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UKMLA Prep > cancer > Flashcards

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)

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2
Q

Which tumour markers assessed for testicular cancer.

A
  • AFP
  • B-Hcg
  • LDH
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3
Q

Spinal cord compression first line investigation

A

MRI

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4
Q

AFP

A
  • fetal serum protein that becomes undetectable after birth
  • frequently used for the diagnosis of hepatocellular carcinoma
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5
Q

Conditions where AFP is raised

A

GI cancer
Lung cancer
Pregnancy
Germ cell tumours

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6
Q

Clinical presentation of Hepatocellular carcinoma

A
  • abdominal pain
  • weight loss
  • Jaundice
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7
Q

Gastro-intestinal cancer presentation

A

Persistent abdominal pain
Unexplained weight loss
Change in bowel habit

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8
Q

Metastatic lung cancer presentation

A

persistent cough, breathlessness, unexplained weight loss, fatigue

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9
Q

AFP and pregnancy

A

AFP levels are typically higher in pregnancy, with significantly elevated levels potentially indicative of fetal neural tube defects

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10
Q

Germ cell tumour presentation

A

palpable mass
testicular pain or discomfort
gynecomastia in men
irregular menstruation or vaginal bleeding in women

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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)
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12
Q

Head and neck cancer investigations

A
  • CT, MRI, PET scans
  • Endoscopy to visualise tumour
  • Biopsy and histological subtype of cancer
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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.
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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

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15
Q

Epidemiology of TLS

A

acute leukaemia and high-grade lymphomas, particularly after the initiation of cytotoxic therapy.

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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
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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.

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18
Q

Management of tumor lysis syndrome

A
  • correct electrolyte imbalances
  • administer IV fluids (flush out intracellular content)
  • Rasburicase
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19
Q

Prevention of TLS

A
  • combination of hydration and allopurinol.
  • Rasburicase
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20
Q

Colorectal cancer

A
  • uncontrolled cell growth in the lining of the colon or rectum
  • may start as benign polyps
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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

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22
Q

Weak risk factors of colorectal cancer

A

Lack of dietary fibre
Limited physical activity
Asbestos exposure
Red meat (non-processed)

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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

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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%

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25
Q

common association of HNPCC

A

colorectal cancer
Endometrial cancer

Lynch syndrome

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26
Q

Lynch syndrome association (10)

A

Colorectal cancer
Endometrial cancer
Ovarian cancer
Stomach cancer
Small intestine cancer
Liver cancer
Urinary tract cancer
Gallbladder duct cancer
Brain cancer
Skin cancer

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27
Q

Three types of the colorectal cancers

A

sporadic (95%)
hereditary non-polyposis colorectal carcinoma (HNPCC, 5%)
familial adenomatous polyposis (FAP, <1%)

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28
Q

Three criteria of Lynch syndrome

A

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

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29
Q

What is dabigatran?

A

An oral anticoagulant that works as a direct thrombin inhibitor

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30
Q

What are the main indications for dabigatran?

A
  • Prophylaxis of venous thromboembolism following hip or knee replacement surgery
  • Prevention of stroke in patients with non-valvular atrial fibrillation with specific risk factors
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31
Q

What are the risk factors for using dabigatran in stroke prevention?

A
  • 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
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32
Q

What is the major adverse effect of dabigatran?

A

Haemorrhage

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33
Q

What should be done with dabigatran doses in chronic kidney disease?

A

Doses should be reduced; do not prescribe if creatinine clearance is < 30 ml/min

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34
Q

What is used for rapid reversal of dabigatran’s anticoagulant effects?

A

Idarucizumab

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35
Q

What significant findings were reported in the RE-ALIGN study regarding dabigatran?

A

Significantly higher bleeding and thrombotic events in patients with recent mechanical heart valve replacement compared to warfarin

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36
Q

What is the mechanism of action of dabigatran?

A

Direct thrombin inhibitor

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37
Q

How is dabigatran excreted from the body?

A

Majority renal

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38
Q

What are the two main types of heparin?

A
  • Unfractionated heparin
  • Low molecular weight heparin (LMWH)
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39
Q

What is the mechanism of action of heparins?

A

Activating antithrombin III

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40
Q

What are common adverse effects of heparins? (4)

A
  • Bleeding
  • Thrombocytopenia
  • Osteoporosis
  • Hyperkalaemia
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41
Q

What is the main difference in administration between standard heparin and LMWH?

A
  • Standard heparin: Intravenous
  • LMWH: Subcutaneous
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42
Q

What is heparin-induced thrombocytopenia (HIT)?

