Cancer Flashcards
1
Q
FAP inheritance
A
AD
2
Q
Most common type of RCC
A
Clear cell (think that wee is clear)
3
Q
System to grade prostate histology
A
Gleason score
4
Q
System to grade gynaecological cancer
A
Figo
5
Q
System to grade gynaecological cancer
A
Figo
6
Q
Two risk factors for developing squamous cell carcinoma of bladder
A
Smoking
Schistosomiasis infection
7
Q
Which type of testicle cancer is AFP raised in
A
Non-seminoma
8
Q
4 risk factors for TCC
A
Smoking
Aniline dyes
Rubber manufacture
Cyclophosphamide
9
Q
First line investigation for ?prostate cancer
A
Multi parametric MRI
10
Q
What cancer is acanthosis nigricans associated with
A
Gastric endocrine cancer
11
Q
What cancer is acanthosis nigricans associated with
A
Gastric endocrine cancer
12
Q
What blood group is associated with an increased risk of gastric cancer
A
Group A
13
Q
Tumour marker for breast cancer
A
15-3
14
Q
Sign seen on all imaging in pancreatic cancer
A
Double duct
15
Q
Under what size tumour can an WLE be used
A
4 cm and under
16
Q
When would Herceptin be used
A
In HER2 positive breast cancer patients (cannot be used in patients with cardiac disorders)
17
Q
What axilla surgery should a women with no palpable lymph nodes have
A
None - US first to assess then if positive sentinel node biopsy
18
Q
What must be given during the first weeks of Gosrelin
A
Antiandrogen to reduce tumour flare effect
19
Q
Gold standard ix for ?oesphageal cancer
A
Endoscopy
20
Q
Most likely oesophageal cancer by location
A
Top 2/3 - squamous cell ca
Bottom 1/3 - adenocarcinoma
21
Q
Indicator in a FBC that may suggest lung cancer
A
Raised platelets
sorry for awful question
22
Q
Main complication of prostate removal
A
ED
23
Q
How long after a UTI can a PSA be taken
A
4 week
24
Q
How long after exercise and ejactulation can a PSA be taken
A
48 hours
25
3 common paraneoplastic syndromes associated with small cell carcinoma
ADH
ACTH
Lambert Eaton syndrome (legs worse than arms)
26
Clubbing is most associated with what cancer
Squamous
27
All men over 60 with microcytic anaemia should receive
2 ww ?colorectal cancer and colonoscopy
28
What patients get a 2 ww for ?RCC
Over 45 with unexplained visible haematuria
29
Consequence of FAP
Malfunctioning of tumour suppressor gene: adenomatous polpyposis coli (APC)
Causes development of polyps (adenomas) in large colon.
30
Treatment of FAP mutation
Panproctocolectomy
31
2 genetic causes of increased bowel cancer risk
FAP
| HNPCC (Lynch syndrome)
32
What is HNPCC
Hereditary nonpolyposis colorectal cancer
DOES NOT CAUSE ADENOMAS LIKE FAP
Increases risk of bowel cancer
33
Difference between FAP and HNPCC on colonoscopy
FAP causes multiple adenomas (polyps)
34
NICE 2ww criteria for ?bowel cancer
Over 40: abdominal pain and weight loss
Over 50: unexplained rectal bleeding
Over 60: iron deficiency anaemia or change in bowel habit
35
Difference between FIT test and FOB test
FIT test is for human hb (currently used)
| FOC is for blood so could be from diet etc
36
When should a FIT test be used
In general practice if patient doesn't meet NICE 2ww criteria
Over 50: unexplained weight loss
Under 60: change in bowel habit
37
Who for and how often is bowel cancer screening undergone
60-74 years
Every 2 years FIT test
38
Is CEA used for screening
Not useful in screening
| Useful for checking for reoccurrence of cancer
39
Gold standard investigation for ?bowel cancer
Colonoscopy
40
2 classifications for bowel cancer
Dukes
| TMN
41
3 specific treatments for bone pain
NSAIDS
Radiotherapy
Bisphosphonates (pamidronate infusion)
42
What is pamidronate infusion and whats it used for
Bisphosphonate
Bone pain
Hypercalcaemia
43
What is visceral pain
