Solid Tumors Flashcards
(44 cards)
1
Q
Prostate cancer
- Risk Factors
A
Prostate cancer RFs
- Old age
- Black ethnicity
- Obesity
- BRACA 2
- Family history
2
Q
Prostate cancer
- Histology
A
Prostate cancer
- Adenocarcinoma
- Peripheral zone
3
Q
Prostate cancer
- S&S
A
Prostate cancer
- Frequency/OAB
- Nocturia
- Visible haematuria
- Dribble
- Systemic symptoms
- Back pain
4
Q
PSA Requisites
A
PSA
- No sex or anal sex
- No prostate interventions
- Range changes with age
- No UTI
- No vigorous exercise
5
Q
Prostate cancer screening
A
Prostate cancer screening
NHS does not recommend
opportunistic screening if patient counselled
6
Q
Prostate cancer grading and staging
A
Prostate cancer grading and staging
- Gleason grade
- first and second most common - TNM staging
7
Q
Prostate cancer
- metastasis
A
Prostate metastasis
1. Bones
2. Lymph nodes
8
Q
Prostate Cancer
DRE findings
A
Prostate DRE
- Firm
- Hard
- Asymmetrical
- Irregular
9
Q
Prostate Referral
A
Prostate Referral
- Abnormal DRE
- PSA
10
Q
Prostate cancer diagnosis
- Process
A
Prostate diagnosis
- DRE/PSA
- mpMRI (multi parametric)- Likert 5 point scoring
- Biopsy - transperineal
11
Q
Prostate cancer
- Management
A
Prostate cancer
- Supportive
1. Active surveillance (PSA, DRE, MRI) - Medical
2. GnRH Agonist (Goserelin)
3. Androgen receptor blockers (Bicalutimide)
- Surgical (Radical prostatectomy)
- NB Side effects - Radical radiotherapy
- External beam or Brachy therapy - Bilateral orchidectomy
- Chemotherapy
- Docetaxel
12
Q
Melanoma
- Invasion
A
Melanoma invasion
- Epidermis
- In situ - Dermis
- Invasive - Metastatic
13
Q
Melanoma
- Types
A
Melanoma types
- Superficial spreading melanoma
- 70%
- Young and middle aged lower limbs - Nodular melanoma
- 15%
- Young and middle aged trunk - Acral lentiginous melanoma
- 10%
- Elderly, black and asian palms, soles, nailbeds - Lentigo maligna melanoma
- 5%
- Elderly, face
14
Q
Superficial spreading melanoma
- Demographic
- Sites
- Natural history
A
- Superficial spreading melanoma
70% - Demographic
1. Young adults
2. Middle aged
3. Intermittent high intensity UV
Site
1. Commonly lower limbs
Natural history
1. Pigmented lesion
2. Slowly enlarging
3. Irregular colour and border
15
Q
Nodular melanoma
- Demographic
- Sites
- Natural history
A
Nodular melanoma
- Demographic
1. Young adults
2. Middle aged - Sites
1. Trunk - Natural history
1. Agressive
2. Rapid, deep growth
3. Early metastasis
16
Q
Lentigo maligna melanoma
- Demographic
- Site
- Natural history
A
Lentigo maligna melanoma
- Demographic
1. Elderly
2. Long-term cumulative UV exposure
Site
1. Lentigo maligna
2. Face
Natural history
1. Growth from lentigo maligna
17
Q
Acral lentignious melanoma
- Demographic
- Site
- Natural history
A
Acral lentiginous melanoma
- Demographic
1. Black
2. Asian
3. Elderly - Site
1. Palms and soles
2. Nail beds
18
Q
Pre-cursors for melanoma
A
Pre-cursors for melanoma
- Benign melanocytic naevus
- Normal mole - Atypical or dysplastic naevus
- Benign but asymetrical
- Increased risk of melanoma - Atypical lentiginous junctional naevus
- Flat naevus in heavily sun-damaged skin - Actinic keratosis
- Yellow-white scaly crusts
- Sun-exposed skin - Bowen disease
- Red, scaly plaque
- Slow-enlarging
- Carcinoma in situ (3.5% progress to SCC)
19
Q
Actinic keratosis
- Management
A
Actinic keratosis mx
- Emolient
- Diclofenac (3%)
- Fluorouracil (5%)
+ Hydrocortisone - Imiquimod
- Cryotherapy
- Photodynamic therapy
- Surgical excision and curettage + cautery
20
Q
Melanoma
- ABCDE
A
Melanoma
A - ssymetry
B - order
C - olour
D - iameter
E -volving
21
Q
Melanoma