A

An immune-mediated condition where antibodies form against complexes of platelet factor 4 (PF4) and heparin

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43
Q

What is the treatment for heparin overdose?

A

Protamine sulphate

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44
Q

What is fondaparinux and its mechanism of action?

A

A parenteral anticoagulant that activates antithrombin III to inhibit factor Xa

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45
Q

What is the mechanism of action of warfarin?

A

Inhibits epoxide reductase preventing the reduction of vitamin K to its active form

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46
Q

What are the indications for warfarin?

A
  • Mechanical heart valves
  • Venous thromboembolism
  • Atrial fibrillation
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47
Q

What is the target INR for atrial fibrillation treatment with warfarin?

A

2.5

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48
Q

What factors can potentiate the effects of warfarin?

A
  • Liver disease
  • P450 enzyme inhibitors (e.g., amiodarone)
  • Cranberry juice
  • NSAIDs
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49
Q

What are ‘B’ symptoms in Hodgkin’s lymphoma?

A
  • Weight loss > 10% in last 6 months
  • Fever > 38ºC
  • Night sweats
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50
Q

What is the most common type of Hodgkin’s lymphoma?

A

Nodular sclerosing

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51
Q

What is the characteristic cell found in Hodgkin’s lymphoma?

A

Reed-Sternberg cell

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52
Q

What is Burkitt’s lymphoma associated with?

A

c-myc gene translocation, usually t(8:14), and Epstein-Barr virus (EBV) involvement

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53
Q

What is the ‘starry sky’ appearance in microscopy associated with?

A

Burkitt’s lymphoma

54
Q

What is spinal cord compression in cancer patients most commonly due to?

A

Extradural compression from vertebral body metastases

55
Q

What is the first line treatment for spinal cord compression?

A

High-dose oral dexamethasone

56
Q

What is the most common site for lymphadenopathy in Hodgkin’s lymphoma?

A

Cervical/supraclavicular area

57
Q

What is the significance of a mediastinal mass in Hodgkin’s lymphoma?

A

May be symptomatic or found incidentally on a chest x-ray

58
Q

What is pruritus?

A

Itchiness of the skin.

59
Q

What are common symptoms of Hodgkin’s lymphoma?

A

Loss, pruritus, night sweats, fever (Pel-Ebstein).

60
Q

What is the significance of Reed-Sternberg cells?

A

They are diagnostic for Hodgkin’s lymphoma, appearing as large cells with a bilobed nucleus.

61
Q

What is the bimodal age distribution for Hodgkin’s lymphoma?

A

Most common in the third and seventh decades of life.

62
Q

What does Stage I in Ann-Arbor staging indicate?

A

Single lymph node involvement.

63
Q

What does Stage IV in Ann-Arbor staging indicate?

A

Spread beyond lymph nodes.

64
Q

What is the Lugano classification used for?

A

To stage Hodgkin’s lymphoma and other types of lymphomas.

65
Q

What does ‘B’ signify in the A/B symptom designation?

A

Presence of fever, night sweats, or weight loss.

66
Q

What is the mainstay of treatment for Hodgkin’s lymphoma?

A

Chemotherapy.

67
Q

List two chemotherapy combinations used for Hodgkin’s lymphoma.

A
  • ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine)
  • BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone)
68
Q

What is a common complication of treatment for Hodgkin’s lymphoma?

A

Secondary malignancies, particularly solid tumors.

69
Q

True or False: Non-Hodgkin’s lymphoma has a higher prevalence than Hodgkin’s lymphoma.

70
Q

What is the typical age group affected by Non-Hodgkin’s lymphoma?

A

Elderly, with one-third of cases in those over 75.

71
Q

Name risk factors for Non-Hodgkin’s lymphoma (8)

A
  • 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
Q

What is a classic symptom of Non-Hodgkin’s lymphoma?

A

Painless lymphadenopathy.

73
Q

What imaging is the gold standard for diagnosing brain metastases?

A

MRI with contrast.

74
Q

What is the aim of management for brain metastases?

A

Controlling symptoms, reducing tumor burden, and improving quality of life.

75
Q

What is Tamoxifen used for?

A

Management of oestrogen receptor-positive breast cancer.

76
Q

List two adverse effects of Tamoxifen.

A
  • Menstrual disturbance
  • Hot flushes
77
Q

What is the most common type of breast cancer?

A

Invasive ductal carcinoma.

78
Q

What is the Nottingham Prognostic Index (NPI) used for?

