cancer Flashcards by Guy Gitlin

SVC obstruction: Causes and symptoms

Obstruction of flow through SVC, caused by SCLC, lymphomas
SYMPT:
blackout, early morning headaches, facial swelling, tightness around collar, dyspnoea, cough, hoarse voice
Facial/upper limb odema, prominent blood vessels in neck, trunk and arms. cyanosis

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SVC Obstruction: Investigations

CXR- mediastinal widening and may show tumour
CT
Biopsy

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SVC: Management

High dose corticosteroids (dexamethasone- for short term syx relief)
Vascular stenting required, followed by radiotherapy or chemotherapy

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Metastatic cord compression: symptoms

MOST COMMON (2/3) IN THORACIC SPINE, BREAST, BRONCHUS and PROSTATE
Back pain- uni or bilat. aggrevated by movement, coughing, lying flat
Motor weakness- changes in strength. can develop quick or slow
subjective physical changes precede obj. changes
Bladder/bowel incontinence - often late stage

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MSCC: Signs

change in sensation below level of compression
weakness/paraparesis/paraplegia
INCREASE in reflexes below level of lesion
clonus (like clonic) and painless bladder present

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MSCC: Management

MRI of spine
Corticosteroids (dex) in interim
normally give surgery for vertebral collapse where there is not a lot of disease elsewhere.

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Hypercalcaemia:

Breast, lung, SCC, Myeloma causing bony mets.

ALSO can get from Squamous cell lung cancer creating causing release of ectopic PTHrelatedProtein

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Hypercalcaemia: symptoms and signs

STONES- kidney stones that can cause renal failure .
BONES- pain.
GROANS- n and v, anorexia, indig.
MOANS- confusion, lethargy, memory loss and low mood

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Hypercalcaemia:

serum calcium and serum albumin

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Hypercalcaemia

Rehydration: saline, IV bosphosphonate. average 3- 4 weeks

max response from 6- 11 days.

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Breast cancer: Pathophysiology

Ductal carcinoma (80%)
Lobular carcinoma (20%)
Mets into axilla lymph nodes. Lungs, liver, brain, ovaries

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Breast cancer: RF

Age, long oestrogen exp.- late childbearing, nulliparity, early menarche, late menopause, obesity
COCP
FHx
Genetics: BRCA1 (both ovarian and breast), BRCA2 (breast in men and women)

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Breast cancer: Symptoms

Most painless, immovable lump, thickening of skin.
Nipple changes:
retraction, Paget’s disease- looks like eczema on nipple, discharge (esp. bloody)
Skin changes: dimpled, orange peel

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Breast cancer: Staging

TMN
T: <2cm T1, 2-5cm T2, >5cm T3, to skin or chest wall T4.
N: N1 met to ipsilateral, movable axillary LN, N2 Met to ipsilat. fixed axillary or Int. mammary lymph nodes. N3, infra/supra clavicular LN or axillary and IM LN

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Breast cancer: Investigations

Triple assessment: Clinical assessment (Hx and exam), bilat. mammography, Targeted USS of suspicious area
(biopsy confirms diagnosis either fine needle aspiration or incisional/excisional)

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Breast cancer: Management Chemo

adjuvant effective in reducing recurrence and mortality (only used in higher stage)
Neo- adjuvant can be used. in inflam breast cancer
Comboination

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Breast cancer: Management

Surgery

first line for localised
can get wide local excision or whole mastectomy.
Axillary lymph node assessment done at same time
If not evidence of mets do sentinel node biopsy

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Breast cancer: Management

Radiotherapy

Adjuvant radiotherapy done in all following conservative surgery
Palliative radiotherapy can be indicated in locally recurring disease or to control syx such as bone mets

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Breast cancer: Management

Endocrine

Adjuvant to surgery for 5 years (10 if high risk)
Need to know oestrogen/ progesterone receptors first. If ER/PR +ve can be used as primary treatment
best for treatment: ER+, HER2 -ve
then: triple +ve
worst: triple negative
Tamoxifen
Aromatase Inhibitors: anastrozole, letrozole
Transtazumab (herceptin)

Breast cancer: Screening and prognosis

50-70 have mammogram every 3 years

Prognosis:

Prostate cancer: epid.