- Staging and thickness prognostication
A
Melanoma thickness
- AJCC system
- American joint committee on cancer
- TNM - Breslow thickness
<1mm
1-2 mm
2-4mm
>4mm
22
Q
Melanoma
- Investigations
A
Melanoma investigations
- Examination
- Skin
- Lymph nodes - LDH
- Cell turnover
23
Q
Melanoma
- Mx
A
Melanoma Mx
- WLE
- Skin+fat+muscular fascia
- Margin determined by Breslow thickness - Adjuvant therapy
- Chemotherapy
- Radiotherapy
- Immunotherapy
24
Q
Melanoma
- Histology
A
Melanoma histology
- Growth of melanocytes
- Stratum basale
25
Breast Cancer
- Grading and staging
Breast Cancer
1. Stage 1-4
2. Grade 1-3
26
breast cancer
screening
mammography every 3 years aged 50-70
under 50 if:
- previous cancer
- first degree relative with cancer <50
- known BRCA1/2
27
Breast cancer classification
most are adenocarcinomas:
- in situ / invasive
- ductal / lobular
28
breast cancer risk factors
- female
- increasing age
- FH
- BRCA 1/2
- exposure to unopposed oestrogens:
-> early menarche, late menopause, nulliparity etc.
- chest radiation
- obesity
29
breast cancer presentation
- asymptomatic
- lump - usually firm, mostly painless
- nipple retraction
- skin changes - tethering or dimpling
- nipple discharge
- ulceration
30
breast cancer assessment
triple assessment:
1. examination
2. imaging (USS or mamography)
3. biopsy
31
breast cancer
Mx
surgery
- WLE
- mastectomy
- sentinal node biopsy
radiotherapy
- after WLE
chemo
- neoadjuvant, adjuvant or palliative
hormonal
- pre menopause - SERM - Tamoxifen
- post menopause - aromatase inhibitors - anastrozole
biological
- herceptin (trastuzumab) - if HER2 +ve
32
bowel cancer
histology - most common
adenocarcinoma
33
bowel cancer - 2 genetic mutations
- adenomatous polyposis (ANP)
- hereditary nonpolyposis colorectal cancer (HNPCC)
34
bowel cancer
- risk factors
- increasing age
- male
- FH
- IBD
- low fibre diet
- high processed meat intake
- smoking, alcohol
35
bowel cancer
- Ix
- gold standard: colonoscopy with biopsy
- staging: CT, MRI rectum, endo-anal ultrasound
36
Bowel Cancer
- Grading
Bowel Cancer
- Grade 1-3
37
Bowel cancer
- Staging
Bowel cancer staging
1. TNM
2. Stage 1-4
3. Dukes A-D
TNM 1-4 equivalent
38
lung cancer
- epidaemiology
3rd most common cancer
commonest cancer death
39
lung cancer
- risk factor
- smoking
- silica
- asbestos
- family history
- radiation to chest
- air polution
- COPD, fibrosis, TB, HIV
40
lung cancer
- histology
- small-cell lung cancer (20%)
- release neuroendocrine hormones
- can cause paraneoplastic syndromes
- non-small cell lung cancer (80%)
- adenocarcinoma (40%)
- squamous cell carcinoma (20%)
- large-cell carcinoma (10%)
- other types (10%)
- mesothelioma - affects mesothelial cells of the pleura
- liked to asbestos inhalation
- poor prognosis
- latent period between exposure and development of cancer
41
lung cancer
- presentation/red flags
- SOB
- cough - unexplained cough lasting more than 3 weeks
- haemoptysis
- finger clubbing
- recurrent pneumonia
- weight loss
- lymphadenopathy
- lethargy
- weakness
- hoarseness
- dysphagia
- chest pain
- wheeze
- fever
42
name 4 extrapulmonary manifestations of lung cancer
- recurrent laryngeal nerve palsy
- SVCO
- horner's syndrome
- SIADH
43
lung cancer
- Ix
- CXR first line
- staging CT
- PET CT
biopsy:
- ultrasound guided endobronchial biopsy
- CT guided transthoracic
44
lung cancer
- general management
non-small cell
- surgery - first line for non-small cell - if disease isolated
- radiotherapy can also be used for non-small cell if inoperable
- adjuvant/palliative chemo
small-cell
- chemo and radiation
- prognosis worse
