Cancer Flashcards
1
Q
What are the risk factors for basal cell carcinoma ?
A
UV radiation
fair skin
scars and ulcers
chemical agent exposure
previous skin cancer
immunosuppression
2
Q
which is the most common basal cell carcinoma and how does it present ?
A
Nodular BCC
Presents on the head ( eyelids, cheeks and forehead) as pearly shiny papules or nodules with small telangiectasias and depressed centre on ulceration.
3
Q
what is the most common site for BCC
A
head / neck ( sun-exposed sites)
4
Q
how is a BCC referred and managed ?
A
Routine referral
Managed through :
Surgical removal
Curettage
Cryotherapy
5
Q
what are the other types of basal cell carcinoma and which has the worst prognosis ?
A
Superficial BCC
Pigmented BCC
Morpheaform BCC : worst prognosis
6
Q
why are BCC known as rodent ulcers ?
A
due to slow growth and local invasion
7
Q
what are the risk factors for bladder cancer ?
A
smoking
increasing age
aromatic amines ( dye and rubber industry)
schistosomiasis can lead to SCC
8
Q
what is the most common type of bladder cancer ?
A
Transitional cell carcinoma
9
Q
How does bladder cancer present ?
A
Painless macroscopic haematuria
10
Q
what is the referral process for suspected bladder cancer ?
A
2 week wait is recommended when
1) patient is >45 with unexplained visible haematuria ( with or without UTI)
2) patient is >60 with microscopic haematuria PLUS dysuria / raised WCC
> 60 with recurrent UTI –> refer non-urgently
11
Q
how is bladder cancer managed
A
Non invasive bladder cancer can be managed by TURBT : Transurethral resection of bladder cancer
12
Q
what are the risk factors for breast cancer ?
A
BRCA1, BRCA2
1st degree relative premenopausal with breast cancer
Nulliparity, 1st pregnancy > 30
early menarche and late menopause
previous breast cancer
obesity
smoking
combined contraceptive pill : risk reduces to normal after 10 years of stopping
HRT
13
Q
which is the most common kind of breast cancer ?
A
Invasive ductal carcinoma
14
Q
what are the common breast cancers ?
A
Invasive ductal carcinoma
Invasive lobular carcinoma
ductal carcinoma in situ
lobular carcinoma in situ
15
Q
what is triple negative breast cancer ?
A
cancer that lacks oestrogen receptors progesterone receptors and does not have HER2 proteins
16
Q
How does inflammatory breast cancer present ?
A
presents like breast abscess or mastitis
swollen, warm, tender breast with pitting skin ( peau d’orange)
non-responding to abx
17
Q
how does Paget’s disease of the nipple present?
A
eczema of nipple / areola
erythematous scaly rash
breast cancer could involve the nipple
18
Q
how often is breast cancer screening done and what is the test called ?
A
mammogram
every 3 years
women between 50-70
19
Q
what is the criteria for someone to be at high risk of developing breast cancer ?
A
1st degree relative :
under 40 with breast cancer
male with with breast cancer
bilateral breast cancer < 50
2 first degree relatives
20
Q
what is the screening process for breast cancer in those at high risk for it ?
A
mammogram to women from age 30 annually
21
Q
what chemo preventive drugs can be offered to those at high risk of breast cancer
A
tamoxifen : Premenopausal
anastrozole : post-menopausal
22
Q
how does breast cancer present ?
A
hard irregular painless lumps
tethered to skin or chest wall
nipple retraction
lymphadenopathy
23
Q
when is the 2 week wait recommended for suspected breast cancer ?
A
- Unexplained breast lump in patients 30 or above
- Unilateral nipple changes in patients aged 50 or above
consider 2 week wait :
unexplained lump in the axilla in patients 30/above
skin changes suggesting breast cancer
24
Q
what does triple assessment involve ?
A
Clinical assessment ( history and exam)
Imaging ( ultrasound / mammography)
Biopsy ( fine needle aspiration / core biopsy)
25
what is the management of oestrogen receptor positive breast cancer ?
Tamoxifen : selective oestrogen receptor modulator
Aromatase inhibitors
26
what medications are used in the management of HER2 receptor positive cancer ?
Trastuzumab
Pertuzumab
27
what are the risk factors in the development of cervical cancer ?
HPV
smoking
HIV
early first intercourse, many sexual partners
high parity
lower socioeconomic status
COCP
28
which is the most common type of cervical cancer ?
SCC
29
What is the presentation of cervical cancer ?
abnormal vaginal bleeding
vaginal discharge
pelvic pain
dyspareunia
30
how often are women with HIV screened for cervical cancer ?
Annually
31
what is the screening process for cervical cancer?
high risk HPV test where cytological examination is only performed if hrHPV is positive
every 3 years (25-49)
every 5 years ( 50-64)
32
explain the management of an inadequate smear sample
repeat in 3 months
if still inadequate, refer to colposcopy
33
how is a hrHPV positive sample managed ?
cytological examination
34
what is the management of abnormal cytology of sample
colposcopy referral
35
what is the management of normal cytology of sample after hrHPV +ve
repeat test at 12 months
hrHPV -ve : normal recall
hrHPV +ve at 12 months : repeat test at 12 months again
hrHPV +ve : Colposcopy
hrHPV -ve : normal recall
36
what is the management of cervical intra-epithelial neoplasia
large loop excision of transformation zone
37
explain the management of cervical cancer by stage
stage 1A : cone biopsy ( for fertility)
gold standard : hysterectomy and lymph node clearance
1B : radiotherapy with concurrent chemotherapy
1B2 : radical hysterectomy with pelvic node dissection
II,III : concurrent chemotherapy
IV : radiotherapy and / or chemotherapy
Palliative chemotherapy for IVB
38
what is the most common location for colorectal cancer tumours
rectum ( 40%)
39
describe FIT screening
National screening programme
every 2 years
Men and women aged 60-74
40
In which groups is a FIT test recommended ?
abdominal mass / change in bowel habit / IDA
40/over = unexplained weight loss AND abdominal pain
<50 with rectal bleeding AND abdominal pain OR weight loss
50/ over : rectal bleeding OR abdominal pain OR weight loss
60/ over anaemia
41
under what circumstances should a patient immediately be offered a colonoscopy
rectal mass
unexplained anal mass
unexplained anal ulceration
42
what are the risk factors for endometrial cancer ?
Excess oestrogen :
Nulliparity
Early menarche and Late menopause
Unopposed oestrogen
metabolic :
obesity
diabetes mellitus
PCOS
Tamoxifen
HNPCC
43
what are protective factors to the development of endometrial cancer ?
Multiparity
COCP
Smoking
44
what is the classical feature of endometrial cancer ?
Post menopausal bleeding
45
what is the suspected cancer referral pathway for endometrial cancer ?
post menopausal bleeding in a woman > 55
TVUSS ( > 4mm thickness cancer (?)
hysteroscopy with biopsy
46
what is the management of endometrial cancer ?
total abdominal hysterectomy with bilateral salpingo-oophrectomy
47
what are the risk factors for gastric cancer ?
Helio-bacter Pylori
Atrophic gastritis
Diet
smoking
blood group A
48
what are the features of Gastric cancer ?
abdominal pain
weight loss and anorexia
nausea and vomiting
dysphagia
49
how does lymphatic spread in gastric cancer present?
Left supraclavicular lymph node ; Virchow's node
Periumbilical node : Sister Mary Josephs node
50
how is gastric cancer diagnosed and what sign may be present
OGD with biopsy
signet ring cells
51
what is a fibroadenoma? how does it present?
Common benign tumours of breast tissue. common in young women between the ages of 20-40.
They present as :
Painless, smooth, round, well circumscribed, firm, mobile lumps up to 3 cm in diameter
52
what are fibrocystic breast changes and how do they present
cyclical symptoms due to the cumulative effect of oestrogen and progesterone leading to bilateral lumpy breasts and breast pain.
53
what is fat necrosis of the breast
benign lump usually triggered by localised trauma, radiotherapy or surgery.
Painless, firm, irregular, fixed in local structures.
54
what is a galactocele
Occurs in women that are lactating , after stopping breastfeeding.
Usually present with a firm, mobile, painless lump generally below the areola.
55
what is a phyllodes tumour ?
rare tumours of the connective tissue occurring most often between ages 40 and 50. Large and fast growing.
56
what are the features of hypercalcaemia
Bones, stones moans groans
corneal calcification
short QT
HTN
57
what is the management of Hypercalcaemia
rehydration with normal saline followed by bisphosphonates ( IV Zoledronate)
2nd line : Calcitonin
58
what is leukaemia ? what are its major types ?
cancer of stem cells of the bone marrow with excessive production of one type of abnormal white blood cell and supressing other cell lines causing underproduction of other cell types.
4 major types:
Acute lymphoblastic leukaemia
Acute myeloid leukaemia
Chronic myeloid leukaemia
Chronic lymphocytic leukaemia
59
What is the presentation of leukaemia?
Non specific presentation of :
Fever
Fatigue
Pallor
Petechiae
Abnormal bleeding
Lymphadenopathy
Failure to thrive
hepatosplenomegaly
60
Expand on Acute lymphoblastic leukaemia :
Who does it affect ?
What are its features?
What are poor prognostic factors for it ?
most common malignancy affecting children accounting for 80% of childhood malignancies.
Occurs between the ages of 2-5.
features are :
Anaemia : Lethargy and pallor
Neutropenia : frequent + severe infections
Thrombocytopenia: Easy bruising / petechiae
poor prognostic factors include :
age <2 or >10
WBC > 20
T/B cell surface markers
non white
male
61
what can precipitate acute myeloid leukaemia ? What is its characteristic feature on bone marrow biopsy ?
Myeloproliferative disorders such as polycythaemia rubra vera or myelofibrosis.
blood film/ bone marrow biopsy : blast cells + Auer rods
62
what is chronic lymphocytic leukaemia ? What is Richter's transformation? What type of cells are associated with chronic lymphocytic leukaemia ?
Slow proliferation of a single well differentiated lymphocyte, usually B-lymphocyte.
Richter's transformation is when the CLL transforms into high grade B lymphoma.
Smear or Smudge cells are associated with CLL.
63
what are the three phases of chronic myeloid leukaemia ?
Chronic : asymptomatic, incidental raised WCC
Accelerated : abnormal blast cells take up a high proportion of bone marrow and blood cells and patients become symptomatic.
Blast phase: high proportion of blast cells in the blood. severe symptoms
64
what chromosome is CML associated with?
Philadelphia chromosome. reciprocal translocation of genetic material between chromosome 9 and 22.
65
what is the most common form of leukaemia seen in adults
chronic lymphocytic leukaemia
66
what medication can be used to manage chronic myeloid leukaemia
Imatinib: tyrosine kinase inhibitor
67
what is tumour lysis syndrome? How does it present? How do you treat it ?
Tumour lysis syndrome: results from chemicals released when cells are destroyed by chemotherapy leading to high uric acid, high potassium, high phosphate, low calcium.
hydration is needed and allopurinol can be given.
68
how is leukaemia diagnosed?
FBC within 48 hours for suspected leukaemia
Blood film
Bone marrow biopsy : definitive diagnosis
Lymph node biopsy
69
what are the features of lung cancer?
Persistent cough
haemoptysis
dyspnoea
chest pain
WL + anorexia
Hoarseness : Pancoast tumour pressing on recurrent laryngeal nerve
70
what are examination findings in lung cancer
Fixed monophasic wheeze
supraclavicular lymphadenopathy / cervical lymphadenopathy.
Clubbing
71
what is the most common type of cancer in :
smokers
non smokers
overall
squamous cell carcinoma
adenocarcinoma
adenocarcinoma
72
what paraneoplastic features are the following associated with
1) SCLG
2) Squamous cell carcinoma
3) Adenocarcinoma
1) ADH, ACTH, Lambert Eaton syndrome
2) PTH --> hypercalcaemia, hyperthyroidism , hypertrophic pulmonary osteoarthropathy
3) gynaecomastia
73
what is the 2 week wait referral criteria for someone with suspected lung cancer?
CXR suggesting lung cancer
40/over + unexplained haemoptysis
74
what is a mesothelioma ? What is it associated with ?
affects the mesothelial cells of the pleura, and strongly linked to asbestos inhalation.
75
what is superior vena cava obstruction? How does it present?
What is Pemberton's sign?
Complication of lung cancer that occurs due to direct compression of the tumour on the superior vena cava, presenting with facial swelling, difficulty breathing and distended veins in the neck and upper chest.
76
What is a lymphoma? What are its two major types?
It is a type of cancer affecting the lymphocytes inside the lymphatic system.
Hodgkin's lymphoma
Non-Hodgkin's lymphoma
77
What are the risk factors for Hodgkin's lymphoma? At what age does it occur?
Risk factors:
HIV
EBV
Auto-immune conditions
Fhx
Bimodal age distribution with peaks around 20-25 and 80 years.
78
what are the types of Non-Hodgkin's lymphoma?
Diffuse large B cell lymphoma
Burkitt lymphoma
MALT lymphoma
79
what are the risk factors for Non-Hodgkin's lymphoma?
HIV
EBV
H. Pylori
Hepatitis B/C
80
How does lymphoma present ?
Lymphadenopathy : key presenting feature ( pain may be worse on drinking alcohol)
B symptoms:
Fever
weight loss
night sweats
81
What are the investigations done when a lymphoma is suspected? What is a characteristic finding?
Lymph node biopsy
Reed-Sternberg cells ; characteristic findings
82
what system is used for the classification of lymphoma? expand on it ?
Lugano classification
stage 1 : confined to one node / group of nodes
Stage 2 : More than one group of nodes but same side of diaphragm
Stage 3: lymph nodes both above and below the diaphragm
stage 4 : widespread involvement including non lymphatic organs like lung or liver
83
what is the management of Lymphoma?
Chemotherapy and radiotherapy
ABVD : ( Adriamycin) doxorubicin, bleomycin, vinblastine, dacarbazine.
84
which is the most aggressive form of melanoma?
nodular melanoma
85
what are the main symptoms of a malignant melanoma
ABCDE
Asymmetry
Borders ( Irregular)
Colour variation
Diameter > 6 mm
Elevation
86
what are the types of malignant melanoma?
Superficial spreading : long radial phase + most common
Lentigo : Hutchinson's freckle, very long radial phase
Nodular : no radial phase, aggressive type
Acral lentiginous : short radial phase + dark skin tones on palms and soles
Sub-ungal: under nail
Amelanotic
87
What are the risk factors for malignant melanoma?
history of skin cancer, melanoma
fhx of melanoma
pale skin ( Fitzpatrick skin type 1/2)
sunburn
sun exposure
moles
age
immunosuppression
88
what is the management of a malignant melanoma?
wide local excision
sentinel node biopsy to check for the spread of cancer
89
what is multiple myeloma?
haematological malignancy in which b -lymphocytes differentiate into mature plasma cells ( antibodies producing b lymphocytes)
90
what are the features of myeloma
CRABBI
Calcium : hypercalcaemia
Renal failure
Anaemia
Bleeding
Bone lesions and bone pain
Infection
91
What are the investigations performed for myeloma?
Bloods
Blood film : Rouleaux formation
U+E : renal failure ( Bence jones proteins in urine)
Bone profile : Hypercalcaemia
Bone marrow aspiration : plasma cells significantly raised
Imaging : whole body MRI
X-ray shows rain drop skull
92
what is the diagnostic criteria for myeloma?
one major + minor
3 minor
Major:
Plasmacytoma
30% plasma cells in bone marrow samples
elevated M protein in blood urine
Minor :
10-30% plasma cells in bone marrow sample
minor elevation in M protein
osteolytic lesions
low levels of antibodies
93
what are the features of myeloma?
Persistent bone pain
pathological fractures
unexplained fatigue
unexplained weight loss
fever
hypercalcaemia
anaemia
renal impairment
94
what is the management of myeloma
chemotherapy ( bortezomib)
Thalidomide
dexamethasone
high dose chemo and stem cell transplant
95
what are some differentials to myeloma
Monoclonal gammopathy of undetermined significance (MGUS) involves the production of a specific paraprotein without other features of myeloma or cancer. MGUS is often an incidental finding in an otherwise healthy person. It has a small risk of progression to myeloma (about 1% per year).
Smouldering myeloma involves abnormal plasma cells and paraproteins but no organ damage or symptoms. It has a greater risk of progression to myeloma (about 10% per year).
96
what are the main 2 types of oesophageal cancer and which is more common
Adenocarcinoma ( most common in developed countries) : Lower third
Squamous cell cancer ( developing) : Upper third
97
what are the risk factors for oesophageal cancer
GORD
Barrets
smoking
Obesity
98
what are the common presenting features of oesophageal cancer?
Dysphagia -painful dysphagia with solids then liquids and weight loss suggests oesophageal pathology.
Anorexia + WL
vomiting
odynophagia, hoarseness, melaena, cough
99
how is oesophageal cancer diagnosed
Upper GI endoscopy
100
what are the risk factors for ovarian cancer ?
Age
BRCA1/2
Increased number of ovulations ( no pregnancies, early onset of periods, late menopause)
Obesity
Smoking
recurrent clomiphene use
101
what are protective factors in the development of ovarian cancer?
COCP
Breastfeeding
Pregnancy
102
what is the presentation of ovarian cancer
Abdominal bloating
early satiety
Loss of appetite
Pelvic pain
urinary symptoms ( frequency/urgency)
weight loss
abdominal/ pelvic mass
ascites
103
What investigations are recommended for suspected ovarian cancer?
CA125 blood test
Ultrasound of pelvis
104
what is the criteria for a 2 week wait for suspected ovarian cancer?
physical examination shows :
Ascites
Pelvic mass
Abdominal mass
105
what is the risk of malignancy index?
estimates risk of an ovarian mass being malignant :
Menopausal status
Ultrasound findings
CA125
106
what are the most common ovarian cancers
epithelial cell tumours= serous carcinomas
germ cell tumours in young people
107
what is a krukenberg tumour
refers to a metastasis in the ovary generally from a GI tract cancer. Characteristic signet ring cells
108
what is the most common benign ovarian tumour?
Serous cystadenoma
109
what is the most common pancreatic tumour? How does it present?
Adenocarcinoma
Presents as :
Painless jaundice
pale stools, dark urine and pruritic
hepatomegaly
palpable gallbladder
anorexia, weight loss and epigastric pain
110
what is the imaging of choice for pancreatic cancer? How does it present?
How is pancreatic cancer managed?
high resolution CT
double duct sign
Whipple's resection: Pancreaticoduodenectomy
111
what is the referral criteria for suspected pancreatic cancer?
2 week wait for -
over 40 with jaundice
over 60 with weight loss plus ( diarrhoea, back pain, abdominal pain, nausea, vomiting, constipation
112
what are the features of prostate cancer ?
Lower urinary tract symptoms
hesitancy
frequency
weak flow
terminal bleeding
nocturia
haematuria
erectile dysfunction
113
how is breast cancer managed
surgery dependent on palpable axillary lymphadenopathy
present : axillary node clearance
absent : sentinel node biopsy
wide local excision / mastectomy
114
what is the first line investigation of suspected clinically localized prostate cancer?
MRI ( Multi-parametric)
115
what are the risk factors for prostate cancer?
Increasing age
Obesity
Afro-Caribbean ethnicity
family history
116
what is a common complication of radical prostatectomy?
erectile dysfunction
117
How is prostate cancer diagnosed and managed
PS test
DRE
Transrectal USS + biopsy
118
what types of tumours are present in testicular cancer
germ cell tumours ( seminomas and non-seminomas)
non germ cell tumours ( Leydig cell tumours and sarcomas)
119
what are the symptoms of testicular cancer ?
Painless lump ( most common symptom)
Pain
Hydrocele
Gynaecomastia
120
what are the tumour markers for testicular cancer ?
How is it diagnosed?
seminomas : hCG ( elevated in 20% of cases)
Non-seminomas : AFP/ B-hcg
Diagnosis is made by ultrasound
121
what are the risk factors for squamous cell carcinoma?
exposure to sunlight
actinic keratosis
immunosuppression
Bowens disease
smoking
leg ulcers
genetic conditions
122
what are the features of squamous cell carcinoma
sun-exposed sites like head and neck/dorsum of hands arms
rapidly expanding painless nodules
cauliflower like appearance
123
what is the purpose of neo-adjuvant chemotherapy?
to downsize the primary tumour meaning that breast conserving surgery can be performed instead of a mastectomy
124
when is radiotherapy recommended in the management of breast cancer
when a woman has had a wide local excision as this may reduce risk of re-occurrence by 2/3rds
125
what haematological finding is seen in lung cancer ?
Raised platelets
126
what is the most common form of prostate cancer
adenocarcinoma
127
what is the investigation of choice in multiple myeloma
MRI whole body
128
what are the complications of radiotherapy for prostate cancer?
proctitis, bladder, colon and rectal cancer following radiotherapy
129
what medications are used in the medical management of prostate cancer ?
GnRH agonists / antagonists ( Goserelin)
130
where are bone metastases most likely to originate in a woman
breast
131
what is the most common site of bone metastases
spine
132
how is ovarian cancer staged
stage 1 - confined to ovary
stage 2 - outside ovary within pelvis
stage 3 outside pelvis within abdomen
stage 4 distant metastases
133
what is the most relevant risk factor for bladder cancer
smoking
134
what thrombotic complication is associated with ALL
disseminated intravascular coagulation
135
what paraneoplastic syndrome is associated with squamous cell carcinoma
parathyroid hormone related protein secretion
136
what is the effect of aromatase inhibitors
Inhibition of peripheral oestrogen synthesis
137
what are the complications of axillary lymph node clearance?
arm lymphedema and functional arm impairment
138
in which patients does spinal cord compression most commonly present in ?
Patients with lung breast and prostate cancer
139
what are the features of spinal cord compression
back pain ( earliest and most common symptom)
worse on lying down and coughing
lower limb weakness and sensory changes
140
how is spinal cord compression investigated and managed
urgent MRI within 24h of presentation
managed with high dose oral dex and urgent oncological assessment
141
what is seen on blood film in acute pro-myelocytic leukaemia
auer rods
142
explain cannonball metastases
The multiple large, round, well-circumscribed masses in both lungs seen on Chest X-ray here are a characteristic description for 'cannonball metastases'. Metastases with this appearance are often due to renal cell carcinoma,
143
which type of testicular cancer has the better prognosis ?
Seminomas
144
what is the first line investigation of a testicular mass ?
Testicular ultrasound scan
145
what are the risk factors for testicular cancer?
Infertility
Cryptorchidism
Family history
Klinefelter's syndrome
Mums orchitis
146
what is mammary duct ectasia?
Non malignant breast disease seen with increasing age and can have nipple retraction and can mimic breast cancer.
147
depending on the lesion, how does spinal cord compression present?
Lesions above L1 result in upper motor neuron signs in the legs and a sensory level.
Lesions below L1 causes lower motor neuron signs in the legs + perianal numbness
148
which type of lymphoma carries the best prognosis ?
Which one carries the worst prognosis ?
lymphocyte predominant
Lymphocyte depleted
149
What are the investigations performed for suspected myeloma?
Bloods : FBC, blood film : Rouleaux formation, U+E = Renal failure
Bone Profile : Hypercalcaemia
Protein electrophoresis : Increased IgA, IgG , known as Bence Jones proteins in urine.
Bone marrow aspiration : plasma cells significantly raised.
150
what is the diagnostic investigation for pancreatic cancer ?
High resolution CT
151
What can be used pre-emtively to reduce tumour flare
Flutamide
152
what can caused raised PSA?
BPH, prostatitis, UTI, ejaculation in last 48h, vigorous exercise 48h, urinary retention
153
what is the importance of taking cyproterone acetate
prevents a paradoxical rise in symptoms with GnRH agonistys
154
