cancer Flashcards
Presentation and conditions
1
Q
SCLC- other syndromes associated with
A
S- SIADH
C- Cushing syndrome
L- Lambert-Eaton myasthenia syndrome (LEMS)
C- Calciaemia (Hypercalcemia)
2
Q
Which tumour markers assessed for testicular cancer.
A
- AFP
- B-Hcg
- LDH
3
Q
Spinal cord compression first line investigation
A
MRI
4
Q
AFP
A
- fetal serum protein that becomes undetectable after birth
- frequently used for the diagnosis of hepatocellular carcinoma
5
Q
Conditions where AFP is raised
A
GI cancer
Lung cancer
Pregnancy
Germ cell tumours
6
Q
Clinical presentation of Hepatocellular carcinoma
A
- abdominal pain
- weight loss
- Jaundice
7
Q
Gastro-intestinal cancer presentation
A
Persistent abdominal pain
Unexplained weight loss
Change in bowel habit
8
Q
Metastatic lung cancer presentation
A
persistent cough, breathlessness, unexplained weight loss, fatigue
9
Q
AFP and pregnancy
A
AFP levels are typically higher in pregnancy, with significantly elevated levels potentially indicative of fetal neural tube defects
10
Q
Germ cell tumour presentation
A
palpable mass
testicular pain or discomfort
gynecomastia in men
irregular menstruation or vaginal bleeding in women
11
Q
Clinical features of head and neck cancers
A
- Dysphagia
- Odynophagia
- Dysphonia
- ALARM symptoms (tiredness, unexplained weight loss, loss of appetite)
- Lymphadenopathy
- Airway compromise (stridor)
- Bad breath (halitosis)
- Focal neurology (VII cranial nerve palsy)
12
Q
Head and neck cancer investigations
A
- CT, MRI, PET scans
- Endoscopy to visualise tumour
- Biopsy and histological subtype of cancer
13
Q
Management of head and neck cancer
A
- Surgery: To remove the tumor and regional lymph nodes if necessary.
- Radiotherapy: Can be used as a primary treatment, adjuvant therapy, or for palliation.
- Chemotherapy: Used in combination with radiotherapy for locally advanced disease or as palliative treatment for metastatic disease.
14
Q
Tumour lysis syndrome
A
*Lethal metabolic condition
* Rapid death of tumour cells in response to chemo
* Results in massive release of intracellular contents in bloodstream
* Results in significant electrolyte imbalance
15
Q
Epidemiology of TLS
A
acute leukaemia and high-grade lymphomas, particularly after the initiation of cytotoxic therapy.
16
Q
Signs and symptoms of Tumour Lysis syndrome
A
- Dysuria or oliguria
- Abdominal pain
- Weakness
- Nausea or vomiting
- Muscle cramps
- Seizures
- Cardiac arrhythmias
- Gout/joint swelling
17
Q
Tumor lysis syndrome investigations
A
U&E: Potassium and phosphate are usually raised, raised Cr suggestive of AKI/renal failure.
Calcium: Typically low in tumour lysis syndrome.
Uric acid: Usually elevated.
ECG: To identify any metabolic abnormalities such as hyperkalaemia that may precipitate life-threatening arrhythmias.
18
Q
Management of tumor lysis syndrome
A
- correct electrolyte imbalances
- administer IV fluids (flush out intracellular content)
- Rasburicase
19
Q
Prevention of TLS
A
- combination of hydration and allopurinol.
