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.
A 30 year old woman presents to Mary’s A&E with sudden onset severe knee pain after stepping out of a cab. She limped there with the support of a kind stranger. The XR shows lytic lesions right up to the articular surface with no calcification.
A. Giant cell tumour (borderline malignancy)
Can present with pathological fracture. More common in women aged 20-40 years. Doesn’t occur in immature bone. Common site is the knee/epiphysis.
Histology - Osteoclast-type multinucleate giant cells on background of spindle/ovoid cells.
A 16 year old boy presents with pain and swelling in his right knee. The XR shows an ill defined mass in the distal femur that is sclerotic and lytic. Codman’s triangle is present. A biopsy is taken and the cells are malignant and mesenchymal in origin and ALP positive.
- Osteosarcoma
- Chondrosarcoma
- Ewing’s sarcoma
- Giant cell tumour
- Osteochondroma
A1. Osteosarcoma
Most common primary bone malignancy. Poor prognosis (5yr survival is 60%). Majority occur in teenagers and young adults at the distal femur and proximal tibia (knee). Codman’s triangle = elevated periosteum.
- Chondrosarcoma (>40yo), axial skeleton/femur/tibia/pelvis - lytic lesion with fluffy calcification
- Ewing’s (<20yo), long bones/pelvis - onion skinning of periosteum, translocation (11:22), CD99+
- Giant cell (20-40), knee - lytic lesions to articular surface
- Osteochondroma (teenage) - well defined bony protuberance from bone (benign)
Presents with painless haematuria, increased frequency and urgency. Associated with smoking and exposure to aromatic amines.
A. Transitional cell (urothelial) tumour
Most common (90% of bladder tumours) More prevalent in men aged 50-80.
Ix: Cystoscopy and biopsy
Type of bladder tumour more frequent in countries with urinary schistosomiasis.
A. Squamous cell carcinoma
Rare bladder tumour arising from extensive intestinal metaplasia or from urachal remnants.
A. Adenocarcinoma
Commonest form of prostate cancer in men over 50. Arises from peipheral zone of gland.
A. Adenocarcinoma
Graded with Gleason system..
Ix: Hx, ex and PSA >4ng/ml
Risk factors for this tumour include crytptoorchidism (10x risk), testicular dysgenesis and Kleinfelter’s. It is the most common type of its group and peaks at age 30. It is radiosensitive.
A. Seminoma
Germ cell tumours form 95% of testicular tumours.
Other germ cell: spermatocytic seminoma, embryonal carcnioma, yolk sac tumour, choriocarcinoma and teratoma.
This tumour is only regarded as malignant when it occurs in the post-pubertal male. It is chemosensitive. Biologic markers include AFP, HCG and LDH.
A. Teratoma
Clinical features: painless enlargement
Testicular tumour derived from stromal cells.
A. Leydig cell tumour
Testicular tumour derived from sex cord
A. Sertoli cell tumour
Patient presents with costovertebral pain, a palpable loin mass and haematuria. On biopsy of the mass it shows well differentiated cells.
A. Clear cell carcinoma
Renal tumour linked with dialysis-associated cystic disease.
A. Papillary carcinoma
Histology of this renal cell tumour shows pale, eosionophilic cells.
A. Chromophobe renal carcinoma
Presents with postmenopausal bleeding, typically in perimenopausal women. Risk factors are related to oestrogen excess.
A, ENDOMETRIOID endometrial carcinoma (80%)
Mostly adenocarcinomas, but may show squamous differentiation
10% of women with PMB will have malignancy
RF: obesity, anovulatory amenorrhoea e.g. PCOS, nulliparity, early menarche, late menopause, tamoxifen, DM, HTN
Presents with postmenopausal bleeding, usually in elderly women. Development is unrelated to oestrogen excess.
A. NON-ENDOMETRIOID endometrial carcinoma (20%)
- Papillary
- Serous
- Clear cell
More aggressive than endometrioid type.
What type of cell does vulval carcinoma arise from?
Give three causes/risk factors
A. Squamous cell
RF: VIN (HPV-16), Paget’s of the vulva, lichen sclerosis
VIN -
- Younger women associated with warty/basaloid SCC
- Older women associated with keratinizing BCC
Most common type of ovarian carcinoma. Psamomma bodies common.
A. Serous cystadenoma
Mimics tubal epithelium i.e. columnar epithelium
Can be benign, borderline or malignant.
Oetrogen secreting ovarian carcinoma of epithelial origin that typically affects younger women. No psamomma bodies.
