Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 SOFIA CONDITIONS > Cancer > Flashcards

Cancer Flashcards

1
Q

What is bladder cancer?

A

Malignancy of bladder cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the aetiology of bladder cancer

A
  • Unknown
  • Common genetic abnormalities are chromosome 9 deletions in superficial tumours and p53 mutations and 14q and 17q deletions in more invasive tumours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the risk factors of bladder cancer?

A
  • Smoking
  • Exposure to carcinogens in dye, rubber and leather industries
  • Cyclophosphamide treatment
  • Pelvic irradiation (e.g. for cervical carcinoma
  • Chronic UTI
  • Schistosomiasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the epidemiology of bladder cancer?

A
  • 2nd most common cancer of genitourinary system
  • Males 2-3x more commonly affected as woken
  • 50-70 yrs peak incidence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the presenting symptoms of bladder cancer?

A
  • Painless macroscopic haematuria
  • Urinary frequency, urgency, nocturia (irritative)
  • Recurrent UTIs
  • Pain due to clot retention
  • Ureteral obstruction
  • Extension to pelvis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the signs of bladder cancer on examination?

A
  • Often no signs

- Under anaesthetic, bimanual examination is part of disease staging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the investigations for bladder cancer?

A
  • Cytoscopy: allows visualisation of tumour, biopsy or removal
  • USS, IVU: To assess upper and lower urinary tract, as tumours can be multifocal
  • CR or MRI: For staging
  • Urine cytology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is breast cancer?

A

Malignancy of breast tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the aetiology of breast cancer?

A

Combination of genetic and environmental factors. BRCA-1 and BCRA-2
- Risk factors: Age, prolonged exposure to female sex hormones (particularly oestrogen), nulliparity, early menarche, late menopause and obesity. Fhx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the epidemiology of breast cancer?

A
  • Common
  • 1:9 in UK
  • 4-70= peak incidence
  • Rare in men
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the presenting symptoms of breast cancer?

A
  • Breast lump (usually painless) or changes in breast shape
  • Nipple discharge or axillary lump
  • Symptoms of malignancy: Weight loss, bone pain, paraneoplastic syndromes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the signs of breast cancer on examination?

A
  • Breast lump (usually hard, irregular, may be fixed)
  • Peau d’orange appearance of skin, skin tethering, fixed to chest wall
  • Skin ulceration, nipple inversion
  • Examine axillary nodes for lymphatic spread
  • Paget’s disease of the nipple: Eczematous, ulcerated, discharging nipple. This is ductal carcinoma in situ infiltrating the nipple
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the investigations for breast cancer?

A
  • Triple assessment: Standardised approach to investigating breast lump. Consists of clinical examination, imaging (mammography or ultrasound) and tissue diagnosis (cytology or biopsy)
  • Sentinal lymph node biopsy
  • Staging: CXR, liver ultrasound. Consider isotope bone scan
  • Bloods, FBC, U&E’s Ca, bone profile, LFT, ESR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is a CNS tumour?

A

Primary tumour arising from brain tissues

- Tumours arising from meninges/CNS have better prognosis than intra-axial tumours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is a meningioma?

A

Benign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is an acoustic neuroma?

A

Benign

- Slow, growing, cerebellopontine angle tumour from vestibular part of CN8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is a fibrilliary astrocytoma?

A

Most common form in cerebrum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is pilocytic astrocytoma?

A

In brainstem and cerebellum, cystic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is glioblastoma multiforme?

A

High grade invasive tumours

Poor prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is haemangioblastoma?

A

Vascular tumour in cerebellum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is medulloblastoma?

A

Invasive malignant midline cerebellar tumour in children (vermis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is ependyoma?

A

In 4th ventricles, spinal cord, benign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is lymphoma?

A

In immunosuppressed, high malignant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is craniopharyngioma?

A

Benign, extra-axial, epithelial tumours of CNS

  • Seen in both children and adults
  • Most commonly arise within the sellar/suprasellar space
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is a pituitary adenoma?