Deep seated poorly located pain that can be spasmodic
44
Treatment for visceral pain
Using WHO pain ladder
| Spasms can be helped with anticholinergics - hycosine for bowels and oxybutyl for bladder
45
Drug used for bladder spasm
Ocybutynin
46
Pain due to raised ICP
Dex (16mg daily reduced to least effective dose)
47
Two classes of drugs used for neuropathic pain
Anti epileptic - pregablin
| Anti depressant - amitriptyline
48
What may happen to patients started on mrophine that begin to feel nauseous
Improve after a few days
49
When titrating up pain relief, what does increase should be used
30-50%
50
Breakthrough pain relief dose
1/6th
51
How long do fentanyl patches last for
72 hours
52
2 drugs that can be used for anorexia
```
Dex (4mg)
Megestrol acetate (can cause fluid retention)
```
53
4 key causes of nausea in oncology
Gastric stasis - metoclopramide
Toxins - haloperidol
Cerebral - (dex) plus cyclizine
Vestibular - cyclizine
Levomepramazine is a good all rounder
54
What type of drug is levomepromazine
Anti emetic
55
3 classes of laxative
Bulk forming (fibre - not used much)
Osmotic
Prokinetic
56
Give examples of pro kinetic and osmotic laxative
Osmotic: lactulose, docuaste
Stimulant: MCR, Senna, dantron
Mixed: movicol
57
What gene does cigarette smoke damage
p53 tumour suppressor
58
Aromatic amines are associated with what cancer
Blader
59
What cancer is benzene associated with
Leukaemia
60
What cancer is wood dust associated with
Nasal adenocarcinoma
61
What cancer is vinyl chloride associated with
Angiosarcomas
62
What cancers is EBV associated with
NH lymphoma
| Burkitts
63
What is synergism
Giving multiple chemotherapy agents at once to maximise cell death
64
When is WBCs drop the lowest and what is this called
10-14 days after beginning of cycle
| Nadir
65
When would you infuse patients having chemo with platelets
Less than 10x10^9 - always
| 10-20x10^9 if symptoms
66
5 types of non small cell lung cancer
```
Adenocarcinoma (non smokers)
Squamous
Large cell
Alveolar (++ sputum)
Bronchial (mostly carcinoid)
```
67
What should women be offered after WLE
Radiotherapy
| Plus potential other treatments
68
Most common type of thyroid cancer
Papillary
69
Second cancer associated with HNPCC
Endometrial
gastric, biliary and ovarian possible
70
Triad of RCC
Haematuria
Loin pain
Abdominal pass
71
Possible PNS of RCC
EPO (polycythemia)
PTH
ACTH
72
Adjunctive therapy in postmenopausal women
Anastrazole (aromatase inhibitor)
73
What is brachytherapy
When a radioactive substance is placed inside a cavity or cancerous organ
74
What breast screening is offered in UK
Mammography to all women between 50 and 70 every 3 years
75
What bowel screening is offered in UK
FOB every 2 years 60-70
76
Hypertrophic oestoarthopathy triad and what disease is it associated with
Triad of osperiostitis, digital clubbing and painful arthropathy of the large joints
Lung cancer (squamous and adenocarcinoma)
77
3 paraneoplatic syndromes associated with small cell lung cancer
ADH
ACTH
Lambert Eaton syndrome
78
3 PNP syndromes associated with squamous cell
PTH -> hypercalcaemia
Hypertrophic pulmonary osteoarthopathy
Hyperthyroidism due to ectopic TSH
79
2 PNP syndromes associated with adenocarcinoma
Gynaecomastia
| Hypertrophic pulmonary osteoarthopy
80
Lung cancer strongly associated with clubbing
Squamous
Central, PTHrp, HPOA
81
Which lung cancer is most common in non-smokers
Adenocarcinoma
82
Lung cancer that secrets bHCG
Large cell
83
Lung cancers that grow peripherally
Adenocarcinoma
| Large cell
84
Prostatitis effect on GI system
Pain on bowel movements
85
What hormones is prostate cancer dependant on
Androgens (testosterone)
86
