Cancer Flashcards
What type of cancer is most common in the bladder?
Transitional cell carcinomas
Recall 3 risk factors for bladder cancer
Recurrent UTIs
Schistomiasis
Naphthylamine dye exposure
Recall a key epidemiological factor for bladder cancer
2-3 x more common in males
Recall the symptoms of bladder cancer
Normal urinary symptoms you would expect: polyuria, urgency, nocturia
Painless, macrocytic haematuria
Recurrent UTIs
Recall the initial investigation used for bladder cancer
Cytoscopy
What sort of scan is used to stage bladder cancer?
CT or MRI
What is the most common type of cancer in the breast?
Invasive ductal carcinoma
Recall 3 things that prolong oestrogen exposure
Nulliparity
Late menopause
Obesity
Recall the symptoms of breast cancer
Breast lump: irregular size/shape, may have bloody discharge
Axillary lump
Cardinal symptoms
Recall the signs of breast cancer including the characteristic appearance of the lump
Lump is firm and irregular, and tethered to surrounding tissues
Peau d’orange and skin tethering
Nipple inversion
Paget’s disease of the nipple (eczema like surrounding skin)
Recall the triple assessment investigative procedure used in breast cancer
- Examination
- Ultrasound/ mammogram
- FNA/ core biopsy
What investigations may be done in breast cancer in order to stage the tumour?
CT, CXR, Liver US (looking for mets)
Bloods (including Ca2+ and bone profile)
What is a cholangiocarcinoma?
Primary adenocarcinoma of the biliary tree
Recall the 3 risk factors for cholangiocarcinoma
Choledochal cyst
Primary sclerosing cholangitis
Ulcerative colitis
Recall the symptoms of jaundice
Mnemonic: You Shall Poo Stools Deemed Unhealthily Pale Yellow Skin Pale Stool Dark Urine Prutitis
Recall the symptoms of cholangiocarcinoma
Jaundice
Abdominal pain
Cardinal symptoms
Recall the LFT results expected in cholangiocarcinoma
Raised ALP and GGT
What tumour marker may be present in cholangiocarcinoma?
CEA
Carcinoembryonic antigen
What is the key investigation to do to diagnose cholangiocarcinoma?
ERCP - also use to do biopsy
How are CNS tumours classified?
High or low grade
What is the difference between high and low grade CNS tumours?
Rate of growth - only low grade ones may be treated
Recall examples of high grade CNS tumours
Mnemonic = GLUM
Glioma (+ glioblastoma multiforme)
Lymphoma (primary cerebral)
Medulloblastoma
Recall examples of low grade CNS tumours
Meningioma
Acoustic neuroma
Chraniopharyngoma
Who is particularly at risk of low grade CNS tumours?
HIV/AIDS patients
What is an important differential to rule out when you suspect a CNS tumour?
Temporal arteritis
Why are CNS tumours not staged?
Metastases from primary pretty much non-existent
What type of cancer is colon cancer?
Adenocarcinoma
Recall the relative proportion of distribution of colon cancers
10% in ascending and transverse colon
30% in descending colon
60% in sigmoid colon/ recum
What are the key mutations implicated in colon cancer?
KRas and APC
Recall the 3 key risk factors for colon cancer?
IBD
Polyps
Western diet
Differentiate the symptoms seen in cancers of the ascending/ transverse colon and symptoms that present in descending/sigmoid/rectal tumours
Ascending/transverse: later presentation: anaemia, malaiase, weight loss
Descending/sigmoid/rectal = earlier presentation: change in bowel habit, rectal bleeding, tenesmus
Why do colon cancers often present as an emergency?
Obstruction/ haemorrhage is common
Where is colon cancer most likely to metastasise to?
Liver
What is an important blood test to do in primary investigations for colon cancer?
FBC as will show anaemia
Which tumour markers may be present in colorectal cancer?
Ca19-9
CEA
What screening test may be used for colorectal cancer?
Faecal occult blood
How should a biopsy be obtained for colorectal cancer?
Endoscopy
How is colorectal cancer staged?
CONTRAST CT
Recall 3 risk factors for gastric cancer
Smoked/processed foods
H. pylori
Gastric polyps
What are the gastric symptoms of gastric cancers?
Early satiety
Gastric mass
Tenderness
Dysphagia
Recall 2 weird signs of gastric cancer
Virchow’s node
Sister Mary Joseph’s Nodule
Define hepatocellular carcinoma
Primary malignancy of liver parenchyma
Recall 3 pathologies associated with hepatocellular carcinoma
Chronic liver disease
Metabolic disease (eg haemochromatosis)
Aflatoxin infection
Recall 2 symptoms of hepatocellular carcinoma
Jaundice
Abdominal distention
Recall the signs of hepatocellular carcinoma
Mnemonic: Hepatocellular Carcinoma Always Leaves Bad Jaundice Hepatomegaly Cachexia Ascites Lymphadenopathy Bruits over liver Jaundice
What is the tumour marker implicated in hepatocellular carcinoma?
AFP
How might cytology samples be obtained for hepatocellular carcinoma?
