Week 5: A surgeons view of cancer Flashcards
(51 cards)
What is the incidence of cancer like in the UK?
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
What people may be involved in the MDT for cancer patients?
Surgeons
Physicians
Oncologists
Radiologists
Pathologists
Specialist nurses
Data clerks
What is a fungating tumour?
A tumour that breaks through the skins surface and creates an open wound
What are the four most common sites of metastatic spread?
Liver
Bone
Lungs
Brain
How does cancer cause illness?
- Interference with function
- Erosion - bleeding
- Obstruction
- Cachexia (weightloss)
What is pancoast tumour?
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
What type of cancer often causes problems by bleeding?
Gastro-intestinal tumours
Rare
Commonly found in the stomach or small intestine
Often presents as anemia or a major upper GI haemorrhage
What is an example of cancer causing injury by obstruction?
Malignant large bowel - secondary to stenosis
Occurs in 20% of patients with colorectal cancer
How does cancer cause cachexia?
Unexplained weight loss - cachexia
Progressive muscle wasting
Loss of appetite
Caused by nausea, tumour metabolism, chronic inflammatory changes.
What type of cancer treatment is likley to cure cancer?
Neoadjuvant chemo and radiotherapy followed by surgery
What are the different elements of treating cancer?
Finding it - symptomatic or screening
Treatment - surgery, chemo, radiotherapy etc
Prevent it - identification of premalignant conditions, prophylactic treatment
Palliative care
What is an example of prophylatic treatment for cancer?
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
What is the TMN classificatoin for cancer?
Score given for:
Tumour
Nodal disease
Metasases
What is the T score is TNM classification of colorectal cancer?
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.
What is the N score in TNM classification of colorectal cancer?
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.
What is the M score in the TN classification of colorectal cancer?
M - metastasis
0: no metastias to other parts of body
1: spread to other parts of the body
What is Dukes classification for colorectal cancer?
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.
What is the breast cancer screening pathway?
All women aged 50-70yrs
Every 3 years
What is meant by palliation in cancer care?
What are some examples?
Improves quality of life without necessarily affecting survival
e.g removing a fungating tumour, removing a bowel obstruction despite metastasis
What are breast cancer survial rates like based on stage?
1 - near 100%
2 - near 80%
3 - near 70%
4 - near 30%
How does breast cancer risk and differential diagnosis vary with age?
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
How has breast cancer mortality changes over time?
Incidence increased
Mortality decreases
These diverged the most after screening was introduced - detected at early stage so early intervention
What are the common presentations of breast cancer?
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
What investigations are often done for breast cancer?
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
