Cancer Flashcards
1
Q
What is bladder cancer?
A
Malignancy of bladder cells
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
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
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
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
6
Q
What are the signs of bladder cancer on examination?
A
- Often no signs
- Under anaesthetic, bimanual examination is part of disease staging
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
8
Q
What is breast cancer?
A
Malignancy of breast tissue
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
10
Q
What is the epidemiology of breast cancer?
A
- Common
- 1:9 in UK
- 4-70= peak incidence
- Rare in men
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
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
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
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
15
Q
What is a meningioma?
A
Benign
16
Q
What is an acoustic neuroma?
A
Benign
- Slow, growing, cerebellopontine angle tumour from vestibular part of CN8
17
Q
What is a fibrilliary astrocytoma?
A
Most common form in cerebrum
18
Q
What is pilocytic astrocytoma?
A
In brainstem and cerebellum, cystic
19
Q
What is glioblastoma multiforme?
A
High grade invasive tumours
Poor prognosis
20
Q
What is haemangioblastoma?
A
Vascular tumour in cerebellum
21
Q
What is medulloblastoma?
A
Invasive malignant midline cerebellar tumour in children (vermis)
22
Q
What is ependyoma?
A
In 4th ventricles, spinal cord, benign
23
Q
What is lymphoma?
A
In immunosuppressed, high malignant
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
25
What is a pituitary adenoma?
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
26
What is the epidemiology of CNS tumours?
- Meningioma most common, esp in women
| - Peak in children and elderly
27
What is the aetiology of CNS tumours?
- Unknown causes in adults
| - Children: embryological errors in development
28
What are the risk factors for CNS tumours?
- 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
29
What are the presenting symptoms of a meningioma?
- Mostly benign (can be atypical/malignant)
- Occurs at cranial and spinal sites
- Mass effects: Headaches, altered speech, personality seizures)
- Broca's aphasia
30
What are the presenting symptoms of an acoustic neuroma?
- 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
31
What are the presenting symptoms of medulloblastoma?
- Morning headaches
- Nausea
- Vomiting relieves headaches
- Irritability
32
What are the presenting symptoms of astrocytoma?
- Gerstmann's syndrome: dominant parital love
- Neglect
- Hypothalamic syndrome
- Cognitive decline
- Emotional lability
- Visual change
- Motor weakness
- Speech deficit
33
What are the presenting symptoms of a craniopharyngioma?
- 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
34
What are the signs on examination of an acoustic neuroma?
- Loss of balance
- Swallowing difficulties
- Slow blink
- Gait
- Papilloedema
- Raised ICP
35
What are the signs on examination of medulloblastoma?
- Diplopia-6th nerve palsy
- Ophthalmoplegia- difficulty in lateral gaze
- Ataxia
- Bulging anteria fontanella
- Papilloedema
- Nystagmus
- Head tilt
- Ataxia
- Dysmetria
36
What are the signs of pituitary adenoma on examination?
- Decreased acuity
- Bitemporal hemianopia
- Pituitary apoplexy
- Diplopia
37
What are the investigations for CNS tumours?
- 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)
38
What is cholangiocarcinoma?
Primary adenocarcinoma of the biliary tree
39
What is the aetiology of cholangiocarcinoma?
Largely unknown
- Known associated with ulcerative colitis and primary sclerosing cholangitis, choledochal cysts, Caroli's disease and parasitic infections of biliary tract
40
What is the epidemiology of cholangiocarcinoma?
- Rare
- Slightly more common in males
- More common in developing world due to parasitic infections
41
What are the presenting symptoms of cholangiocarcinoma?
- Obstructive jaundice (yellow skin and sclera, pale stools, dark urine, pruritis)
- Abdominal fullness or pain
- Symptoms of malignancy: weight loss, malaise
42
What are the signs of cholangiocarcinoma on examination?
- Jaundice
- Palpable gallbladder
- Epigastric or right upper quadrant mass
- May be hepatomegaly
43
What are the investigations for cholangiocarcinoma?
- 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
44
What is Courvoisier's law?
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
45
What is colorectal cancer?
Malignant adenocarcinoma of the large bowel
46
What is the aetiology of colorectal cancer?
- 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)
47
What are the risk factors for colorectal cancer?
- 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)
48
What is the epidemiology of colorectal cancer?
- 60-65 avg age at dx
- Rectal carcinomas more common in males
- Colon carcinomas more common in females
49
What are the presenting symptoms of colorectal cancer in the left-sided colon and rectum?
- 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)
50
What are the presenting symptoms of colorectal cancer in the right-sided colon?
- 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
51
What are the signs of colorectal cancer on examination?