Most common type of prostate cancer
Adenocarcinoma (and grow peripherally)
87
Ethnicity risk for prostate cancer
Black African and Caribbean
88
2 key non LUTS prostate cancer symptoms
ED
| Haematuria
89
Age to request a PSA
50
90
PSA rates of false positives and negative
FP: 75% of time
FN: 15% of time
91
First line investigation in ?prostate cancer
Multiparametric MRI
92
Grading score for prostate histology
Gleason
93
What is Gleason score
Histology grading of two numbers between 1 and 5
| 10 is worst
94
Hormone therapy in prostate cancer
Reduce testosterone levels
Androgen receptor blockers (bicalutamide)
GnRH agonists (goserelin)
Bilateral orchidectomy
95
Two types of testicular cancer
Seminomas
| Non-seminomas (teratomas)
96
4 key risk factors for testicular ca
Undescended testicles
Male infertility
FH
Increased height
97
Is testicular cancer normally painful
Painless
98
Would a testicular cancer transilluminate
No
99
What key symptom does Leydig cell tumour give
Gynaecomastia (testicular tumour)
100
3 tumour markers in testicular cancer
AFP - non-seminomas
bHCG - both
LDH - very non specific
101
4 most common mets location from testicle
Lymph, lung, liver, brain
102
Over what age should a smoker with haemoptysis be referred to a 2ww clinic
40
103
Which lung ca is most sensitive to radiotherapy
Small cell
104
What cancer is BRACA2 associated with in men
Prostate
105
Signet ring cells are assocoiated with…
Adenocarcinoma of lung
106
Double duct sign is seen in
Pancreatic ca
107
Triad of hypotension, haemconcentrate and low albumin
Capilary leak syndrome
108
How do the majority of lymphoma patients present
Lymph nodes
109
Why would uric acid be measured in lymphoma
Risk of tumour lysis syndrome with treatment
110
Faulty BRCA1 gene leads to what increased risk
70% will develop breast cancer by 80
50% will develop ovarian cancer
Bowel and prostate cancer risk
111
If you have a faulty BRAC2 gene, what are your increased risks
60% risk of breast cancer by 80
| 20% risk of ovarian cancer
112
Which cancers effected by BRAC1
Breast, ovarian, bowel and prostate
113
How does COOP affect breast cancer risk
Small increase but back to normal 10 years after stopping
114
What chemoprevention may be offered to high risk men and women of breast cancer
Tamoxifen if pre
| Anatrozole if postmenomausal
115
Which lumps are the most concerning in breast cancer
Hard, irregular, painless and fixed in place
116
NICE 2ww for breast cancer guidelines
Unexplained breast lump in over 30s
| Unilateral nipple changes in over 50s
117
Where does breast cancer mets to
2Ls 2Bs
Lung liver
Bones brain
118
What two cancers can practically and regularly do, spread anywhere
Breast and melanoma
| Lung, liver, bone, brain most common in breast
119
When can aromatase inhibitor be used
In postmenapausal women with ER positive cancer
120
How does tamoxifen work
Oestrogen receptor modulator (blocker)
121
How long is hormonal treatment in breast cancer
5-10 years
122
Why may ovaries be removed in breast cancer
If ER+ve to reduce oestrogen levels
123
When is trstuzumab used and what is it
HER2 +ve breast cancer
124
Key risk with trastuzumab
Alter heart function
125
Under what eGFR should oxycodone be used
50
126
Good non-pharmacological bone pain relief
Radiotherapy
127
Once a patient is treated for breast cancer, how should they be managed.
Surveillance mammograms yearly for 5 years
Tamoxifen/ anastrozole for 5-10 years if ER+ve
128
Most common cells affected in HandN cancer
Squamous cell
129
How do head and neck cancers normally spread
Lymph nodes
130
Risk factors for H and N cancers (5)
Smoking
Alcohol
HPV (16)
EBV
Betel quid (something chewed in SE Asia?)
