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Biomedicine II > 17. Oncology: Pathlogies > Flashcards

17. Oncology: Pathlogies Flashcards

1
Q

Lung Cancer

A

The peak incidence of lung cancer is between 60–70 years of age.
• More commonly affecting men (3:1).
• Second most common malignancy in men.
• Five-year survival rate of 15%.
• 95% arise in bronchi. Diagnosed by x-ray.
• 90% due to smoking. Frequently follows COPD.
• A study found that a diet rich in fruit and vegetables reduces the incidence of lung cancer by 25%.
• Most commonly secondary (colorectal, osteosarcoma, prostate)

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2
Q

Lung Cancer: Signs and Symptoms

A
  • Dry and persistent cough.
  • Dyspnoea and chest pain.
  • Weight loss and voice hoarseness.
  • Haemoptysis (bloody / raspberry sputum).
  • Wasting of muscles in hand (if apical tumour).
  • ‘Clubbing’ of nails.
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3
Q

Lung Cancer: Investigations

A

Sputum culture
FBC
chest X-ray
CT scan

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4
Q

Lung Cancer: Treatment

A

Radio / chemotherapy, surgery.

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5
Q

Colorectal Cancer

A

Locally invasive but metastatic spread may be evident before growth produces symptoms.
• Metastasises to the liver, lungs, brain and bone.
• Common over 50 years of age.
• More common in developed countries.
• Screening in developed countries often involves stool analysis and endoscopy (looking for occult blood in stool).
• Five-year survival: Stage I = 93%. Stage IV = 3%

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6
Q

Colorectal Cancer: Risk Factors

A

Strong link with a diet high in meat, low in fibre, lack of vitamin D. Polyps, family history.

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7
Q

Colorectal: Signs and Symptoms

A
  • Initially few symptoms.
  • Rectal bleeding, blood / mucus in stool.
  • Obstruction causing colicky abdominal pain.
  • Anaemia -> fatigue, pallor, etc.
  • Consistent change in bowel habits (diarrhoea / constipation).
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8
Q

Colorectal Cancer: Investigations

A
  • Colonoscopy and biopsy. Stool analysis (occult blood and M2-PK).
  • Blood test (CEA and inflammatory markers).
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9
Q

Colorectal Cancer: Treatment

A

Radio - internal
Chemo
Surgery
Palliative

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10
Q

Benign Breast Masses

A

Most breast lumps are benign. These will generally be either cysts or fibroadenomas.
• Fibrocystic breast disease often presents as breast pain / tender masses / nodules:
- Most prevalent in pre-menstrual women and cysts often shrink following the onset of menses.
• Benign breast tumours are typically mobile, smooth and have regular borders. This differs from a malignant mass.
• Hormones are thought to be critical in aetiology.
• It is worth highlighting that breast pain is not usually associated with breast cancer.

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11
Q

Breat Cancer

A

Breast cancer is the most common female cancer.
• Either ductal or lobular epithelial cells.
• Breast cancer can also affect men (1% of breast cancer cases).

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12
Q

Breast Cancer: Signs and Symptoms

A
  • Asymptomatic usually.
  • Painless, unilateral fixed lump (benign breast tumours are very common and typically present as mobile lumps).
  • Overlying skin changes; i.e. dimpling, ‘orange peel’ appearance.
  • Asymmetry of breasts, inverted and discharging nipple.
  • Enlarged axillary lymph nodes.
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13
Q

Breat Cancer: Risk Factors

A

• Breast cancer cells contain receptors that hormones or other proteins can bind to and promote tumour growth.
- These receptors are most commonly for oestrogen (80%).
- The two other receptor types are for ‘progesterone’ or ‘epidermal growth factor’.
- If a tumour contains none of the three receptor types, the breast cancer is ‘triple negative’. This accounts for 15% of cases.
• Therefore, most breast cancer is known to be associated with oestrogen. High oestrogen exposure increases risk. This exposure can include endogenous and exogenous oestrogen.

