17. Oncology - Types of cancers Flashcards
Lung Cancer: peak incidence
60-70 yrs
Lung Cancer: epidemiology
More common in men - 3:1
Lung Cancer: 5 year survival rate
15%
Lung Cancer: secondary to which cancers?
Colorectal
Prostate
Lung Cancer: aetiology
90% - due to smoking*
COPD
* can be from passive smoking
Lung Cancer: signs and symptoms
Dry and persistent cough Dyspnoea Chest pain (later stage) Weight loss (later stage) Voice hoarseness Haemoptysis * Wasting of hands (apical tumours compress nerves to hands) Clubbing of fingernails
*Blood in sputum
Lung Cancer: diagnostics
X-ray
CT scan
FBC
Sputum culture
Colorectal Cancer: peak incidence
Common over 50 yrs old
Colorectal Cancer: metastasis locations
Liver
Lungs
Brain
Bone
Colorectal Cancer: 5 year survival rate
93% (stage 1)
3% (stage 4)
Colorectal Cancer: aetiology
Strong link with diet high in non-organic meat, low fibre, lack of vit D
Polyps
Family history
Colorectal Cancer: signs and symptoms
Fluctuating bowel habits (constipation/diarrhoea)
Blood (and mucus) in stools
Abdominal pain (usually left side)
Anaemia (due to blood loss)
Colorectal Cancer: diagnostics
Colonoscopy, biopsy Stool analysis (occult blood and M2PK - tumour marker found in stools) Blood test (CEA*, inflammatory markers, low Hb)
Carcinoembryonic Antigen, tumour marker
Breast Tumours: characteristics
Cysts or fibroadenomas
Most breast lumps are benign
Benign tumours - mobile, smooth, regular borders (different from malignant mass)
Fibrocystic breast disease - breast pain, tender masses, nodules - usually pre-menstrual
Breast Cancer: pathophysiology
Ductal or lobular
Endogenous/exogenous oestrogens*
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 (15% cases)
*oestrogen is a growth stimulate
Breast Cancer: aetiology
Family history and age
Genetic mutations in BRCA1 or BRCA2
Obesity - increase of IGF-1 and oestrogen
Regular alcohol intake and smoking
Oestrogen excess - early menarche/late menopause/OCP/HRT
Aluminium/parabens* - mimic oestrogen
BPA (in plastics) - mimics oestrogen
*in antiperspirants and deodrants
Breast Cancer: signs and symptoms
Asymptomatic usually Painless, unilateral fixed lump Overlying skin changes e.g. dimpling, orange peel appearance Inverted/discharging nipple Enlarged axillary lymph nodes
Breast Cancer: diagnostics
Mammography
Thermography
Breast Cancer: complications
Metastatic spread via lymphatics
Breast cancer: Treatment
Radiotherapy, chemotherapy, surgery.
Hormonal therapy: If oestrogen positive — tamoxifen (blocks oestrogen receptors). This can cause hot flushes, joint pains, osteoporosis, DVT and sleep irregularities.
Ovarian Cancer: epidemiology
Mostly affects women over 40 yrs
Ovarian Cancer: aetiology
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
Ovarian Cancer: signs and symptoms
Early stage asymptomatic
Vague abdominal discomfort/bloating
Abdominal mass with pelvic pain, ascites
75% present with advanced disease
Later: change in bowel habits
Ovarian Cancer: diagnostics
Ultrasound
CT/MRI
Blood test: CA-125
Ovarian Cancer: 5 year survival rate
38%
Most lethal gynaecological malignancy
Cervical Cancer: epidemiology
Most common in young women - 25-35 yrs
What percentage of female cancers does cervical cancer form?
