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Y3 > Cancer > Flashcards

Cancer Flashcards

1
Q

What are the common genetic abnormalities in bladder cancer?

A

Superficial tumours = Chr9 deletions

Invasive tumours = p53 mutations + 14q/17q deletions

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2
Q

What are the risk factors for bladder cancer?

A
  • Smoking
  • Naphthylamines/benzidine in dye, rubber, leather industries
  • Cyclophosphamide treatment (chemo for other Ca)
  • Pelvic irradiation (cervical Ca)
  • Chronic UTIs
  • Schistosomiasis
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3
Q

Who usually gets bladder cancer?

A

Twice as common in men

50-70yos

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4
Q

How does bladder cancer present?

A
  • Painless, macroscopic haematuria
  • Increased urinary frequency
  • Urgency
  • Nocturia
  • Recurrent UTIs
  • Rarely pain due to clot retention
  • Ureteral obstruction or extension to pelvis
    Often no signs O/E
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5
Q

How is bladder cancer investigated initially?

A

Cystoscopy

Allows visualisation of tumour, biopsy or removal

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6
Q

How can bladder cancer be investigated?

A

Cystoscopy
USS, IVU - to assess upper and lower UTs as tumours can be multifocal
CT/MRI - staging
Urine cytology

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7
Q

What are the risk factors for breast cancer?

A
  • Female
  • Increasing age
  • Prolonged exposure to oestrogen - nullparity, early menarche, late menopause, obesity
  • FH
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8
Q

What is the lifetime risk of breast cancer for women in the UK?

A

1:9

Commonest cancer in women

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9
Q

How does breast cancer usually present?

A
  • Painless breast lump or change in breast shape
  • Nipple discharge or axillary lump
  • Symptoms of malignancy: WL, bone pain, paraneoplastic syndromes
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10
Q

What are the signs of breast cancer O/E?

A
  • Hard, irregular breast lump
  • Peau d’orange, skin tethering, fixed to chest wall
  • Skin ulceration, nipple inversion
  • Axillary nodes - may be spread
  • Paget’s disease of nipple: eczematous, ulcerated, discharging nipple (ductal carcinoma in situ infiltrating nipple)
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11
Q

How is breast cancer investigated?

A

TRIPLE ASSESSMENT

  1. Clinical examination
  2. Mammography >35, US<35
  3. Core biopsy (histo) / FNA (cyto/drainage)
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12
Q

When does breast cancer screening start?

A

Mammogram
50-71
Every 3 years

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13
Q

How is breast cancer staged?

A

CXR
Liver US
Isotope bone scan
CT (brain or thorax)

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14
Q

What are CNS tumours?

A

Primary tumours arising from any of the brain tissue types

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15
Q

What causes CNS tumours in children and in adults?

A

Children - embryonic errors in development

Adults - unknown

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16
Q

When are the peaks in incidence of CNS tumours?

A

Children

Elderly

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17
Q

How do CNS tumours present?

A
  • Headache + vomiting - due to raised ICP
  • Epilepsy
  • Focal neuro deficits - dysphagia, hemiparesis, ataxia, visual field defects, cognitive impairment
  • Personality change
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18
Q

What are the signs of CNS tumours O/E?

A
  • Papilloedema/false localising signs - due to raised ICP

- Focal neuro deficits - dysphagia, hemiparesis, ataxia, visual field defects, cognitive impairment

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19
Q

How are CNS tumours investigated?

A

CT head - initial

MRI brain - higher sensitivity

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20
Q

What is cholangiocarcinoma?

A

Primary adenocarcinoma of the biliary tree

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21
Q

What causes cholangiocarcinoma?

A

Unknown

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22
Q

What is cholangiocarcinoma associated with?

A

UC
PSC
Parasitic infections of biliary tract

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23
Q

Who is cholangiocarcinoma more common in?

A

Men

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24
Q

Where is cholangiocarcinoma more common?

A

Developing world due to parasitic infections

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25
Q

How does cholangiocarcinoma present?

A
  • Obstructive jaundice - yellow skin + sclera/pale stools/dark urine/pruritis
  • Abdominal fullness or pain
  • Symptoms of malignancy - WL, malaise
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26
Q

What are the signs of cholangiocarcinoma O/E?

