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year 4-oncology block > 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
  • pneumonia
  • atelectasis
  • pleural effusion
  • anaemia
  • anxiety
  • radiation pneumonia
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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

****-MEN 1- **pituitary, parathyroid and pancreas.mutation in MEN1 gene.

  • MEN 2- medullary thyroid cancer, phaechromacytoma, parathyroid adenoma. mutation in RET oncogene.
  • MEN2B- also causes above + mucosal neuroma, craniosynostosis.
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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?

A
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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?

A
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17
Q

What is the referral criteria for breast cancer?

A
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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?

A
20
Q

What is the referral criteria for lymphoma?

A
21
Q

What is the referral criteria for endometrial and ovarian cancer?

A
22
Q

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

A
23
Q

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

A
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
Q

What are the principles of a good screening programme?

A
  • *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
Q

How should you treat immunotherapy side effects?

A

Steroids

Immunotherapy works by stimulating immune system so need to suppress immune system

27
Q

What size do you consider lymphadenopathy to be pathological and what investigation should you do?

A

>3cm

Do a lymphoreticular exam then excision lymph node biopsy

28
Q

Which department from GP should you refer a patient to for cervical lymphadenopathy?

A

ENT as will need excision lymph node biopsy even if lymphoma

FNA cannot be done as may miss cancer

29
Q

Why is doing an an FBC important in the work up for lymphoma?

A

Look at WCC

If Hb and Platelets low suggests bone marrow involvement so then need a bone marrow biopsy

30
Q

How should you treat low grade lymphomas?

A

Watch and wait until they get symptomatic as can live normal life without the chemo making them sick

31
Q

What do you think has happened and what should you investigate?

A

Either progression or transformation to higher grade

32
Q

What do you think has happened and what should you investigate?

Why may this patient have pancytopenia?

A

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
Q

If someone has a high LDH what should we be thinking about?

A

Risk of tumour lysis syndrome

34
Q

What are the causes of the following splenomegaly:

  • Mild
  • Moderate
  • Massive
A

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
Q

What is an important blood test to do in acute leukaemia?

A
  • Clotting profile - may be coagulopathy
  • Urate
  • LDH
36
Q

What is seen on blood film with ALL and AML and how do you differentiate between the two?

IMPORTANT

A
  • Blasts
  • Need bone marrow aspirates to do flow cytometry and immunophenotyping
37
Q

What tests are done on bone marrow biopsy?

A
  • Flow cytometry/Immunophenotyping
  • Immunohistochemistry
  • Cytogenetics e.g karyotyping, FISH for things like BCR-ABL
38
Q

Hydroxycarbamide is used for cytoreduction if the WCC are really high in leukaemia. What do you need to think about when giving this?

A
  • Prophylaxis for TLS
  • Monitor FBC as will lower WCC but also RBC and platelets so may need transfusion of these
39
Q

How can you monitor the response of treatment for CML?

A

Monitor BCR-ABL load by PCR

40
Q

What staging investigation is needed and what is NOT needed for Hodgkin’s lymphoma?

A
  • PET-CT: can upstage normal CT
  • ESR: prognostic marker

DO NOT NEED BONE MARROW BIOPSY

41
Q

How is Hodgkin’s lymphoma treated?

A

Radiotherapy PLUS chemotherapy

High cure rate with no stem cell transplant

42
Q

What is the long term sequelae after treatment for HL?

A
  • Secondary leukaemia, lymphoma, sarcoma, breast cancer
  • Cardio and respiratory issues from chemo drugs
43
Q

What lymphoma is Rituximab used for?

A

NHL

44
Q

What is the characteristic cytogenetics for AML?

A

T(8:21)

45
Q

What is done to determine clonality of plasma cells?

A

Flow cytometry

46
Q

What examination do you need to do on a patient with suspected MSCC?

A
  • Neuro exam: UMN signs and sensory level
  • PR Exam

year 4-oncology block (19 decks)

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