17. Oncology - Types of cancers Flashcards
1
Q
Lung Cancer: peak incidence
A
60-70 yrs
2
Q
Lung Cancer: epidemiology
A
More common in men - 3:1
3
Q
Lung Cancer: 5 year survival rate
A
15%
4
Q
Lung Cancer: secondary to which cancers?
A
Colorectal
Prostate
5
Q
Lung Cancer: aetiology
A
90% - due to smoking
COPD
6
Q
Lung Cancer: signs and symptoms
A
Dry and persistent cough Dyspnoea Chest pain Weight loss Voice hoarseness Blood in sputum
7
Q
Lung Cancer: diagnostics
A
X-ray
CT scan
FBC
Sputum culture
8
Q
Colorectal Cancer: peak incidence
A
Common over 50 yrs old
9
Q
Colorectal Cancer: metastasis locations
A
Liver
Lungs
Brain
Bone
10
Q
Colorectal Cancer: 5 year survival rate
A
93% (stage 1);
3% (stage 4)
11
Q
Colorectal Cancer: aetiology
A
Strong link with diet high in non-organic meat, low fibre, lack of vit D
Polyps
Family history
12
Q
Colorectal Cancer: signs and symptoms
A
Fluctuating bowel habits (constipation/diarrhoea)
Blood (and mucus) in stools
Abdominal pain
13
Q
Colorectal Cancer: diagnostics
A
Colonoscopy, biopsy Stool analysis (occult blood and M2PK - tumour marker found in stools) Blood test (CEA (tumour marker), inflammatory markers, low Hb)
14
Q
Breast Cancer: characteristics
A
Ductal or lobular
Most breast lumps are benign
Benign tumours - mobile, smooth, regular borders
Fibrocystic breast disease - breast pain, tender masses, nodules - usually pre-menstrual
15
Q
Breast Cancer: pathophysiology
A
Breast cancer cells contain receptors that hormones or other proteins bind to that promote tumour growth
Oestrogen receptors - 80%
Also progesterone and epidermal growth factor receptors
If none of these receptor types present, the cancer is triple negative
16
Q
Breast Cancer: aetiology
A
Family history and age
Genetic mutations in BRCA1 or BRCA2
Obesity - increase of IGF-1
Regular alcohol intake and smoking
Oestrogen excess - early menarche/late menopause/OCP/HRT
Aluminium/parabens - mimic oestrogen
BPA - chemical in plastics - mimics oestrogen
17
Q
Breast Cancer: signs and symptoms
A
Asymptomatic usually Painless, unilateral fixed lump Overlying skin changes e.g. dimpling, orange peel appearance Inverted/discharging nipple Enlarged axillary lymph nodes
18
Q
Breast Cancer: diagnostics
A
Mammography
Thermography
19
Q
Breast Cancer: complications
A
Metastatic spread via lymphatics
20
Q
Ovarian Cancer: epidemiology
A
Mostly affects women over 40 yrs
21
Q
Ovarian Cancer: aetiology
A
Family history and age
Genetic mutations in BRCA1 or BRCA2
Oestrogen excess - early menarche/late menopause/OCP/HRT
Infertility/never given birth
Poor lifestyle: exercise, smoking, obesity
Diet rich in animal fats
Talcum powder used between legs
22
Q
Ovarian Cancer: signs and symptoms
A
Early stage asymptomatic
Vague abdominal discomfort/bloating
Abdominal mass with pelvic pain
75% present with advance disease
23
Q
Ovarian Cancer: diagnostics
A
Ultrasound
CT/MRI
Blood test - CA-125
24
Q
Ovarian Cancer: 5 year survival rate
A
38%
25
Cervical Cancer: epidemiology
Most common in young women - 25-35 yrs
26
What percentage of female cancers does cervical cancer form?