Lifetime risk: 1/8, for black men:1/4
may be linked to testosterone. Radiation, diet, anabolic steroids also linked
Genetic: BRCA 2 and pTEN

Prostate cancer: pathophysiology

95% adenocarcinomas of glandular tissue on posterior/ peripheral part of prostate
(BPH arises in centre of gland)

Prostate cancer: Symptoms

Urinary Syx: reduced flow, dribbling, frequency, nocturia
Impotence
1 in 5 have met. syx. e.g. bony mets: anaemia, pain, path. fracture, spinal cord compression
OE: PR- enlarged, craggy/ nodular, hard, with obliteration of median sulcus

Prostate cancer: staging

TNM
T1: no palpable/visible tumour. only positive biopsy
T2: tumour in prostate
T3: beyond prostate into seminal vesicle
T4: in rectum or bladder
Only N0- no lymph node
N1- lymph node involved

Prostate cancer: grading

Gleason The tumours Primary and secondary areas are given a number based on the histology. 1: well differentiated. small uniform glands 5: poorly differentiated. lack of or occasional glands so a tumour can score (3+4)

Prostate cancer: Surgery

radical or palliative. men <70 . Done by perineal or retroperitoneal routes

Prostate cancer: Radiotherapy

curative in T1 and T2. adjuvant if concern of residual disease non invasive SE: risks of rectal bleeding, diarrhea, dysuria, impotence and incontinence External beam OR Brachytherapy (implantation of radioisotopes: for fit men w/ no comorbidities

Prostate cancer: Hormone therapy

esp. for advanced met. disease. neoadjuvant to surgery max. androgen blockade achieved by LHRH (leuporelin) and anti- androgen (GNRH antagonist e.g. degarelix), oestrogen therapy SE: male menopasue. impotence, loss of libido, tumour flare up on initiation of treatment, loss of muscle bulk, weight gain, cardiac risks and osteoporosis

Lung cancer: Risk factors

Smoking; causes 90% of lung cancer. Carcinogens cause mutation in p53 occupation: asbestos, radiation Genetic Hx of COPD

Lung cancer: Pathophysiology

SCLC- mets earlier, so cannot be operated on. Spreads to liver, bones, brain and adrenals 15% of all lung cancers NSCLC: e.g. squamous cell- central close to bronchi- CIGS, adenocarcinoma- in peripheral, large cell

Lung cancer: Paraneoplastic syndrome

Ass with SCLC: SIADH Cushing's Lambert Eaton Myaesthenic syndrome (LEMS)

Lung cancer: symptoms. general

``` General: cough haemoptysis breathlessness chest pain recurrent chest infections clubbing - more with Squamous (NSCLC) ```

Lung cancer: symptoms specific

``` Pancoast tumour (apex of lungs) sympathetic and brachial palsy Horner's syndrome: PAM hand muscle wasting Mediastinal tumour: hoarse voice ```

Lung cancer: investigation

Bronchoscopy with biopsy CXR, CT thorax to assess spread, CT/MRI brain for mets Sputum cytology

Lung cancer: management | SCLC

considered systemic Chemo: responds well. normally primary treatment Radio: also responds well. Can be used as primary, palliative and prophylactic (cranial irridation for mets) Surgery: rare

Lung cancer: management NSCLC

Surgery: can do lobectomy or pneumonectomy (whole lung) Radio: radical for early stage ( 3 times/day for 12 days straight) Chemo: adjuvant for surgery. neoadjuvant for radiotherapy or palliative

Colorectal cancer: basics

rule of thirds: | third in rectum, third in left descending colon and third in rest of colon

Colorectal cancer: RF

Smoking, genetics, diet, obesity, age | Genetics: FAP, HNPCC, P53

Colorectal cancer: Pathophysiology

Adenocarcinoma. normal process if from bening adenomatous polyp --> dysplasia --> invasive adenocarcinoma

Colorectal cancer: symptoms

Left des. colon: bright red bleeding. change in bowel habits, collicky abdo pain flatulence and bloating, tenesmus right asend.: fewer syx, pain in RIF, palpable mass, IDA

Colorectal cancer: investigations

Abdo exam, PR, flexible sigmoidoscopy and colonoscopy allows biopsy, CT staging chestabdopelvis for rectal fo CT and MRI for colon: only CT

Colorectal cancer: screening

over 60: | FIT/FOB. both come in post for you to dip stool sample in

Colorectal cancer: staging

``` TNM or Duke's stage a- not breaching bowel wall b- through bowel wall, not lymph nodes c- affecting lymph nodes d- mets to other organs ```

Colorectal cancer: management colon

Surgery: hemicolectomy or ant. resection chemo: adjuvant for micromets or neoadjuvant radio: rare

Colorectal cancer: management rectal

surgery: total resection chemo: use if more advanced radio: can be used esp preoperative