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Unit 10 > Week 5: A surgeons view of cancer > Flashcards

Week 5: A surgeons view of cancer Flashcards

1
Q

What is the incidence of cancer like in the UK?

A

2 new cases every minute
Most common in females ins breast cancer
Most common in males is prostate cancer
Lung and Bowel cancer as also common

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2
Q

What people may be involved in the MDT for cancer patients?

A

Surgeons
Physicians
Oncologists
Radiologists
Pathologists
Specialist nurses
Data clerks

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3
Q

What is a fungating tumour?

A

A tumour that breaks through the skins surface and creates an open wound

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4
Q

What are the four most common sites of metastatic spread?

A

Liver
Bone
Lungs
Brain

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5
Q

How does cancer cause illness?

A
  1. Interference with function
  2. Erosion - bleeding
  3. Obstruction
  4. Cachexia (weightloss)
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6
Q

What is pancoast tumour?

A

Shows how cancer causes damage through interference with function
Tumour located in the apex of the lung can invade and press on nearby structures mainly the brachial plexus
results in severe shoulder pain, weakness in hand on affected side.
Horners syndrome -facial flushing, inability to sweat, small constricited pupil and drooping eyelid on affected side only

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7
Q

What type of cancer often causes problems by bleeding?

A

Gastro-intestinal tumours
Rare
Commonly found in the stomach or small intestine
Often presents as anemia or a major upper GI haemorrhage

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8
Q

What is an example of cancer causing injury by obstruction?

A

Malignant large bowel - secondary to stenosis
Occurs in 20% of patients with colorectal cancer

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9
Q

How does cancer cause cachexia?

A

Unexplained weight loss - cachexia
Progressive muscle wasting
Loss of appetite
Caused by nausea, tumour metabolism, chronic inflammatory changes.

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10
Q

What type of cancer treatment is likley to cure cancer?

A

Neoadjuvant chemo and radiotherapy followed by surgery

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11
Q

What are the different elements of treating cancer?

A

Finding it - symptomatic or screening
Treatment - surgery, chemo, radiotherapy etc
Prevent it - identification of premalignant conditions, prophylactic treatment
Palliative care

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12
Q

What is an example of prophylatic treatment for cancer?

A

People with FAP given daily aspirin, protective against polyps
In this scenarios risk of cancer without aspirin is greater than risk of GI bleed with aspirin

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13
Q

What is the TMN classificatoin for cancer?

A

Score given for:
Tumour
Nodal disease
Metasases

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14
Q

What is the T score is TNM classification of colorectal cancer?

A

TX - cannot be measured
T0 - main tumour cannot be found
T1- inner layer of bowel (submucosa)
T2 - grown into the muscularis mucosa of the bowel wall
T3 - grown through muscle into subserosa or outer connective tissue covering
T4 - through the outer lining of the bowel and invades other tissue or nearby organs and/or perforates visceral peritoneum.

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15
Q

What is the N score in TNM classification of colorectal cancer?

A

TO - no nearby lymph node involvement
N1- 1 to 3 lymph nodes or nearby tissue
N2: 4 to 7 lymph nodes still perirectal/ppericolic
N3: metastasis to a lymph node along the course of a name vessel.

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16
Q

What is the M score in the TN classification of colorectal cancer?

A

M - metastasis
0: no metastias to other parts of body
1: spread to other parts of the body

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17
Q

What is Dukes classification for colorectal cancer?

A

Stage A - only in inner lining of bowel (submucosa max)
B1 - invaded muscle
B2 - invaded through bowel wall
C - invaded nearby lymph nodes but not through bowel wall
D - metastasised to lymph nodes and spread through bowel wall.

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18
Q

What is the breast cancer screening pathway?

A

All women aged 50-70yrs
Every 3 years

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19
Q

What is meant by palliation in cancer care?
What are some examples?

A

Improves quality of life without necessarily affecting survival
e.g removing a fungating tumour, removing a bowel obstruction despite metastasis

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20
Q

What are breast cancer survial rates like based on stage?

A

1 - near 100%
2 - near 80%
3 - near 70%
4 - near 30%

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21
Q

How does breast cancer risk and differential diagnosis vary with age?

A

1 in 8 women develop breast cancer
Risk increases exponentially with age
20 yrs - most likely fibroadenoma or benign nodularity
From 25yrs + more likely to be a cyst aswell
From 40yrs - most likely benign nodularity of cyst
Breast cancer only becomes the most likely diagnosis after 55yrs

22
Q

How has breast cancer mortality changes over time?

A

Incidence increased
Mortality decreases
These diverged the most after screening was introduced - detected at early stage so early intervention

23
Q

What are the common presentations of breast cancer?

A

Common - firm irregular painless lump, that may be fixed to skin or muscle
Pain 10%
Axillary/supraclavicular lymph nodes
Nipple retraction or blood discharge
Pagets disease - eczema like changes to nipple and areola
Peau de orange - puckered skin
Sign of metastasis - fractured femur bone as often goes to bone next
Asymptomatic at screening

24
Q

What investigations are often done for breast cancer?

