Cancer 3 Flashcards

Question

What are Astrocytomas ?

Answer 1

``` 0 Astrocytoma (Mutated Astrocytes ) e.g Grade 1 - Pilocyctic Grade 2- Diffuse Grade 3- Anaplastic - Grade 4- Glioblastoma ``` Astrocytes -found in brain & spinal cord so these types of cancers can form in all these places. Also form part of the Blood - brain barrier. ``` RISK FACTORS History of : - neurofibromatosis Type 1 - Tuberous sclerosis - Li - Fraumeni - Turcot's cancer syndrome - exposure to radiation ``` SIGNS / SYMPTOMS - altered mental status - headache - nausea & vomiting - gait abnormality - Ataxia - associated with cellebular lesion - Weakness - seizures FOCAL - depending on region - Visual disturbances - speech deficit (D) - sensory D - motor weakness (lesion in contralateral posterior frontal lobe or descending coticospinal tract ) - Papilloedema - (more common in posterior fossa tumour ) - A cranial nerve palsy + other unrelated (?) symptoms

Answer 2

MRI head - most sensitive - first choice CT scan If presentation is acute - need to rule out other causes e.g stroke , hemorrhage. Spectroscopy MRI head Perfusion MRI head both used to - determine grade of cancer 0 Biopsy if patient present with Hypopituitarism or known hypothalamic or pituary lesion. - Pituitary hormone test

Answer 3

if Elevated Intercranial pressure of vasogenic oedema -1st line Corticosteriod (e.g Dexamethasone )+/- mannitol if having seizure as well ; IV Phenytoin (followed by oral ) or Levetiracetam (prefered - less side effects ) if also in coma or intubated (Endotracheal tube inserted to assist with breath - allow them to placed on ventilator ) : - Temporary Hyperventilation.

Answer 4

If accesible -most will undergo : Maximal safe resection Accessible without symptoms Observation Unaccessible with symptoms Radiotherapy or radiosurgery Diffuse potina glioma - always radiotherapy if recurrent diffuse : 0 Chemo Above grades 4 or equal - MSR & radiotherapy & chemo - if accesible if not just radio & chemo Grade 3 - similar to grade 4 but you can choose to use chemo ot not for both accessible or not. (+ / - ) https://bestpractice.bmj.com/topics/en-gb/729/treatment-algorithm#patientGroup-1-0 too much to write look at link.

Answer 5

``` Most are Benign either : 0 Functional (hormone secreting) - may cause hypersecretion of hormones - Cortisol - Cushing's Syndrome - Growth Hormone- Acromegaly - ``` 0 Non Functional (non horomone secreting ) can be microademoas (< 1cm or macroadenomas .( > 1cm )

Answer 6

Because oligodendrocytes are found through the brain and spinal cord, oligodendrogliomas can form in any of these locations, but adult oligodendrogliomas typically form in the frontal lobes of the cerebral cortex because those neurons are the most heavily myelinated. These tumors are categorized as grade II or III, with an overall tendency to be relatively slow-growing tumors, though they still have the ability to become malignant. Histologically, prominent features can vary from fairly small, round nuclei, surrounded by well-defined “halos” or thick white borders of cytoplasm giving them a “fried egg” appearance in grade II tumors; to having a “chicken wired” pattern of nearby blood vessels with areas of calcifications in grade III tumors. Ok, so, now let’s focus on an infratentorial adult tumors, a hemangioblastoma. These tumors derive from cells with blood vessel origins, so while they can develop anywhere in the brain they are most often found in the cerebellum, especially in a middle-aged person. They are slow-growing tumors and are typically grade I. Histologically, there are often thin-walled capillaries that are arranged close to one another. Now, the most common symptoms of brain tumors include headaches, nausea, vomiting, and seizures - and they are a result of the compression and destruction of healthy brain tissue. In addition, it’s important to consider the cell type that’s involved. So, for example, a pituitary adenoma causing an increase in prolactin secretions may lead to amenorrhea in women and infertility in men. In addition, as the tumor grows in size, it can compress nearby cells and structures, interrupting their normal functions. For example, as meningiomas enlarge - the mass of the tumor can compress nearby ventricles blocking the flow of cerebrospinal fluid, causing swelling which results in hydrocephalus. Generally, the diagnosis of central nervous system tumors includes medical imaging, like CT scans but more commonly MRIs. But definitive diagnosis needs to be made based on the histologic and molecular characteristics of a tissue biopsy. Treatments depend on the tumor type, grade, and symptoms. And can include surgical removal, radiotherapy, or chemotherapy - frequently in a combination. But specific courses of treatment are guided by the molecular characteristics of the tumor based on the biopsy. Finally, the chance of recurrence gets higher in high grade tumors and in tumors that have not been fully removed or destroyed.

