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ALM4 - Surgery > cancer > Flashcards

cancer Flashcards

1
Q

What is the most common type of oesophageal cancer in Western countries?

A

adenocarcinoma

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2
Q

What is the pathophysiology of oesophageal adenocarcinoma?

A

Goblet cells in the oesophagus undergo metaplasia to intestinal cell types (Barret oesophagus)

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3
Q

What is Barret oesophagus?

A

Metaplastic changes to the goblet/mucous cells in the lower oesophagus that results in intestinal types replacing them.

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4
Q

What are the 3 key risk factors for developing oesophageal adenocarcinoma?

A

Obesity, Gastroesophageal reflux disease (GERD), male sex

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5
Q

What are the 3 key risk factors for developing oesophageal adenocarcinoma?

A

Obesity, Gastroesophageal reflux disease (GERD), Male sex

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6
Q

What is the most common type of oesophageal cancer in developing countries?

A

squamous cell carcinoma

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7
Q

What are the 2 key risk factors for oesophogeal squamous cell carcinoma?

A

smoking, alchohol

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8
Q

Why does oesophogeal cancer metastasise early (compared to other cancers)?

A

The oesophagus has no serosa, so there is no barrier to prevent spread to adjacent structures and into lymphatics

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9
Q

Which parts of the oesophagus does squamous cell carcinoma typically arise in?

A

The upper 2 thirds

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10
Q

Which parts of the oesophagus does adenocarcinoma typically arise in?

A

The lower third

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11
Q

Which symptoms does oesophageal cancer typically present with?

A

progressive dysphagia (solid to liquid), odynophagia(pain when swallowing), reflux/regurgitation

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12
Q

What is the initial test for diagnosing oesophageal cancer?

A

Barium study - will show narrowed oesophagus with an irregular border protruding into the lumen

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13
Q

What is the definitive test for oesophageal cancer?

A

EGD (esophagogastrodudenoscopy) with biopsy

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14
Q

What are the treatments for oesophageal cancer?

A

Chemotherapy, surgical resection with large margins

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15
Q

What are the treatments/interventions for Barret’s oesophagus?

A

acid suppressive therapy, surveillance endoscopy

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16
Q

What is the most common type of gastric cancer?

A

Gastric carcinoma, e.g. adenocarcinoma

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17
Q

What are the risk factors for gastric cancers?

A

H. pylori infection, smoking, alcohol, nitrite rich diet, pernicious anaemia, blood type A

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18
Q

What is the clinical presentation of gastric cancers?

A

Late presentation, with refracotry gastric ulcers, constitutional symptoms, GI bleeding, acanthosis nigracans,

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19
Q

What are the 3 ‘classical signs’ of gastric cancer?

A

Virchow’s node (left supraclavicular lympahadenopathy), Krukenberg tumor (ovarian metastases), Sister Mary Joseph node (umbilical metastases)

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20
Q

What are the treatments for gastric cancer?

A

surgical resection, chemoradiotherapy

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21
Q

What is the most common type of primary liver cancer?

A

Hepatocellular carcinoma (hepatoma)

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22
Q

What are the risk factors for hepatocellular carcinoma?

A

cirrhosis, chronic Hep B/Hep C, Oral contraceptive pill, smoking, alcohol,

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23
Q

What are the symptoms of Hepatocellular carcinoma?

A

RUQ pain, fatigue, jaundice, GI bleeding, weight loss

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24
Q

What are the signs of Hepatocellular carcinoma on examination?