A

To give an indication of survival in breast cancer.

79
Q

What factors are considered in calculating the NPI?

A
  • Tumor size
  • Lymph node score
  • Grade score
80
Q

What does a NPI score of 2.0 to 2.4 indicate?

A

Percentage 5 year survival.

81
Q

How is the Nottingham Prognostic Index calculated?

A

Tumour Size x 0.2 + Lymph node score + Grade score

The lymph node and grade scores are derived from specific tables.

82
Q

What is the 5-year survival percentage for an NPI score of 2.5 to 3.4?

A

85%

This indicates a relatively good prognosis.

83
Q

Which factors are not included in the NPI but impact survival?

A

Vascular invasion and receptor status

These factors can account for varying prognoses often cited in literature.

84
Q

What are the main management options for breast cancer?

A
  • Surgery
  • Radiotherapy
  • Hormone therapy
  • Biological therapy
  • Chemotherapy

Management depends on staging, tumour type, and patient background.

85
Q

What is the recommended management for women with no palpable axillary lymphadenopathy?

A

Pre-operative axillary ultrasound followed by sentinel node biopsy if negative

This helps assess the nodal burden before surgery.

86
Q

What is the most common type of surgery offered for breast cancer?

A

Wide-local excision

About two-thirds of tumours can be removed this way.

87
Q

What are some factors determining whether a mastectomy or wide-local excision is performed?

A
  • 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

These factors influence the choice of surgical procedure.

88
Q

What is the role of whole breast radiotherapy post-surgery?

A

Reduces risk of recurrence by around two-thirds after wide-local excision

Particularly important for patients with certain tumour characteristics.

89
Q

What is the first-line hormonal therapy for pre- and peri-menopausal women?

A

Tamoxifen for 5 years

Tamoxifen is effective for hormone receptor positive tumours.

90
Q

What are some important side effects of tamoxifen?

A
  • Increased risk of endometrial cancer
  • Venous thromboembolism
  • Menopausal symptoms

These side effects must be monitored during treatment.

91
Q

What is trastuzumab (Herceptin) used for?

A

Biological therapy for HER2 positive breast cancer

It is only effective in 20-25% of breast cancer cases.

92
Q

What is the significance of neoadjuvant chemotherapy?

A

Used to downstage a primary lesion before surgery

This approach may improve surgical outcomes.

93
Q

What are the criteria for a suspected cancer pathway referral for breast cancer?

A
  • Aged 30 and over with unexplained breast lump
  • Aged 50 and over with nipple discharge or changes

These criteria help prioritize timely diagnosis.

94
Q

What is the lifetime risk of breast/ovarian cancer associated with BRCA1 and BRCA2 genes?

A

40%

This genetic predisposition significantly increases cancer risk.

95
Q

What is the age range for the NHS Breast Screening Programme?

A

50-70 years

Mammograms are offered every 3 years within this range.

96
Q

What type of breast cancer is the most common?

A

Invasive ductal carcinoma

It is also referred to as ‘No Special Type (NST)’.

97
Q

What is Paget’s disease of the nipple associated with?

A

An underlying breast malignancy

Present in 1-2% of breast cancer patients.

98
Q

What is the most prevalent type of gastric cancer?

A

Gastric adenocarcinoma

It arises from the glandular epithelium of the stomach lining.

99
Q

What are common risk factors for gastric cancer?

A
  • Helicobacter pylori
  • Diet (salt, nitrates)
  • Smoking
  • Blood group A

These factors contribute to the development of gastric cancer.

100
Q

What symptoms are indicative of gastric cancer?

A
  • Abdominal pain
  • Weight loss
  • Nausea
  • Dysphagia
  • Overt upper gastrointestinal bleeding

Symptoms often relate to advanced disease.

101
Q

What is the peak incidence age for acute lymphoblastic leukaemia (ALL)?

A

2-5 years

It is the most common malignancy in children.

102
Q

What are common features of acute myeloid leukaemia (AML)?

A
  • Anaemia
  • Neutropenia
  • Thrombocytopenia
  • Splenomegaly
  • Bone pain

These features are related to bone marrow failure.

103
Q

What translocation is associated with acute promyelocytic leukaemia (APML)?

A

t(15;17)

This causes fusion of PML and RAR-alpha genes.

104
Q

What is the treatment for acute promyelocytic leukaemia?

A

All-trans retinoic acid (ATRA)

ATRA helps to mature immature granulocytes.

105
Q

What is Richter’s transformation?

