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Y4 Cancer Care > 2 - Investigation and Diagnosis > Flashcards

2 - Investigation and Diagnosis Flashcards

1
Q

What are causes of raised AFP?

A
  • Hepatocellular carcinoma
  • Liver metastasis
  • Neural tube defects
  • Germ cell tumours
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2
Q

What are some differentials for a mass in the liver?

A
  • Hepatocellular carcinoma
  • Lymphoma
  • Cholangiocarcinoma
  • Haemangioma
  • Hydatid cyst
  • Hepatic abscess
  • Metastatic lesions.
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3
Q

What are some differentials for SOB in oncology patients?

A
  • Ascites
  • Hepatomegaly
  • PE
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4
Q

What are some differentials for confusion in oncology patients?

A
  • Metabolic disturbance (hypoglycaemia, hypercalcaemia)
  • Infection (pneumonia, UTI)
  • Metastatic spread to the brain
  • Anaemia
  • Intense pain
  • Side effects of pain medication
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5
Q

What PRN medications are written up for anticipatory medications?

A
  • Morphine
  • Midazolam
  • Levomepromazine
  • Glycopyrronium bromide
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6
Q

What cancers are associated with MEN syndromes?

A
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7
Q

What is the referral criteria for the following?

A
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8
Q

What is the urgent referral criteria for the three main skin cancers?

A
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9
Q

What is the referral criteria for prostate cancer?

A
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10
Q

What is the referral criteria for bladder or renal cancer?

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11
Q

What is the referral criteria for testicular and penile cancer?

A
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12
Q

What is the referral criteria for lung cancer?

A
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13
Q

What is the referral criteria for CNS cancer?

A
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14
Q

What is the referral criteria for oesophageal and pancreatic cancer?

A
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15
Q

What is the referral criteria for gallbladder and liver cancer?

A
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16
Q

What is the referral criteria for bone sarcoma?

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17
Q

What is the referral criteria for breast cancer?

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18
Q

What is the referral criteria for leukaemia?

A
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19
Q

What is the referral criteria for myeloma?

20
Q

What is the referral criteria for lymphoma?

21
Q

What is the referral criteria for endometrial and ovarian cancer?

22
Q

What is the referral criteria for vaginal, vulval and cervical cancer?

23
Q

What is the referral criteria for colorectal cancer and anal cancer?

24
Q

If you are referring someone from GP for a 2 week wait what information do you need give them?

A
  • Explain to people they are being referred to a cancer service. Reassure them, as appropriate, that most people referred will not have a diagnosis of cancer, and discuss potential alternative diagnoses with them
  • Assess if they need support in the interim
  • Advise people who may not meet the referral criteria to contact you again if their symptoms persist or progress.
  • Give people information on their possible diagnosis (both benign and malignant), in accordance with their wishes for information
  • What type of tests may be carried out and what will happen during these procedures.
25
What are the principles of a good screening programme?
* *Disease** 1. Known aetiology and risk factors 2. Known natural history 3. High incidence and/or prevalence 4. High morbidity and/or mortality * *Test** 1. Simple 2. Acceptable 3. Valid 4. Reliable **Treatment** 1. Available 2. Acceptable 3. Effective 4. Benefits from early detection * *Programme** 1. Cost-effective 2. Agreed protocol 3. Quality assurance 4. Does “more good than harm"
26
How should you treat immunotherapy side effects?
**Steroids** Immunotherapy works by stimulating immune system so need to suppress immune system
27
What size do you consider lymphadenopathy to be pathological and what investigation should you do?
\>3cm Do a lymphoreticular exam then excision lymph node biopsy
28
Which department from GP should you refer a patient to for cervical lymphadenopathy?
**ENT** as will need **excision lymph node biopsy** even if lymphoma FNA cannot be done as may miss cancer
29
Why is doing an an FBC important in the work up for lymphoma?
Look at WCC If Hb and Platelets low suggests bone marrow involvement so then need a bone marrow biopsy
30
How should you treat low grade lymphomas?
Watch and wait until they get symptomatic as can live normal life without the chemo making them sick
31
What do you think has happened and what should you investigate?
Either **progression** or transformation to higher grade
32
What do you think has happened and what should you investigate? Why may this patient have pancytopenia?
Either **progression** or **transformation to higher grade** Do a CT CAP and then **CT guided core biopsy of biggest mass**. No point biopsying old lymph nodes as these may not have transformed yet Pancytopenia from **bone marrow infiltration**
33
If someone has a high LDH what should we be thinking about?
Risk of tumour lysis syndrome
34
What are the causes of the following splenomegaly: * Mild * Moderate * Massive
**_Massive_** * Myelo and Lymphoproliferative disorders * Myelofibrosis * CML * Malaria * EBV * Gaucher's **_Moderate_** * Portal hypertension e.g. secondary to cirrhosis * Haemolytic anaemia * Infective endocarditis * Sickle-cell, thalassaemia * Rheumatoid arthritis (Felty's syndrome)
35
What is an important blood test to do in acute leukaemia?
* **Clotting profile -** may be coagulopathy * Urate * LDH
36
What is seen on blood film with ALL and AML and how do you differentiate between the two? IMPORTANT
* Blasts * Need bone marrow aspirates to do **flow cytometry** and **immunophenotyping**
37
What tests are done on bone marrow biopsy?
* **Flow cytometry/Immunophenotyping** * **Immunohistochemistry** * **Cytogenetics** e.g karyotyping, FISH for things like BCR-ABL
38
Hydroxycarbamide is used for cytoreduction if the WCC are really high in leukaemia. What do you need to think about when giving this?
* Prophylaxis for TLS * Monitor FBC as will lower WCC but also RBC and platelets so may need transfusion of these
39
How can you monitor the response of treatment for CML?
Monitor BCR-ABL load by PCR
40
What staging investigation is needed and what is NOT needed for Hodgkin's lymphoma?
* **PET-CT:** can upstage normal CT * **ESR:** prognostic marker DO NOT NEED BONE MARROW BIOPSY
41
How is Hodgkin's lymphoma treated?
**Radiotherapy PLUS chemotherapy** High cure rate with no stem cell transplant
42
What is the long term sequelae after treatment for HL?
* Secondary leukaemia, lymphoma, sarcoma, breast cancer * Cardio and respiratory issues from chemo drugs
43
What lymphoma is Rituximab used for?
NHL
44
What is the characteristic cytogenetics for AML?
T(8:21)
45
What is done to determine clonality of plasma cells?
Flow cytometry
46
What examination do you need to do on a patient with suspected MSCC?
* **Neuro exam:** UMN signs and sensory level * **PR Exam**

Y4 Cancer Care (19 decks)

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