A. Mucinous cystadenoma
Ovarian carcinoma of epithelial origin that mimics endometrium. Endometriosis is a risk factor.
A. Endometriod carcinoma of the ovary
Ovarian carcinoma showing abundant clear cytoplasm and a hobnail appearance on histology.
A. Clear cell carcinoma of the ovary (epithelial origin)
Give the three types of germ cell ovarian tumours and a feature of each.
A. Germ cell tumours form 20% of ovarian carcinoma. They are usually benign in adults and malignant in children.
- Dysgerminoma - undifferentiated, radiosensitive
- Teratoma - mature are benign, immature are malignant (secrete AFP)
- Choriocarcinoma - malignant, secrete hCG
Benign ovarian tumour associated with Meig’s syndrome (ascites + pleural effusion)
A. Fibroma (stromal origin)
Borderline ovarian tumour of sex cord-stromal origin that produces oestrogen
A. Granulosa-Theca cell tumour
Mucinous cystadenomas are also oestrogen secreting, but are of epithelial origin
Benign ovarian tumour that secretes androgens
A. Sertoli-Leydig cell tumour (sex cord-stromal)
Can present with post-coital bleeding, IMB, PMB, discharge and pain. Classified as carcinoma once invaded through the basement membrane. Mostly squamous cell carcinoma.
A. Cervical carcinoma
20% are adenocarcinoma, adenosquamous, or other
Most common malignancy in women. Risk factors include, age, BRCA1/2, exposure to oestrogen, family history, obesity, smoking and alcohol.
A. Breast carcinoma
Sx - hard, fixed lump, Paget’s disease, peau d’orange, nipple retraction.
Screening - from 47-73yo, 3 yearly mammography
Neoplastic epithelial proliferation limited to breast ducts/lobules by basement membrane
A. Carcinoma in situ (30%)
Can be lobular or ductal type
Usually an incidental finding on biopsy of breast tissue as no microcalcifications or stromal reactions. Cells lack adhesion protein E-cadherin.
A. Lobular carcinoma in situ (LCIS)
Appears as areas of microcalcification on mammography. Only 10% have clinical symptoms. Low risk of becoming invasive.
A. Ductal carcinoma in situ (DCIS)
Have ductal (most common), lobular (chains), tubular and mucinous subtypes.
A. Invasive breast carcinoma (70%)
Ductal carcinoma is also known as No special type (NST)
Associated with poor prognosis in invasive breast carcinoma
A. HER2+
Breast biopsy shows sheets of atypical cells with lymphocytic infiltrate. Stain positive for CK5/6/14
A. Basal-like carcinoma
Arise from interlobular stroma in the breast, with increased cellularity and mitoses. Present in over 50s as a palpable breast mass. Most benign but can be aggressive.
A. Phyllodes tumour
Commonest form of adult brain tumour. Well demarcated, solitary/multiple, surrounding oedema.
A. Secondary tumour (lung, breast, melanoma)
Commonest type of primary brain tumour
A. Astrocytoma
Associated with neuorofibromatosis type II
A. Meningioma
Ventricular tumour causing hydrocephalus
A. Ependyoma
Indolent childhood brain tumour
A. Pilocytic astrocytoma
Soft, gelatinous and calcified brain tumour
A. Oligodendroma
Premalignant skin lesion that shows solar elastosis and parakeratosis on histology.
A. Actinic keratosis
Rough, sandpaper like, scaly lesions
Solar elastosis Parakeratosis Atypia Inflamattion Not full thickness (SPAIN)
Premalignant skin lesion that grows over 2-3 weeks and then clears spontaneously. Shows atypia throughout and nuclear crowding.
A. Keratoacanthoma
Flat, red, scaly skin lesion showing full thickness atypia. Premalignant.
A. Bowen’s disease (SCC in situ)
Malignant skin lesion that is red, scaly and shows atypia throughout, spreading into dermis.
A. SCC
Malignant skin lesion with a pearly surface and telangiectasia that shows “palisading” alignment of nuclei and is slow growing but locally destructive.
A. BCC
Most important prognostic factor in malignant melanoma
A. Breslow thickness
Malignant skin lesion which initially grows horizontally, then vertically, producing a “buckshot appearance” (Pagetoid cells)
A. Malignant melanoma
Name four types of melanoma
A.
Lentigo - flat and large
Superficial (typical) - irregular borders
Nodular - stuck on appearance
Acral lentiginous - palms, souls and under nails