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14
Q

Breast Cancer: Risk Factors (1)

A
  • Oestrogen has the ability to promote the growth of breast cancer cells (as it does at puberty and in pregnancy). Oestrogen is a hormone that will always promote growth in the body.
  • BRCA1 or BRCA2 mutations increase the risk of breast (and ovarian) cancer. However, it is essential to consider the environment these genes are bathed in! These mutations only account for 5% of all breast cancers.
  • A longer ‘reproductive life’ (early menarche, late menopause = higher oestrogen exposure), the combined oral contraceptive pill and HRT.
  • BPA (a chemical in plastics) — mimics oestrogen.
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15
Q

Breast Cancer: Risk Factors (2)

A
  • IGF-1 (cow milk) promotes breast cancer in women with high oestrogen levels.
  • Breast quadrants and breast cancer:
  • Once oestrogen is metabolised, it has to leave the breast via the upper lateral quadrant, where most cancers occur.
  • Aluminium is found within many antiperspirants, which may be absorbed and cause oestrogen-like hormonal effects.
  • Parabens in deodorants can also mimic oestrogen (found in breast tumours).
  • Upper medial quadrant tumours are becoming more common (mobile phones?).
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16
Q

Breast Cancer: Diagnosis

A

• Mammography:
- An X-ray that directs radiation into breasts.
- Mammography looks for the presence of tumours. These tumours would need to reach a certain size before becoming visible on an
X-ray (the tumour didn’t just ‘appear’).
• Mammography increases breast cancer risk!
• Thermography:
- A safer and more effective method of detecting earlier pathological cancerous changes.
- As already mentioned, as cancer cells divide, they must undergo angiogenesis (this increases the local temperature).

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17
Q

Breast Cancer: Complications

A

•Metastatic spread via lymphatics.

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18
Q

Breast Cancer: Treatment

A
  • Radiotherapy, chemotherapy, surgery.
  • Hormonal therapy: If oestrogen positive — tamoxifen (blocks oestrogen receptors). This can cause hot flushes, joint pains, osteoporosis, DVT and sleep irregularities.
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19
Q

Ovarian Cancer

A

Ovarian cancer mostly affects women over 40 years of age.
• Most lethal gynaecological malignancy.
• Ovarian cancer is generally oestrogen dependent, like breast cancer.

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20
Q

Ovarian Cancer: Risk Factors

A
  • Family history.
  • BRCA 1 and 2.
  • Late menopause, early menarche.
  • Infertility / never given birth.
  • HRT.
  • Poor lifestyle: Exercise, smokers, obesity.
  • Diet rich in animal fats.
  • Talcum powder used between legs.
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21
Q

Ovarian Cancer: Signs and Symptoms

A
  • Early stage asymptomatic.
  • Vague abdominal discomfort and bloating.
  • Abdominal mass with pelvic pain.
  • 75% present with advanced disease Later: Change in bowel habits.
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22
Q

Ovarian Cancer: Diagnosis

A
  • Ultrasound.
  • CT, MRI.
  • Bloods: CA-125 tumour marker
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23
Q

Ovarian Cancer: Prognosis

A

38% - five-year survival

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24
Q

Cervical Cancer

A

Most common cancer in young women. Commonly 25–35 years of age.
• 20% of all cancers in women.
• 4,500 cases per year.

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25
Q

Cervical Cancer: Risk Factors

A
  • Persistent HPV infection (16 + 18 cause 70%).
  • Sexual behaviour (multiple partners, younger age).
  • Smoking, COCP.
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26
Q

Cervical Cancer: Screening

A
  • 30% detected by screening.

* ’Smear’: To detect cancerous and pre-cancerous changes.

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27
Q

Cervical Cancer: Signs and Symptoms

A
  • Non-specific symptoms.
  • Abnormal vaginal bleeding (after sexual intercourse, between menstrual periods).
  • Vaginal discharge.
  • White / red patches on cervix.
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28
Q

Cervical Cancer: Diagnosis

A

Biopsy and histological examination. MRI, CT.

