cancer Flashcards
define breast cancer and outline aetiology/risk factors
malignancy of breast tissue
invasive ductal carcinoma most common
genetic factors
environmental factors
risk factors:
- age
- prolonged exposure to oestrogen (early period, late menopause)
- FHx (BRACA1/2)
- increased OCP
- not breast fed
presenting symptoms of breast cancer
breast lump (typically painless) changes in breast shape
nipple discharge (may be bloody)
axillary lump
signs of malignancy
- weight loss
- bone pain
- paraneoplastic syndromes
physical examination findings of breast cancer
- breast lump
- firm
- irregular
- fixed to surrounding structures
- peau d’orange (inflammatory cancer)
- skin tethering
- fixed to chest wall
- skin ulceration
- nipple inversion
- Paget’s
- lymphadenopathy
Paget’s disease of the nipple
eczema like hardening of skin on nipple
- due to ductal carcinoma in situ infiltrating nipple
investigations for breast cancer
triple assessment = clinical examination + imaging + tissue diagnosis
imaging:
- US if <35yrs
- mammogram if >35yrs
tissue diagnosis:
- fine needle aspiration
- core biopsy
staging:
- CXR
- Liver US
- CT (brain/thorax)
- sentinniel lymph node bipsy (radioactive tracer injected into tumour => scan identifies sentinel lymph node=> biopsy of node to check spread)
bloods:
- FBC
- U&Es
- calcium
- bone profile
- LFT
- ESR
Management of breast cancer
Localised
- wide lobe excision/mastectomy
- +/- radiotherapy
- if lymph node invasion- sentinel lymph node biopsy/ axillary node dissection
Advanced cancer:
- Tamoxifen (endocrine therapy) for oestrogen-receptor-positive cancer
- chemotherapy (for life threatening/ symptomatic)
- Trastuzumab (biologic)- HER2 positive cancer
*aromatase inhibitor =>less oestrogen => early menopause)
for post-menopausal women with invasive cancer => bisphosphonates
radiotherapy
define colorectal cancer
malignant adenocarcinoma of large bowel
- 60% rectum and sigmoid
- 30% descending colon
- 10% rest of colon
aetiology/risk factors of colorectal cancer
environmental + genetic
sequence of genetic changes
risk factors:
- western diet
- colorectal polyps
- previous colorectal cancer
- FHx
- IBD
presenting symptoms of colorectal cancer
left sided colon and rectum:
- change in bowel habit
rectal bleeding
tenesmus
right sided colon:
- presents later
anaemia symptoms
weight loss
non-specific malaise
lower abdominal pain (rare)
* 20% present as emergency with pain and distension
- large bowel obstruction
- haemorrhage/peritonitis due to perforation
signs of colorectal cancer on physical examination
anaemia
abdominal mass
hepatomegaly
ascites
low lying rectal tumours may be palpable on DRE
investigations for colorectal cancer
FBC
LFTs
tumour markers
FOBT
endoscopy
- sigmoidoscopy
colonoscopy
double contrast barium enema
contrast CT for staging