A

Leukaemia cells enter lymph nodes and transform into high-grade lymphoma

Symptoms include lymph node swelling and fever.

106
Q

What is the most common form of leukaemia in adults?

A

Chronic lymphocytic leukaemia (CLL)

It is characterized by a proliferation of B-cells.

107
Q

What is often the initial finding in Chronic Lymphocytic Leukaemia (CLL)?

A

Lymphocytosis

Lymphocytosis may be picked up incidentally.

108
Q

What are constitutional features of Chronic Lymphocytic Leukaemia (CLL)?

A
  • Anorexia
  • Weight loss
  • Bleeding
  • Infections
  • Lymphadenopathy more marked than chronic myeloid leukaemia
109
Q

What does a full blood count in CLL typically show?

A
  • Lymphocytosis
  • Anaemia
  • Thrombocytopenia
110
Q

What are smudge cells also known as?

A

Smear cells

111
Q

Which immunophenotyping panel is key for identifying most cases of CLL?

A
  • CD5
  • CD19
  • CD20
  • CD23
112
Q

What complications can arise from Chronic Lymphocytic Leukaemia (CLL)?

A
  • Anaemia
  • Hypogammaglobulinaemia
  • Warm autoimmune haemolytic anaemia
  • Transformation to high-grade lymphoma (Richter’s transformation)
113
Q

What are symptoms that indicate Richter’s transformation?

A
  • Lymph node swelling
  • Fever without infection
  • Weight loss
  • Night sweats
  • Nausea
  • Abdominal pain
114
Q

What is the Philadelphia chromosome associated with?

A

Chronic myeloid leukaemia (CML)

115
Q

What is the translocation responsible for the Philadelphia chromosome?

A

t(9:22)(q34; q11)

116
Q

What is the first-line treatment for Chronic Myeloid Leukaemia (CML)?

117
Q

What are the most common tumors causing bone metastases in descending order?

A
  • Prostate
  • Breast
  • Lung
118
Q

What is the most common site for bone metastases in descending order?

A
  • Spine
  • Pelvis
  • Ribs
  • Skull
  • Long bones
119
Q

What features may accompany bone pain from metastases?

A
  • Pathological fractures
  • Hypercalcaemia
  • Raised ALP
120
Q

What are ‘cannonball metastases’?

A

Multiple, round well-defined lung secondaries, often seen with renal cell cancer

121
Q

What investigations does NICE recommend for all patients with suspected metastatic disease?

A
  • FBC
  • U&E
  • LFT
  • Calcium
  • Urinalysis
  • LDH
  • Chest X-ray
  • CT of chest, abdomen and pelvis
  • AFP and hCG
122
Q

What does the Mirel Scoring system assess?

A

The risk of spontaneous fracture for bone metastasis

123
Q

What symptoms may indicate spinal metastases?

A
  • Unrelenting lumbar back pain
  • Thoracic or cervical back pain
  • Worse with sneezing, coughing or straining
  • Nocturnal pain
  • Associated tenderness
124
Q

What is the most prevalent type of gastric cancer?

A

Gastric adenocarcinoma

125
Q

What are common risk factors for gastric cancer?

A
  • Helicobacter pylori
  • Diet (salt, nitrates)
  • Smoking
  • Blood group A
  • Pernicious anaemia
  • Atrophic gastritis
126
Q

What are typical features of gastric cancer?

A
  • Abdominal pain
  • Weight loss
  • Anorexia
  • Nausea and vomiting
  • Dysphagia
  • Overt upper gastrointestinal bleeding
127
Q

What is the recommended diagnostic procedure for gastric cancer?

A

Oesophago-gastro-duodenoscopy with biopsy

128
Q

What staging investigations are indicated for gastric cancer?

A
  • CT scan of chest, abdomen, and pelvis
  • Endoscopic ultrasound
  • (FDG)-PET scanning
  • Pre-operative staging laparoscopy
129
Q

What are common symptoms associated with lung cancer?

A
  • Persistent cough
  • Haemoptysis
  • Dyspnoea
  • Chest pain
  • Weight loss
  • Hoarseness
130
Q

What are paraneoplastic features associated with small cell lung cancer?

A
  • ADH secretion
  • ACTH secretion
  • Lambert-Eaton syndrome
  • Hypercalcaemia
131
Q

What complications can arise from lung cancer?

A
  • Hoarseness
  • Stridor
132
Q

True or False: Gastric cancer is more common than colorectal cancer.

UKMLA Prep (48 decks)

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