Cancer Flashcards
Outline the Breast cancer screening program?
- mammogram for women >35 with risk.
- US used for women <35 screening occurs from 50-74 (but still available for 70+) every 2 years.
Tripple assessment:
- palpation
- radiology
- FNA cytology
Risk:
moderate <50 FDR, 2 FDR or 2SDR with one <50 and might get mammograms from 40 years
high risk ovarian high, mutation or FDR <40, etc… possible SERMs and individualised screening.
What are the risk categories for a women presenting with a breast lump concern?
Moderate:
- >1 FDR <50 with it
- >2 FDR on same side
- >2 SDR same side <50
High:
- ovarian cancer high risk
- >2 FDR/SDR with ovarian or breast + 1 of:
- <40 years old when got it
- Ashkenazi Jew
- male
- FHx of established mutation
Outline some definitions of the types of cancer?
Non-invasive (any dysplasia):
- ductal cancer in situ
- lobular cancer in situ
Invasive:
- infiltrative ductal cancer
- medullary
- papillary
- tubular
- mucinous
Other:
- adenoid
- secretory
- apocrine
Remember flow chart from first year.
sporadic to dysplasia
- if E-cadherin is mutated it becomes lobular
- if not it becomes ductal
- sporadic amplification of HER2 - its a HER2 amplified carcinoma (trastuzumab targets it)
- if its BRCA1/2 mutation thats a TSG and becomes ‘basal-like’ or ‘triple negative’
What are some RFs for breast cancer?
- Family history
- Oestrogen exposure (nulliparity)
- Advancing age
- Alcohol
- Radiation exposure
- Obestity
- Inherited mutation
What is the Presentation of a women with Ovarian cancer?
very non-specific:
- abdominal bloating
- LOA
- weight gain or loss
- fatigue
- change in bowel habit
- pelvic pain
What are the Investigations for Ovarian cancer?
- Pelvic US (preferrably transvaginal)
- ADNEX model
- CT scan
- Routine bloods specifically looking for CA125
Talk through PSA testing, and how you would counsel a patient?
- secreted from the prostatic epithelium and secreted into semen
- Pros:
- good for recurrent disease
- might pick up cancer that normally presents late.
- Cons:
- overtreatment of indolent cancer
- non-specific to cancer (BPH, prostate infarcts, instrumentation and ejaculation increase it)
- reference range changed over the years.
Guidelines say a PSA score of 3 determines further investigation.
Outline the presentation of prostate cancer?
usually assymptomatic
- mostly affects the peripheral zone, therefore doesn’t present with obstruction often.
Symptoms:
- haematuria
- LUTS
- metastatic (bone pain, sciatica)
RFs of:
- BRCA,
- FHx of cancer,
- age,
- African descent
Outline the diagnosis of Prostate cancer?
- PSA screening MRI - assist in biopsy planning Biopsy (TRUS/transperineal) -
- Gleason Score (6=low, 7=moderate, 8-10 = high)
- Staging - TNM (CT CAP, bone scan, PET) 5 grades based on glandular pattern, as most tumours contain multiple patterns a secondary and primary score are assigned.
What is the treatment of Prostate cancer?
depends on age (<70 or >70) and whether its metastasised Metastatic: - castration - GNRH analogues (target LH) - agonists - surge stops feedback loop. - antagonists - bilateral orchidectomy if it resists this treatment go chemo (poor prognosis) low risk <70 ‘active surveillance’ - regular review 3-6 monthly for PSA/DRE - 2nd confirmatory biopsy in 1 year - 1/3 progress <70 mod/severe - radiotherapy - prostatectomy - adjunct hormones >70 watchful waiting - follow PSA/DREs - same as young but with no curative intent.
What is the Screening program for Colorectal cancer?
FOBT between the ages of 50-75 or <10 years from the age of onset of family
Moderate risk:
- colonoscopy every 5 years
- 1 FDR <55
- 2 FDR or 1FDR + SDR
High risk:
- 3FDR/SDR same side
- Syndromes suspected
Known high risk mutation:
- Lynch - 1-2 years from 25 (low dose aspirin)
- FAP - every 6 months
Cervical Cancer screening program?
- within 2 years of first sexual intercourse or after the age of 20.
LSIL (low-grade squamous intraepithelial lesions):
- repeat in 12 months for PAP smear
- colposcopy >30 years
- repeat at 6 months or colposcopy
HSIL
- colposcopy +/- biopsy
- HPV testing every 12 months
What advice would you give to a patient pre-colonoscopy?
- bowel preparation 3pm and 7pm day prior fleet or polyethylene glycol 1-3hours the day prior
- Anaesthesia - IV benzos (diazepam or midazolam) or propofol
- discontinue warfarin, aspirin, NSAIDs and iron supplements days prior.
- positioning in the left lateral decubitus position.
- Relative Contraindications due to increase risk of perforation:
- pregnancy
- suspected colonic perforation
- toxic megacolon
- fulminant colitis
- severe IBD with ulceration
What are some risks associated with colonoscopy?
- risk that an abnormality may not be detected, this is reduced with proper bowel prep. - intolerance to the bowel preparation
- reaction from the sedatives or anaesthetic
- perforation
- major bleeding from the bowel (from polyp removal)
What is the Screening for Cervical Cancer? What are some of the changes coming up?
- In Dec 2017 it will switch to 25 testing 2 yearly.
- At present its at 20 years old or 2 years after first sexual activity. See women’s health for Guardisil