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29
Q

Cervical Cancer: Treatment

A

Surgical - historectomy (preferred up to stage 2)

Chemo-radioo therapy

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30
Q

Liver Cancer

A
  • Primary or secondary (spread from another tissue).
  • Usually co-exists with liver cirrhosis.
  • More commonly affecting men, peak ~ 60s.
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31
Q

Liver Cancer: Signs and Symptoms

A
  • In the advanced stages: Jaundice, ascites, hepatomegaly.
  • Pruritus (itchy skin), bleeding oesophageal varices (secondary to portal hypertension), weight loss.
  • Vomiting, loss of appetite, feeling very full after eating, feeling sick, pain or swelling in the abdomen, fatigue and weakness.
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32
Q

Liver Cancer: Causes

A
  • Associated with liver cirrhosis: Alcohol, toxins -> necrosis > chronic inflammation and cell proliferation (turnover).
  • Hepatitis B / C -> viral integration into host genome (host DNA deletions; oncogenes activated).
33
Q

Liver Cancer: Treatment

A

Surgery - Transplant

34
Q

Gastric Cancer

A

Second highest cause of cancer-related deaths in the world (higher rates in Eastern Asia, with the highest rates worldwide being Korea and Japan).

35
Q

Gastric Cancer: Causes/Risk Factors

A

Diet rich in salted, pickled and smoked foods (N-nitroso compounds).
•Male, smoking, age (55 yrs+).
•H. pylori infection.
•Low fruit and vegetable diet.

36
Q

Gastric Cancer: Diagnosis

A
  • Blood in stool. Endocopy, biopsy.

* Tumour markers: CEA and CA 19-9.

37
Q

Gastric Cancer: Signs and Symptoms

A

Early stages:
• Persistent indigestion, frequent burping, heartburn, feeling full quickly when eating, bloated, abdominal discomfort.
Advanced stages:
• Black blood in the stools, loss of appetite, weight loss, tiredness, anaemia, jaundice.

38
Q

Gastric Cancer: Treatment

A

Gastrectomy, chemo/radiotherapy

39
Q

Oesophageal Cancer

A

A common aggressive tumour with a poor prognosis.

40
Q

Oesophageal Cancer: Signs and Symptoms

A
  • Few early symptoms, later obstruction may occur.
  • Dysphagia (red flag!).
  • Anorexia and melaena (due to oesophageal bleeding).
41
Q

Oesphageal Cancer: Causes and Risk Factors

A
  • Chronic irritation, alcohol, smoking.
  • GORD and Barrett’s oesophagus.
  • Obesity, low fruit and veg diet, age.
42
Q

Pancreatic Cancer

A

Common in older people, uncommon in people under 40 years; poor prognosis.
• Most arise from the exocrine cells.
• Less commonly from endocrine Islet cells (‘pancreatic neuroendocrine tumour’).
• Approx. 60% metastatic at diagnosis.

43
Q

Pancreatic Cancer: Causes

A
  • Cause is unknown, but risks include: age, smoking, family history (germ line defects in 5–10%).
  • Other health conditions (chronic pancreatitis, diabetes, H. pylori).
44
Q

Pancreatic Cancer: Signs and Symptoms

A
  • Asymptomatic early.
  • Epigastric pain radiating to the back.
  • Unexplained weight loss, anorexia and fatigue.
  • Jaundice.
  • Post-prandial nausea.
  • Glucose intolerance (neuroendocrine tumours).
45
Q

Pancreatic Cancer: Treatment

A

Surgery, chemo/radio

46
Q

Prostate Cancer

A

Most common cancer in men. Generally 50+ years. Increasing incidence.
•90% of prostate cancer never grows out of the capsule.

47
Q

Prostate Cancer: Signs and Symptoms

A
  • Same urinary symptoms as BPH.
  • Key symptoms include nocturia and haematuria.
  • Back pain can indicate bone metastases.
48
Q

Prostate Cancer: Investigations

A
  • Elevated PSA.
  • Digital rectal examination.
  • Biopsy.
49
Q

Prostate Cancer: Risk Factors

A
  • Increasing age: Mainly affects men over 50 years old.
  • Diet: High red meat intake (especially processed, non-grass fed), high diary intake (with raised IGF), acidic.
  • Ethnicity: Men of black ethnicity are at the highest risk of developing prostate cancer.
  • Family history: The risk of developing prostate cancer will increase depending upon the number of relatives affected.
  • Genetics: Associated with genes such as BRCA1/2.
  • Obesity: Anabolic steroid use.
50
Q

Prostate Cancer: Treatment

A
  • Radiotherapy (localised, non-invasive).
  • Androgen deprivation therapy.
  • Chemotherapy.
  • Surgery (removal) — 50% never recover urinary / erectile function
51
Q

Bladder Cancer

A

Two times more common in men and most common in the 70–80 year age group.
• Commonly originates from transitional epithelial cells in the bladder.

