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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
How does cholangiocarcinoma present?
- Obstructive jaundice - yellow skin + sclera/pale stools/dark urine/pruritis - Abdominal fullness or pain - Symptoms of malignancy - WL, malaise
26
What are the signs of cholangiocarcinoma O/E?
- Jaundice - Palpable gallbladder - Epigastric or RUQ mass - Hepatomegaly
27
What is Courvoisier's law?
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
28
What bloods would you do for suspected cholangiocarcinoma?
``` FBC U+E LFT - raised bilirubin, alkphos, GGT Clotting Tumour markers - CA19-9 raised ```
29
What is the tumour marker for cholangiocarcinoma?
Ca19-9
30
How is cholangiocarcinoma investigated?
Bloods Endoscopy - ERCP US - biliary duct dilatation CT/MRI/MRCP/Bone scan - stage tumour and visualise regional spread Arteriogram
31
What is colorectal carcinoma?
Malignant adenocarcinoma of the large bowel
32
What causes colorectal carcinoma?
- Environmental and genetic factors - Epithelial dysplasia > adenoma > carcinoma - Accumulation of genetic changes in oncogenes (APC, K-ras) and TSGs (p53, DCC)
33
What are the risk factors for colorectal carcinoma?
``` 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 ```
34
What is the 2nd most common cause of cancer death in the West?
Colorectal carcinoma
35
What is the average age of diagnosis of CRC?
60-65
36
Who is rectal carcinoma more common in?
Men
37
Who is colon carcinoma more common in?
Women
38
How do L-sided colon and rectal cancer present?
Change in bowel habit Rectal bleeding Blood/mucus mixed in with stools Tenesmus
39
How does R-sided colon cancer present?
``` Later presentation Symptoms of anaemia Weight loss Non-specific malaise (Rare) lower abdominal pain ```
40
What do up to 20% of CRC tumours present with?
Emergency | Pain and distension due to LBO, haemorrhage or peritonitis due to perforation
41
What are the signs of CRC O/E?
``` R-sided: anaemia may be only sign Abdo mass w metastatic disease Hepatomegaly Shifting dullness of ascites Low lying rectal tumours may be palpable ```
42
How is CRC investigated?
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
43
What does CRC look like on barium enema?
Apple core stricture
44
How is CRC screened for?
Faecal occult blood
45
What is the tumour marker for CRC?
CEA
46
What causes gastric cancer?
Unknown
47
What is gastric cancer associated with?
``` Diet high in smoked and processed foods Nitrosamines Smoking Alcohol H pylori infection Atrophic gastritis Blood group A Pernicious anaemia Partial gastrectomy Gastric polyps ```
48
Where has the highest incidence of gastric cancer?
Asia esp Japan
49
Who is gastric cancer more common in?
Men 2x | Over 50
50
How does gastric cancer present?
``` Asymptomatic at first Satiety + epigastric discomfort WL, anorexia, n+v Haematemesis, melaena, anaemia Dysphagia (tumours of cardia) Ascites, jaundice (liver mets) ```
51
What are the signs of gastric cancer O/E?
``` Epigastric mass Abdo tenderness Ascites Signs of anaemia Virchow's node - L supraclavicular fossa Sister Mary Joseph's node - umbilicus ```
52
How is gastric cancer investigated?
1. Bloods - FBC (anaemia), LFT 2. CT/MRI - staging 3. Bone scan - staging 4. Upper GI endoscopy 5. Endoscopic USS
53
What is hepatocellular carcinoma?
Primary malignancy of the liver parenchyma
54
What are the risk factors for HCC?
Chronic liver damage - ALD, hep C, AI disease Metabolic disease - haemochromatosis Aflatoxins - from cereals contaminated w fungi or biological weapons
55
Where is HCC incidence increased?
Where hep B and C are endemic South Med Far East
56
How does HCC present?
Malaise, WL, loss of appetite High alcohol intake Hep B or C, aflatoxins Fullness in abdo and jaundice
57
What are the signs of HCC O/E?