A

Space occupying/endocrine effects. Benign

  • Prolactinoma: secrete prolactin
  • Somatotroph adenoma: secrete GH
  • Corticotroph adenoma: secrete ACTH
  • Gonadotroph adenoma: Secrete FSH, LH, alpha and beta subunits
  • Null cell adenoma: secrete no hormones
  • Thyrotroph adenoma: secrete TSH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the epidemiology of CNS tumours?

A
  • Meningioma most common, esp in women

- Peak in children and elderly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the aetiology of CNS tumours?

A
  • Unknown causes in adults

- Children: embryological errors in development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the risk factors for CNS tumours?

A
  • Meningioma: FH brain tumour, NF2, breast cancer, radiation
  • Acoustic neuroma: NF2
  • Medulloblastoma: age, male, familial syndromes (ataxia-telangectasia, Rubinstein-Taybi syndrome, Gorlin’s syndrome)
  • Astrocytic: industrial countries, white males, NF1, tuberous sclerosis, Li-Farumeni
  • Lymphoma: HIV
  • Pituitary adenomas: MEN1, familial isolated pituitary adenomas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the presenting symptoms of a meningioma?

A
  • Mostly benign (can be atypical/malignant)
  • Occurs at cranial and spinal sites
  • Mass effects: Headaches, altered speech, personality seizures)
  • Broca’s aphasia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the presenting symptoms of an acoustic neuroma?

A
  • Cerebellopontine angle, unilateral sensorineural deafness, facial weakness, unilateral ataxia- walks into things, dizziness, hemifacial sensory impairment
  • Tinnitus, difficulty localising sounds, decreased tears, headache, metallic taste, diplopia on lateral gaze, nystagmus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the presenting symptoms of medulloblastoma?

A
  • Morning headaches
  • Nausea
  • Vomiting relieves headaches
  • Irritability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the presenting symptoms of astrocytoma?

A
  • Gerstmann’s syndrome: dominant parital love
  • Neglect
  • Hypothalamic syndrome
  • Cognitive decline
  • Emotional lability
  • Visual change
  • Motor weakness
  • Speech deficit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the presenting symptoms of a craniopharyngioma?

A
  • Diplopia, vision loss, headache, short stature
  • Children: Acute visual loss. Other age groups: gradual vision loss
  • Macrocephaly in infants
  • Growth failure
  • Amenorrhoea, erectile dysfunction, galactorrhoea
  • Headache
  • Raised ICP
  • Optic atrophia
  • Polyuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the signs on examination of an acoustic neuroma?

A
  • Loss of balance
  • Swallowing difficulties
  • Slow blink
  • Gait
  • Papilloedema
  • Raised ICP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are the signs on examination of medulloblastoma?

A
  • Diplopia-6th nerve palsy
  • Ophthalmoplegia- difficulty in lateral gaze
  • Ataxia
  • Bulging anteria fontanella
  • Papilloedema
  • Nystagmus
  • Head tilt
  • Ataxia
  • Dysmetria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the signs of pituitary adenoma on examination?

A
  • Decreased acuity
  • Bitemporal hemianopia
  • Pituitary apoplexy
  • Diplopia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are the investigations for CNS tumours?

A
  • CT head
  • MRI brain: high sensitivity
  • CXR or CT: Determine whether lesion is secondary or primary
  • Blood: CRP, ESR, consider HIV screen, toxoplasma serology
  • Brain biopsy: Type and grading
  • Lumbar puncture: contraindicated if there is evidence of raised intracranial pressure, may cause coning (herniation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is cholangiocarcinoma?

A

Primary adenocarcinoma of the biliary tree

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is the aetiology of cholangiocarcinoma?

A

Largely unknown
- Known associated with ulcerative colitis and primary sclerosing cholangitis, choledochal cysts, Caroli’s disease and parasitic infections of biliary tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is the epidemiology of cholangiocarcinoma?