52
Q

Bladder Cancer: Causes and Risk Factors

A
  • Smoking (amines / hydrocarbons = carcinogens -> pool in the bladder and induce mutations).
  • Chronic cystitis, increasing age, catheterisation.
53
Q

Bladder Cancer: Signs and Symptoms

A
  • Painless haematuria (90%).
  • Increased urine frequency, urgency, dysuria.
  • Bone metastases (with pain; e.g. in spine)
54
Q

Bladder Cancer: Treatment

A

Transurethral resection or cystectomy

55
Q

Testicular Cancer

A

Most common cancer in young men (15–35 yrs).
• Higher risk if undescended testis and family history.
• Excellent prognosis if caught early: Orchidectomy.

56
Q

Testicular Cancer: Signs and Symptoms

A
  • Hard, painless, unilateral mass.
  • Dragging sensation and dull ache.
  • Metastasises to bone, brain, lungs and liver.
57
Q

Testicular Cancer: Support

A
  • Regular, monthly self-examination.
  • Herbs, nutritional supplements — antioxidants, diet is essential for all forms of cancer (primarily plant-based diet rich in nutrients and antioxidants). Homeopathy and acupuncture.
58
Q

Skin Cancer

A

Visible, generally easily detected and develops slowly = good prognosis.
• Highest rate of re-occurrence.
• Usually arises on head, neck or back (sun-exposed areas mostly commonly).
• Most common in fair skinned people aged 40+.
• Cases are on the increase. Strong connection to UV light exposure and the chemicals in sunscreens.
• Skin cancer types differ based on the cells affected.

59
Q

Basal Cell Carcinoma

A

The most common skin cancer.
• Raised, smooth, pearly bump on the sun-exposed skin of the head, neck or shoulders.
• Sometimes small blood vessels can be seen within the tumour.
• Crusting and bleeding in the centre of the tumour is often mistaken for a sore that does not heal.
• Good prognosis and with proper treatment can be completely eliminated, often without scarring.

60
Q

Squamous Cell Carcinoma

A

Malignant tumour from keratinised epithelial cells.
• Second most common skin cancer.
• A red, scaling, thickened nodule / patch on sun-exposed skin.
• Some are firm hard nodules with central necrosis = ulcer / bleeding.
• When not treated, it may develop into a large mass.
• It is dangerous, but not nearly as dangerous as a melanoma.

61
Q

Melanoma

A

Most spread out within epidermis (can be in-situ). Women > men 30–50 yrs.
• Risk factors: Pale skin, sun exposure.
• Often brown / black lesions, occasionally pink or red in colour.
• Warning signs that might indicate a malignant melanoma include change in size, shape, colour; elevation of a mole or new mole.
• Five-year survival = 80%.
• Surgical, chemotherapy.Most spread out within epidermis (can be in-situ). Women > men 30–50 yrs.
• Risk factors: Pale skin, sun exposure.
• Often brown / black lesions, occasionally pink or red in colour.
• Warning signs that might indicate a malignant melanoma include change in size, shape, colour; elevation of a mole or new mole.
• Five-year survival = 80%.
• Surgical, chemotherapy.

62
Q

Bone Tumours

A

Bone tumours can be benign or malignant.
• An ‘osteosarcoma’ is a malignant bone tumour.
• Primary osteosarcomas most commonly affect teenagers and typically occur around the knee or in the humerus (i.e. consider knee pain?).
• Primary osteosarcomas rapidly metastasise (often to the lung).
• Malignant bone tumours are most commonly secondary tumours. The spine is commonly affected due to a venous network in the spine.
• Malignant bone tumours cause worsening pain that becomes unremitting. The pain can wake the patient at night and causes systemic symptoms; e.g. weight loss, malaise, fatigue, night sweats.

63
Q

Brain Tumours: General

A

Both benign and malignant brain tumours account for significant mortality. As these tumours grow, they cause severe effects due to the
space-limiting structure of the cranium.
• Brain tumours that grow rapidly aggressively are often referred to as ‘high-grade tumours’, whilst slower replicating tumours are ‘low-grade’.
• High-grade tumours include ‘gliomas’ and ‘glioblastomas’, whilst low-grade tumours include ‘meningiomas’.
• Most intracranial tumours are metastases from other tumours (10 x more > primaries). Common primary sites include the lung, breast, stomach and prostate.

