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Year 4 - OncologY > Big 4 > Flashcards

Big 4 Flashcards

1
Q

what is the most common female cancer in the UK

A

breast then endometrial then ovarian

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2
Q

what is the incidence of breast cancer

A

15% of all breast cancer

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3
Q

how many women in the UK in a year will develop breast cancer

A

1 in 8 women

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4
Q

how many men in the UK in a year will develop breast cancer

A

1 in 870

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5
Q

what are some RF for breast cancer

A

1) inc age
2) inc oestrogen exposure - nulliparious, early menarche, late menopause, obesity
3) obesity
4) oral contraceptive pill and some HRT
5) alcohol
6) obesity
7) Ionising radiation
8) FH - 1st-degree relative

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6
Q

which are the genes that are related to breast cancer

A

BRCA1/2

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7
Q

what other cancer is BRCA 1 related to

A

ovarian

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8
Q

what other cancer is BRCA 2 related to

A

early onset breast cancer

more common in male breast cancer

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9
Q

what are the different types of breast cancer

A

1) invasive ductal carcinoma - most common - 70-80%
2) lobular carcinoma - 10%
3) medullary
4) colloid
5) comedo
6) papillary

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10
Q

which type of breast cancer is particularly related to multi-centric breast cancer

A

lobular

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11
Q

which type of breast cancer doe ductal carcinoma in situ cause?

A

invasive ductal carcinoma

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12
Q

how does ductal carcinoma in situ cause breast cancer

A

atypical proliferation of the epithelial cells –> fills and plugs the ductus –> invasive ductal carcinoma

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13
Q

how does DCIS present on a mammogram?

A

calcification of the ductus

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14
Q

symptoms of breast cancer?

A

1) breast mass ( painless is a RFL)
2) nipple discharge - bloody
3) puckered/indrawn nipples
4) Peau d’ orange (can be mastitis, so will need follow up after ABx given)
5) paget’s = nipple eczema
6) swollen arm, numbness in hand –> signs of lymphadenopathy
7) symptoms of mets

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15
Q

where does breast cancer spread to most commonly

A

to lungs, liver, bone, brain and lymph nodes

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16
Q

Ix for breast cancer

A

triple assessments

  • clinical exams and history
  • bilateral mammogram - bilateral because of mets, multicentric
  • USS guided biopsy to the suspicious area +/- axillary nodes

if high risks of mets –> isotope bone scans, CT liver scans

if discrepancy within the triple assessment then do MRI to further confirm

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17
Q

what modality of biopsy is done to investigate breast cancer as part of the triple assessment

A 
fine needle aspiration cytology 
core biopsy 
incisional biopsy 
excisional biopsy 
needle biopsy
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18
Q

which stage system does breast cancer employ?

A

TNM

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19
Q

what the T part of the breast cancer staging like?

A 
T0 = no primary tumour 
Tis = in situ disease, non-invasve 
T1 = invasive tumour < 2 cm
T2 = invasive tumour 2-5 cm 
T3 = invasive tumour >5cm 
T4 = skin involvement
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20
Q

what the N part of the breast cancer staging like?

A 
N0 = no LN involvement 
N1 = mobile axillary nodes 
N2 = fixed axillary nodes 
N3 = internal mammary nodes
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21
Q

what the M part of the breast cancer staging like?

A 
M0 = no mets 
M1 = mets
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22
Q

what is the TNM make up of stage 0 breast cancer

A

Tis, N0, MO

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23
Q

what is the TNM make up of stage 1 breast cancer

A

T1, N0, M0

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24
Q

what is the TNM make up of stage 2 breast cancer

A

T2/3, N0, M0 or T0/1/2, N1, M0

25
Q

what is the TNM make up of stage 3 breast cancer

A

T or N > stage 2, M0

26
Q

what is the TNM make up of stage 4 breast cancer

A

any T and N but M1

27
Q

when will you consider neoadjuvant cancer prior to surgery in breast cancer

A

when surgery not suitable
to allow for breast conservation
HER2 +ve or triple -ve breast cancer as high response rates are possible

28
Q

what sort of surgery is used to treat breast cancer

A

mastectomy or local wide excision + adjuvant radio (depends on grades)