131
What is Kaposis sarcoma
Herpes virus 8 induced sarcoma seen in end stage HIV
Induces red purple rash over body
132
Pt presents with liver mets, what scan should be arranged
Colononscopy
133
Most common bug that causes line infections
Staph epididmitis
134
Do seminomas raise AFP
No
135
Testicle cancer type by age groups
30-50 seminoma
| 20-30 non seminoma
136
What MST dose does NICE recommend for new pts
20-30 mg per day
137
What would you prescribe for someone with spinal cord compression?
16mg dex PO
PPI - don't forget!!!!
138
Acronym for breaking bad news (and its meaning)
```
SPIKES
Setting
Perception
Invitation (do they want to know today)
Emotions
Strategy and summary
```
139
Average age of Hodgkins Lymphoma
Bimodal age
| 20 years and 75 years
140
4 risk factors for Hodgkins lymphoma
HIV, EBV, AI conditions, FH
141
Description of lymphoma lymph nodes
Non-tender and rubbery
WORSE ON DRINKING ALCOHOL
142
Key diagnostic test in Hodgkins lymphoma
Biopsy that shows Reed Sternberg cells (large B cells with multiple nuclei)
143
What are Reed Sternberg cells a sign of
Hodgkins lymphoma
144
Staging system used in H lymphoma
Ann Arbor
(same in both)
```
1 = one region
4 = metastatic spread
```
145
Staging system used in non H lymohoma
Ann Arbor
(same in both)
```
1 = one region
4 = metastatic spread
```
146
Management of H lymohoma
Chemotherapy and radiotherapy
```
Chemo = risk of leukaemia and infertility
Radio = risk of cancer and hypothyroidism
```
147
3 key non H lymphomas
Burkitt (EBV, malaria, HIV)
MALT (mucosa associated lymphoid tissue normally in stomach and associated with H Pylori)
Diffuse large B cell lymphoma (rapidly growing painless mass in over 65s)
148
What is trichloroethylene a risk for
Non H lymphoma
149
What is lymphoma a cancer of
Lymphocytes
150
What is leukaemia a cancer of
Stem cells in bone marrow
151
Blood results found in almost all leukaemias
Pancytopenia - anaemia, leukopenia, thrombocytopenia
152
Age distribution of leukaemia
ALL CeLL (mates have) CoMmon AMbitions
ALL - under 5 over 45
CLL over 55
CML over 65
AML over 75
153
Nice guidelines for suspected leukaemia
FBC within 48 hours
154
Key test for leukaemia
Bone marrow biopsy
155
ALL blood film shows
Blast cells
| ALL blast off? bLAst off?
156
Common association with ALL in kids
T21
| Philadelphia chromosome
157
CLL transforms to Lymphoma is called
Richters transformation
158
What type of anaemia is CLL associated iwth
Warm auto immune haemolytic anaemia
159
Two leukaemias associated with Philadelphia chromosome
ALL and CML
| opposite besucase Philidelipa is opposite?
160
Cells seen within CLL
Smudge/ smear
| get the all CLLear when you go for a smear
161
Most common adult leukaemia
AML
162
What is seen on an AML blood film
Auer rods
163
CML is broken down into three what?
Phases
Chronic - 5 years and normally asymptomatic expected a raised WCC
Accelerated - abnormal blast cells take up a high proportion of bone marrow cells so patients become anaemic, thrombocytopenia and immunocompromised
Blast - even higher proportion of cells - normally fatal
164
Key chemical released in tumour lysis syndrome
Uric acid
165
Two drugs used to treat tumour lysis syndrome
Allopurinol or rasburicase
166
Electrolyte derangement seen in tumour lysis syndrome
High uric acid
High K
High PO4
(low calcium as high po4)
167
calcium levels in tumour lysis syndrome
can be low as phosphate is high
168
What cells is myeloma a cancer of
Plasma (B lymphocyte that makes anti bodies)
169
What is Monoclonal gammopathy of undetermined significance (MGUS)
Similar to myeloma when body makes excess of a single type of antibody without other features of myeloma
170
4 key features of myeloma
CRAB
Calcium (elevated)
Renal failure
Anaemia
Bone lesions/ pain
171
Risk factors for myeloma
Older age, male, black African, FH, obesity