64
Q

Brain Tumours

A
  • Brain tumours can occur at any age but most commonly occur in those aged between 50–70, as well as children / young adults.
  • Possible links with mobile phone use.
65
Q

Brain Tumours: Signs and Symptoms

A
  • Unexplained headaches — worse in the mornings.
  • Vomiting and nausea, seizures.
  • Double vision, behaviour changes, slurred speech.
  • Signs: Papilloedema.
66
Q

Brain Tumours: Treatment

A

Surgery (often dependent on location) or radiotherapy (external beam).

67
Q

Lymphoma

A

Lymphoma describes a malignancy of lymphatic cells (i.e. cancer of the lymphatic system). Differs from leukaemia where the malignancy arises from the bone marrow.
•There are two main types of lymphoma: Non-Hodgkin’s and Hodgkin’s lymphoma.
•Non-Hodgkin’s lymphoma is five x more common.
•Most lymphomas involve B-lymphocytes.
•Non-Hodgkin’s: peak age 50 years+ and children / young adults.
•Hodgkin’s: peak age 20–35 years and is also a common paediatric malignancy.

68
Q

Lymphoma: Risk Factors

A
  • The Epstein-Barr virus (EBV) has been found in 50% of patients with Hodgkin’s lymphoma.
  • Other risk factors include HIV and general immunosuppression.
  • Exposure to pesticides and herbicides, chemotherapy and radiotherapy.
69
Q

Lymphoma: Signs and Symptoms

A
  • Commonly presents as an enlarged and asymptomatic lymph node in neck.
  • Chest discomfort, cough, dyspnoea.
  • Drenching night sweats, fever, weight loss.
  • Lymphadenopathy, hepatomegaly, splenomegaly.
70
Q

Lymphioma: Diagnosis

A
  • Biopsy of lymph node (surgical or fine needle).

* Blood tests: Raised ESR, leukocytosis, lymphopenia, anaemia and HIV testing

71
Q

Lymphoma: Treatment

A

•Chemotherapy is the main treatment approach (however, this is well recognised to cause secondary tumours!)

72
Q

Leukaemia

A

‘Leukaemia’ describes a group of bone marrow cancers, characterised by an abnormal over-production of leukocytes.
•This uncontrolled proliferation results in supressed erythrocyte production (= anaemia) and thrombocytes (= thrombocytopenia).
Divided into:
•Acute leukaemias: Rapid onset, more aggressive course. Immature cells (>20% -blast cells in bone marrow).
•Chronic leukaemias: Insidious onset and more differentiated cells.

73
Q

Leukaemia: Acute

A 
Age: All ages.
Onset: Sudden.
Leukaemic cells: Immature (-blasts).
Anaemia: Prominent.
Thrombocytopenia:
Prominent.
Leukocyte count:
Variable.
Lymph node enlargement:
Mild.
Splenomegaly:
Mild.
74
Q

Leukaemia: Chronic

A 
Age: Usually adults.
Onset: Insidious.
Leukaemic cells: Mature.
Anaemia: Mild.
Thrombocytopenia: 
Mild.
Leukocyte count: Increased.
Lymph node enlargement:
Prominent.
Splenomegaly:
Prominent.
75
Q

Leukaemia: Types

A
  1. Acute myelogenous leukaemia (AML).
  2. Acute lymphocytic leukaemia (ALL).
  3. Chronic myeloid leukaemia (CML).
  4. Chronic lymphocytic leukaemia (CLL).
76
Q

Leukaemia: Signs and Symptoms

A
  • Malaise, anaemia (fatigue, pallor etc.), frequent infections, easy bleeding / bruising.
  • Fever, weight loss.
  • Splenomegaly (abdominal swelling / discomfort).
  • Lymph node enlargement.
77
Q

Leukaemia: Diagnosis

A
  • Full blood count: Anaemia, low thrombocytes, variable leukocyte count.
  • Blood film (viewing sample of blood).
  • Bone marrow biopsy.
78
Q

Leukaemia: Treatment

A

Chemotherapy

Bone Marrow Transplant

Biomedicine II (16 decks)

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