+ sentinel node investigation

+/- axillary clearance (if mets present before surgery or after

29
Q

what other agents are used to treat microscopic disease after initial treatment

A

hormonal therapy

chemo

30
Q

what are some consideration for using adjuvant chemo/hormonal therapy

A 
ER/PR status 
HER2 status 
menopausal status 
tumour size and grade 
nodal involvment 
performance status
31
Q

what age is chemo most effective in breast cancer

A

< 50

32
Q

what is the most commonly used chemo for breast cancer

A

Trastuzamab (Herceptin) - effective against both localised and mets

usually given for 12 months

33
Q

what receptor does trastuzamab targets for

A

HER2

34
Q

what is one serious SE for trastuzamab

A

affect cardiac function and so will need regular monitoring of the heart

35
Q

what special monitoring requirement is there for trastuzamab

A

MUGA scan - multi-gated acquisition scan - video of ventricle of the heart

36
Q

what are the 2 types of hormonal/endocrine treatment for breast cancer

A

oestrogen antagonist - Tamoxifen

aromatas inhibitor - anastrazole, letrozole

37
Q

which type of patient would tamoxifen be used on

A

pre-menopausal

38
Q

which type of patient would letrozole be used on

A

post-menopausal - prove to be more effective in post-menopausal women

39
Q

what is the treating regimen of tamoxifen in breast cancer

A

20mg per day up to 5 years of diagnosis but if high risk then 10 years

only suitable for ER/PR +ve cancer types

40
Q

what are some SE for tamoxifen

A

inc thrombotic risks

inc risk of endometrial cancer

41
Q

what is the MOA of anastrozole

A

stop the conversion of testosterone to oestrogen

42
Q

SE of letrozole

A

osteoporsis - so need DEXA scans and lifestyle changes, vit D< bisphosphonate, Ca supplement

43
Q

what is the role of radiotherapy in breast cancer treatment

A

when wide local excision - compulsory adjuvant radio

when mastectomy is done but still a high risk of recurrence or mets

lymph node involvement

palliative

44
Q

what is high risk of recurrance of breast cancer

A

deep resection margin involvement
large primary tumour > 4 cm
multiple axillary nodes containing mets
widespread lymphovascular tumour permeation

45
Q

what is the radiotherapy treatment regime of breast cancer

A

daily for 3 weeks

if high risk of recurrence the ‘boosts’ ie an extra week

46
Q

when is hormonal therapy used as primary treatment in breast cancer

A

when it is a slowly progressive cancer and no visceral involvement

47
Q

what does hormonal therapy include?

A

oestrogen antagonist

ovarian ablation - can be surgical/radio/LHRH agonist

48
Q

what is the 5 years survival rate for breast cancer

A

Stage 1 - 95%
stage 2 - 80%
stage 3 - 60%
stage 4 - 25%

49
Q

what is the screening programme of breast cancer like?

A

from 50 - 70 yrs old
every 3 years
mammogram

50
Q

how common is lung cancer in the UK

A

3rd most common cancer in the UK
1 in every 13 men
1 in every 15 women

22% of cancer-related deaths in the UK

51
Q

RF for lung cancer

A 
genetic disposition 
cigarette smoking 
inc age 
COPD 
industrial exposure to asebtos, chromium, arsenic, iron oxide
52
Q

what can you find chromium

A

coating for metals for prevention of rust

53
Q

what are the 2 main subtypes of lung cancer

A

small cells lung cancer

none-small cell lung cancer

54
Q

what is the % of SCLC in overall lung cancer

A

15%

55
Q

what is the % of NSCLC in overall lung cancer

A

85%

56
Q

what are the different subtype of NSCLC

A

squamous cell carcinoma - 42%
adenocarcinoma - 39%
large cells carcinoma - 8%
calloid, mesothelioma, sacroma, lymphoma

57
Q

what are some characteristics fo squamous cell carcinoma

A

usually found centrally near the bronchi
due to cigarette smoking
PTH related peptide
associated with hypercalcaemia due to PTH

58
Q

what are some characteristics fo adenocarcinoma

A 
more frequent in women 
not associated with smoking 
found peripherally 
associated with activating mutation in EGFR and ALK (important prognostic factors) 
previous asbetos exposure
59
Q

what are some characteristics fo large cell carcinoma

A

less differentiated than the other NSCLC

mets early

Year 4 - OncologY (4 decks)

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