20% of all cancers
Cervical Cancer: aetiology
Persistent HPV infection (strains 16 & 18 cause 70%)
Sexual behaviour (multiple partners, younger age)
Smoking
COCP
Cervical Cancer: signs and symptoms
Non-specific symptoms
Abnormal vaginal bleeding (inter-cycle bleeding, after intercourse)
Vaginal discharge
White/red patches on cervix
Cervical Cancer: diagnostics
Screening - detects 30% - smear test
Biopsy
MRI/CT scan
Cervical Cancer: allopathic treatment
Brachytherapy (internal radiotherapy)
Chemo-radiotherapy
Surgery - hysterectomy (preferred up to stage 2)
Liver Cancer: types of
Primary - if from liver cirrhosis
Secondary - if spread from elsewhere
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
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
Liver Cancer: allopathic treatment
Surgery - transplant
Liver Cancer: epidemiology
More common in men
Peak around 60
Gastric Cancer: epidemiology
Male 55 yrs+
2nd highest cause of cancer-related death in the world
Highest in Korea and Japan (diet)
Gastric Cancer: areas affected/percentages
50% affects pylorus
25% affects lesser curvature
Gastric Cancer: aetiology
Smoking
H. pylori infection
Diet rich in salted, pickled and smoked foods (N-nitroso compounds)
Low food/veg diet
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
Gastric Cancer: diagnostics
Stool analysis (blood*)
Endoscopy
Biopsy
Tumour markers - CEA, CA 19-9
black, tarry
Gastric Cancer: allopathic treatment
Gastrectomy
Chemo/radiotherapy
Oesophageal Cancer: aetiology
Chronic irritation Alcohol Smoking GORD and Barrett's oesophagus Obesity Low fruit/veg diet Age
Oesophageal Cancer: signs and symptoms
Few early symptoms, obstruction may occur later*
Dysphagia (difficulty swallowing)
Extreme weight loss
Melaena (blood in stools)
Obstruction can reach 75% before it’s noticed
Pancreatic Cancer: pathophysiology
Most arise from the exocrine cells
Less common from the endocrine cells
Pancreatic Cancer: metastatic percentage
Approx 60% metastatic at diagnosis
Pancreatic Cancer: aetiology
Cause is unknown
Risks include age, smoking, family history
Diabetes, chronic pancreatitis, H. pylori
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
Pancreatic Cancer: allopathic treatment
Surgery
Chemotherapy
Radiotherapy
Prostate Cancer: epidemiology
The most common cancer in men
Generally 50+ yrs
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
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
Same urinary symptoms as BPH
Prostate Cancer: diagnostics
Elevated PSA
Digital rectal exam
Biopsy
Prostate Cancer: allopathic treatment
Radiotherapy
Androgen deprivation therapy
Chemotherapy
Surgery (removal) - 50% never recover urinary/erectile function
Bladder Cancer: epidemiology
More common in men - 2:1
70-80 yr group
Bladder Cancer: where does it originate?
Originates from transitional epithelial cells in bladder
Bladder Cancer: aetiology
Smoking - carcinogens pool in bladder and induce mutations
Chronic cystitis
Increasing age
Catheterisation
Bladder Cancer: signs and symptoms
Painless haematuria (90%)
Increased urine frequency & urgency
Dysuria
Bone metastases (with pain in spine)
Bladder Cancer: allopathic treatment
Transurethral resection
Cystectomy
Testicular Cancer: epidemiology
Young men (15-35 yrs)
Testicular Cancer: aetiology
Higher risk if undescended testes
Family history
Testicular Cancer: signs and symptoms
Hard, painless, unilateral mass
Dragging sensation
Dull ache
Metastastises to bone, brain, lungs, liver
Skin Cancer: prognosis
Visible, generally easily detectable
Develops slowly - good prognosis
Skin Cancer: typical locations for moles
Usually arises on head, neck or back
Skin Cancer: epidemiology
Most common in fair-skinned people, 40+
Becoming more prevalent
Highest rate of recurrence
Skin Cancer: what to look out for
Asymmetry Border Colour Diameter Evolving
What is the most common skin cancer?
