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cancer Flashcards

1
Q

SVC obstruction: Causes and symptoms

A

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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2
Q

SVC Obstruction: Investigations

A

CXR- mediastinal widening and may show tumour
CT
Biopsy

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3
Q

SVC: Management

A

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

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4
Q

Metastatic cord compression: symptoms

A

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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5
Q

MSCC: Signs

A

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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6
Q

MSCC: Management

A

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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7
Q

Hypercalcaemia:

A

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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8
Q

Hypercalcaemia: symptoms and signs

A

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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9
Q

Hypercalcaemia:

A

serum calcium and serum albumin

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10
Q

Hypercalcaemia

A

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

max response from 6- 11 days.

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11
Q

Breast cancer: Pathophysiology

A 
Ductal carcinoma (80%)
Lobular carcinoma (20%)
Mets into axilla lymph nodes. Lungs, liver, brain, ovaries
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12
Q

Breast cancer: RF

A

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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13
Q

Breast cancer: Symptoms

A

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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14
Q

Breast cancer: Staging

A

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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15
Q

Breast cancer: Investigations

A

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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16
Q

Breast cancer: Management Chemo

A

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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17
Q

Breast cancer: Management

Surgery

A

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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18
Q

Breast cancer: Management

Radiotherapy

A

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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19
Q

Breast cancer: Management

Endocrine

A

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)

20
Q

Breast cancer: Screening and prognosis

A

50-70 have mammogram every 3 years

Prognosis:

21
Q

Prostate cancer: epid.

A

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

22
Q

Prostate cancer: pathophysiology

A

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

23
Q

Prostate cancer: Symptoms

A

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

24
Q

Prostate cancer: staging

A

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

25
Q

Prostate cancer: grading

A

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)

26
Q

Prostate cancer: Surgery

A

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

27
Q

Prostate cancer: Radiotherapy

A

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

28
Q

Prostate cancer: Hormone therapy

A

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

29
Q

Lung cancer: Risk factors

A

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

30
Q

Lung cancer: Pathophysiology

A

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

31
Q

Lung cancer: Paraneoplastic syndrome

A

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

32
Q

Lung cancer: symptoms. general

A 
General:
cough
haemoptysis
breathlessness
chest pain
recurrent chest infections
clubbing - more with Squamous (NSCLC)
33
Q

Lung cancer: symptoms specific

A 
Pancoast tumour (apex of lungs)
sympathetic and brachial palsy
Horner's syndrome: PAM
hand muscle wasting 
Mediastinal tumour: hoarse voice
34
Q

Lung cancer: investigation

A

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

35
Q

Lung cancer: management

SCLC

A

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

36
Q

Lung cancer: management NSCLC

A

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

37
Q

Colorectal cancer: basics

A

rule of thirds:

third in rectum, third in left descending colon and third in rest of colon

38
Q

Colorectal cancer: RF

A

Smoking, genetics, diet, obesity, age

Genetics: FAP, HNPCC, P53

39
Q

Colorectal cancer: Pathophysiology

A

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

40
Q

Colorectal cancer: symptoms

A

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

41
Q

Colorectal cancer: investigations

A

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

42
Q

Colorectal cancer: screening

A

over 60:

FIT/FOB. both come in post for you to dip stool sample in

43
Q

Colorectal cancer: staging

A 
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
44
Q

Colorectal cancer: management colon

A

Surgery: hemicolectomy or ant. resection

chemo: adjuvant for micromets or neoadjuvant
radio: rare

45
Q

Colorectal cancer: management rectal

A

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

CCC (5 decks)

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