A
  • Rare
  • Slightly more common in males
  • More common in developing world due to parasitic infections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are the presenting symptoms of cholangiocarcinoma?

A
  • Obstructive jaundice (yellow skin and sclera, pale stools, dark urine, pruritis)
  • Abdominal fullness or pain
  • Symptoms of malignancy: weight loss, malaise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are the signs of cholangiocarcinoma on examination?

A
  • Jaundice
  • Palpable gallbladder
  • Epigastric or right upper quadrant mass
  • May be hepatomegaly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What are the investigations for cholangiocarcinoma?

A
  • Bloods: FBC, U&Es, LFT (bilirubin, alkphos), clotting, tumour markers (CA19-9 raised and cholangiocarcinoma and pancreatic carcinoma)
  • Endoscopy
  • Ultrasound
  • CT, MRI or MRCP, bone scan: stage and visualise spread
  • Arteriogram
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is Courvoisier’s law?

A

In the presence of jaundice, an enlarged gallbladder is unlikely to be due to gallstones i.e. carcinoma of the pancreas or lower biliary tree more likely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is colorectal cancer?

A

Malignant adenocarcinoma of the large bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is the aetiology of colorectal cancer?

A
  • Environmental and genetic factors
  • Sequence of epithelial dysplasia -> adenoma -> carcinoma due to genetic changes in oncogenes (e.g. APC, K-ras) and tumour suppressor genes (e.g. p52, DCC)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What are the risk factors for colorectal cancer?

A
  • Western diet (high intake of red meat, alcohol, fat, sugar and reduced vegetable and fibre intake)
  • Presence of colorectal polyps
  • Previous colorectal cancer
  • Family history
  • IBD (particularly longstanding UC)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is the epidemiology of colorectal cancer?

A
  • 60-65 avg age at dx
  • Rectal carcinomas more common in males
  • Colon carcinomas more common in females
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are the presenting symptoms of colorectal cancer in the left-sided colon and rectum?

A
  • Change in bowel habit
  • Rectal bleeding or blood/mucous mixed in with the stools
  • Rectal masses may also present as tenesmus (sensation of incomplete emptying after defecation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What are the presenting symptoms of colorectal cancer in the right-sided colon?

A
  • Later presentation
  • Symptoms of anaemia, weight loss and non-specific malaise
  • 20% present as emergency- pain, distension due to large bowel obstruction, peritonitis due to perforation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What are the signs of colorectal cancer on examination?

A
  • Anaemia may be only sign: particularly in right sided lesion
  • Abdominal mass
  • Hepatomegaly
  • Shifting dullness of ascites
  • Low lying rectal tumours may be palpable on rectal examination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What are the investigations for colorectal cancer?

A
  • Blood: FBC (for anaemia), LFT, tumour markers (CEA to monitor treatment response or disease recurrence)
  • Stool: occult or frank blood
  • Endoscopy: Sigmoidoscopy, colonoscopy.
  • Barium contrast studies: ‘Apple core’ stricture on barium enema
  • Contrast CT scan: staging
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is gastric cancer?

A

Gastric malignancy, most commonly adenocarcinoma, more rarely lympphoma, leiomosarcoma or stromal tumours (GIST)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is the aetiology of gastric cancer?

A
  • Unknown
  • Risk factors: Diet high in smoked and processed foods, smoking, alcohol, H. pylori and atrophic gastritis, blood group A, Pernicious anaemia, Gastric polyps
55
Q

What is the epidemiology of gastric cancer?

A
  • Common
  • Highest incidence in Asia, especially Japan
  • ## Usual age of presentation more than 50 yrs
56
Q

What are the presenting symptoms of gastric cancer?

A
  • Early often asymptomatic
  • Early satiety or epigastric discomfort
  • Weight loss, anorexia, nausea and vomiting
  • Haematemesis, melaena, symptoms of anaemia
  • Dysphagia (tumours of cardia)
  • Symptoms of metastases, particularly abdominal swelling (ascites) or jaundice (liver involvement)
57
Q

What are the signs of gastric cancer on examination?

