Cancer Flashcards
Ascites: causes
Management:
- reduce dietary sodium
- fluid restrict if Na+ <125mmol/L
- aldosterone antagonist e.g. spirinolactone
- drainage if tense
- prophylactic ABX for SBP: ciprofloxacin
- TIPS
What is this lesion?
How do you manage it?
- Basal cell carcinoma
- Surgical removal, curettage, cryotherapy, topical creams (iquimod, fluoracil), radiotherapy
Bladder cancer
Benign tumours - uncommon
Bladder malignancies:
- Urothelial (transitional cell) carcinoma (>90% of cases)
- Squamous cell carcinoma ( 1-7% -except in regions affected by schistosomiasis)
- Adenocarcinoma (2%)
Risks for transitional cell: smoking, aniline dye exposure (printing/textile), rubber manufacture, cyclophosphamide
Risk for SCC: schistomiasis, smoking
Presentation: painless, macroscopic haemarturia
Staging: cytoscopy or biopsy.
CT and MRI for distant disease.
Treatment:TURBT in isolation
- those with recurrences or higher grade are given intravesical chemo
- T2 disease are offered surgery or radial radiotherapy
Breast cancer
Screening: offered to women 50-70 years. Mammogram every 3 years.
Referral: 2ww
- >30 with unexplained breast lump with or without pain
- >50with nipple discharge, retraction or changes
Types of breast cancer:
- invasive ductal carcinoma: most common type
- invastive lobular carcinoma
- ductal carcinoma-in-situ
- lobular carcinoma-in-situ
Risk factors:
- BRCA1, BRCA2
- 1st degree prelative
- nulliparity, 1st child >30 or <25
- early menarche, late menopause
- combined hormone replacement therapy
- p53 gene mutations
- obesity
Management:
Surgery (see picture)
Radiotherapy: recommended after a woman has had a wide-local excision as this may reduce the risk of recurrence by around two-thirds
Hormonal therapy:
- ER+: pre- & peri-menopausal women: taoxifen
- ER+ post-menopausal: anastrozole
Biologics: trastuzumab (herceptin) if HER2+ (contra in heart problems)
Chemotherapy
Hypercalcaemia
Symptoms:
- bones, stones, groans, psychic moans
- corneal calcification
- **shortened QT **
- HTN
Mx:
- rehydration with normal saline
- bisphosphanates
- calcitonin: quicker effect than bisphosphonates
- steroids in sarcoidosis
Lung cancer
Subtypes
1. SCC: hypercalcaemia, cavitating lung lesions
2. adenocardinoma: non-smokers most common in
3. large cell: secrete b-HCG, poor prog
4. small cell: hyponatraemia, cushings
Sx - cough, haemoptysis, weight loss, hoarseness (pancoast), SCV syndrome
SVC obstruction - treat initially with IV dex then SVC stenting definitive Mx
Referral:
- 2ww >40 with unexplained haemoptysis
- Urgent CXR: >40 and cough, fatigue,SOB, chest pain, weight loss
Exam - fixed monophonic wheeze, lymphadenopathy, clubbing
Paraneoplastic features (see table):
Investigation
1. CXR
2. CT investigation of choice
3. Bronchoscopy
4. PET scan
5. bloods - raised platelets
Management
Non-small cell
- 20% suitable for surgery
- currative or palliative radiotherapy
- poor response to chemo
Small cell:
- normally metastatic at time of diagnosis
- can be considered for surgery
- mainly chemo and radiotherapy
- palliative
Malignant melanoma
Subtypes (see table)
Major diagnostic criteria: change in size, shape or colour
Minor criteria: diameter >=7mm, inflammation, oozing, altered sensation
Mx:
- suspicious lesions undergo excision biopsy
Neoplastic spinal cord compression
Features:
- back pain
- lower limb weakness
- sensory loss & numbness
- neurological signs: above L1 gives UMN sigs in legs, below cause LMN in legs and perianal numbness
Invesitgation:
urgent whole MRI scan within 24h of presentation
Mx:
- high dose oral dexamethasone
- urgent oncological assessment
Prostate cancer
Risk: age, obesity, afro, FH
Features:
- asymtomatic
- bladder outlet obstruction: hesitancy, urinary retention
- haematuria, haematospermia
- pain: back, perineal or testicular
- digital rectal examination: asymmetrical, hard, nodular enlargement with loss of median sulcus
Investigation:
- PSA: normal upper limit 4ng/ml
- transrectal USS +/- biopsy
- MRI/CT and bone scan for staging
MX:
- watch and wait in elderly
- radiotherapy external
- surgery: radical prostatectomy
- hormonal therapy: testosterone
Hodgkins lymphoma
Presentation:
- lymphadenopathy (worsens with alcohol)
- assymetrical spreading lymphadenopathy
- B Sx: weight loss, night sweats
Investigation:
- normocytic anaemia
- eosinophillia
- LDH raised
- Reed-Sternberg cells (mirror image nuclei)
Ann-Arbor Staging:
I: single lymph node
II: 2 or more lymph nodes/regions on the same side of the diaphragm
III: nodes on both sides of the diaphragm
IV: spread beyond lymph nodes
Management: chemo
Chronic lymphocytic leukaemia
Features: often none, incidental
Investigations:
- FBC: lymphocytosis, anaemia, thrombocytopenia
- smear: smudge cells (see pic)
Main complication: Richters transformation into a fast growing non-Hodgkin lymphoma
Chronic myeloid leukaemia
Presentation:
- anaemia
- weight loss & sweating
- splenomegaly
Investigation:
- neutrophilia
- increased granulocytes at different stages of maturation +/- thrombocytosis
Management
- imatinib
- hydroxyurea
- interferon-alpha
- allergic bone marrow transplant
Testicular cancer
ADENOCARCINOMAS are the most common
95% of testicular cancers are germ-cell tumours. Subtypes:
- seminomas
- non-seminomas: embryonal, yolk sac, teratoma and choriocardinoma
Non-germ cell: leydig and sarcoma
Risk factors:
- infertility (x3 increased risk)
- cryptochidism
- FH
- klinefelters
- mumps orchitis
Features:
- painless lump
- hydrocele
- gynaecomastia due to increased oestrogen:androgen ratio
Tumour makrers:
- seminomas: hCG elevated in 20%
- non-seminomas: AFP or b-hCG elevated
- LDH elevated in 40%
Diagnosis: USS
Mx:
- depends on whether it is seminoma or non-seminoma
- orchidectomy (remove teste)
chemotherapy and radiotherapy may be given depending on staging and tumour type
Breast cancer drugs
SERM: ER+ pre-menopasue
- menstrual disturbance: vaginal bleeding, amenorrhoea
- hot flushes - 3% of patients stop taking tamoxifen due to climacteric side-effects
- venous thromboembolism
- endometrial cancer
Aromatase: ER+ post-menopause
- osteoporosis: NICE recommends a DEXA scan when initiating a patient on aromatase inhibitors for breast cancer
- hot flushes
- arthralgia, myalgia
- insomnia
Ovarian cancer
Risk factors
- FH: BRCA1 or BRCA2
- many ovulations
Sx: vague
- abdo distension & bloating
- abdo & pelvic pain
- urinary Sx
- diarrhoea
Investigation
- CA125 >35: USS abdo pelv
- USS
- diagnostic laparotomy
- risk of malignancy index(RMI): USS findings, menopausal status & CA125 levels
Management: surgery & platinum based chemo