A

tender hepatomegaly, jaundice

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25
What are the non-surgical treatment options for Hepatocellular carcinoma?
transarterial chemoembolization, radiofrequency ablation
26
What are the surgical treatments for Hepatocellular carcinoma?
partial hepatectomy, liver transplantation
27
What is the most common type of pancreatic cancer?
Adenocarcinoma of head of pancreas
28
What are the risk factors for pancreatic cancer?
smoking, chronic pancreatitis, family history
29
What is the clinical presentation for pancreatic cancer?
vague abdo pain, obstructive jaundice, constitutional symptoms
30
Which serum marker is a test for pancreatic cancer?
CA-19-9
31
What are the treatments for pancreatic cancer?
- Resectable: pancreaticodudenectomy, adjuvant chemotherapy - non-resectable: palliative chemotherapy, decompression
32
Which presentation in the elderly should be investigated for colon cancer?
Iron deficiency anaemia
33
What is the dominant risk factor for bowel cancer?
Age (>50)
34
What are the general risk factors for bowel cancer?
smoking, low fibre diet, colonic conditions (adenomatous polyps, IBD, etc.)
35
Which genetic conditions are associated with bowel cancer?
Lynch syndrome, familial adenomatous polyposis, Peutz Jegher syndrome
36
What are the most common sites of metastases for bowel cancer?
liver, lung, bone, brain
37
What is the typical morphology of right colon bowel cancers?
exophytic lesions with occult bleeding
38
What is the typical morphology of left colon bowel cancers?
annular (ring-like), invasive lesions
39
What is the typical morphology of rectal bowel cancers?
ulcerating lesions
40
What is the clinical presentation of right colon bowel cancer?
constitutional symptoms (weight loss, fatigue, etc.), iron-deficiency anaemia, rarely obstruction, rarely RLQ mass
41
What is the clinical presentation of left colon bowel cancer?
change in bowel habit (constipation, overflow), pencil stools, abdominal pain, rectal bleeding, large bowel obstruction
42
What is the clinical presentation of rectal bowel cancer?
change in bowel habit (constipation, overflow), tenesmus, rectal bleeding, palpable mass on DRE
43
Which serum marker is often tested for in patients with suspected bowel cancer?
CEA (carcinoembryonic antigen) serum marker
44
What is the gold standard for bowel cancer diagnostic imaging?
Colonoscopy with biopsy
45
What is the surgical treatment for colon cancer?
wide surgical resection + lymphadenectomy (often with adjuvant chemotherapy)
46
What are the surgical treatment options for rectal cancer?
LA (low anterior) resection (if adequate distal margins), otherwise AP (abdominoperineal) resection with colostomy
47
What is an LA resection for rectal cancer?
Low anterior resection - surgical removal of the upper rectum while leaving the sphincters intact
48
What is an AP resection for rectal cancer?
Abdominoperitoneal resection - Removal of the distal colon, rectum and anus resulting in permanent colostomy
49
What is the clinical presentation of renal cell carcinoma?
presents late with gross haematuria, palpable mass, flank pain, constitutional symptoms
50
What is the treatment for renal cell carcinoma?
partial or radical nephrectomy and lymphadenectomy +/- chemoradiotherapy
51
Which demographic is most affected by urothelial (bladder) cancer?
elderly males
52
What is the predominant risk factor for bladder cancer in the developed world?
Smoking
53
What is the predominant risk factor for bladder cancer in the developing world?
schistosomiasis
54
What is schistosomiasis?
A parasitic flat worm infection of the urinary tract or bowel
55
What is the clinical presentation of bladder/urothelial cancer?
painless haematuria +/- other urinary symptoms
56
57
What is the gold standard diagnostic tool for bladder cancer?
cystoscopy with biopsy
58
What are the treatments for non-muscle invasive bladder cancer?
(TURBT) Transurethral resection of bladder tumor +/- intravesical chemo/immuno therapy (put into bladder via catheter)
59
What are the treatments for muscle invasive bladder cancer?
radical cystectomy, TURBT (transurethral resection of bladder cancer) with chemoradiotherapy
60
Which part of the prostate does BPH affect?
The transition (peri-urethral) zone of the prostate
61
What part of the prostate does prostate adeoncarcinoma affect?
The peripheral zone of the prostate
62
What are the risk factors for prostate cancer?
age, family history
63
What is the clinical presentation of BPH?
obstructive symptoms: hesitancy, weak/intermittent stream, retention irritative symptoms: frequency, urgency, nocturia
64
What are the findings on a digital rectal examination in BPH?
smooth, uniformly enlarged, rubbery prostate
65
What are the treatments for BPH?
alpha-blockers (doxasozin), 5a-reductase inhibitors, TURP (trans-urethral resection of the prostate)
66
What is the clinical presentation of prostate cancer?
typically asymptomatic, but may present with obstructive urinary symptoms, back pain, bony metastases pain
67
What are the findings in a digital prostate exam for prostate cancer?
hard, irregular, nodular prostate
68
How is prostate cancer diagnosed?
TRUS (transrectal ultrasound) guided biopsy
69
What are the treatments for prostate cancer?
chemoradiotherapy, hormonal therapy (androgen ablation), radical prostatectomy
70
What are the risks of radical prostatectomy?
impotence, incontinence
71
Which demographic are most affected by testicular cancer?
Young males
72
What are the 2 broad categories of testicular cancer?
Germ cell (malignant), non-germ cell (typically benign)
73
What is the most common type of germ cell testicular cancer?
Seminoma
74
What is the typical clinical presentation of testicular cancer?
Painless testicular enlargement
75

ALM4 - Surgery (4 decks)

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