``` Cachexia Lymphadenopathy Hepatomegaly - nodular, tender Jaundice Ascites Liver bruit ```
58
How is HCC investigated?
1. Bloods - FBC, ESR, LFT, clotting, alpha fetoprotein, hepatitis serology 2. Imaging - US, CT, MRI (last 2 for staging) 3. Angiography
59
What type of lung cancer is most common?
Non-small cell (80%)
60
What causes lung cancer?
Smoking Asbestos exposure Both cause genetic alterations --> neoplastic transformation Also occupational exposures - polycyclic hydrocarbons, nickel, chromium, cadmium, radon, atmospheric pollution
61
What is the most common fatal malignancy in the West?
Lung cancer
62
Who is lung cancer more common in?
3x men
63
How does lung cancer present?
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
What are the signs of lung cancer O/E?
``` May be no signs Fixed monophonic wheeze Lobar collapse/pleural effusion Virchow's node Hepatomegaly ```
65
How is lung cancer diagnosed?
``` CXR Sputum cytology Bronchoscopy w brushing or biopsy CT/US guided percutaneous biopsy LN biopsy ```
66
How is lung cancer staged?
CT chest CT/MRI head and abdo Bone scan, PET
67
What bloods are done for lung cancer?
``` FBC UE Ca - hyperCa common Alkphos - increased in bone mets LFT ```
68
What is mesothelioma?
Malignancy involving the mesothelial cells that normally line body cavities, including the pleura, peritoneum, pericardium, testis
69
What causes is the main cause of malignant pleural mesothelioma?
Asbestos
70
Who is mesothelioma more common in?
Men 3x
71
When does mesothelioma incidence peak?
35-45 years after asbestos exposure
72
How does mesothelioma present?
``` Dyspnoea Non-pleuritic chest pain Chest discomfort FL-WS Can be asymp w pleural effusion ```
73
What are the signs of mesothelioma O/E?
Pleural effusion
74
How is mesothelioma investigated?
Bedside - obs, BP, lung function tests Bloods - FBC, UE, LFT Imaging - CXR, CT, bronchoscopy Tissue biopsy Cytology - aspirates, washings
75
What is neutropenic sepsis?
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
What predisposes to neutropenic sepsis?
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
What causes neutropenic sepsis?
Virus - herpes simplex Bacteria - E Coli, Klebsiella, Pseudomonas aeruginosa, Staph epidermis, Staph aureus, C diff - MOST COMMON Fungi - candida, aspergillus
78
How does neutropenic sepsis present?
``` Fever or hypothermia SOB Confusion Palpitations Decreased UO ```
79
What are the signs of neutropenic sepsis O/E?
``` Pyrexia or hypothermia RR > 20 SBP < 90 Decreased cognition w acute confusion Tachycardia Oliguria < 1mL/kg/hr ```
80
How is neutropenic sepsis investigated?
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
What are the 2 major histological types of oesophageal cancer?
Squamous cell carcinoma | Adenocarcinoma
82
What are the risk factors for squamous cell oesophageal cancer?
``` Alcohol Smoking Paterson-Kelly syndrome Tylosis Achalasia Scleroderma Coeliac disaese Vitamin deficiencies Nitrosamines ```
83
What are the risk factors for adenocarcinoma of the oesophagus?
GORD | Barrett's oesophagus
84
Who is oesophageal cancer more common in?
3x men
85
How does oesophageal cancer present?
``` Often asymptomatic Progressive dysphagia, initially worse for solids Regurgitation Cough or choking on food Hoarseness Odynophagia WL Fatigue - IDA ```
86
What are the signs of oesophageal cancer O/E?
Usually none Mets - supraclavicular lymphadenopathy, hepatomegaly, hoarseness (RLN involvement)
87
How is oesophageal cancer investigated?
1. Endoscopy - brushings, biopsy, US for staging 2. Imaging - barium swallow, CXR 3. Staging - CT chest and abdomen
88
What causes pancreatic cancer?
Unknown
89
What percentage of pancreatic cancers are hereditary?
5-10% | MEN, HNPCC, Gardner, VHL syndrome
90
What are the risk factors for pancreatic cancer?