- Rasburicase
20
Q
Colorectal cancer
A
- uncontrolled cell growth in the lining of the colon or rectum
- may start as benign polyps
21
Q
Strong risk factors of colorectal cancer
A
Increasing age
Hereditary syndromes
Familial adenomatous polyposis
Hereditary nonpolyposis colorectal cancer (Lynch Syndrome)
Juvenile polyposis
Peutz-Jeghers syndrome
Increased alcohol intake
Smoking tobacco
Processed meat
Obesity
Previous exposure to radiation
Inflammatory bowel disease
22
Q
Weak risk factors of colorectal cancer
A
Lack of dietary fibre
Limited physical activity
Asbestos exposure
Red meat (non-processed)
23
Q
Signs and symptoms of colorectal cancer (6)
A
*rectal bleeding
* unexplained weight loss
* change in bowel habit
* Abdominal pain
* Iron-deficiency anaemia
* Bowel obstruction
24
Q
Colorectal cancer screening
A
Faecal immunochemical test (FIT) every 2 years for men and women age 60-74. If positive patients are referred for colonoscopy.
Screening programme has reduced death by 16%
25
common association of HNPCC
colorectal cancer
Endometrial cancer
Lynch syndrome
26
Lynch syndrome association (10)
Colorectal cancer
Endometrial cancer
Ovarian cancer
Stomach cancer
Small intestine cancer
Liver cancer
Urinary tract cancer
Gallbladder duct cancer
Brain cancer
Skin cancer
27
Three types of the colorectal cancers
sporadic (95%)
hereditary non-polyposis colorectal carcinoma (HNPCC, 5%)
familial adenomatous polyposis (FAP, <1%)
28
Three criteria of Lynch syndrome
at least 3 family members with colon cancer
the cases span at least two generations
at least one case diagnosed before the age of 50 years
29
What is dabigatran?
An oral anticoagulant that works as a direct thrombin inhibitor
30
What are the main indications for dabigatran?
* Prophylaxis of venous thromboembolism following hip or knee replacement surgery
* Prevention of stroke in patients with non-valvular atrial fibrillation with specific risk factors
31
What are the risk factors for using dabigatran in stroke prevention?
* Previous stroke, transient ischaemic attack, or systemic embolism
* Left ventricular ejection fraction below 40%
* Symptomatic heart failure of NYHA class 2 or above
* Age 75 years or older
* Age 65 years or older with diabetes mellitus, coronary artery disease, or hypertension
32
What is the major adverse effect of dabigatran?
Haemorrhage
33
What should be done with dabigatran doses in chronic kidney disease?
Doses should be reduced; do not prescribe if creatinine clearance is < 30 ml/min
34
What is used for rapid reversal of dabigatran's anticoagulant effects?
Idarucizumab
35
What significant findings were reported in the RE-ALIGN study regarding dabigatran?
Significantly higher bleeding and thrombotic events in patients with recent mechanical heart valve replacement compared to warfarin
36
What is the mechanism of action of dabigatran?
Direct thrombin inhibitor
37
How is dabigatran excreted from the body?
Majority renal
38
What are the two main types of heparin?
* Unfractionated heparin
* Low molecular weight heparin (LMWH)
39
What is the mechanism of action of heparins?
Activating antithrombin III
40
What are common adverse effects of heparins? (4)
* Bleeding
* Thrombocytopenia
* Osteoporosis
* Hyperkalaemia
41
What is the main difference in administration between standard heparin and LMWH?
* Standard heparin: Intravenous
* LMWH: Subcutaneous
42
What is heparin-induced thrombocytopenia (HIT)?
An immune-mediated condition where antibodies form against complexes of platelet factor 4 (PF4) and heparin
43
What is the treatment for heparin overdose?
Protamine sulphate
44
What is fondaparinux and its mechanism of action?
A parenteral anticoagulant that activates antithrombin III to inhibit factor Xa
45
What is the mechanism of action of warfarin?
Inhibits epoxide reductase preventing the reduction of vitamin K to its active form
46
What are the indications for warfarin?
* Mechanical heart valves
* Venous thromboembolism
* Atrial fibrillation
47
What is the target INR for atrial fibrillation treatment with warfarin?
2.5
48
What factors can potentiate the effects of warfarin?
* Liver disease
* P450 enzyme inhibitors (e.g., amiodarone)
* Cranberry juice
* NSAIDs
49
What are 'B' symptoms in Hodgkin's lymphoma?
