Types of cancers

Question 1

What are the RFs for breast cancer?

Answer 1

Increasing age, increased periods oestrogen exposure, ionising radiation, FH

Question 2

Most common type of breast carcinoma?

Answer 2

Infiltrating or invasive ductal carcinoma in situ

Question 3

How is Dx of breast cancer confirmed?

Answer 3

Biopsy - FNAC, needle, incisional or excision

Question 4

A patient has a tumour in her left breast measuring 4cm. She also has involvement of 3 axillary lymph nodes which are fixed to the chest wall. On CT scan there is no evidence of metastases. What is the TNM stage of the cancer?

Answer 4

T2 N2 M0

Question 5

When would you give Tamoxifen?

Answer 5

To an oestrogen receptor (ER) positive tumour.

Question 6

What are the risks assoc with tamoxifen Tx? (2) What could you use to treat breast cancer instead if you were worried about these risks?

Answer 6

Thrombotic complications, endometrial cancer. Use aromatase inhibitors e.g. anastazole, letrozole

Question 7

What mutations are assoc with colorectal cancer?

Answer 7

APC, p53, ras, DCC

Question 8

Most common histological type of colorectal cancer?

Answer 8

adenocarcinoma = 90-95%

Question 9

Patient comes in with altered bowel habits & occasional rectal bleeding. What is your first investigation?

Answer 9

DRE - can feel 75% rectal lesions

Question 10

What chemo is usually used to Tx colorectal Ca?

Answer 10

5-FU

Question 11

When can you use radiotherapy to Tx colorectal cancer?

Answer 11

Rectal cancers (colon too close to adjacent organs)

Question 12

What chromosomal deletion is associated with lung cancer?

Answer 12

3p (and 13q, 17p)

Question 13

What type of lung cancer are EGFR activating mutations associated with?

Answer 13

Adenocarcinoma

Question 14

Types of NSC lung cancers?

Answer 14

SCC, adenocarcinoma, large cell

Question 15

Sx of lung cancer?

Answer 15

Chest pain, cough, SOB, haemoptysis, persistent chest infections

Question 16

Patient presents with Hx of cough and unilateral ptosis & pupil constriction. What is the likely diagnosis?

Answer 16

Apical lung tumour on ipsilat side - Pancoast’s tumour

Question 17

What signs might indicate mediastinal involvement of lung cancer? (2)

Answer 17

Recurrent laryngeal N palsy (hoarse voice), SVCO

Question 18

What sign is associated with SCC of lung?

Answer 18

Clubbing

Question 19

What investigations are available to help Dx lung cancer?

Answer 19

CXR, sputum cytology, bronchoscopy & biopsy, CT

Question 20

What tumour markers can you look for in lung cancer? What might they show?

Answer 20

Neuron-specific enolase (SCLC) & LDH - poss indicators of tumour activity

Question 21

What size primary lung tumour determines if T1/2/3?

Answer 21

T1 - 3cm or less
T2 - >3 but <7cm
T3 - >7cm

Question 22

What is the main Tx used for small cell lung cancer?

Answer 22

Chemotherapy. SCLC very chemo-sensitive.

Question 23

What Tx can you offer to pt with lung cancer to prevent frequency of advancing metastatic disease?

Answer 23

Prophylactic cranial irradiation - decreases freq brain mets.

Question 24

When can you perform surgery in NSCLC?

Answer 24

Stage 1 or 2 - 30% of pts

Question 25

When could imatinib be used to Tx lung cancer?

Answer 25

NSCLC with EGFR activating mutations

Question 26

What system is used to grade prostate cancers?

Answer 26

Gleason.

Question 27

What might you find on DRE of prostate ca?

Answer 27

Enalrged, hard, crazy, obliteration of median sulcus

Question 28

How is a histological Dx made of prostate cancer?

Answer 28

Transrectal biopsy with USS guidance. Sample many different areas & assess size of gland

Question 29

What might PSA levels reflect in prostate Ca?

Answer 29

Low levels - localised disease, high - systemic mets

Question 30

When is radical prostatectomy performed in prostate Ca?

Answer 30

If stage T2 or less.

Question 31

Which cancers commonly metastasise to bone?