Basal cell carcinoma
What is the second most common skin cancer?
Squamous cell carcinoma
Who is more likely to develop melanoma?
Women, 30-50 yrs
What is the 5 year survival rate for melanoma?
80%
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
Squamous cell carcinoma: signs and symptoms
Red, scaling thickened nodule/patch
Some are firm hard nodules with central necrosis = ulcer/bleeding
Melanoma: signs and symptoms
Brown/black lesions
Change in size, colour, elevation of a mole or new mole
Bone Tumours: definition
Can be malignant or benign
Most commonly secondary tumour
What is osteosarcoma?
Malignant bone tumour
Who is most likely to be affected by primary osteosarcomas?
Teenagers
Where are osteosarcomas most likely to form?
Typically occur around the knee or humerus
Bone Tumours: signs and symptoms
Worsening pain that becomes unremitting
Wake patient at night
Systemic symptoms - weight loss, malaise, fatigue, night sweats
Brain Tumours: types of
High grade - rapid growth tumours
Low grade - lower growth tumours
Example of high grade brain tumour
Mostly gliomas (common type is astrocytoma)
glioblastomas (immature cells)
Example of low grade brain tumours
Meningiomas
Pituitary tumours
Brain Tumours: epidemiology
Most common 50-70 yrs
Where do malignant brain tumours usually metastasise from?
Metastatic 10x more common than primary
* Lung
* Breast
* Stomach
* Prostate
Brain Tumours: aetiology
Mobile phone use
Brain Tumours: signs and symptoms
Morning headaches, increasing in frequency
Nausea, vomiting, seizures
Uneven pupils, double vision
Papilloedema - bulging of optic nerve
Lymphoma: definition
Malignancy of lymphatic cells
Types of lymphoma
Non-Hodgkin’s lymphoma
Hodgkin’s lymphoma
Non-Hodgkin’s lymphoma: epidemiology
5 times more common
Peak age - 50+ and children/young adults
Hodgkin’s lymphoma: epidemiology
Peak age 20-35
Also paediatric
Which cells are involved in lymphomas?
B-lymphocytes
Lymphoma: aetiology
EBV - found in 50% of patients with Hodgkin's HIV General immunosuppression Pesticides/herbicides Chemo/radiotherapy
Lymphoma: signs and symptoms
Enlarged and asymptomatic lymph node in neck
Chest discomfort*, cough
Dyspnoea
Drenching night sweats, fever, weight loss
Lymphadenopathy
Hepatomegaly, splenomegaly
*can be created by enlarged thymus
Lymphoma: diagnostics
Biopsy of lymph node - surgical/fine needle
Blood tests - raised ESR, leukocytosis, lymphopenia, anaemia, HIV testing
Leukaemia: definition
Bone marrow cancers characterised by over-production of leukocytes
Leukaemia: pathophysiology
Over-proliferation in leukocytes results in supressed RBC production (=anaemia) and suppressed platelet production (=thrombocytopenia)
Acute leukaemias: characteristics
All ages Rapid onset More aggressive Immature (blast) cells Anaemia/thrombocytopenia prominent
Chronic leukaemias: characteristics
Usually adults Gradual onset More mature Differentiated cells Lymph node enlargement/splenomegaly prominent
Leukaemia: Signs and symptoms
Anaemia symptoms Malaise Frequent infections Fever, weight loss Easy bleeding/bruising Splenomegaly - excess haemolysis causes spleen to enlarge Lymph node enlargement
Leukaemia: diagnostics
Bone marrow biopsy
Blood test - FBC and blood film
Leukaemia: allopathic treatment
Chemotherapy
Bone marrow transplant
Radiotherapy
Relapse is common
Leukaemia: types
Four types of leukaemia:
1. Acute myelogenous leukaemia (AML)
2. Acute lymphocytic leukaemia (ALL)
3. Chronic myeloid leukaemia (CML)
4. Chronic lymphocytic leukaemia (CLL)
