Cancer Flashcards
What are the types of breast cancer
Ductal carcinoma in situ
Lobular carcinoma in situ
Infiltrative ductal carcinoma
Invasive lobular carcinoma
Paget’s
Inflammatory carcinoma
Most common type of breast ca
Infiltrative ductal carcinoma
What is paget’s disease
ductal ca invades nipple with eczema
What is the most aggressive form of breast ca
Inflammatory carcinoma
(peau d’orange sign of advanced disease)
What is the follow up for breast ca
Q3-6 months for yr 1-3, q6-12 months for yr 4-5 then q1year
Treatment for stage 0 breast ca
BCS +/- radiotherapy and mastectomy
Treatment for stage 1 breast ca
BCS + axillary node dissection + radiotherapy, mastectomy +/- chemo
Treatment for stage 2 breast ca
BCS + axillary node dissection + radiotherapy + chemo/estrogen receptor negative followed by tamoxifen if ER positive
Treatment for stage 3 breast ca
Likely mastectomy + axillary node dissection + radiotherapy + chemo + hormones
Treatment for stage 4 breast ca
Likely mastectomy + axillary node dissection + radiotherapy + chemo + hormones
How often to do pap in immunocomprised
yearly
How often to do pap in SLE
yearly
How often to do pap in total hysterectomy
If no hx of dysplasia or HPV then none
If hx of HSIL, AIS or cancer, annual vault smear for lifeS
Signs and symptoms of cervical cancer
Abnormal spotting
Bleeding/pain after intercourse
Change in menstrual periods
Discharge
Pain in pelvis/back
Management of CIN 1
Observation with repeat in 12 months, can consider excision biopsy
Management of CIN 2 and <25 y/o
Colposcopy q6 months up to 24 months before considering treatment
Management of CIN 3 and <25 y/o
Excisional procedure, if positive margins repeat colposcopy
Management of CIN 2 or 3 and >/ 25 y/o
Excisional procedure, if positive margins repeat colposcopy
Adenocarcinoma in situ
Excisional procedure or type 3 transformation zone excision
When/How to screen people with 1 or more first degree relative for colon ca
1st line: colonoscopy age 40-50 or 10 years younger than diagnosis age (whichever earlier). Screen q5-10 years.
When/how to screen people with IBD for colon ca
Colonoscopy 8-10 years after pan colitis or 12-15 years after left sided colitis done q1-2 years.
When/how to screen people with FAP for colon ca
Genetic counselling
Flexible sigmoidoscopy q1years starting age 10-12 years.
When/how to screen people with HNPCC (Lynch syndrome) for colon ca
Genetic counselling
Colonoscopy q1-2 years starting age 20 or 10 years earlier than family case.
What is the definition of leukaemia?
Uncontrolled proliferation of haematopoietic stem cells in the bone marrow
What are the risk factors for leukaemia?
Down syndrome and neurofibromatosis
Ionising radiation
Exposure to benzene
Household pesticides
Obesity
What are the acute signs and symptoms of leukaemia in children?
Fever, lethargy, bleeding, MSK, symptoms, enlarged liver/spleen, lymphadenopathy
What are the acute signs and symptoms of leukaemia in adults?
Fever, fatigue weight loss anaemia related symptoms, thrombocytopenia related symptoms can have enlarged liver/spleen
What is the most common acuteleukaemia in children?
Acute lymphocytic leukaemia
What is the most common acute leukaemia and adults?
Acute myelogenous leukaemia
What are the signs and symptoms of chronic leukaemia?
Often asymptomatic, less common to have constitutional symptoms, often enlarged liver/spleen
What are the initial investigations for leukaemia?
CBC - high white blood cells, acute leukaemias can also have leukopenia usually with anaemia and thrombocytopenia
Peripheral smear - michelle, increased haematopoietic precursor cells were marked increase in lymphocytes, which is suggestive of possible leukaemia
LFTs creatinine electrolytes, coagulation studies
What are the common follow-up investigations for leukaemia?
Bone marrow, aspirate and biopsy
Cytogenetics molecular genetics, flow cytometry
What is the treatment for leukaemia?
Chemotherapy radiation, monoclonal antibodies, stem cell transplantation
What is seen on a peripheral blood smear and bone marrow aspirate in acute myelogenous leukaemia
Blast cells on PBS or BMA
Auer rods on peripheral smear
What age do most cases of AML occur
Adults, mean age 67
Symptoms and signs of AML
Fever, fatigue, weight loss, bleeding, bruising
Hepatomegaly
What are the subtypes of AML and associated prognosis
Acute promyelocytic and myelomono leukemia - favorable
Normal karyotype AML - intermediate
AML with complex karyotype - poor
Diagnostic work up for AML
CBC, WCC often > 100 x 10^9
More than 20% blasts on marrow or blood smear
Serum uric acid, LDH - prognositic relevance
Blood group and HLA type - for potential stem cell transplant
Surveillance for AML
CBC q1-2 months x 3 years then q3-6 months for 5 years
Echo and ECG q2years
What is seen on a peripheral blood smear and bone marrow aspirate in acute lymphocytic leukaemia
Blast cells
What age do most cases of ALL occur
Children and young adults
Signs and symptoms of ALL
Fever, lethargy, bleeding, MSK pain/dysfunction
Hepatosplenomegaly and lymphadenopathyS
Surveillance for ALL
Annual CBC, Cr, lytes, urea, calcium, magnesium, phosphorus, TSH, urinalysis
Echo and ECG q3-5 years if pretreatment abnormalities or signs of heart failure
Routine eye/dental
What is chronic mylegenous leukemia
Philadelphia chromosome
Signs of symptoms of CML
Splenomegaly
20% asymptomatic
Investigations for CML
Often WBC > 100 x 10^9
Management of CML
Early stage chronic leukemia (no anaemia, thrombocytopenia, <3 nodal involvement) can often be monitored without treatment
Surveillance for CML
CBC q3months
What is CLL
Clonal expansion of atleast 5000 B lymphocytes in the peripheral blood
What age do most cases of CLL occur
Older adults
Signs and symptoms of CLL
50% asymptomatic
Hepatosplenomegaly and lymphadenopathy
What is the management of CLL
Early stage chronic leukemia (no anaemia, thrombocytopenia, <3 nodal involvement) can often be monitored without treatment
Monoclonal antibodies, chemo, radiation and transplant
Surveillance for CLL
Untreated:
Routine visits and CBC
Flu shot annualy, pneumo q5years
Avoid live vaccines
Treated:
Refer to cardio
Resting and stress echo
What is the treatment for non-small cell lung cancer?
Surgical resection for stage 1 to 2, chemo and radiation for stage 3, palliatie for stage 4
What is the treatment for small cell lung cancer?
Chemo and radiation
Where are the most common prostate cancer is found?
The peripheral zone
What are the signs and symptoms of prostate cancer?
Usually asymptomatic
May have lower urinary tract symptoms
Back pain - mets
On DRE, a hard irregular nodule or diffuse dense induration involving one or both lobes
What’s the management for low risk prostate cancer?
PSA Q3 to 6 months
DRE annually
Consider biopsy
Can choose curative management if personal preference, which would include radical prostatectomy, brachytherapy and radiation
The management for intermediate risk prostate cancer?
Radical prostatectomy
Brachytherapy
Radiation
What is management for high risk prostate cancer?
Radiotherapy in androgen deprivation therapy
Radical prostatectomy
Post prostatectomy radiation radiotherapy
Where does prostate cancer metastasise?
Adrenal gland, bone, liver, lung
What are the tumour markers for esophageal cancer?
CEA
CA 19-9