Answer 31

Rule of two's: thyroid, lung, breast, renal, prostate + haematological e.g. myeloma

Question 32

What types of radiotherapy are available to Tx prostate ca?

Answer 32

external beam irradiation, brachytherapy

Question 33

What alternative Tx (not surgery, chemo or radio) can be used in prostate Ca?

Answer 33

LHRH agonists - goserelin, buserelin Oestrogen therapy Anti-androgens Bilateral orchidectomy

Question 34

Which chemo agents are used in prostate Ca?

Answer 34

Docetaxel + cabazitaxel

Question 35

Main type of testicular cancer?

Answer 35

Germ cell tumour - 95%

Question 36

What type of tumour is a yolk sac tumour?

Answer 36

Non-seminomatous germ cell tumour

Question 37

Involvement of para-aortic nodes might suggest what type of primary tumour?

Answer 37

testicular

Question 38

What tumour markers are associated with testicular Ca?

Answer 38

Beta-human chorionic gonadotrophin - raised in seminoma & non-sen. A-fetoprotein - non-sem

Question 39

What does the IGCCC system tell you?

Answer 39

Prognosis of testicular cancer

Question 40

What test can be done in A&E to aid Dx testicular cancer?

Answer 40

Pregnancy test

Question 41

AFP of 700, hCG 4000 and normal LDH might suggest what prognosis of testicular Ca?

Answer 41

Good prognosis

Question 42

Main Tx of testicular Ca?

Answer 42

Orchidectomy

Question 43

What chemo regime used in non-sem testicular ca?

Answer 43

Bleomycin, etoposide & cisplatin (BEP)

Question 44

How might you Tx a stage 1 seminoma after/alongside surgery?

Answer 44

1 dose of carboplatin

Question 45

Where might you find SCCs?

Answer 45

Lung or head & neck

Question 46

Woman with peritoneal carcinomatosis might have what?

Answer 46

Ovarian cancer spread

Question 47

What chemo agent combination is best to Tx a tumour of unknown primary origin?

Answer 47

Antracycline + platinum, e.g. epirubcun + cisplatin

Question 48

What Tx option is available for post-menopausal women with breast cancer?

Answer 48

Aromatase inhibitors - block peripheral oestrogen production. Also hysterectomy

Question 49

What is a potential problem assoc with tamoxifen?

Answer 49

Increased risk thrombosis + endometrial cancer

Question 50

What is a potential problem associated with aromatase inhibitors?

Answer 50

Risk of osteoporosis

Question 51

A patient presents with weight loss, diarrhoea and iron deficiency anaemia. Where might he have a cancer?

Answer 51

R side of colon --> iron not being absorbed, and any bleeding may not be as obvious

Question 52

In Dukes staging, what determines whether stage A, B or C?

Answer 52

``` A = invasion of submucosa or muscularis proprietary B = invasion subserosa or beyond C = metastasised to lymph nodes ```

Question 53

Which types of lung cancer are associated with smokers and non-smokers?

Answer 53

Smokers - SCC (clubbing) | Non-smokers + women - adenocarcinoma

Question 54

What are the Sx of Horners syndrome? When might you see this?

Answer 54

Seen in apical lung tumours pressing on the sympathetic trunk. Get ipsilateral mitosis (constricted pupil), partial ptosis (droopy lid), and anhydrosis

Question 55

What is CHART? When is it used?

Answer 55

Continuous hyperfractionated accelerated RT. Given 3x day for 12 consecutive days. Used in Tx of NSCLC

Question 56

Where in the prostate would you see enlargement due to a tumour as opposed to due to BPH?

Answer 56

Tumours - posterior or peripheral parts | BPH - centre

Question 57

What Tx options are available for prostate cancer?

Answer 57

Surgery - TURP RT - external beam RT or brachytherapy LHRH agonists - goserelin --> decrease testosterone Chemo - docetaxel + cabazitel

Question 58

What are the main types of testicular cancer?

Answer 58

Germ cell tumours --> seminomatous (40%), or non-seminomatous (60%)

Question 59

Where do testicular cancers commonly spread to?

Answer 59

Para-aortic nodes --> mid-line disease

Question 60

How can you determine using biochemical tests whether a testicular tumour is seminomatous or non-sem?

Answer 60

``` Seminoma = raised bHCG Non-sem = raised bHCG + AFP ```