A
  • Epigastric mass, abdominal tenderness, ascites
  • Signs of anaemia
  • Eponymous signs found in metastatic spread:
  • Virchow’s node or Troisier’s sign
  • Sister Mary Joseph’s node
  • Krukenberg’s tumour: Ovarian metastases
58
Q

What is Sister Mary Joseph’s node?

A

Metastatic nodule on umbilicus

59
Q

What are the investigations for gastric cancer?

A
  • Upper GI endoscopy
  • Bloods: FBC (for anaemia), LFT
  • CT/MRI: Staging of tumour and planning for surgery
  • Bone scan: Staging of tumour
  • Endoscopic USS: Assess depth of gastric invasion and local lymph node involvement
  • Laparoscopy may be needed to determine if tumour is resectable
60
Q

What is hepatocellular carcinoma?

A

Primary malignancy of the liver parenchyma

61
Q

What is the aetiology of hepatocellular carcinoma?

A
  • Associated with chronic liver damage (alcoholic liver disease, hep C, autoimmune disease), metabolic disease (haemochromatosis) and aflatoxins
62
Q

What is the epidemiology of hepatocellular carcinoma?

A
  • Common

- Increased incidence in regions where hep B and C are endemic (e.g. southern Mediterranean, Far East)

63
Q

What are the presenting symptoms of hepatocellular carcinoma?

A
  • History of malignancy: weight loss, malaise, loss of appetite
  • History of exposure to carcinogens: High alcohol intake, hep B or C, aflatoxins
  • Fullness in abdomen and jaundice
64
Q

What are the signs of hepatocellular carcinoma on examination?

A
  • Signs of malignancy: Cachexia, lymphadenopathy
  • Hepatomegaly: Nodular (but may be smooth). Deep palpation may elicit tenderness
  • Jaundice, ascites
  • May be bruit heard over the liver
65
Q

What are the investigations for hepatocellular carcinoma?

A
  • Bloods: FBC, ESR, LFT, clotting, a-feroprotein, hepatitis serology
  • Imaging: Abdominal ultrasound may identify a fixed lesion within a cirrhotic liver. CT scan or MRI is gold standard for staging
  • Angiography
  • Histology
  • Staging: chest, abdo and pelvic CT scans. Consider bone scan
66
Q

What is non small cell lung cancer?

A
  • Primary malignant neoplasm of lung

- Histological types: squamous cell carcinoma, adenocarcinoma, large cell carcinoma and adenosquamous carcinoma

67
Q

What is the aetiology of non small cell lung cancer?

A
  • Factors such as smoking (active or passive though to cause genetic alterations that result in neoplastic transformation
  • Risk factors: occuational exposures (asbestos, nickel, chromium, cadmium, radon), atmospheric pollution
  • Tumours generally arise in main or lobar bronchi. Adenocarcinomas tend to occur more peripherally
68
Q

What is the epidemiology of non small cell lung cancer?

A
  • Most common fatal malignancy in the West

- 3x more common in men (but increasing in women)

69
Q

What are the presenting symptoms of non-small cell lung cancer due to primary?

A
  • May be asymptomatic with radiographic abnormality found

- Due to primary: Cough, haemoptysis, chest pain, recurrent pneumonia

70
Q

What are the presenting symptoms of non-small cell lung cancer due to local invasion?

A
  • Brachial plexus (Pancoast tumur, in apex of lung) causing pain in shoulder or arm
  • Left recurrent laryngeal nerve (hoarseness and bovine cough)
  • Oesophagus (dysphagia)
  • Heart (palpitations/arrhythmias)
71
Q

What are the presenting symptoms of non-small cell lung cancer due to metastatic disease or paraneoplastic phenomena?

A
  • Weight loss
  • Fatigue
  • Fits
  • Bone pain or fractures
  • Neuromyopathies
72
Q

What are the signs of non-small cell lung cancer due to local invasion on examination?