20% of all cancers
27
Cervical Cancer: aetiology
Persistent HPV infection (16+18 cause 70%)
Sexual behaviour (multiple partners, younger age)
Smoking
COCP
28
Cervical Cancer: signs and symptoms
Non-specific symptoms
Abnormal vaginal bleeding
Vaginal discharge
White/red patches on cervix
29
Cervical Cancer: diagnostics
Screening - detects 30% - smear test
Biopsy
MRI/CT scan
30
Cervical Cancer: allopathic treatment
Surgery - hysterectomy (preferred up to stage 2)
| Chemo-radiotherapy
31
Liver Cancer: types of
Primary - if from liver cirrhosis
| Secondary - if spread from elsewhere
32
Liver Cancer: aetiology
Associated with liver cirrhosis
Alcohol, toxins = necrosis = chronic inflammation and cell proliferation (turnover)
Hepatitis B/C = viral integration into host genome affecting DNA
33
Liver Cancer: signs and symptoms
```
In advanced stages:
Jaundice
Ascites
Hepatomegaly
Pruritus (itchy skin)
Bleeding oesophageal varices (secondary to portal hypertension)
Loss of appetite
Feeling very full after eating
Nausea/vomiting
Pain or swelling in the abdomen
Fatigue and weakness
```
34
Liver Cancer: allopathic treatment
Surgery - transplant
35
Liver Cancer: epidemiology
Common in men, peak around 60s
36
Gastric Cancer: epidemiology
Male 55 yrs+
2nd highest cause of cancer-related death in the world
Highest in Korea and Japan (diet)
37
Gastric Cancer: areas affected/percentages
50% affects pylorus
| 25% affects lesser curvature
38
Gastric Cancer: aetiology
Smoking
H. pylori infection
Diet rich in salted, pickled and smoked foods (N-nitroso compounds)
Low food/veg diet
39
Gastric Cancer: signs and symptoms
Early stages - persistent indigestion, frequent burping, heartburn, feeling full quickly when eating, bloating, abdominal discomfort
Advanced stages - black blood in stools
Loss of appetite, weight loss, tiredness, anaemia, jaundice
40
Gastric Cancer: diagnostics
Stool analysis (blood)
Endoscopy
Biopsy
Tumour markers - CEA, CA 19-9
41
Gastric Cancer: allopathic treatment
Gastrectomy
| Chemo/radiotherapy
42
Oesophageal Cancer: aetiology
```
Chronic irritation
Alcohol
Smoking
GORD and Barrett's oesophagus
Obesity
Low fruit/veg diet
Age
```
43
Oesophageal Cancer: signs and symptoms
Few early symptoms, obstruction may occur later
Dysphagia (difficulty swallowing)
Extreme weight loss
Melaena (blood in stools)
44
Pancreatic Cancer: pathophysiology
Most arise from the exocrine cells
| Less common from the endocrine cells
45
Pancreatic Cancer: metastatic percentage
Approx 60% metastatic at diagnosis
46
Pancreatic Cancer: aetiology
Cause is unknown
Risks include age, smoking, family history
Diabetes, chronic pancreatitis, H. pylori
47
Pancreatic Cancer: signs and symptoms
```
Asymptomatic early on
Epigastric pain, radiating to back
Unexplained weight loss
Fatigue
Jaundice (bilirubin can't get out)
Nausea after eating
Glucose intolerance
```
48
Pancreatic Cancer: allopathic treatment
Surgery
Chemotherapy
Radiotherapy
49
Prostate Cancer: epidemiology
Most common cancer in men
| Generally 50+ yrs
50
Prostate Cancer: aetiology
Obesity
Diet - high meat consumption (esp. chargrilled), dairy and saturated fats, refined sugars
Ethnicity - black men at highest risk
Genetics - BRCA1/2
51
Prostate Cancer: signs and symptoms
```
Obstructed/poor urinary flow
Increased urinary frequency
Intermittent urine flow and dribbling of urine
Nocturia
Haematuria
Back pain can indicate bone metastases
```
52
Prostate Cancer: diagnostics
Elevated PSA
Digital rectal exam
Biopsy
53
Prostate Cancer: allopathic treatment
Radiotherapy
Androgen deprivation therapy
Chemotherapy
Surgery (removal) - 50% never recover urinary/erectile function
54
Bladder Cancer: epidemiology
More common in men - 2:1
| 70-80 yr group
55
Bladder Cancer: where does it originate?
Originates from transitional epithelial cells in bladder
56
Bladder Cancer: aetiology
Smoking - carcinogens pool in bladder and induce mutations
Chronic cystitis
Increasing age
Catheterisation
57
Bladder Cancer: signs and symptoms
Painless haematuria (90%)
Increased urine frequency & urgency
Dysuria
Bone metastases (with pain in spine)
58
Bladder Cancer: allopathic treatment
Transurethral resection
| Cystectomy
59
Testicular Cancer: epidemiology
Young men (15-35 yrs)
60
Testicular Cancer: aetiology
Higher risk if undescended testes
| Family history
61
Testicular Cancer: signs and symptoms
Hard, painless, unilateral mass
Dragging sensation
Dull ache
Metastasises to bone, brain, lungs, liver
62
Skin Cancer: prognosis
Visible, generally easily detectable
| Develops slowly - good prognosis
63
Skin Cancer: typical locations for moles
Usually arises on head, neck or back
64
Skin Cancer: epidemiology
Most common in fair-skinned people, 40+
65
Skin Cancer: what to look out for
```
Asymmetry
Border
Colour
Diameter
Evolving
```
66
What is the most common skin cancer?
