - Herceptin
85
What is one of the major side-effects of Herceptin?
Risk of Cardiac Toxicity

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