A
  • Superior vena cava compression (facial congestion, distension of neck veins, upper limb oedema)
  • Brachial plexus: wasting of small muscles of the hand
  • Sympathetic chain: Horner’s syndrome- pupillary miosis and facial anhydrosis
73
Q

What are the signs of non-small cell lung cancer on examination?

A
  • May be no signs
  • Fixed monophonic wheeze
  • Signs of collapse, consolidation or pleural effusion
74
Q

What are the signs of non-small cell lung cancer due to paraneoplastic phenomena on examination?

A
  • Hypertrophic osteoarthropathy: clubbing, painful swollen wrists/ankles (periosteal new bone formation)
  • Dermatological signs
75
Q

What are the signs of non-small cell lung cancer due to metastases on examination?

A
  • Supraclavicular lymphadenopathy

- Hepatomegaly

76
Q

What are the investigations for non-small cell lung cancer?

A
  • Diagnosis: CXR, sputum, bronchoscopy, with brushings or biopsy, CT, lymph node biopsy
  • TNM staging: CT chest, CT or MRI head and abdo, bone scan, PET scan
  • Bloods: FBC, U&E’s, Ca++ (hypercalcaemia is common), AlkPhos (increased in bone mets), LFT
  • Pre-Op: ABG, Pulmonary function tests, V/Q scan, ECG, echo
77
Q

What are the signs of non-small cell lung cancer on a CXR?

A
  • Coin lesions
  • Lobar collapse
  • Pleural effusion
  • Features of lymphagitis carcinomatosis
78
Q

What is small cell lung cancer?

A
  • Malignant neoplasm of neuroendocrine Kulchitsky cells of the lung with early dissemination
  • Also knows as oat cell carcinoma
79
Q

What is aetiology of small cell lung cancer?

A
  • Smoking

- Occupational and environmental exposures

80
Q

What is the epidemiology of small cell lung cancer?

A

Accounts for 20% of lung cancer

81
Q

What are the presenting symptoms of small cell lung cancer?

A

May be asymptomatic with radiological abnormality found

  • Due to primary tumour: Cough, haemoptysis, dyspnoea, chest pain
  • Due to metastatic disease: Weight loss, fatigue, bone pain
  • Due to paraneoplastic syndrome: Weakness, lethargy, seizures, muscle fatiguability
82
Q

What are the signs of small cell lung cancer on examination?

A
  • May be no signs or a fixed wheeze on auscultation of the chest
  • Signs of lobar collapse or pleural effusion
  • Signs of metastases e.g. supraclavicular lymphadenopathy or hepatomegaly
  • Signs of paraneoplastic syndrome
83
Q

What are the investigations for small cell lung cancer?

A
  • Diagnosis: sputum cytology, bronchoscopy with brushing and biopsy or percutaneous biopsy, thoracoscopy
  • Staging: CT of chest, abdomen, head. Isotope bone scan
  • Other: LFT, FBC, U&E, Ca++, AlkPhos, LFT
84
Q

What is mesothelioma?

A

Aggressive epithelial neoplasm arising from lining of lung, abdomen, pericardium or tunica vaginalis

85
Q

What is the aetiology of mesothelioma?

A
  • Exposure to asbestos principle risk factor
  • Also could be prior exposure to radiotherapy, genetic predisposition (BAP1 gene)
  • Family history
86
Q

What is the epidemiology of mesothelioma?

A
  • More common in men and white people

- Typically occurs in older adults (60-85)

87
Q

What are the presenting symptoms of mesothelioma?

A
  • Shortness of breath
  • Chest pain
  • Cough
88
Q

What are the signs of mesothelioma on examination?

A
  • Diminished breath sounds
  • Dullness to percussion
  • Constitutional symptoms: fatigue, fever, sweats, weight loss
89
Q

What are the investigations fro mesothelioma?

