Cancer Flashcards
Diagnostic investigations for bladder cancer
Cystoscopy
(other Ix: bloods - FBC for anaemia, ALP may be high. Urinalysis - haematuria. Urinary cytology. Renal and bladder USS. CT urogram. Bone scan)
In situ means
Tumour has not invaded the basement membrane i.e. not yet malignant
Breast cancer risk factors
Increasing age Early menarche Late menopause Positive FH Endogenous/exogenous oestrogen exposure (hormone therapy/OCP)
Breast cancer with eczema like rash
Paget’s disease of the breast
Tumour marker for breast cancer
Ca15-3
n.b. it has poor sensitivity and Ca27-29 is now better. These are still not commonly used.
Breast cancer Ix
<35years - USS
>35years - mammogram
+/ biopsy of breast lump/nodes if signs of mets
Cholangiocarcinoma (malignancy of bile ducts with poor prognosis) risk factors
Primary sclerosing cholangitis
Flukes (in the East)
Congenital biliary cysts
Toxins (n-nitrosos)
ERCP and biopsy is diagnostic.
Neutropenic sepsis definition, signs + symptoms.
Low WCC count due to chemo/radiotherapy
Low neutrophil count
Pyrexia (>38oC)
Other signs/symptoms consistent with clinical sepsis
Neutropenic sepsis Ix
Bloods (FBC, U+Es, LFTs inc albumin, inflammatory markers, lactate)
Blood culture (identifies underlying cause of sepsis)
Urinalysis
Tumour lysis syndrome occurs in patients with cancer usually after starting cytotoxic treatment (but can happen spontaneously). It is characterised by excess death of tumour neoplastic cells. Metabolic and biochemical abnormalities are…
Hyperphosphataemia
Hyperuricaemia
Hyperkalaemia
Hypocalcaemia (since high serum phosphate binds to Ca2+)
Commonest CNS tumours
Glioblastoma Meningioma Craniopharyngioma Pituitary adenoma Haemangioblastoma Lymphoma mets
Colorectal carcinoma symptoms depend on location of the tumour. Consider the difference of presentations in:
L-sided colon and rectum (60%)
R-sided colon (20%)
L-sided colon and rectum: change in bowel habit, rectal bleeding, blood/mucous mixed with stools. Rectal masses = tenesmus.
R-sided colon: later presentation. FLAWS, lower abdo pain.
All may present with large bowel obs = pain and distension, peritonitis due to perforation. Mets = hepatomegaly and ascites.
Tumour marker for colorectal carcinoma
CEA
n.b. this lacks sensitivity and specificity to diagnose.
‘Apple core’ stricture on barium enema contrast studies suggests…
colorectal carcinoma
Prognosis of colorectal carcinoma depends on Dukes classification for staging. What are the stages?
A - Confined to bowel wall. 5yr survival (80%)
B - Through muscularis mucosa. -ve LN (60%)
C - Through muscularis mucosa. +ve LN (30%)
D - Distant mets. (<5%)
Gastric carcinoma cancers (mostly commonly adenocarcinoma) risk factors
H pylori infection Atrophic gastritis Diet Smoking Alcohol Pernicious anaemia
The following signs are related to which condition?
Virchow’s node/Troisier’s sign
Sister Mary Joseph node
Krukenberg’s tumour
Gastric carcinoma
Sister Mary Joseph node
Metastatic nodule on umbilicus from gastric carcinoma
Krukenberg’s tumour
Metastatic ovarian cancer from gastric or breast cancers
Histological types of NSCLC
Squamous cell carcinoma
Adenocarcinoma - peripherally
Large cell carcinoma
Adenosquamous carcinoma
Oat cell carcinoma is also known as
Small cell lung cancer
= malignant neoplasm of neuroendocrine Kulchitsky cells of lung with early dissemination. 20% of lung cancers. Usually in peri-hilar region.
Histological types of oesophageal carcinoma and their location
Squamous cell carcinoma (mid-upper part of oesophagus)
Adenocarcinoma (lower part or gastrooesophageal junction)
Oesophageal adenocarcinoma risk factors
GORD
Barrett’s oesophagus
GORD -> Barrett’s -> adenocarcinoma
Cancers most likely to metastasise to the spine
Breast Lung Thyroid Prostate Renal
Hypercalcaemia of malignancy Rx
IV fluids (rehydration) Bisphosphates
then consider chemo
Testicular tumours can be germ cell tumours (95%) and non-germ cell tumours (5%). Germ cell types
Semitomas (40%)
Teratomas (10%)
Slow-growing papules/nodules with overlying telangectasia
Well-dermarcated border with a pearly, rolled edge
Likely diagnosis?
Basal cell carcinomas – commonest skin malignancy, on sun-exposed areas e.g. head & neck.
They are slow growing and never mets, but can erode into structures hence also referred to as rodent ulcers.