- 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
52
What are the investigations for colorectal cancer?
- 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
53
What is gastric cancer?
Gastric malignancy, most commonly adenocarcinoma, more rarely lympphoma, leiomosarcoma or stromal tumours (GIST)
54
What is the aetiology of gastric cancer?
- 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
What is the epidemiology of gastric cancer?
- Common
- Highest incidence in Asia, especially Japan
- Usual age of presentation more than 50 yrs
-
56
What are the presenting symptoms of gastric cancer?
- 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
What are the signs of gastric cancer on examination?
- 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
What is Sister Mary Joseph's node?
Metastatic nodule on umbilicus
59
What are the investigations for gastric cancer?
- 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
What is hepatocellular carcinoma?
Primary malignancy of the liver parenchyma
61
What is the aetiology of hepatocellular carcinoma?
- Associated with chronic liver damage (alcoholic liver disease, hep C, autoimmune disease), metabolic disease (haemochromatosis) and aflatoxins
62
What is the epidemiology of hepatocellular carcinoma?
- Common
| - Increased incidence in regions where hep B and C are endemic (e.g. southern Mediterranean, Far East)
63
What are the presenting symptoms of hepatocellular carcinoma?
- 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
What are the signs of hepatocellular carcinoma on examination?
- 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
What are the investigations for hepatocellular carcinoma?
- 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
What is non small cell lung cancer?
- Primary malignant neoplasm of lung
| - Histological types: squamous cell carcinoma, adenocarcinoma, large cell carcinoma and adenosquamous carcinoma
67
What is the aetiology of non small cell lung cancer?
- 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
What is the epidemiology of non small cell lung cancer?
- Most common fatal malignancy in the West
| - 3x more common in men (but increasing in women)
69
What are the presenting symptoms of non-small cell lung cancer due to primary?
- May be asymptomatic with radiographic abnormality found
| - Due to primary: Cough, haemoptysis, chest pain, recurrent pneumonia
70
What are the presenting symptoms of non-small cell lung cancer due to local invasion?
- 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
What are the presenting symptoms of non-small cell lung cancer due to metastatic disease or paraneoplastic phenomena?
- Weight loss
- Fatigue
- Fits
- Bone pain or fractures
- Neuromyopathies
72
What are the signs of non-small cell lung cancer due to local invasion on examination?
- 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
What are the signs of non-small cell lung cancer on examination?
- May be no signs
- Fixed monophonic wheeze
- Signs of collapse, consolidation or pleural effusion
74
What are the signs of non-small cell lung cancer due to paraneoplastic phenomena on examination?
- Hypertrophic osteoarthropathy: clubbing, painful swollen wrists/ankles (periosteal new bone formation)
- Dermatological signs
75
What are the signs of non-small cell lung cancer due to metastases on examination?
- Supraclavicular lymphadenopathy
| - Hepatomegaly
76
What are the investigations for non-small cell lung cancer?
- 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
What are the signs of non-small cell lung cancer on a CXR?
- Coin lesions
- Lobar collapse
- Pleural effusion
- Features of lymphagitis carcinomatosis
78
What is small cell lung cancer?
- Malignant neoplasm of neuroendocrine Kulchitsky cells of the lung with early dissemination
- Also knows as oat cell carcinoma
79
What is aetiology of small cell lung cancer?
- Smoking
| - Occupational and environmental exposures
80
What is the epidemiology of small cell lung cancer?
Accounts for 20% of lung cancer
81
What are the presenting symptoms of small cell lung cancer?
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
What are the signs of small cell lung cancer on examination?
- 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
What are the investigations for small cell lung cancer?
- 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
What is mesothelioma?
Aggressive epithelial neoplasm arising from lining of lung, abdomen, pericardium or tunica vaginalis
85
What is the aetiology of mesothelioma?
- Exposure to asbestos principle risk factor
- Also could be prior exposure to radiotherapy, genetic predisposition (BAP1 gene)
- Family history
86
What is the epidemiology of mesothelioma?
- More common in men and white people
| - Typically occurs in older adults (60-85)
87
What are the presenting symptoms of mesothelioma?
- Shortness of breath
- Chest pain
- Cough
88
What are the signs of mesothelioma on examination?
- Diminished breath sounds
- Dullness to percussion
- Constitutional symptoms: fatigue, fever, sweats, weight loss
89
What are the investigations fro mesothelioma?
- 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
What is neutropenic sepsis?
Defined as a fever over 38 degrees for 1 hour, with an absolute neutrophil count (ANC) of less than 500 cells/microlitre
91
What is the aetiology of neutropenic sepsis?
