Cancer Flashcards
Breast Cancer
- aetiology: define, types, risk factors, stages
- clinical features
- investigations
- management
- prognosis + complication
2nd most common cancer in women
Peak incidence: post menopausal, incidence increases with age, 50% of breast cancers are over 65yrs old
Associated with:
- BRCA-1
- BRCA-2
2 types:
- Invasive ductal carcinoma → Most common
- Ductal carcinoma in situ → Non-invasive
NHS Screening programme: mammogram every 3 years for women 50-70
RF
- Increased exposure to oestrogen:
- Not having kids
- Early menarche <13 yrs
- Late menopause >51 yrs
- Obesity
- COCP
- HRT
- Smoking
- Alcohol consumption
- FH of breast cancer
- Increasing age
CLINICAL FEATURES
- Breast lump: Non-tender, Poorly defined margins, Painless, Hard mass located in upper outer quadrant, May be fixed to deep tissue
- Change in breast shape- asymmetric breasts
- Nipple discharge (May be bloody)- Single duct more concerning than multiple ducts
- Axillary lump (Lymphadenopathy)
- Lump is firm and rigid, doesn’t change shape upon compression
- Paget’s disease of the nipple: Eczema like hardening of the skin on the nipple usually caused by ductal carcinoma in situ infiltrating the nipple
Signs of metastasis:
bone : bone pain, pathological fractures, spinal compression
Liver:abdo pain, distension, nausea, jaundice
Lung: cough, haemoptysis, dyspnoea, chest pain
Brain: headaches, seizures, cognitive deficits, focal neurological deficits
INVESTIGATIONS
- Women <35 → Breast ultrasound (Mammogram difficult due to denser breast tissue)
- Women >35 → Mammography
Need biopsy, scan and lymph node biopsy
To create TNM score need:
- Core needle biopsy (T)
- Sentinel node biopsy (N)
- PET scan (M)
Biopsy
- Fine needle aspiration → cytological information
- Core needle biopsy → histological and cytological information
All invasive cancers must have sentinel lymph node biopsy
Can also check for mets with:
- Bone scan
- CXR
- FBC
- LFTs
- Calcium levels
- CT chest + abdo
CA 15-3 is a marker of breast cancer
Urgent 2WW for:
- over 30 with unexplained breast mass
- over 50 with nipple discharge, retraction or other concerning features
MANAGEMENT
Surgery
1)Mastectomy (entire breast and other structures like lymph nodes and muscles): do this IF multifocal tumour, central tumour, large lesion in small breast, ductal carcinoma in situ
2) Wide local excision (removal of just cancer airea, preserve most of breast tissue): for peripheral small solitary lesions. After this surgery should have whole breast radiotherapy to reduce recurrence by 2/3
3) Axillary lymph node clearance (for clinical/palpable axillary lymphadenopathy): can cause lymphoedema and functional arm impairment. If doesnt want surgery: axillary radiotherapy
Hromonal therapy is offered as an adjuvant therapy for women who are oestrogen receptor positive
- Pre menopausal: Tamoxifen (Oestrogen receptor modulator/antagonist)
- Post-menopausal: Anastrazole (Aromatase inhibitor) Side effect: osteoporotic fractures as reduces oestrogen
Biological therapy: if HER2 positive give Trastuzumab (Herceptin) SE: cardiac toxicity so needs an echo before
Other:
- chemotherapy: neoajuvant or ajuvant.
if get chemo induced N+V then A 5HT-3 antagonist → Ondansetron (+ metronidazole)
COMPLICATIONS
- Pleural effusion
- Paraneoplastic syndromes
- High recurrence rate
- Lymphoedema of the arm
PROGNOSIS
Stage at time of diagnosis
- Earlier stages have significantly better prognosis due to less spread
Bone Metastatic disease
- aetiology: define, types, risk factors, stages
- clinical features
- investigations
- management
- prognosis + complication
Bone mets most common cause:
- Breast cancer
- Lung cancer
- Prostate cancer
Most common site of bone mets
Spine> Pelvis> Ribs> Skull> Long bones
Spinal mets associated with: back pain when sneezing/coughing, worse at night, tenderness
CLIN FEATURES
bone pain, pathological fractures, hypercalcaemia, high ALP
TREATMENT
- Pain management (radiotherapy)
- Chemotherapy
- Bisphosphonates for pain (inhibit bone resorption)
- Surgery (if pathological fractures or spinal cord compression)
If neoplastic spinal cord compression whilst awaiting imaging give high dose oral dexamethosone
Brain Metastatic disease
- aetiology: define, types, risk factors, stages
- clinical features
- investigations
- management
- prognosis + complication
Common cause:
- Lung cancer- most common
- Breast cancer
- Bowel cancer
- Melanoma
- Renal cell carcinoma
Features:
- Seizures
- Focal neurological deficits
- Cognitive deficits
- Headaches
MANAGEMENT
- Surgical resection
- Stereotactic radiosurgery
- Patients with poor functional status may be treated palliatively
Lung Metastatic disease
- aetiology: define, types, risk factors, stages
- clinical features
- investigations
- management
- prognosis + complication
- Breast cancer
- Colorectal cancer
- Renal cell carcinoma
- Prostate cancer
- Bladder cancer
- Melanoma
CXR Multiple rounded lesions → “Cannonball metastases”
usually due to renal cell cancer so need CT CAP
Pathological Fracture
- aetiology: define, types, risk factors, stages
- clinical features
- investigations
- management
- prognosis + complication
A spontaneous fracture following mild physical exertion or minor trauma due to abnormal weakness of the bone that is caused by an underlying condition
2 causes:
1) Disorders affecting bone metabolism
- Osteoporosis
- Paget disease
- Osteopetrosis- Rare disease that causes bones to grow abnormally and become overly dense and brittle
- Osteomalacia
- Osteogenesis imperfecta
2) Masses:
- Malignant bone tumours- such as:
- Osteosarcoma (sunburst pattern on X-ray)
- Chondrosarcoma
- Ewing’s tumour (onion skin appearance on X-ray)
- Bone metastases
- Benign bone tumours
- Multiple myeloma
Common sites:
- Spine
- Hip
- Wrist
INVESTIGATIONS
if isolated ALP = pagets, give bisphosphonates (alendronate)
If suspect malignant bone tumour: plain radiograph. Confirm with biopsy
In bone mets: high calcium and ALP
XRay: sclerotic lesions and osteolytic lesions
