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Cancer Care > Solid Malignancies > Flashcards

Solid Malignancies Flashcards

(44 cards)

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1
Q

H+N Cancers:

A

Increasingly common.
Starts on mucosal surfaces lining the cavities; SCC.
Can affect salivary glands as well.

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2
Q

H+N Cancers signs for 2ww.

A 
Oral cancer:
Lip/oral cavity lump
Oral cavity red+/-white patches consistent with erthryoplakia or erythroleuplakia
Ulceration >3wks
Laryngeal cancer:
Hoarsenss 45+
Persistent/unexplained neck lump 45yrs+
Thyroid cancer:
Thyroid lump
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3
Q

H+N Cancers symptoms:

A

Depends on the location of the tumour.
Involved lymph nodes are noticed first by the pt.
Usually diagnosed at advanced stage.
Difficulty breathing, eating, communicating, etc.

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4
Q

H+N Cancers RF:

A 
Smoking
Spirits (Alcohol)
Sunlight (inc radiation exposure)
Sepsis (chronic)
STI (HPV, HIV)
Spices (betal chewing)
Occupation; wood dust, asbestos, formaldehyde.
EBV
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5
Q

H+N Cancers Investigations:

A 
US and FNA
CT/MRI
Panendoscopy + biopsy EUA
PET 
P16 staining (look for active HPV)
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6
Q

H+N Cancers Management:

A 
MDT involvement to help manage all the symptoms (i.e. many senses involved)- Maxillofacial, dental, dietician, SALT, CNS.
Either radical (definitive, adjuvant, neoadjuvant) or palliative care depending on the pt.
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7
Q

H+N Cancers Management Detail:

A 
Aim to remove the cancer whilst preserving function.
Either:
Single modality of surgery/radiotherapy.
Surgery + adjuvant/neoadjuvant
Radiotherapy +adjuvant chemo.
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8
Q

H+N Cancers Radiotherapy SE:

A 
Dry mouth
Skin reaction
Mucositis
Difficulty swallowing
Osteonecrosis
Secondary cancers
CANNOT SMOKE!!
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9
Q

Lung cancer:

A

Two types:
Small cell cancer- Less common than NSC but common in heavy smokers (SIADH, Lambert Eaton syndrome, ACTH).
Non SC- Squamous cell (PTHrP), adenocarcinoma and large cell carcinoma.

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10
Q

Lung cancer RF:

A

Single most important RF is smoking or second hand smoking. Inhaled carcinogens alter the lung lining, repeated exposure means repair is difficult.
Previous radiotherapy (esp at chest)
Exposure to radon gas
Exposure to asbestos and other carcinogens
Family history of lung cancer

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11
Q

Lung cancer symtoms:

A 
A new cough that doesn't go away
Coughing up blood, even a small amount
Shortness of breath
Chest pain
Hoarseness
Losing weight without trying
Bone pain
Headache
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12
Q

Lung cancer Investigations:

A

CXR/CT
Sputum cytology
Biopsy- via bronchoscopy, mediastinoscopy or fine needle (might take from LN also)
Then stage with CT/MRI/PET

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13
Q

Lung cancer Management:

A 
Surgery +/- (neo)adjuvant radio/chemo. Surgery inc wedge resection, segmental resection, lobectomy or pneumonectomy. 
Radiotherapy
Chemotherapy
Immunotherapy
Targeted drug therapy
Palliative care
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14
Q

Lobar carcinoma in situ (LCIS):

A

This is not a cancer
Increases the risk of breast cancer; therefore need regular observation and preventative either tamoxifen or aromatase inhibitor
Not picked up on mammogram

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15
Q

Breast cancer types:

A

DCI- This is confined to the ductal cells.
IDC- This is spread from the ductal cells, is most common invasive breast cancer (~80%)
ILC- This is less common than IDC for invasive breast cancer (~10%)

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16
Q

Breast cancer signs/symptoms:

A 
A breast lump or thickening 
Change in the size, shape or appearance 
Changes to the skin over the breast
Newly inverted nipple
Peeling, scaling, crusting or flaking of the pigmented area of skin surrounding the nipple (areola) or breast skin
Peau d'orange
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17
Q

Breast cancer RF:

A 
Female
Increasing age
LCIS
Hx of breast cancer 
Current use of HRT
No/few children
Early menarche
Late menopause
FHx
Obesity 
Alcohol consumption
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18
Q

Breast cancer diagnosis:

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A

Triple assessment:
Clinical- Hx + examination
Imaging- Mammogram if >40yrs (caudio-cranial and medio-lateral views), USS if <40yrs.
Biopsy- FNA or core

NB MRI may be used for LCI, dense breasts or to exclude multifocal disease.

19
Q

Breast cancer management:

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A

Surgery-
Breast- Either wide local excision (conserve breast) or mastectomy.
Axilla- Either SLNB or axillary clearance

Radiotherapy:
To the breast after WLE
To the chest wall after mastectomy

Endocrine:
Tamoxifen or aromatase inhibitors (anastrozole)

Biological- Herceptin

20
Q

Breast cancer screening:

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A

47-73 yr olds
If increased risk of breast cancer then screen earlier
Mammogram.
Biopsy/FNA may be needed if mammogram suspicious of cancer.

21
Q

Breast cancer radiotherapy side effects:

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A

Acute- Skin reaction, fatigue, chest wall pain.

Chronic- Fibrosis, atrophy, telangiectasia.

22
Q

Colorectal cancer:

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A

More common cancer and becoming more as a result of lifestyle as opposed to genetics. Begins as a polyp, progressing to adenoma and then carcinoma.

23
Q

Colorectal cancer RF:

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A 
Increasing age
Male
UK, Canada, America, Europe, Australia (Geographic)
Smoking
Alcohol
Western diet
Obesity
FAP (Autosomal dominant)
HNPCC
IBD
Exercise is protective
24
Q

Colorectal cancer symptoms and signs:

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A

Right colon- Least common. Weight loss, weakness and Fe deficiency anaemia.

25
Colorectal cancer investigations:
``` Baseline bloods and tumour marker CEA. Colonoscopy- Gold Standard Flexible sigmoidoscopy Barium enema- apple core appearance. CT Chest Abdo Pelvis ```
26
Colorectal cancer management:
Depends on stage at presentation, where 25% present metastatic. Options include curative; surgery (R/L hemicolectomy, anterior resection) and chemo/radiotherapy or palliative with biologicals and chemo. Chemo- i.e. 5FU ADR- Myelosuppression, mucositis, peripheral neuropathy, N+V, diarrhoea and constipation. Biologicals- Cetuximab or panitumumab. ADR- pruritus, skin toxicity (dry/acne), hair growth disorders, fatigue.
27
Long term effects of treatment (bowel cancer):
``` As a result of treatment. Sexual difficulties Pain Fatigue Financial/job worries Mental health Anxiety Urological symptoms Chemo side effects ```
28
Prostate cancer:
Most common cancer for males.
29
Prostate cancer signs/symptoms:
``` Hesitancy Weak flow Feeling of incomplete voiding Haematuria Increased frequency Nocturia Increased urgency ```
30
Prostate cancer RF:
``` FHx Black>White>Asian Genetics- BRCA2, Lynch disease Diet- Calcium, red meat, fat dairy, obesity High pesticide exposure ```
31
Prostate cancer investigations:
PSA DRE MRI Biopsy- Transperineal (through the skin behind the scrotum) or transrectal (through the rectum to the prostate).
32
Prostate cancer management:
Localised PC: Low risk- Active surveillance. Intermediate/High risk: Prostatectomy and radiotherapy. Locally advanced PC: 3-6 months of radiotherapy preceded and followed by LHRHa (agonist)- ADT. May need for 2 yrs if Gleason score>8. Metastatic PC: Bilateral orchidectomy, androgen deprivation therapy (ADT), palliative care.
33
Non Melanoma Skin Cancers:
Most common type of cancer worldwide; mainly BCC then cutaneous SCC.
34
Non Melanoma Skin Cancers RF:
UV light exposure. BCC-intermittent exposure or childhood exposure. cSSC- chronic exposure. Lack of melanin Previous history of NMSC FHx of NMSC Xeroderma pigmentosa (XP) increases risk.
35
Non Melanoma Skin Cancers signs/symptoms:
New skin lesion. (BCC- scaly, shiny, telangiectasia, pink, well defined, ulcerate and bleed, months to years to develop). (cSCC- More invasive are poorly differentiated, develops over months, erythematous. Systemic- weight loss, fever, night sweats
36
Non Melanoma Skin Cancers Investigations:
Physical examination. Biopsy- Excisional (inc normal margins), incisional (part of the lesion). punch (remove a cone shape lesion to show the depth of invasion), shaving (removal of protruding portion). Imaging is rarely used Lab tests rarely used Stage with TNM- T1-<2cm, T2- 2-4cm, T3 >4cm and/or invasion.
37
Non Melanoma Skin Cancers Management:
Palliative- Cyrotherapy (NO2 to remove tumour), topical treatment (5FU), watch and wait. Chemotherapy- Excisional therapy, radiotherapy, if lower risk lesions then also consider cyrotherapy or topical treatment. {Patients then need follow ups}
38
Melanoma:
8th and 9th most common cancer in men and women respectively.
39
Melanoma RF:
Intermittent intense exposure to sunlight/UV Early childhood sunburns Skin which doesn't tan easily- more likely to burn Indoor tanning bedds Navi Personal Hx of melanoma FHx of melanoma
40
Melanoma signs/symptoms:
``` Asymmetry Border irregularities Colour variations Diameter>6mm Evolving ```
41
Melanoma investigtions:
``` Hx Physical ABCDE Biopsy Lab tests Imaging- USS for LN mets, CXR for lung mets. ```
42
Melanoma management:
Wide margin local excision is recommended (if localised) Resectable stage 3/4- usually drain to LN then treat via resection and adjuvant therapy. Advanced unresectable disease- systemic treatment is the mainstay, unless if brain mets then need resection. LN mets- needs complete LN dissection. Do sentinel LN to help guide treatment- more treatment options available and will increase survival rate. Adjuvant therapy- chemo does not work so use immunotherapy.
43
Melanoma Breslow thickness:
Will indicate how deep the melanoma has reached. | It is useful for prognosis.
44
What to give in a PE whilst pt on chemotherapy? Pt presents with breathlessness, found to have multiple PE.
Give LMWH (daltaparin) because it is reversible, give once a day at therapeutic dose- need to know renal function and weight. Carry on with the chemotherapy. Chemotherapy- reduces the blood count therefore increased risk of bleeding so need to have a reversible anticoagulation. If non curable cancer then anticoaggulate for life. Anticoaggulation purpose is to prevent another PE, and stops original clot from getting bigger.

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