cancer

Question 1

Breast Ca: what chemotherapy regimes are used

Answer 1

FEC/FEC-D chemotherapy

Question 2

Breast Ca: chemo for node +ve disease

Answer 2

FEC-D chemotherapy

Question 3

Breast Ca: chemo for node -ve disease

Answer 3

FEC checmotherapy

Question 4

Breast Ca management: ER+ tumour

Answer 4

• Aromatase inhibitors
• Tamoxifen

Question 5

Breast Ca management: HER2+ tumour

Answer 5

Herceptin

Question 6

Breast Ca management: purpose of using chemotherapy

Answer 6

• may be used prior to surgery ‘neo-adjuvant chemo’ - to downstage a primary lesion
• may be used after surgery, depending on stage of tumour

Question 7

What presenting Sx is a red flag for bladder cancer

Answer 7

painless haematuria

Question 8

Squamous cell carcinoma of bladder: RFs

Answer 8

• Smoking
• Schistosomiasis

Question 9

1st line Rx for malignancy induced hypercalcemia

Answer 9

IV fluids i.e. rehydration with normal saline
usually 3-4L a day

Question 10

what medications are given in the management of hypercalcemia

Answer 10

• bisphosphonates are given following rehydration (these take 2-3 days to work and max effect seen at 7 days)
• calcitonin - may be used (has a quicker effect than bisphosphonates)
• steroids - may be used in sarcoidosis
• furosemide - may be used in pts who can’t tolerate aggressive fluid resus (should be used w caution as they can → worsen electrolyte derangement + volume depletion

Question 11

Breast Ca: indication for axillary node clearance following WLE w/ adjuvant radiotherapy

Answer 11

If sentinel node biopsy shows that < 3 nodes are involved - no further management of the axilla is needed

if 3 or more nodes involved - further axilla management needed

Question 12

Ovarian Ca: initial site of metastasis

Answer 12

para-aortic lymph nodes (which drain ovaries and fallopian tubes) - ovarian Ca spreads by local invasion so would spread locally first to these nodes

Question 13

Ovarian Ca: RFs

Answer 13

• the more ovulations = ↑ risk : nulliparity, early menarche, late menopause
• FHx: mutations of BRCA1 or BRCA2 gene

Question 14

Pancreatic Ca: diagnostic Ix of choice

Answer 14

HRCT (high resolution CT) of the pancreas

Question 15

Why can a high-grade prostate Ca present with normal PSA

Answer 15

• As tumour cells become more aggressive, they are less organised and produce fewer secretory products like PSA.
• So PSA may either be normal/only mildly elevated

High grade e.g. Gleason score of 8 (4+4)

Question 16

What cancer to suspect in a woman with post-menopausal bleeding

Answer 16

Endometrial Ca (until proven otherwise)

Question 17

2WW referral criteria for suspected endometrial Ca

Answer 17

A woman >= 55 y/o presenting w post-menopausal bleeding (i.e. more than 12 months after menstruation has stopped) should be referred using the suspected cancer pathway (within 2 weeks) to exclude endometrial Ca

Question 18

1st line Ix for suspected endometrial Ca

Answer 18

TVUS to check for endometrial thickening - a normal endometrial thickness (< 4 mm) has a high negative predictive value

Question 19

2nd line Ix for endometrial Ca

Answer 19

Hysteroscopy w endometrial biopsy

done if endometrium appears thickened on TVUS

Question 20

Endometrial Ca: management

Answer 20

• surgery = mainstay: total abdominal hysterectomy + bilateral salpingo-oopohorectomy
• pts w high risk disease may have radiotherapy post-op

Question 21

Endometrial Ca: management in those not suitable for surgery

Answer 21

• Usually - frail older women who are not suitable for surgery: managed w progestogen therapy
• Progesterone helps counteract the oestrogen-driven growth of endometrium

Question 22

Following UTI/prostatitis, how long before PSA is allowed to be measured again

Answer 22

6 weeks after finishing treatment

• PSA levels can be significantly elevated due to inflammation from prostatitis, which can last well beyond the resolution of symptoms. Measuring PSA too soon after treatment could give a falsely elevated result
• NICE guidelines recommend waiting at least 6 weeks after finishing treatment to allow inflammation to fully subside and provide a more accurate PSA reading