* Weight loss > 10% in last 6 months
* Fever > 38ºC
* Night sweats
50
What is the most common type of Hodgkin's lymphoma?
Nodular sclerosing
51
What is the characteristic cell found in Hodgkin's lymphoma?
Reed-Sternberg cell
52
What is Burkitt's lymphoma associated with?
c-myc gene translocation, usually t(8:14), and Epstein-Barr virus (EBV) involvement
53
What is the 'starry sky' appearance in microscopy associated with?
Burkitt's lymphoma
54
What is spinal cord compression in cancer patients most commonly due to?
Extradural compression from vertebral body metastases
55
What is the first line treatment for spinal cord compression?
High-dose oral dexamethasone
56
What is the most common site for lymphadenopathy in Hodgkin's lymphoma?
Cervical/supraclavicular area
57
What is the significance of a mediastinal mass in Hodgkin's lymphoma?
May be symptomatic or found incidentally on a chest x-ray
58
What is pruritus?
Itchiness of the skin.
59
What are common symptoms of Hodgkin's lymphoma?
Loss, pruritus, night sweats, fever (Pel-Ebstein).
60
What is the significance of Reed-Sternberg cells?
They are diagnostic for Hodgkin's lymphoma, appearing as large cells with a bilobed nucleus.
61
What is the bimodal age distribution for Hodgkin's lymphoma?
Most common in the third and seventh decades of life.
62
What does Stage I in Ann-Arbor staging indicate?
Single lymph node involvement.
63
What does Stage IV in Ann-Arbor staging indicate?
Spread beyond lymph nodes.
64
What is the Lugano classification used for?
To stage Hodgkin's lymphoma and other types of lymphomas.
65
What does 'B' signify in the A/B symptom designation?
Presence of fever, night sweats, or weight loss.
66
What is the mainstay of treatment for Hodgkin's lymphoma?
Chemotherapy.
67
List two chemotherapy combinations used for Hodgkin's lymphoma.
* ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine)
* BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone)
68
What is a common complication of treatment for Hodgkin's lymphoma?
Secondary malignancies, particularly solid tumors.
69
True or False: Non-Hodgkin's lymphoma has a higher prevalence than Hodgkin's lymphoma.
True.
70
What is the typical age group affected by Non-Hodgkin's lymphoma?
Elderly, with one-third of cases in those over 75.
71
Name risk factors for Non-Hodgkin's lymphoma (8)
* Elderly
* Caucasians
* History of viral infection (e.g., Epstein-Barr virus)
* Family history
* Certain chemical agents (pesticides, solvents)
* History of chemotherapy or radiotherapy
* Immunodeficiency
* Autoimmune disease (SLE, Sjogren's, coeliac disease)
72
What is a classic symptom of Non-Hodgkin's lymphoma?
Painless lymphadenopathy.
73
What imaging is the gold standard for diagnosing brain metastases?
MRI with contrast.
74
What is the aim of management for brain metastases?
Controlling symptoms, reducing tumor burden, and improving quality of life.
75
What is Tamoxifen used for?
Management of oestrogen receptor-positive breast cancer.
76
List two adverse effects of Tamoxifen.
* Menstrual disturbance
* Hot flushes
77
What is the most common type of breast cancer?
Invasive ductal carcinoma.
78
What is the Nottingham Prognostic Index (NPI) used for?
To give an indication of survival in breast cancer.
79
What factors are considered in calculating the NPI?
* Tumor size
* Lymph node score
* Grade score
80
What does a NPI score of 2.0 to 2.4 indicate?
Percentage 5 year survival.
81
How is the Nottingham Prognostic Index calculated?
Tumour Size x 0.2 + Lymph node score + Grade score
## Footnote
The lymph node and grade scores are derived from specific tables.
82
What is the 5-year survival percentage for an NPI score of 2.5 to 3.4?
85%
## Footnote
This indicates a relatively good prognosis.
83
Which factors are not included in the NPI but impact survival?
Vascular invasion and receptor status
## Footnote
These factors can account for varying prognoses often cited in literature.