A
  • CXR: unilateral pleural effusion, irregular pleural thickening, reduced lung volumes, and/or parenchymal changes related to asbestos exposure (lower zone linear interstitial fibrosis)
  • Chest CT scan: pleural thickening and/or discrete pleural plaques, pleural/pericardial effusions, enlarged hilar, chest wall invasion
90
Q

What is neutropenic sepsis?

A

Defined as a fever over 38 degrees for 1 hour, with an absolute neutrophil count (ANC) of less than 500 cells/microlitre

91
Q

What is the aetiology of neutropenic sepsis?

A
  • Common complication of many chemotherapeutic regimens for all types of cancers
  • Risk is greatest with first treatment but is cumulative with ongoing cycles of therapy
92
Q

What is the epidemiology of neutropenic sepsis?

A

Most common life threatening complication of cancer therapy

93
Q

What are the presenting symptoms of neutropenic sepsis?

A
  • Recent chemotherapy
  • Fever
  • Age over 65
  • Shortness of breath
  • Abdominal pain
  • Diarrhoea
  • Dysuria
  • Skin erythema, warmth, tenderness
  • Mucositis or oral ulcers
  • Infection, inflammation or ulceration of genital and anal area
94
Q

What are the signs of neutropenic sepsis on examination?

A
  • Tachycardia
  • Hypotension
  • Prior episodes of neutropenia following chemotherapy
  • Haematological malignancies
  • Prior antibiotic regimens
95
Q

What are the investigations for neutropenic sepsis?

A
  • FBC and differential: ANC
  • Urea and creatinine: normal or elevated
  • LFTs: albumin less than 35g
  • LFTs: Albumin less than 35g/L, total bilirubin and aminotransferases elevated
  • Blood cultures for bacteria: peripheral and central lines: positive for a pathogen; differential time to positivity of >120 minutes between central line and peripheral cultures is diagnostic of a line infection
  • CXR: infiltrates in pneumonia
96
Q

What is oesophageal cancer?

A

Malignant tumour arising in the oesophagus.

Two major histological types: squamous cell carcinoma and adenocarcinoma

97
Q

What is the aetiology of squamous oesophageal cancer?

A
  • Alcohol
  • Tobacco
  • Paterson-Kelly syndrome (also knows as Plummer-Vinson syndrome)
  • Tylosis
  • Achalasia
  • Scleroderma
  • Coeliac disease
  • Certain nutritional deficiencies (vit A and C, trace elements)
  • Dietary toxins (nitrosamines) also implicated
98
Q

What is oesophageal cancer?

A

Malignant tumour arising in the oesophagus.

Two major histological types: squamous cell carcinoma and adenocarcinoma

99
Q

What is the aetiology of squamous oesophageal cancer?

A
  • Alcohol
  • Tobacco
  • Paterson-Kelly syndrome (also knows as Plummer-Vinson syndrome)
  • Tylosis
  • Achalasia
  • Scleroderma
  • Coeliac disease
  • Certain nutritional deficiencies (vit A and C, trace elements)
  • Dietary toxins (nitrosamines) also implicated
100
Q

What is the aetiology of oesophageal adenocarcinoma?

A
  • GORD

- Barrett’s oesophagus (intestinal metaplasia of the distal oesophageal mucosa

101
Q

What is the pathology of oesophageal cancer?

A
  • Squamous cell carcinomas are more common in the mid-upper oesophagus
  • Adenocarcinoma usually develops in the lower oesophagus, or, increasingly, in the gastro-oesophageal junction.
  • Barrett’s intestinal metaplasia can progress to low grade dysplasia, high-grade dysplasia and invasive carcinoma
  • Spread is typically indirect (oesophagus has no serosa) and longitudinal via an extensive network of submucosal lymphatics to tracheobronchial, mediastinal, coeliac, gastric or cervical nodes
102
Q

What is the epidemiology of oesophageal cancer?