Ascitic tap
Recall the relative prevalence of small cell and non-small cell lung cancer
Small cell = 20%, non-small cell = 80%
Which type of cancer is asbestos associated with?
Lung cancer
What is the relative prevalence of lung cancer in women to men?
1:3
Recall symptoms of lung cancer due to the primary tumour
Haemoptysis
Chest pain
Recurrent pneumonia
Recall symptoms of lung cancer that are related to local inflammation
Of nerves:
SNS compression: Horner’s
Brachial plexus compression: shoulder/arm pain
LRL compression: hoarseness and bovine cough
Of tissue: dysphagia and arrhythmias
What sort of wheeze results from lung tumours
Obstruction –> fixed monophonic wheeze
What electrolyte imbalance is common in lung cancer?
Hypercalcaemia
What blood result is indicative of bony mets?
Raised LFTs
Where does mesothelioma most commonly occur?
Pleura (90%)
What is the key risk factor to remember for mesothelioma?
Asbestos
Recall the signs and symptoms of mesothelioma
Mnemonic: Mesothelioma Presents With Particularly Fierce Nail Clubbing Signs M: mass P: pyrexia W: weight loss P: pain in chest F: fatigue N: night sweats C: clubbing S: SOB
What is the main investigation that needs to be done in mesothelioma?
Pleural fluid cytology
Recall the diagnostic criteria for neutropenic sepsis
Temp >38
Neutrophils < 0.5 x 10^9/L
Why may a neutropenically septic patient not have fever even though they have a high temp?
They are likely to be on anti-pyretics
Recall some acquired causes of neutropenic sepsis, thinking systematically
- Decreased production of neutrophils: B12/folate deficiency, chemotherapy, aplastic anaemia
- Accelerated turnover of neutrophils: hypersplenism
- Dengue fever!
What is the most common cause of neutropenic sepsis?
Cytotoxic chemotherapy
Recall the investigations required to identify neutropenia and sepsis
FBC
Blood cultures
What are the 2 major histological types of oesophageal cancer?
Squamous cell carcinoma
Adenocarcinoma
Recall 4 risk factors for squamous cell carcinoma of the oesophagus
Achalasia
Coeliac
Alcohol
Scleroderma
Recall 2 risk factors for adenocarcinoma of the oesophagus
GORD
Barrett’s oesophagus
Is oesophageal cancer more common in men or women?
Men
Recall the symptoms of oesophageal cancer
Dysphagia Regurgitation Choking Hoarseness Odynophagia Cough
Recall 2 investigations for oesophageal cancer
Barium swallow
Endoscopy
Is pancreatic cancer more common in men or women?
Men
Recall the symptoms of pancreatic cancer
Mnemonic: Pancreatic Malignancy Affects Disaster With No Justice Pain Malaise Anorexia Diabetes Weight loss Nausea Jaundice
What is trousseau’s sign of malignancy?
superficial thrombophlebitis
In which cancer is trousseau’s sign of malignancy present?
Pancreatic
Which tumour markers may be present in pancreatic cancer
Ca19-9
CEA
Recall the characteristic findings on PR in prostate cancer
Loss of midline sulcus
Asymmetrical hard nodular prostate
How would a biopsy be done in prostate cancer?
TRUS
What is the most common medical therapy for prostate cancer?
Androgen deprivation therapy
Recall the types of renal cell carcinoma and their relative prevalences
Renal CLEAR cell = 80% Papillary cell carcinoma = 10% Transitional cell (at renal pelvis) = 10%
Recall 3 inherited conditions associated with renal cell carcinoma
Von Hippel-Lindau
Tuberous sclerosis
Polycystic kidney disease
What is Strauffer’s syndrome?
Abnormal LFTs in absence of liver mets due to renal cell carcinoma
What percentage of renal cell carcinomas are asymptomatic, and what are the possible symptoms?
90%
Haematuria, flank pain, abdominal mass
Why does renal cell carcinoma cause hypertension?
Suppresses RAAS
Why can renal cell carcinoma cause a left-sided varicocele?
Obstructs left-sided testicular vein where it joins renal vein
Which staging system is used for renal cell carcinoma?
Robson staging
What are the 3 types of testicular cancer?
Seminomas
Non-seminamatous germ cell tumours
Teratoma
Which metastases are most common in testicular cancer?
Lung
Recall 3 signs of testicular cancer
- Hard mass
- Lymphadenopathy
- Gynaecomastia (tumour produces hCG)
Recall 2 tumour markers for testicular cancer
AFP
beta-hCG
Which staging system is used for testicular cancer?
Royal Marsden Hospital Staging System
What is tumour lysis syndrome?
Metabolic abnormalities that occur as a complication of cancer treatment
In which cancer does the treatment most commonly produce tumour lysis syndrome?
Lymphoma/ leukaemia
Recall 3 electrolytes that are high in TLS and the consequences of each of these being raised
Phosphate: calcium phosphate deposited in kidney leading to acute renal failure
K+: causes arrhythmias
Uric acid: gout