- 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
What is the epidemiology of neutropenic sepsis?
Most common life threatening complication of cancer therapy
93
What are the presenting symptoms of neutropenic sepsis?
- 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
What are the signs of neutropenic sepsis on examination?
- Tachycardia
- Hypotension
- Prior episodes of neutropenia following chemotherapy
- Haematological malignancies
- Prior antibiotic regimens
95
What are the investigations for neutropenic sepsis?
- 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
What is oesophageal cancer?
Malignant tumour arising in the oesophagus.
| Two major histological types: squamous cell carcinoma and adenocarcinoma
97
What is the aetiology of squamous oesophageal cancer?
- 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
What is oesophageal cancer?
Malignant tumour arising in the oesophagus.
| Two major histological types: squamous cell carcinoma and adenocarcinoma
99
What is the aetiology of squamous oesophageal cancer?
- 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
What is the aetiology of oesophageal adenocarcinoma?
- GORD
| - Barrett's oesophagus (intestinal metaplasia of the distal oesophageal mucosa
101
What is the pathology of oesophageal cancer?
- 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
What is the epidemiology of oesophageal cancer?
- 8th most common malignancy
- 4:1= male:female
- Peak incidence 50-70 yrs
103
What are the presenting symptoms of oesophageal cancer?
- 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
What are the signs of oesophageal cancer on examination?
- 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
What are the investigations for oesophageal cancer?
- 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
What is pancreatic cancer?
Malignancy arising from the exocrine or endocrine tissues of the pancreas
107
What is the aetiology of pancreatic cancer?
- 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
What is the epidemiology of pancreatic cancer?
- Increasing in incidence
- 2x more in males
- Peak age 60-80 yrs
109
What are the signs of pancreatic cancer on examination?
- 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
What are the investigations for pancreatic cancer?
- 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
What is prostate cancer?
Primary malignant neoplasm of the prostate gland
112
What are the risk factors of prostate cancer?
- 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
What is the epidemiology of prostate cancer?
- Common
| - 2nd most common cause of male cancer deaths
114
What are the presenting symptoms of prostate cancer?
- 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
What are the signs of prostate cancer on examination?
- Asymmetrical hard nodular prostate gland with loss of the midline sulcus on rectal examination
116
What are the investigations for prostate cancer?
- 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
What is renal cell carcinoma?
Renal malignancy arising from renal parenchyma/cortex and accounts for 85% of renal cancers
118
What is the aetiology of renal cell carcinoma?
- Smoking
- Obesity and hypertension
- Renal transplantation and dialysis
- Positive family syndrome
- von Hippel Lindau syndrome
119
What is the epidemiology of renal cell carcinoma?
- Median age of presentation= 64 tears
| - Men 2x more likely
120
What are the presenting symptoms of renal cell carcinoma?
- Asymptomatic (incidental finding)
- Haematuria
- Flank pain
121
What are the signs of renal cell carcinoma on examination?
Palpable abdominal mass
| - Lower limb oedema
122
What are the investigations for renal cell carcinoma?
- 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
What is testicular cancer?
Malignant tumour of the testes
124
What are the risk factors for testicular cancer?
- Testicular maldescent or ectopic testis, increases risk 40x
- Contralateral testicular tumour and atrophic testis
125
What is the epidemiology of testicular cancer?
- Uncommon
- 1% of male malignancies
- Most common malignancy in 18-35 yrs
126
What are the presenting symptoms of testicular cancer?
- 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
What are the investigations for testicular cancer?
- 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
What are the investigations for testicular cancer?
- 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
What is tumour lysis syndrome?
Combination of metabolic and electrolyte abnormalities that occurs in pts with cancer, usually after the initiation of cytotoxic treatment but also spontaneously
130
What is the aetiology of tumour lysis syndrome?
- 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
What is the epidemiology of tumour lysis syndrome?
- Unknown incidence
- It is more prevalent in malignancies with high proliferating rates, tumour burden, and chemosensitivity
- Advanced age may increase risk
132
What are the presenting symptoms of tumour lysis syndrome?
- History of haematological malignancy
- Pre-existing renal compromise
- Nausea and vomiting
- Diarrhoea
- Muscle cramps
- Lethargy
133
What are the signs of tumour lysis syndrome on examination?
- Muscle weakness
- Paraesthesia
- Lymphadenopathy
- Splenomegaly
- Hypertension/hypotension
- Oliguria/anuria/haematuria
134
What are the investigations for tumour lysis syndrome?
- Serum uric acid
- Serum phosphate
- Serum potassium
- FBC: elevated WBC count
- Lactate dehydrogenase: elevated