A
  • 8th most common malignancy
  • 4:1= male:female
  • Peak incidence 50-70 yrs
103
Q

What are the presenting symptoms of oesophageal cancer?

A
  • Early: Symptomatic/symptoms of reflex
  • Later: Dysphagia, initially worse for solids, regurgitation, cough or choking after food, pain (odynophagia), weight loss, fatigue, voice hoarseness (may indicate laryngeal nerve palsy)
104
Q

What are the signs of oesophageal cancer on examination?

A
  • No physical signs evidence
  • Signs of weight loss
  • With metastatic disease, there may be supraclavicular lymphadenopathy, hepatomegaly.
  • Respiratory signs may be due to aspiration or direct tracheobronchial involvement
105
Q

What are the investigations for oesophageal cancer?

A
  • Endoscopy: Tumour location and biopsy.
  • Imaging: Barium swallow, CT (chest, abdo, pelvis), PET can detect previously occult distant metastases
  • Other: Bronchoscopy, bone scan. Laparoscopy and peritoneal washings, thoracoscopy
106
Q

What is pancreatic cancer?

A

Malignancy arising from the exocrine or endocrine tissues of the pancreas

107
Q

What is the aetiology of pancreatic cancer?

A
  • Unknown
  • 5-10% have familial component, hereditary syndromes include BRCA2 mutation, familial atypical mole melanoma, Peutz-Heghers, hereditary pancreatitis, MEN, HNPCC, FAP, Gardner, von-Hippel-Lindau syndromes
108
Q

What is the epidemiology of pancreatic cancer?

A
  • Increasing in incidence
  • 2x more in males
  • Peak age 60-80 yrs
109
Q

What are the signs of pancreatic cancer on examination?

A
  • Signs of weight loss, epigastric tenderness or mass
  • Jaundice and palpable gallbladder (Courvoisier’s law)
  • In pts with metastatic spread, there may be hepatomegaly
  • Troussaeu’s sign is an associated superficial thrombophlebitis
110
Q

What are the investigations for pancreatic cancer?

A
  • Bloods: Tumour markers CA19-9 and CEA can be elevated. If causing obstructive jaundice, increased bilirubin, ALP, clotting may be deranged
  • Imaging: Ultrasound, endoscopic ultrasound and FNA, CT, MRI, PET and laparoscopy are all useful in staging the disease
  • Other: Staging laparoscopy or intraoperative ultrasound
111
Q

What is prostate cancer?

A

Primary malignant neoplasm of the prostate gland

112
Q

What are the risk factors of prostate cancer?

A
  • Age
  • Race (Afro Carribean more than Caucasian, former also present at younger age with more progressive disease)
  • Geographic distribution (higher in North America, low in far East)
  • Family history
  • Dietary factors (high fat, meat and alcohol consumption)
113
Q

What is the epidemiology of prostate cancer?

A
  • Common

- 2nd most common cause of male cancer deaths

114
Q

What are the presenting symptoms of prostate cancer?

A
  • Often asymptomatic and detected on PSA testing
  • Lower urinary tract obstruction: Frequency, hesitancy, poor stream, nocturia and terminal dribble
  • Metastatic spread: Bone pain or spinal cord compression from the bone metastases
  • General symptoms of malignancy ( malaise, anorexia and weight loss)
  • Paraneoplastic syndromes (e.g. hypercalcaemia)
115
Q

What are the signs of prostate cancer on examination?

A
  • Asymmetrical hard nodular prostate gland with loss of the midline sulcus on rectal examination
116
Q

What are the investigations for prostate cancer?

A
  • Bloods: FBC, U&Es, PSA, acid phosphatase, LFT, bone profile
  • Prostate-specific antigen: Values may be age-related and increased in BPH, prostatitis, following catheterisation
  • CT/MRI: Assesses extent of local invasion and lymph node involvement
  • TRUS and needle biopsy: for histological diagnosis
  • Isotope bone scan: for bone metastases
117
Q

What is renal cell carcinoma?