84
What are the main management options for breast cancer?
* Surgery
* Radiotherapy
* Hormone therapy
* Biological therapy
* Chemotherapy
## Footnote
Management depends on staging, tumour type, and patient background.
85
What is the recommended management for women with no palpable axillary lymphadenopathy?
Pre-operative axillary ultrasound followed by sentinel node biopsy if negative
## Footnote
This helps assess the nodal burden before surgery.
86
What is the most common type of surgery offered for breast cancer?
Wide-local excision
## Footnote
About two-thirds of tumours can be removed this way.
87
What are some factors determining whether a mastectomy or wide-local excision is performed?
* Multifocal tumour vs. solitary lesion
* Central tumour vs. peripheral tumour
* Large lesion in small breast vs. small lesion in large breast
* DCIS > 4cm vs. DCIS < 4cm
## Footnote
These factors influence the choice of surgical procedure.
88
What is the role of whole breast radiotherapy post-surgery?
Reduces risk of recurrence by around two-thirds after wide-local excision
## Footnote
Particularly important for patients with certain tumour characteristics.
89
What is the first-line hormonal therapy for pre- and peri-menopausal women?
Tamoxifen for 5 years
## Footnote
Tamoxifen is effective for hormone receptor positive tumours.
90
What are some important side effects of tamoxifen?
* Increased risk of endometrial cancer
* Venous thromboembolism
* Menopausal symptoms
## Footnote
These side effects must be monitored during treatment.
91
What is trastuzumab (Herceptin) used for?
Biological therapy for HER2 positive breast cancer
## Footnote
It is only effective in 20-25% of breast cancer cases.
92
What is the significance of neoadjuvant chemotherapy?
Used to downstage a primary lesion before surgery
## Footnote
This approach may improve surgical outcomes.
93
What are the criteria for a suspected cancer pathway referral for breast cancer?
* Aged 30 and over with unexplained breast lump
* Aged 50 and over with nipple discharge or changes
## Footnote
These criteria help prioritize timely diagnosis.
94
What is the lifetime risk of breast/ovarian cancer associated with BRCA1 and BRCA2 genes?
40%
## Footnote
This genetic predisposition significantly increases cancer risk.
95
What is the age range for the NHS Breast Screening Programme?
50-70 years
## Footnote
Mammograms are offered every 3 years within this range.
96
What type of breast cancer is the most common?
Invasive ductal carcinoma
## Footnote
It is also referred to as 'No Special Type (NST)'.
97
What is Paget's disease of the nipple associated with?
An underlying breast malignancy
## Footnote
Present in 1-2% of breast cancer patients.
98
What is the most prevalent type of gastric cancer?
Gastric adenocarcinoma
## Footnote
It arises from the glandular epithelium of the stomach lining.
99
What are common risk factors for gastric cancer?
* Helicobacter pylori
* Diet (salt, nitrates)
* Smoking
* Blood group A
## Footnote
These factors contribute to the development of gastric cancer.
100
What symptoms are indicative of gastric cancer?
* Abdominal pain
* Weight loss
* Nausea
* Dysphagia
* Overt upper gastrointestinal bleeding
## Footnote
Symptoms often relate to advanced disease.
101
What is the peak incidence age for acute lymphoblastic leukaemia (ALL)?
2-5 years
## Footnote
It is the most common malignancy in children.
102
What are common features of acute myeloid leukaemia (AML)?
* Anaemia
* Neutropenia
* Thrombocytopenia
* Splenomegaly
* Bone pain
## Footnote
These features are related to bone marrow failure.
103
What translocation is associated with acute promyelocytic leukaemia (APML)?
t(15;17)
## Footnote
This causes fusion of PML and RAR-alpha genes.
104
What is the treatment for acute promyelocytic leukaemia?
All-trans retinoic acid (ATRA)
## Footnote
ATRA helps to mature immature granulocytes.
105
What is Richter's transformation?
Leukaemia cells enter lymph nodes and transform into high-grade lymphoma
## Footnote
Symptoms include lymph node swelling and fever.
106
What is the most common form of leukaemia in adults?
Chronic lymphocytic leukaemia (CLL)
## Footnote
It is characterized by a proliferation of B-cells.
107
What is often the initial finding in Chronic Lymphocytic Leukaemia (CLL)?
Lymphocytosis
## Footnote
Lymphocytosis may be picked up incidentally.
108
What are constitutional features of Chronic Lymphocytic Leukaemia (CLL)?
* Anorexia
* Weight loss
* Bleeding
* Infections
* Lymphadenopathy more marked than chronic myeloid leukaemia
109
What does a full blood count in CLL typically show?
* Lymphocytosis
* Anaemia
* Thrombocytopenia
110
What are smudge cells also known as?
Smear cells
111
Which immunophenotyping panel is key for identifying most cases of CLL?
* CD5
* CD19
* CD20
* CD23
112
What complications can arise from Chronic Lymphocytic Leukaemia (CLL)?
* Anaemia
* Hypogammaglobulinaemia
* Warm autoimmune haemolytic anaemia
* Transformation to high-grade lymphoma (Richter's transformation)
113
What are symptoms that indicate Richter's transformation?
* Lymph node swelling
* Fever without infection
* Weight loss
* Night sweats
* Nausea
* Abdominal pain
114
What is the Philadelphia chromosome associated with?
Chronic myeloid leukaemia (CML)
115
What is the translocation responsible for the Philadelphia chromosome?
t(9:22)(q34; q11)
116
What is the first-line treatment for Chronic Myeloid Leukaemia (CML)?
Imatinib
117
What are the most common tumors causing bone metastases in descending order?
* Prostate
* Breast
* Lung
118
What is the most common site for bone metastases in descending order?
* Spine
* Pelvis
* Ribs
* Skull
* Long bones
119
What features may accompany bone pain from metastases?
* Pathological fractures
* Hypercalcaemia
* Raised ALP
120
What are 'cannonball metastases'?
Multiple, round well-defined lung secondaries, often seen with renal cell cancer
121
What investigations does NICE recommend for all patients with suspected metastatic disease?
* FBC
* U&E
* LFT
* Calcium
* Urinalysis
* LDH
* Chest X-ray
* CT of chest, abdomen and pelvis
* AFP and hCG
122
What does the Mirel Scoring system assess?
The risk of spontaneous fracture for bone metastasis
123
What symptoms may indicate spinal metastases?
* Unrelenting lumbar back pain
* Thoracic or cervical back pain
* Worse with sneezing, coughing or straining
* Nocturnal pain
* Associated tenderness
124
What is the most prevalent type of gastric cancer?
Gastric adenocarcinoma
125
What are common risk factors for gastric cancer?
* Helicobacter pylori
* Diet (salt, nitrates)
* Smoking
* Blood group A
* Pernicious anaemia
* Atrophic gastritis
126
What are typical features of gastric cancer?
* Abdominal pain
* Weight loss
* Anorexia
* Nausea and vomiting
* Dysphagia
* Overt upper gastrointestinal bleeding
127
What is the recommended diagnostic procedure for gastric cancer?
Oesophago-gastro-duodenoscopy with biopsy
128
What staging investigations are indicated for gastric cancer?
* CT scan of chest, abdomen, and pelvis
* Endoscopic ultrasound
* (FDG)-PET scanning
* Pre-operative staging laparoscopy
129
What are common symptoms associated with lung cancer?
* Persistent cough
* Haemoptysis
* Dyspnoea
* Chest pain
* Weight loss
* Hoarseness
130
What are paraneoplastic features associated with small cell lung cancer?
* ADH secretion
* ACTH secretion
* Lambert-Eaton syndrome
* Hypercalcaemia
131
What complications can arise from lung cancer?
* Hoarseness
* Stridor
132
True or False: Gastric cancer is more common than colorectal cancer.
False