Answer 7

Neoplasia /tumour (mass) in the pancreas Pancreatic ductal Adenocarcinoma (adeno - glands ) - Pancreatic cancer usually occurs in the head of pancreas (affecting the ductal epithelium - in the glands) SIGNS / SYMPTOMS 0 Pain in epigastric region which refer to back. 0 Jaundice ( be aware that there can painless obstructive jaundice - so if havent found a reason for jaundice could be pancreatic cancer) 0 weight loss and anorexia (* rapid weight loss is associated with unresectability) OTHER SIGNS - Steatorrhoea (excess fat in stools , bulky & difficult to flush ) cancer can block pancreatic ducts causing exocrine dysfunction - digestive enzymes not released ------> malabsorption) - New onset diabetes (if no predisposing features or postive Hx of diabetes - consider Pancreatic cancer ) (Endocrine dysfuntion (inability to release hormones can cause -------------------------> thirst , polyria , nocturia , weight loss - these can cause new onset diabetes) PC should be ruled out in pl with unexplained episode of pancreatitis with nausea & V , anorexia & mid- epigastric pain. SIGNS OF ADVANCE DISEASE - epigastric abdominal mass - positive courvoisier's sign (painless palpable gallbladder and jaundice ) - Positive Trousseau's sign - BV - formation of Blood causing inflammation of BV which is recurrent or migrates. associated with cancer (pancreatic , gastric , lung acncer) - Hepatomegaly (suggest hepatic metastases) RISK FACTORS - Smoking - FHx of pancreatic cancer - Other hereditary cancer syndromes.

Answer 8

Carcinoma - cancer of epithelial tissue (like to metastasis to lymph nodes) Sarcoma - cancer of muscle (like to metastise to blood )

Answer 9

Pancreatic protocol CT - all patients suspected of PC. 0 Abdominal ultrasound - but Pancreatic protcol CT is better & always done. if pancreatic protocol CT if PPCT unclear & they have jaundice - do ERCP (endoscopic retrograde cholangiopancreatography and / r EUS guided tissue sampling. if they have no jaudice do : - FDG- PET / CT 0 LFT can do ; - PT - FBC -

Answer 10

Resectable/ Borderline - Surgery resesction ADJUNCT - neoadjunvant radio / chemotherpay (given to strink tumout before surgery (only offer as part of clinical trail ) PLUS - Nutritional support - PANCREATIN -Pancreatic enzymerelacement therapy * if has pancreatdudenectomy (give early enteral nutrition (relies on GI tract e.g. through mouth , esophagus , stomach , intestines - e.g. can place tube directly into stomach ?rather than parenteral ) Locally advanced pancreatic cancer 1ST LINE - Systemic combination chemotherapy e.g . if not tolerated ; Gemcitabine - chemotherapy drug Metastatic 1ST LINE FOLFIRNOX (oxaliplatin , fluorouracil , irinotecan , folinic acid ) - Combination chemotherapy drugs. (do a ECOG score - measure ability of pateints to take care of themselves (Should be btw 0-1) if FOLFIRINOX - not well enough to tolerate give Gemcitabine combination therapy (if not well enough to tolerate combination give - just gemcitabine) 2ND LINE - IF cancer has progressed since FOLFIRINOX started - Gemcitabine - based - chemotherpay or can give oxaliplatin - based chem - if not used in first line PAIN MANAGEMENT FOR ALL - if : - uncontrolled pancreatic pain - unacceptable opiod adverse effects - receiving escalating doses of analgesics GIVE EUS or image guided percantaneous neurolytic coeliac plexus block.

Answer 11

OTHER NAME Hepatoma - Cancer arising from the hepatocytes (usually due presence of cirrhosis but can happen in its absence ) SIGNS / SYMPTOMS - RUQ pain - Abdomainal distension ( due to ascities - associated with cirrhosis) - leg oedema - weight loss - cachexia - oesphageal or gastric variceal bleeding - early satiety (early fullness - compression of the stomach by ascites) - Hepatic encephalopathy (asterixis & fector hepaticus (STRONG MUSTY BREATH - sign that liver is failing to removing toxins) these indicate decompensated cirrhosis resulting in hepatic encephalopthy) Normal signs of cirrhosis (which is precipating for HC) 0 Jaundice 0 splenomegaly (cirrhosis most common cause of Hepatic Cancer ------------> cirrhosis leads to portal hypertension ) 0 Palmar erythema 0 spider naevi 0 periumbilical collateral veins (normal venous channels are not working so blood collects in collateral veins ) RISK FACTORS - Cirrhosis - Chronic Hepatitis B infection - Chronic hepatitis C cirrhosis - chronic heavy alcohol use

Answer 12

0 FBC - anaemia 0 Basic metabolic pattern 0 Liver function test (LFTs) 0 PT / INR ( elevated - lack of clotting factors usually produced by liver ) 0 Viral hepatitis panel (viral hepatitis may have caused cirrhosis which can be a precrusor for hepatci cancer) 0 Alpha fetoprotein ( elevated - AFP produced by liver cells when the are regenerating - so chronically elevated in liver cancer , hepatitis etc. 0 Abdominal ultrasound . 0 Contrast CT scan ( superior to ultrasound)

Answer 13

System used to determine how severe liver damage is & the prognosis . Score up to 3 given to each of these 5 catergories . ``` 0 Total bilirubin 0 serum albumin 0 Prothrombin time 0 ascites 0 Hepatic encephalopathy ``` ex - no ascities (1) - ascities - mild/ responds to diuretics (2) - ascities moderate / no response to diuretics (3) ``` Class A ( 5-6 points) Class B (7-9 points) Class C (10 -15 points ) ```

Answer 14

Resectable (good surgical candidate - Stage A 1ST LINE Resection if not possible (unrestectable - DO LIVER TRANSPLANT) IF this not possible either consider : - percutaneous ablation ( destruction of tumour cells by chemicals) - Atezolizumab plus bevacizumab - Lenvatinib - Sorafenib , regorafenib not completely sure about treatmebt for stage B , C