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Medicine Y6 > Cancer > Flashcards

Cancer Flashcards

1
Q

How do you calculate the breakthrough dose for a pt on regular daily morphine?

A

Breakthrough dose = 1/6th of daily morphine dose

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2
Q

Identify appropriate investigations for testicular cancer

A
  • Bloods: serum beta-hCG (raised, esp in choriocarcinoma), serum AFP (raised in non-seminomas)
  • Imaging :
    • First line: USS testicle
    • CT abdo/pelvis (for staging)

(passmedicine, BMJ)

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3
Q

Generate a management plan for testicular cancer

A
  • Surgical
    • 1st line: inguinal (radical) orchidectomy
      • retroperitoneal LN dissection (1w later, after tumour markers back) if non-seminoma
  • Medical (post-orchidectomy)
    • If seminoma: external beam radiation OR carboplatin chemotherapy
    • If non-seminoma: chemotherapy (eg bleomycin + etoposide + cisplatin)

(BMJ)

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4
Q

Identify the possible complications of testicular cancer

A

Short: surgery-related infertility, chemo-related AKI, chemo-related neutropenia

Long: radio/chem-related secondary malignancy

(BMJ)

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5
Q

Summarise the prognosis for patients with testicular cancer

A

Highly curable when diagnosed early

Excellent 5y prognosis if Stage 1: teratoma = 85%, seminoma = 95%

(passmedicine)

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6
Q

GP: indications for 2-week wait referral to ENT for ?laryngeal carcinoma

A

Pt >45 with either

  • persitent unexplained hoarseness, or
  • unexplained neck lump

(Passmedicine)

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7
Q

GP: indications for 2-week wait referral for CXR in ?lung Ca?

A

Pt >40 with 2+ of the following unexplained, or 1+ if previous smoker:

  • cough
  • fatigue
  • SOB
  • wt loss
  • appettite loss
  • chest pain

Also consider if:

  • persistent/recurrent chest infections
  • finger clubbing
  • signs of lung ca O/E
  • thrombocytosis
  • supraclavicular lymphadenopathy

(ALL pts >40 with unexplained haemoptysis should be reffered straight onto 2w cancer pathway)

(Passmedicine, NICE)

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8
Q

GP: indications for referral directly onto 2-week wait cancer pathway for ?lung cancer

A

1) CXR suggestive of Lung Ca
2) Pt >40 with unexplained haemoptysis

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9
Q

Explain the risk factors of gastric cancer

A

RFs:

H pylori infection

Pernicious anaemia

Gastric adenomatous polyps

Blood type A (gAstric cAncer)

Smoking

Diet: nitrates, salty, spicy

(Passmedicine)

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10
Q

What are the red flags for gastric cancer?

A

Red Flags for gastric cancer:

  • new onset dyspepsia in pt>55
  • progressive worsening dysphagia
  • odynophagia
  • unexplained wt loss
  • unexplained persistent vomiting
  • epigastric pain

(Passmedicine)

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11
Q

Summarise the prognosis for patients with gastric cancer

A

Mortality: varies according to Stage. 5 year - Stage 1A (70%), Stage 1B (50%), Stage II (40%), Stage IIIA (20%), Stage IIIB (10%), Stage IV (5%)

(BMJ)

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12
Q

Generate a management plan for gastric cancer

A

UGI MDT (consider staging, comorbidities, nutrional status, preference)

  • Surgery
    • Endoscopic mucosal/submucosal resection (if mucosal cancer)
    • Oesophageal/gastric resection with regional lymphadenectomy
      • antibiotics + antithrombotics
  • Medicine
    • Chemotherapy: 1st line in oesophageal SCC
    • Adjuvant chemo post-op may be indicated in some ca subtypes

(British Society Gastroenterologists)

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13
Q

Identify appropriate investigations for gastric cancer

A

Imaging

Diagnosis: endoscopy with biopsy

Staging: CT chest abdo pelvis

(Passmedicine)

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14
Q

Identify the possible complications of gastric cancer

A

Short: Bleeding, perforation, obstruction, malnutrition, surgical complications

Long: Chemoradiotherap-associated neutropenia / thrombocytopenia

(BMJ)

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15
Q

Identify the possible complications of tumour lysis syndrome

A

Complications of tumour lysis syndrome include:

  • hyperkalaemia (–> arrythmias, seizures, lactic acidosis)
  • hyperphosphataemia
  • hypocalcaemia
  • hyperuricaemia
  • acute renal failure

(passmedicine)

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16
Q

Generate a management plan for tumour lysis syndrome

A

Medical

  • Prechemotherapy protection
    • IV hydration (maintain high UO)
    • Allopurinol PO/IV or Rasburicase IV (recombinant version of urate oxidase, enzyme for urate metabolism)
    • Phosphate binder (aluminium hydroxide)
      • loop diuretic (furosemide) if high risk, to maintain GFR
  • Acute
    • All of the above
      • correct hyperkalaemia
      • sodium bicarbonate
      • renal dialysis (if severe acidosis or uraemia or CNS toxicity)

(BMJ)

17
Q

Identify appropriate investigations for tumour lysis syndrome

A
  • Bloods: UEs, calcium studies (inc phosphate), FBC, lactate
  • Urine: urine pH
  • Imaging: ECG

(BMJ)

18
Q

Explain the risk factors for pancreatic cancer

A
  • increasing age
  • smoking
  • diabetes
  • chronic pancreatitis (alcohol does not appear an independent risk factor though)
  • hereditary non-polyposis colorectal carcinoma, Peutz-Jeghers syndrome
  • multiple endocrine neoplasia
  • BRCA2 gene