A

Mammography
Ultrasound
Fine needle biospy - syringe
Trucut biospy - removes core using a special needle
Excision biopsy - skin lesion
Wire guided biopsy -
Chest x-ray
Bone scan/CT/MRI

25
Q

What are the different surgical options for breast cancer?

A
  • mastectomy (remove full breast)
  • wide local excision (cancer and a rim of healthy tissue)
  • All women are offered breast reconstruction after breast surgery, can have at time of surgery or at a later date is requested
26
Q

How are the lymph nodes treated in breast cancer?

A

Radiotherapy
Axillary clearance - surgery to remove all or most of axilla lymph nodes

27
Q

What are some long term complications of axillary clearance?

A

Arm present with
Numbness
Pain
Weakness
Limb swelling (lymphedema)
Stiffness

Were a compression arm sleeve to reduce swelling and not allowed any needles etc from that arm.

28
Q

What is the Nottingham Prognostic Index suggest about the factors influencing cancer patient survival rates?

A

Grade of tumour
Lymph node metastases
Size of tumour

Can be used to split survival groups into Excellent, good, poor and very poor prognostic groups

29
Q

What does breast cancer screening aim to detect?

A

Early invasive cancer
Ductal carcinoma in situ

30
Q

What is lead time bias in relation to screening?

A

The view that screening does not actually increase patient survival rather it only appears to.
By diagnosing people earlier they are living with the diagnosis for longer, but are not necessarily living to an an older age than if they had been diagnosed later.

31
Q

What are the high risk groups that are targeted in prevention of breast cancer?

A

BRCA1 BRCA2 genes
Strong family history
Pre-malignant markers (lobular carcinoma in situ)

32
Q

What methods can be used to prevent the development of breast cancer?

A

Drugs (tamoxifen)
Oophrectomy (removal of ovaries)
Bilater risk reducing mastectomy with reconstruction

33
Q

How do most colorectal cancers become diagnosed?

A

Most by two week referall rate from GP (30%)
Then by emergency presentation - such as bowel obstruction leading to perforation (24%)
Then GP referall (not two week pathway)
Then screening (10%)

34
Q

What are the most common sites of colorectal cancer?

A

30% rectum
20% is the sigmoid colon
15% is the caecum
9% asecneding colon

35
Q

What investigations should be done on a patient with colorectal cancer?

A

Colonoscopy
CT colonoscopy
Contrast CT
MRI (pelvis)
Ultrasound (liver)

36
Q

Why and how many patients with colorectal cancer are inoperable at presentation?

A

20% inoperable at presentation

Due to advanced localised disease or metastatic spread.
Lots of people (just over 20%) are diagnosed at stage 2, 3 and 4 respectively, with only 15% being diagnosed at stage 1.

37
Q

What are the different types of operation used for colorectal cancer in regards to the section of bowel removed?

A

Right hemicoloectomy
Extended right hemicolectomy
Left hemicoloectomy
Sigmoid colectomy
Anterior resection
Abdomino-perineal resection

38
Q

What tumours tend to require a right hemicolectomy/

A

Caecaum
Ascending colon
Hepatic flexure
Proximal transverse colon

39
Q

What tumours require an extended right hemicolectomy?

A

Remove bowel from ceacum up until and including splenic flexure
TUmours in distal transverse colon and splenic flexure

40
Q

What tumours recieve a left hemicolectomy?

A

In the splenic flexure
Descending colon

41
Q

What tumours recieved a sigmoid colectomy?

A

In the sigmoid colon

42
Q

What tumours receive an anterior resection?

A

Distal sigmoid colon
upper/middle rectum

43
Q

What tumours reciene an abdomino-perineal resection?

A

Remove from sigmoid colon distally
For tumours in the lower rectum or ano-rectal junction
These patients will require a permanent colostomy bad/

44
Q

What is bowel anastamosis?

A

Joining two sections of the bowel back together after surgery to restore continuity.
Uses a stapler.

45
Q

Why might a stoma be necessary?

A

To divert waste away from an obstruction which cannot be removed
To allow time for bowel anastomosis to heal
Used in patients are high risk of a leak from anastomosis
There is no distal bowel to connect to.

46
Q

What is the survival rate like for different stages of colorectal cancer?

A

Stage 1 - 94%
Stage 2 - 82%
Stage 3 - 67%
Stage 4 - 11%

47
Q

How do you screen for colorectal cancer?

A

Males and females aged 54-74 years old
2 yearly
Faecal Immunohistomchemical Test
If positive patient is invited for colonoscopy.

48
Q

How effective is colorectal screening?

A

Increases diagnosis in stage 1 and stage 2
1 - 35%
1 or 2 - 60%

1 or 2 in two weeks - 40% or by emergency - 25%

49
Q

What is the relationship between poly and cancers in the epoly-cancer sequence?

A

95% of colorectal cancers begin as adenomas
Takes 5 to 10 years for a polyp to develop into a cancer
Removing the polyp reduces the risk of cancer.

50
Q

What procedure removes a polyp from the GIT wall?

A

Colonoscopic polypectomy

51
Q

What are the risks of colonoscopy?

A

Bleeding
Bowel perforation
Sedation effects
Bowel prep effects
Missed pathology

Unit 10 (37 decks)

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