An ulcerated lesion made up of keratin, with irregular, hard, raised edges.
Likely diagnosis?
Squamous cell carcinoma – occurs in sun-exposed areas.
Can lead to metastases.
RF = acitinic keratinosis.
Malignant melanoma
Most aggressive variant is called
Nodular malignant melanoma
Presents as a growing pigmented nodule, which may bleed and ulcerate.
Malignant melanoma
Most common variant is called
Superficial spreading malignant melanoma
Presents as a flat, irregularly pigmented lesion with irregular edges.
Paraneoplastic syndromes associated with SCLCs
SIADH
Lambert-Eaton syndrome
(prostate, thymus, pancreatic cancers + lymphomas can also cause SIADH. Fluid restrict ±demeclocycline)
SVC obstruction presents with dyspnoea, swollen facies and upper limbs, plethora, headache. Engorged veins over neck. +ve Pemberton’s sign. What cancer is this commonly seen in?
Lung cancer
Rx - immediate steroids
GI carcinoid tumours can cause
Appendicitis
Intussusception
Obstruction
Carcinoid syndrome
Carcinoid tumours with liver metastases.
These patients are usually symptomatic and present with spontaneous facial flushing, abdominal pain, and watery diarrhoea. 50% develop cardiac abnormalities
A 32-year-old homosexual male has a 2-week history of indigestion and dysphagia. O/E: multiple purple bruise-like lesions on his R arm, no pain or itching. What is the likely diagnosis?
Kaposi’s sarcoma is a malignant tumour of vascular endothelium. Commonest with HIV or immunosuppressed.
Multiple lesions in the skin appear like purple bruises and are not painful to touch. ~40% of cases have GI involvement.
Pancoast tumours (at apex of lung) are usually associated with
Ipsilateral Horner’s syndrome (ptosis, miosis, anhydrosis)
Sometimes the lower roots of the brachial plexus are also involved = pain and weakness in arm and hand muscles (T1 distribution)
A 6-year-old Ethiopian boy presents with a 4-week history of a swelling in his jaw, which has been progressively enlarging. He has a history of EBV infection. O/E of oral cavity = minor disruption of the teeth with no laryngeal obstruction. What is the likely diagnosis?
Burkitt’s lymphoma
Frequently involves the jaw and previous EBV infection. Other associations are chronic malaria and translocation of Chr8 on c-myc gene with Chr14.
A 60-year-old man with lung cancer complains of a 4week Hx of facial swelling, intermittent blackouts, tightness around the collar and headache worst when he first wakes up. What is the likely diagnosis?
SVC obstruction
What is the recognized presentation for renal cell carcinoma?
Erythrocytosis
Erythropoietin is made in kidneys and RCCs increase production as a paraneoplastic syndrome. This causes a secondary polycythaemia.
Coeliac disease increases risk of
Small bowel adenocarcinoma
T-cell lymphoma
Pernicious anaemia increases risk of
Gastric carcinoma
Asbestos exposure increases risk of
Squamous cell carcinoma (NSCLC)
Mesothelioma
Mesothelioma is a malignnat tumour of pleura (or less commonly the peritoneum). 3 main types of asbestos: white, blue and brown, with blue being the most potent cause. Investigations?
Bloods (FBC)
CXR shows unilateral pleural effusion and pleural thickening
Chest CT
Breast cancer signs and symptoms
Painless growing lump Nipple discharge (blood) Axillary lymphadenopathy Skin changes Retraction/scaling of nipple Eczema-like rash (Paget’s)
Skin changes in breast cancer may include
Colour changes Contour Dimpling Asymmetry Thickening of skin
Hepatocellular carcinoma risk factors
Chronic liver damage (alcohol, hepatitis B+C, autoimmune)
Metabolic (haemochromatosis)
Aflatoxins
Causes of raised PSA
Prostate cancer BPH Urinary retention UTI Catherisation
Trousseau’s sign in pancreatic cancer
An associated superficial thrombophlebitis
A 60yr man presents with poor stream, wt loss, back pain. DRE reveals a hard irregular prostate gland. What is the likely diagnosis?
Carcinoma of prostate
PSA can be normal/raised.
A 68yr old man with signs of chronic liver disease, presents with RUQ pain and fullness. What is the likely diagnosis?
HCC
Raised AFP level. N.b. AFP is also raised in germ-cell tumours, hepatitis and pregnancy. (Vit B12 binding protein is a marker for fibrolamellar HCC)
EBV is a risk factor for which malignancies?
Burkitt’s lymphoma
Post-transplant lymphoma
HIV-associated lymphoma
Nasopharyngeal carcinoma
Bladder cancer histology
transitional cell carcinoma
Renal cell carcinoma histology
Renal tubular cell
adenocarcinoma
Triple assessment in breast disease consists of
History
Imaging: USS <35yrs + mammogram >35yrs
Biopsy: cytology and histology