Basal cell carcinoma
67
What is the second most common skin cancer?
Squamous cell carcinoma
68
Who is more likely to develop melanoma?
Women, 30-50 yrs
69
What is the 5 year survival rate for melanoma?
80%
70
Basal cell carcinoma: signs and symptoms
Raised, smooth, pearly bump on sun-exposed skin
Sometimes small blood vessels can be seen within the tumour
Crusting and bleeding in the centre
71
Squamous cell carcinoma: signs and symptoms
Red, scaling thickened nodule/patch
| Some are firm hard nodules with central necrosis
72
Melanoma: signs and symptoms
Brown/black lesions
| Change in size, colour, elevation of a mole or new mole
73
Bone Tumours: definition
Can be malignant or benign
| Most commonly secondary
74
What is osteosarcoma?
Malignant bone tumour
75
Who is most likely to be affected by primary osteosarcomas?
Teenagers
76
Where are osteosarcomas most likely to form?
Typically occur around the knee or humerus
77
Bone Tumours: signs and symptoms
Worsening pain that becomes unremitting
Wake patient at night
Systemic symptoms - weight loss, malaise, fatigue, night sweats
78
Brain Tumours: types of
High grade - rapid growth tumours
| Low grade - lower growth tumours
79
Example of high grade brain tumour
Mostly gliomas (common type is astrocytoma)
80
Example of low grade brain tumours
Meningiomas
| Pituitary tumours
81
Brain Tumours: epidemiology
Most common 50-70 yrs
82
Where do malignant brain tumours usually metastasise from?
Lung
Breast
Stomach
Prostate
83
Brain Tumours: aetiology
Mobile phone use
84
Brain Tumours: signs and symptoms
Morning headaches, increasing in frequency
Nausea, vomiting, seizures
Uneven pupils, double vision
Papilloedema - bulging of optic nerve
85
Lymphoma: definition
Malignancy of lymphatic cells
86
Types of lymphoma
Non-Hodgkin's lymphoma
| Hodgkin's lymphoma
87
Non-Hodgkin's lymphoma: epidemiology
5 times more common
| Peak age - 50+ and children/young adults
88
Hodgkin's lymphoma: epidemiology
Peak age 20-35
89
Which cells are involved in lymphomas?
B-lymphocytes
90
Lymphoma: aetiology
```
EBV - found in 50% of patients with Hodgkin's
HIV
General immunosuppression
Pesticides/herbicides
Chemo/radiotherapy
```
91
Lymphoma: signs and symptoms
Enlarged and asymptomatic lymph node in neck
Chest discomfort
Cough
Dyspnoea
Drenching night sweats, fever, weight loss
Hepatomegaly, splenomegaly
92
Lymphoma: diagnostics
Biopsy of lymph node - surgical/fine needle
| Blood tests - raised ESR, leukocytosis, lymphopenia, anaemia, HIV testing
93
Leukaemia: definition
Bone marrow cancers characterised by over-production of leukocytes
94
Leukaemia: pathophysiology
Over-proliferation in leukocytes results in supressed RBC production (=anaemia) and suppressed platelet production (=thrombocytopenia)
95
Acute leukaemias: characteristics
```
All ages
Rapid onset
More aggressive
Immature cells
Anaemia/thrombocytopenia prominent
```
96
Chronic leukaemias: characteristics
```
Usually adults
Gradual onset
More mature
Differentiated cells
Lymph node enlargement/splenomegaly prominent
```
97
Leukaemia: Signs and symptoms
```
Anaemia symptoms
Malaise
Frequent infections
Easy bleeding/bruising
Splenomegaly - excess haemolysis causes spleen to enlarge
Lymph node enlargement
```
98
Leukaemia: diagnostics
Blood test - FBC and blood film
| Bone marrow biopsy
99
Leukaemia: allopathic treatment
Chemotherapy
Bone marrow transplant
Radiotherapy