A
  • Jaundice
  • Palpable gallbladder
  • Epigastric or RUQ mass
  • Hepatomegaly
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27
Q

What is Courvoisier’s law?

A

In the presence of jaundice, an enlarged GB is unlikely to be due to gallstones - carcinoma of pancreas or lower biliary tree is more likely

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28
Q

What bloods would you do for suspected cholangiocarcinoma?

A 
FBC
U+E
LFT - raised bilirubin, alkphos, GGT
Clotting
Tumour markers - CA19-9 raised
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29
Q

What is the tumour marker for cholangiocarcinoma?

A

Ca19-9

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30
Q

How is cholangiocarcinoma investigated?

A

Bloods

Endoscopy - ERCP

US - biliary duct dilatation

CT/MRI/MRCP/Bone scan - stage tumour and visualise regional spread

Arteriogram

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31
Q

What is colorectal carcinoma?

A

Malignant adenocarcinoma of the large bowel

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32
Q

What causes colorectal carcinoma?

A
  • Environmental and genetic factors
  • Epithelial dysplasia > adenoma > carcinoma
  • Accumulation of genetic changes in oncogenes (APC, K-ras) and TSGs (p53, DCC)
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33
Q

What are the risk factors for colorectal carcinoma?

A 
Western diet:
High intake of red meat
Alcohol
Fat
Sugar
Reduced veg and fibre intake
Presence of colorectal polyps
Previous CRC
FH
IBD, esp longstanding UC
FAP
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34
Q

What is the 2nd most common cause of cancer death in the West?

A

Colorectal carcinoma

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35
Q

What is the average age of diagnosis of CRC?

A

60-65

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36
Q

Who is rectal carcinoma more common in?

A

Men

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37
Q

Who is colon carcinoma more common in?

A

Women

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38
Q

How do L-sided colon and rectal cancer present?

A

Change in bowel habit
Rectal bleeding
Blood/mucus mixed in with stools
Tenesmus

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39
Q

How does R-sided colon cancer present?

A 
Later presentation
Symptoms of anaemia
Weight loss
Non-specific malaise
(Rare) lower abdominal pain
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40
Q

What do up to 20% of CRC tumours present with?

A

Emergency

Pain and distension due to LBO, haemorrhage or peritonitis due to perforation

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41
Q

What are the signs of CRC O/E?

A 
R-sided: anaemia may be only sign
Abdo mass w metastatic disease
Hepatomegaly
Shifting dullness of ascites
Low lying rectal tumours may be palpable
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42
Q

How is CRC investigated?

A
  1. BLOODS - FBC (anaemia)/LFT/tumour markers (CEA)
  2. STOOL - occult or frank blood in stool - screening test
  3. Endoscopy - sigmoidoscopy/colonoscopy
  4. Barium contrast studies - apple core stricture
  5. Contrast CT scan - staging
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43
Q

What does CRC look like on barium enema?

A

Apple core stricture

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44
Q

How is CRC screened for?

A

Faecal occult blood

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45
Q

What is the tumour marker for CRC?

A

CEA

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46
Q

What causes gastric cancer?

A

Unknown

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47
Q

What is gastric cancer associated with?

A 
Diet high in smoked and processed foods
Nitrosamines
Smoking
Alcohol
H pylori infection
Atrophic gastritis
Blood group A
Pernicious anaemia
Partial gastrectomy
Gastric polyps
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48
Q

Where has the highest incidence of gastric cancer?

A

Asia esp Japan

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49
Q

Who is gastric cancer more common in?

A

Men 2x

Over 50

50
Q

How does gastric cancer present?

A 
Asymptomatic at first
Satiety + epigastric discomfort
WL, anorexia, n+v
Haematemesis, melaena, anaemia
Dysphagia (tumours of cardia)
Ascites, jaundice (liver mets)
51
Q

What are the signs of gastric cancer O/E?

A 
Epigastric mass
Abdo tenderness
Ascites
Signs of anaemia
Virchow's node - L supraclavicular fossa
Sister Mary Joseph's node - umbilicus
52
Q

How is gastric cancer investigated?

A
  1. Bloods - FBC (anaemia), LFT
  2. CT/MRI - staging
  3. Bone scan - staging
  4. Upper GI endoscopy
  5. Endoscopic USS
53
Q

What is hepatocellular carcinoma?

A

Primary malignancy of the liver parenchyma

54
Q

What are the risk factors for HCC?

A

Chronic liver damage - ALD, hep C, AI disease
Metabolic disease - haemochromatosis
Aflatoxins - from cereals contaminated w fungi or biological weapons

55
Q

Where is HCC incidence increased?

A

Where hep B and C are endemic
South Med
Far East

56
Q

How does HCC present?

A

Malaise, WL, loss of appetite
High alcohol intake
Hep B or C, aflatoxins
Fullness in abdo and jaundice

57
Q

What are the signs of HCC O/E?

A 
Cachexia
Lymphadenopathy
Hepatomegaly - nodular, tender
Jaundice
Ascites
Liver bruit
58
Q

How is HCC investigated?

A
  1. Bloods - FBC, ESR, LFT, clotting, alpha fetoprotein, hepatitis serology
  2. Imaging - US, CT, MRI (last 2 for staging)
  3. Angiography
59
Q

What type of lung cancer is most common?

A

Non-small cell (80%)

60
Q

What causes lung cancer?

A

Smoking
Asbestos exposure
Both cause genetic alterations –> neoplastic transformation

Also occupational exposures - polycyclic hydrocarbons, nickel, chromium, cadmium, radon, atmospheric pollution

61
Q

What is the most common fatal malignancy in the West?

A

Lung cancer

62
Q

Who is lung cancer more common in?

A

3x men

63
Q

How does lung cancer present?

A

Asymptomatic

If primary: cough, haemptysis, chest pain, recurrent pneumonia

Pancoast tumour: shoulder/arm pain/Horner’s

Left recurrent laryngeal nerve invasion: hoarseness, bovine cough

Oesophagus invasion: dysphagia

Heart invasion: palpitations, arrhythmia

Weight loss, fatigue, bone pain, fractures, fits

64
Q

What are the signs of lung cancer O/E?

A 
May be no signs
Fixed monophonic wheeze
Lobar collapse/pleural effusion
Virchow's node
Hepatomegaly
65
Q

How is lung cancer diagnosed?

A 
CXR
Sputum cytology
Bronchoscopy w brushing or biopsy
CT/US guided percutaneous biopsy
LN biopsy
66
Q

How is lung cancer staged?

A

CT chest
CT/MRI head and abdo
Bone scan, PET

67
Q

What bloods are done for lung cancer?

A 
FBC
UE
Ca - hyperCa common
Alkphos - increased in bone mets
LFT
68
Q

What is mesothelioma?

A

Malignancy involving the mesothelial cells that normally line body cavities, including the pleura, peritoneum, pericardium, testis

69
Q

What causes is the main cause of malignant pleural mesothelioma?

A

Asbestos

70
Q

Who is mesothelioma more common in?

A

Men 3x

71
Q

When does mesothelioma incidence peak?

A

35-45 years after asbestos exposure

72
Q

How does mesothelioma present?

A 
Dyspnoea
Non-pleuritic chest pain
Chest discomfort
FL-WS
Can be asymp w pleural effusion
73
Q

What are the signs of mesothelioma O/E?

A

Pleural effusion

74
Q

How is mesothelioma investigated?

A

Bedside - obs, BP, lung function tests

Bloods - FBC, UE, LFT

Imaging - CXR, CT, bronchoscopy

Tissue biopsy

Cytology - aspirates, washings

75
Q

What is neutropenic sepsis?

A

Fever > 38C or features of sepsis in a patient with a neutrophil count < 0.5x10^9/L

Medical emergency - must be treated within 1h of detection

76
Q

What predisposes to neutropenic sepsis?

A

Congenital - rare:
Congenital neutropenia
Chediak-Higashi syndrome

Acquired:
Malignancy - haematological, tumour infiltration
Infections - HIV, TB, malaria, typhoid
Drugs - cytotoxics
Aplastic anaemia
Folate and B12 deficiency
Hypersplenism (increased neutrophil turnover)

77
Q

What causes neutropenic sepsis?

A

Virus - herpes simplex

Bacteria - E Coli, Klebsiella, Pseudomonas aeruginosa, Staph epidermis, Staph aureus, C diff - MOST COMMON

Fungi - candida, aspergillus

78
Q

How does neutropenic sepsis present?

A 
Fever or hypothermia
SOB
Confusion
Palpitations
Decreased UO
79
Q

What are the signs of neutropenic sepsis O/E?

A 
Pyrexia or hypothermia
RR > 20
SBP < 90
Decreased cognition w acute confusion
Tachycardia
Oliguria < 1mL/kg/hr
80
Q

How is neutropenic sepsis investigated?

A

Bloods - VBG, FBC, CRP, UE, LFT, bone profile, clotting

Cultures - blood, line, sputum, urinanalysis, stool, C diff toxin, viral PCR, wound swabs, serology for HIV, HCV, HBV

CXR
LP - meningitis, encephalitis
Echo - IE

81
Q

What are the 2 major histological types of oesophageal cancer?

A

Squamous cell carcinoma

Adenocarcinoma

82
Q

What are the risk factors for squamous cell oesophageal cancer?

A 
Alcohol
Smoking
Paterson-Kelly syndrome
Tylosis
Achalasia
Scleroderma
Coeliac disaese
Vitamin deficiencies
Nitrosamines
83
Q

What are the risk factors for adenocarcinoma of the oesophagus?

A

GORD

Barrett’s oesophagus

84
Q

Who is oesophageal cancer more common in?

A

3x men

85
Q

How does oesophageal cancer present?

A 
Often asymptomatic
Progressive dysphagia, initially worse for solids
Regurgitation
Cough or choking on food
Hoarseness
Odynophagia
WL
Fatigue - IDA
86
Q

What are the signs of oesophageal cancer O/E?

A

Usually none

Mets - supraclavicular lymphadenopathy, hepatomegaly, hoarseness (RLN involvement)

87
Q

How is oesophageal cancer investigated?

A
  1. Endoscopy - brushings, biopsy, US for staging
  2. Imaging - barium swallow, CXR
  3. Staging - CT chest and abdomen
88
Q

What causes pancreatic cancer?

A

Unknown

89
Q

What percentage of pancreatic cancers are hereditary?

A

5-10%

MEN, HNPCC, Gardner, VHL syndrome

90
Q

What are the risk factors for pancreatic cancer?

A 
Increasing age
Smoking
DM
Chronic pancreatitis
Low fruit and veg intake
91
Q

Who is pancreatic cancer most common in?

A

Old men

92
Q

How does pancreatic cancer usually present?

A 
Non-specific symptoms
Anorexia
Malaise
Nausea
Epigastric pain
Later - WL, DM, jaundice
93
Q

What are the signs of pancreatic cancer O/E?

A

Weight loss
Epigastric tenderness or mass
Jaundice + palpable gallbladder
Hepatomegaly (mets)

94
Q

How is pancreatic cancer investigated?

A
  1. Bloods: CA19-9 and CEA elevated / high bilirubin / high AlkPhos / deranged clotting (liver mets)
  2. Imaging - US/CT+biopsy/MRI/MRCP/ERCP
  3. Staging laparoscopy
95
Q

What is the biggest risk factor for prostate cancer?

A

Age

96
Q

What are the risk factors for prostate cancer?

A 
INCREASING AGE
Afro-Caribbean - younger, more aggressive disease
FH - BRCA2, Chr1 gene
Diet - high fat, meat, alcohol
Occupational exposure to cadmium
97
Q

Where is prostate cancer most common?

A

North America
Europe

Low in Far East

98
Q

What is the 2nd most common cause of male cancer deaths?

A

Prostate cancer

99
Q

How does prostate cancer present?

A

Asymptomatic

LUTS - frequency, hesitancy, poor stream, nocturia, terminal dribble

Mets - bone pain, SC compression, malaise, anorexia, WL

PNP syndromes - hypercalcaemia - polydipsia + polyuria

100
Q

What does a malignant prostate feel like?

A

Asymmetrical hard nodular prostate gland

Loss of midline sulcus

101
Q

How is prostate cancer investigated?

A 
DRE
Bloods - FBC, UE, PSA, acid phosphatase, LFT, bone profile
CT/MRI
TRUS and needle biopsy - Gleason score
Isotope bone scan
102
Q

Which inherited conditions is renal cell carcinoma associated with?

A

VHL disease
Tuberous sclerosis
Polycystic kidneys
Familial RCC

103
Q

What are the risk factors for renal cell carcinoma?

A 
Smoking
Chronic dialysis
VHL disease
Tuberous sclerosis
Polycystic kidneys
Familial RCC
104
Q

What kind of cancer are the majority of renal cell carcinomas?

A

Renal clear cell carcinoma - 80%

10% papillary
10% transitional cell - renal pelvis

105
Q

Who usually presents with renal cell carcinoma?

A

Men

40-60yo

106
Q

How does renal cell carcinoma present?

A

LATE - asymptomatic in 90%
Triad = haematuria + flank pain + abdominal mass (only 10% patients)
Systemic signs - WL, malaise
PNP syndromes - pyrexia of unknown origin, hypercalcaemia, polycythaemia

107
Q

What are the signs of renal cell carcinoma O/E?

A

Palpable renal mass
HTN
Anaemia

108
Q

How is renal cell carcinoma investigated?

A

Dipstick - haematuria
Urine cytology
Bloods - FBC, UE, Ca, LFT, ESR (raised in 75%)

109
Q

What are the risk factors for testicular cancer?

A

Testicular maldescent or ectopic testis - 40x risk
Contralateral testicular tumour
Atrophic testis

110
Q

What is the most common malignancy in 18-35yo men?

A

Testicular cancer

111
Q

How does testicular cancer present?

A

Swelling/discomfort of testes
Backache - due to para-aortic LN enlargement
Resp symptoms - SOB, haemoptysis from lung mets

112
Q

What are the signs of testicular cancer O/E?

A

Painless, hard testicular mass
Lymphadenopathy - supraclavicular, para-aortic
Signs of pleural effusion
Gynaecomastia - tumour HCG production

113
Q

How is testicular cancer investigated?

A

BLOODS - FBC, UE, FLT, AFP, beta-HCG, LDH
Urine pregnancy test - +ve if tumour produces beta-HCG
CXR - lung mets/effusion
US
CT abdo/thorax/brain - mets

114
Q

What are the tumour markers for testicular cancer?

A

Alpha-fetoprotein
Beta-HCG
LDH

115
Q

What is tumour lysis syndrome?

A

A constellation of metabolic disturbances that may follow the initiation of cancer treatment

116
Q

How does tumour lysis syndrome usually occur in?

A

Patients with bulky, rapidly proliferating, treatment-responsive tumours

Most often = acute leukaemia with high WBC

117
Q

What 2 things is tumour lysis syndrome associated with?

A
  1. Elevated pre-treatment LDH

2. Renal insufficiency prior to therapy

118
Q

How does tumour lysis syndrome present?

A

Within 72h of admin of cytotoxic treatment
Abdo pain/distension
Urinary - dysuria, oliguria, flank pain, haematuria
Hypocalcaemia - anorexia, vomiting, cramps, seizures, spasms, altered mental status, tetany
Hyperkalaemia - weakness, paralysis

Other - lethargy, oedema, CHF, cardiac dysrhythmias, syncope, sudden death

119
Q

What are the signs of tumour lysis syndrome O/E?

A

Hyperkalaemia - paraesthesia, weakness, cardiac arrhythmias

Hypocalcaemia - paraesthesia, tetany, Chvostek, Trousseau, anxiety, carpal and pedal spasms, bronchospasm, seizures, cardiac arrest

Calcium phosphate deposition - pruritis, gangrene, iritis, arthritis

Uraemia - fatigue, weakness, malaise, n+v, anorexia, metallic taste, hiccups, restless legs

120
Q

How is tumour lysis syndrome investigated?

A 
Urine dipstick - ALKALI
Urine output - assess hydration
Imaging - CXR/CT abdo
ECG
Bloods - FBC/UE/LDH
121
Q

What is the first life-threatening abnormality in tumour lysis syndrome? Therefore what must you do?

A

Hyperkalaemia

U+E bloods

Y3 (20 decks)

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