(passmedicine, BMJ)

19
Q

Summarise the epidemiology of pancreatic cancer

A

UK incidence ~12 / 100 000. Increased incidence with age (peak 65-75y)

M=F

(BMJ)

20
Q

Recognise the presenting symptoms of pancreatic cancer

A

Couvoisier’s sign: palpable gallbladder, jaundice, NO abdominal pain/tenderness

Non-specific presentation: wt loss, anorexia, epigastric pain, back pain, steatorrhoea

(BMJ)

21
Q

Identify appropriate investigations for pancreatic cancer

A
  • Confirm diagnosis:
    • Bloods: Ca19-9 (sensitivity 70-90%), LFTS (obstructive picture)
    • Imaging: HR CT abdo - diagnostic ix of choice, USS abdo (60-90% sensitivity), ERCP if CT is equivocal for ampullary tumours
  • Assess complications:
    • Bloods: clotting, FBC

(BMJ)

22
Q

Generate a management plan for pancreatic cancer

A
  • Surgical
    • Stage I-II:
      • Whipple procedure (pancreaticoduodenectomy + antrectomy)
      • +/- pre-operative biliary stenting in pts with cholangitis or chemo/radio
    • Stage III-IV: palliative endoscopic biliary stenting or palliative surgery
  • Medical
      • pancreatic enzyme replacement: CREON (pancrelipase PO)
      • analgesia (WHO ladder, usually opiods)
    • +/- neoadjuvant chemotherapy (if ?mets or borderline performance status)
    • +/- adjuvant chemoradiotherapy in incompletely resected cancer or Stage III-IV

(BMJ)

23
Q

Identify the possible complications of pancreatic cancer

A
  • Short: surgical complications (pancreatic leaks / fistula), early delayed gastric emptying, DVT/PE, bleeding, cholangitis
  • Long: duodenal obstruction

(BMJ)

24
Q

Summarise the prognosis for patients with pancreatic cancer

A

Mortality: >95% die of the disease

Stage I - II: 5y survival 20% (~10% if node +ve, about 30% if node -ve)

Stage IV - survival 3-6m

(BMJ, UpToDate)

25
Q

Generate a management plan for oesophageal cancer

A
  • Surgical options
    • Ivor- Lewis type oesophagectomy: mobilisation of stomach, division of the oesophageal hiatus. The abdomen is closed and a right sided thoracotomy performed. Stomach is brought into the chest and the oesophagus mobilised further. An intrathoracic oesophagogastric anastomosis is constructed.
    • Total oesophagectomy (McKeown) with a cervical oesophagogastric anastomosis. Less risk anastomotic leak (–> mediastinitis).
  • Medical
    • Adjuvant chemotherapy

(passmedicine)

26
Q

Generate a management plan for prostate cancer

A
  • Conservative
    • Active surveillance: NICE recommend if low risk (eg stage T1c, Gleeson score 3+3, relatively low PSA), elderly, multiple comorbidities.
  • Medical
    • Radiotherapy (external): curative and palliative option
      • SEs: radiation proctitis, rectal malignancy
      • Brachytherapy (internal radiotherapy)
    • Hormonal therapy: LHRH analogues or anti-androgens (as prostate ca often shows testosterone dependence)
  • Surgical
    • Radical prostatectomy (esp in localised dx) + obturator LN resection
    • Bilateral orchidectomy (reduced testosterone by 95% = hormonal therapy)

(passmedicine)

27
Q

Identify the possible complications of prostate cancer

A

Metastasis

Iatrogenic:

  • radiation induced: proctitis, rectal cancer, FUNDHIPS, erectile dysfunction
  • hormonal induced: gynaecomastia, sweating
  • surgery induced: urinary stricture, erectile dysfunction

(BMJ)

28
Q

Summarise the prognosis for patients with prostate cancer

A

Morbidity: heavy tx-related SEs

Mortality: very curable. 5y survival >96%

(BMJ)

29
Q

GP: indications for endoscopy referal for ?gastric ca

A
  • Urgent (2w wait)
    • All dysphagia
    • All with upper abdominal mass consistent with stomach cancer
    • >= 55 years + wt loss + ANY of
      • upper abdominal pain
      • reflux
      • dyspepsia
  • Non-urgent
    • Haematemesis
    • >= 55 years + ANY of:
      • treatment-resistant dyspepsia
      • upper abdominal pain, low Hb
      • raised platelet count or N/V + any: wt loss, reflux, dyspepsia, upper abdominal pain

(passmedicine, NICE)

30
Q

Summarise the prognosis for patients with cholangiocarcinoma

A

Poor prognosis

70% recurrence after resection

(500SBAs)

31
Q

Give possible complications of cholangiocarcinoma

A

Biliary obstruction

Cholangitis

Surgical complications (bleeding, infection, biliary leak)

(BMJ)

32
Q

Generate a management plan for cholangiocarcinoma

A
  • Surgical
    • Resection: 30% are resectable +/- adjunct chemo /radiotherapy
    • Palliative biliary stenting

(BMJ, 500SBAs)

33
Q

Identify appropriate investigations for cholangiocarcinoma

A

Bloods: LFTS

Imaging: USS abdo

ERCP: take biopsy

34
Q

Explain the aetiology of cholangiocarcinoma

A
  • Chronic liver disease
  • Gallstones
  • Primary sclerosing cholangitis
  • Biliary cysts
  • Flukes
  • N-nitroso toxins

(500 SBAs, BMJ)

Medicine Y6 (14 decks)

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