``` Increasing age Smoking DM Chronic pancreatitis Low fruit and veg intake ```
91
Who is pancreatic cancer most common in?
Old men
92
How does pancreatic cancer usually present?
``` Non-specific symptoms Anorexia Malaise Nausea Epigastric pain Later - WL, DM, jaundice ```
93
What are the signs of pancreatic cancer O/E?
Weight loss Epigastric tenderness or mass Jaundice + palpable gallbladder Hepatomegaly (mets)
94
How is pancreatic cancer investigated?
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
What is the biggest risk factor for prostate cancer?
Age
96
What are the risk factors for prostate cancer?
``` INCREASING AGE Afro-Caribbean - younger, more aggressive disease FH - BRCA2, Chr1 gene Diet - high fat, meat, alcohol Occupational exposure to cadmium ```
97
Where is prostate cancer most common?
North America Europe Low in Far East
98
What is the 2nd most common cause of male cancer deaths?
Prostate cancer
99
How does prostate cancer present?
Asymptomatic LUTS - frequency, hesitancy, poor stream, nocturia, terminal dribble Mets - bone pain, SC compression, malaise, anorexia, WL PNP syndromes - hypercalcaemia - polydipsia + polyuria
100
What does a malignant prostate feel like?
Asymmetrical hard nodular prostate gland | Loss of midline sulcus
101
How is prostate cancer investigated?
``` DRE Bloods - FBC, UE, PSA, acid phosphatase, LFT, bone profile CT/MRI TRUS and needle biopsy - Gleason score Isotope bone scan ```
102
Which inherited conditions is renal cell carcinoma associated with?
VHL disease Tuberous sclerosis Polycystic kidneys Familial RCC
103
What are the risk factors for renal cell carcinoma?
``` Smoking Chronic dialysis VHL disease Tuberous sclerosis Polycystic kidneys Familial RCC ```
104
What kind of cancer are the majority of renal cell carcinomas?
Renal clear cell carcinoma - 80% 10% papillary 10% transitional cell - renal pelvis
105
Who usually presents with renal cell carcinoma?
Men | 40-60yo
106
How does renal cell carcinoma present?
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
What are the signs of renal cell carcinoma O/E?
Palpable renal mass HTN Anaemia
108
How is renal cell carcinoma investigated?
Dipstick - haematuria Urine cytology Bloods - FBC, UE, Ca, LFT, ESR (raised in 75%)
109
What are the risk factors for testicular cancer?
Testicular maldescent or ectopic testis - 40x risk Contralateral testicular tumour Atrophic testis
110
What is the most common malignancy in 18-35yo men?
Testicular cancer
111
How does testicular cancer present?
Swelling/discomfort of testes Backache - due to para-aortic LN enlargement Resp symptoms - SOB, haemoptysis from lung mets
112
What are the signs of testicular cancer O/E?
Painless, hard testicular mass Lymphadenopathy - supraclavicular, para-aortic Signs of pleural effusion Gynaecomastia - tumour HCG production
113
How is testicular cancer investigated?
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
What are the tumour markers for testicular cancer?
Alpha-fetoprotein Beta-HCG LDH
115
What is tumour lysis syndrome?
A constellation of metabolic disturbances that may follow the initiation of cancer treatment
116
How does tumour lysis syndrome usually occur in?
Patients with bulky, rapidly proliferating, treatment-responsive tumours Most often = acute leukaemia with high WBC
117
What 2 things is tumour lysis syndrome associated with?
1. Elevated pre-treatment LDH | 2. Renal insufficiency prior to therapy
118
How does tumour lysis syndrome present?
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
What are the signs of tumour lysis syndrome O/E?
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
How is tumour lysis syndrome investigated?
``` Urine dipstick - ALKALI Urine output - assess hydration Imaging - CXR/CT abdo ECG Bloods - FBC/UE/LDH ```
121
What is the first life-threatening abnormality in tumour lysis syndrome? Therefore what must you do?
Hyperkalaemia U+E bloods

Y3 (20 decks)

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