A

Renal malignancy arising from renal parenchyma/cortex and accounts for 85% of renal cancers

118
Q

What is the aetiology of renal cell carcinoma?

A
  • Smoking
  • Obesity and hypertension
  • Renal transplantation and dialysis
  • Positive family syndrome
  • von Hippel Lindau syndrome
119
Q

What is the epidemiology of renal cell carcinoma?

A
  • Median age of presentation= 64 tears

- Men 2x more likely

120
Q

What are the presenting symptoms of renal cell carcinoma?

A
  • Asymptomatic (incidental finding)
  • Haematuria
  • Flank pain
121
Q

What are the signs of renal cell carcinoma on examination?

A

Palpable abdominal mass

- Lower limb oedema

122
Q

What are the investigations for renal cell carcinoma?

A
  • FBC: paraneoplastic syndrome, reduced Hb, or elevated RBC
  • LDH: advanced RCC
  • Corrected calcium
  • LFTs
  • Coagulation profile
  • Creatinine
  • Urinalysis: haematuria and/or proteinuria
  • Abdo USS
  • CT abdo
123
Q

What is testicular cancer?

A

Malignant tumour of the testes

124
Q

What are the risk factors for testicular cancer?

A
  • Testicular maldescent or ectopic testis, increases risk 40x
  • Contralateral testicular tumour and atrophic testis
125
Q

What is the epidemiology of testicular cancer?

A
  • Uncommon
  • 1% of male malignancies
  • Most common malignancy in 18-35 yrs
126
Q

What are the presenting symptoms of testicular cancer?

A
  • Swelling or discomfort in the testes
  • Backache due to para-aortic lymph node enlargement
  • Respiratory symptoms, shortness of breath or haemoptysis from lung metastases
127
Q

What are the investigations for testicular cancer?

A
  • Painless hard testicular mass (may be secondary hydrocele)
  • Lymphadenopathy (e.g. supraclavicular, para-aortic) signs of pleural effusion
  • Gynaecomastia (resulting form tumour HCG production)
128
Q

What are the investigations for testicular cancer?

A
  • Bloods: FBC, U&E’s, LFTs, tumour markers should be sent
  • Urine pregnancy test: Often will be positive if tumour produced beta-HCG
  • CXR: Demonstrates lung metastases or pleural effusion
  • Testicular ultrasound: Tumours seen within testicle, hydrocele may be associated
  • CT scan (abdo, thorax): disease staging
129
Q

What is tumour lysis syndrome?

A

Combination of metabolic and electrolyte abnormalities that occurs in pts with cancer, usually after the initiation of cytotoxic treatment but also spontaneously

130
Q

What is the aetiology of tumour lysis syndrome?

A
  • Appears in haematological malignancies characterised by high proliferating rate, especially Hodgkin’s lymphoma, acute lymphocytic leukaemia, AML
  • Risk of developing TLS increases if tumour consists of rapidly dividing cells, if bulk of disease is high and if response to treatment is good
131
Q

What is the epidemiology of tumour lysis syndrome?

A
  • Unknown incidence
  • It is more prevalent in malignancies with high proliferating rates, tumour burden, and chemosensitivity
  • Advanced age may increase risk
132
Q

What are the presenting symptoms of tumour lysis syndrome?

A
  • History of haematological malignancy
  • Pre-existing renal compromise
  • Nausea and vomiting
  • Diarrhoea
  • Muscle cramps
  • Lethargy
133
Q

What are the signs of tumour lysis syndrome on examination?

A
  • Muscle weakness
  • Paraesthesia
  • Lymphadenopathy
  • Splenomegaly
  • Hypertension/hypotension
  • Oliguria/anuria/haematuria
134
Q

What are the investigations for tumour lysis syndrome?

A
  • Serum uric acid
  • Serum phosphate
  • Serum potassium
  • FBC: elevated WBC count
  • Lactate dehydrogenase: elevated

Year 3 SOFIA CONDITIONS (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions