Cancer Flashcards
Lung tumour affecting proximal bronchi with local spread and late metastasis. Less responsive to chemo.
Histology shows keratinisation and intercellular prickles (desmosomes)
A. Squamous cell lung carcinoma (30-50%)
Subtypes: papillary, basiloid
Associated with cavitation and hypercalcaemia.
Most common lung tumour in women and non-smokers. Occurs peripherally and metastasizes early.
Histology shows glandular differentiation and cells contain mucin vacuoles.
A. Adenocarcinoma (20-30%)
EGFR mutations are a target for tyrosine kinase inhibitor therapy if present.
Occurs centrally and in proximal bronchi. Associated with ectopic ACTH secretion, Lambert-Eaton and cerebellar degeneration.
p53 and RB1 mutations common.
A. Small cell carcinoma (10-15%)
Highly malignant with rapid metastasis. Poor prognosis despite chemosensitivity.
Which mutations are associated with a poor prognosis in adenocarcinoma of the lung?
A. Kras (also in squamous) and EML4-ALK indicate poor response to tyrosine kinase inhibitors
Tumour of the lung arising from parietal or visceral pleura. Associated with pleural effusion, chest pain and dyspnoea.
A. Mesothelioma
Associated with asbestos.
Associated with Barrett’s oesophagus. Other risk factors include smoking, obesity and prior radiotherapy.
A. Oesophageal adenocarcinoma
Associated with alcohol and smoking. Other risk factors include achalasia, Plummer-Vinson and HPV. Six times more common in Black people.
A. Squamous cell oesophageal carcinoma
Usually found in middle 1/3 (50%).
Presents with progressive dysphagia, odynophagia, anorexia and severe weight loss.
Caused by H pylori (chronic antigen stimulation)
A. Gastric lymphoma
Rx: triple therapy of PPI, clari +amox/metro
This condition is caused by serotonin producing tumours of enterochromaffin cell origin. Commonly found in the bowel .
A. Carcinoid syndrome
Tumours also found in lung, ovaries and testes. Usually slow growing.
Ix: 24hr urine 5-HIAA
Rx: Octreotide
Benign, mostly asymptomatic lesions that are found incidentally on colonoscopy in over half of those over 50 years old. Classified as tubular, tubulovillous or villous.
A. Colorectal polyp (adenoma)
Ix: regular surveillance if >3.4cm (45% malignant change)
Rare villous type may lead to hypoproteinaemic hypokalaemia.
Which type of non-neoplastic polyp is found in those with juvenile polyposis (AD)?
A. Hamartonous polyp
Malformation of mucosa and lamina propria. May require colectomy to stop bleeding.
Which type of non-neoplastic polyp is thought to be caused by epithelial shedding?
A. Hyperplastic polyp
Associated with iron deficiency anaemia and weight loss. Disease progress monitored with carcinoembryonic antigen.
A. Colorectal cancer (98% adenocarcinoma)
If left sided: LLQ pain and change in bowel habit.
Risk factors: low fibre high fat diet, sedentary, obesity, FAP, HNPCC, IBD
Duke staging
A patient presents to GP with 4 months of tiredness, weight loss and progressively bloodier stool. They are referred to gastroenterology under the 2 week rule and a biopsy shows transmural invasion with no lymph node involvement. What is their Duke’s Stage and 5yr survival?
A. B2 (54%)
A: confined to mucosa (>95%) B1: muscularis propria (67%) B2: transmural, no LN (54%) C1: muscularis propria, LN+ (43%) C2: transmural, LN+ (23%) D: distant mets (<10%)
AD mutation in APC gene or AR mutation in DNA mismatch repair genes
A. Familial adenomatous polyposis (FAP)
Ix: >100 adenomatous polyps at 10-15 years old
Will progress to adenocarcinoma if untreated so most have colectomy. Increased risk of gastric neoplasia.
Hundreds to thousands of colorectal adenomatous polyps with osteoma and dental caries.
A. Gardner’s syndrome
Associated with endometrial, ovarian, small bowel, transitional cell and stomach carcinoma.
A. Hereditary non-polyposis colorectal cancer (Lynch II syndrome)
AD mutations in DNA mismatch repair genes
Carcinomas usually in right colon
NB// Lynch I is just familial colon cancer
Presents with non-specific symptoms or abdominal pain, weight loss, nausea and diarrhoea. May have polyarthralgia. Median survival is 18 months from diagnosis.
A. Acinar cell carcinoma
Rare cancer of the pancreatic epithelial cells with eosinophilic granular cytoplasm. Positive immunoreactivity for lipase, trypsin and chymotrypsin.
10% get multifocal fat necrosis and polyarthralgia due to lipase secretion.
Presents with painless jaundice, pruritus and steatorrhoea. Diagnosis involves measuring CA19.9.
A. Ductal adenocarcinoma (85% of pancreatic cancer)
Trousseau’s syndrome (25%) - recurrent superficial thrombophlebitis
Ix: low Hb, raised Bi and Ca
Mx: palliative 5-FU, Whipple’s procedure in 15%
Give four examples of functional islet cell tumours and their presenting complaint
A.
Insulinoma - hypoglycaemia
Gastrinoma - Zollinger-Ellison
VIPoma - cholera-like diarrhoea
Glucagonoma - necrolytic migrating erythema
Normally on body or tail of pancreas. Cells arranged in nests or trabeculae with granular cytoplasm (1-5cm size)
Associated with aflatoxin and androgenic steroids. Diagnosis involves measuring aFP.
A. Hepatocellular carcinoma
Other causes: Hep B and C, alcoholic cirrhosis and NAFLD
Associated with Lynch syndrome type II and PSC. Poor prognosis.
A. Cholangiocarcinoma
Adenocarcinoma arising from bile ducts
Most common malignant liver lesion.
A. Metastases from other primary tumours
A 22 year old woman presents to A&E with a distended abdomen. She later develops acute onset of 10/10 abdominal pain. An USS shows a mass in her right ovary. Later histological examination of the mass shows three embryonic germ cell layers.
A. Ovarian teratoma
Most common benign cyst that contains all three embryonic germ cell layers. A common complication is torsion.
