Cancer Flashcards by denise lin

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)

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In situ means

Tumour has not invaded the basement membrane i.e. not yet malignant

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Breast cancer risk factors

Increasing age
Early menarche
Late menopause
Positive FH
Endogenous/exogenous oestrogen exposure (hormone therapy/OCP)

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Breast cancer with eczema like rash

Paget’s disease of the breast

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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.

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Breast cancer Ix

<35years - USS
>35years - mammogram

+/ biopsy of breast lump/nodes if signs of mets

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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.

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Neutropenic sepsis definition, signs + symptoms.

Low WCC count due to chemo/radiotherapy
Low neutrophil count
Pyrexia (>38oC)
Other signs/symptoms consistent with clinical sepsis

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Neutropenic sepsis Ix

Bloods (FBC, U+Es, LFTs inc albumin, inflammatory markers, lactate)
Blood culture (identifies underlying cause of sepsis)
Urinalysis

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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+)

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Commonest CNS tumours

Glioblastoma
Meningioma
Craniopharyngioma
Pituitary adenoma
Haemangioblastoma
Lymphoma
mets

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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.

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Tumour marker for colorectal carcinoma

CEA

n.b. this lacks sensitivity and specificity to diagnose.

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‘Apple core’ stricture on barium enema contrast studies suggests…

colorectal carcinoma

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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%)

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Gastric carcinoma cancers (mostly commonly adenocarcinoma) risk factors

H pylori infection
Atrophic gastritis
Diet
Smoking
Alcohol
Pernicious anaemia

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The following signs are related to which condition?
Virchow’s node/Troisier’s sign
Sister Mary Joseph node
Krukenberg’s tumour

Gastric carcinoma

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Sister Mary Joseph node

Metastatic nodule on umbilicus from gastric carcinoma

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Krukenberg’s tumour

Metastatic ovarian cancer from gastric or breast cancers

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Histological types of NSCLC

Squamous cell carcinoma
Adenocarcinoma - peripherally
Large cell carcinoma
Adenosquamous carcinoma

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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.

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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