Cancer incorrects Flashcards
in people aged 60 and over with hypercalcaemia or leukopenia and a presentation that is consistent with possible myeloma eg back pain, what is the first line investigation?
serum electrophoresis
A 44 year old woman has shooting pain in her left leg. She has an advanced rectal cancer compressing the sciatic nerve. She is taking morphine sulfate modified release 20 mg twice daily. This is providing some benefit but not fully controlling her pain.
Which is the most appropriate additional medication?
UKMLA ppq
Amytriptiline! Not NSAIDs
Amitriptyline first line for nerve compression pain / neuropathic pain. Pregabalin, gabapentin and duloxetine are also first line options for treating neuropathic pain.
An 66 year old woman with advanced bowel cancer is taking morphine sulfate modified release, 30 mg twice daily for abdominal pain. She is in the last days of life and is now unable to swallow oral medications. She has not needed any doses for breakthrough pain.Investigations:
eGFR 51 mL/min/1.73 m2 (>60)A continuous subcutaneous infusion of morphine sulfate is required, as a direct conversion from oral morphine sulfate.
Which is the correct dose of morphine sulfate to prescribe over 24 hours?
UKMLA past question
30mg. Subcut is twice as strong!!,
Learn all the conversions
27 year old with 2 cm mobile breast lump. no other findings. management?
routine!!! breast clinic referral
NICE CKS recommends a 2-week-wait referral for those AGED 30!!! or over with an unexplained breast lump,
OR over 50 years old with unilateral nipple changes.
which type of hodgkins lymphoma carry the best and worst prognosis?
most common type?
best = lymphocyte rich
worst = lymphocyte predominant
most common = nodular sclerosing
which type of lung cancer can cause cushings syndrome?
Small cell!!
can also secrete adh (hyponatremia) and can cause lambert eaton syndrome
small cell but make you SADh
small cell cancer but it makes you
describe paraneoplastic syndromes associates with squamous cell lung cancer
what about associated with adenocarcinomas?
hypercalcaemia
hypertrophic pulmonary osteoarthropathy (HPOA)
hyperthyroidism due to ectopic TSH
gynaecomastia
hypertrophic pulmonary osteoarthropathy (HPOA)
side effect of anastrazole use for breast cancer?
osteoporosis -> dexa scan recommended when initiating treatment
how to differentiate AML and CML
CML
=an increase in granulocytes at different stages of maturation +/- thrombocytosis
AML - neutropenia and thrombocytopenia
Rain drop skull is seen on skull x ray in which condition?
Multiple myeloma
Risk factors for non Hodgkin’s lymphoma?
Caucasians - notttt Afro Caribbean!
History of viral infection (specifically Epstein-Barr virus)
Immune deficiency eg HIV!!,
Testicular cancer is typically seen in which age range
15 and 35 years.
First line investigation for suspected bladder cancer?
Bladder cancer symptoms?
Flexible cystoscopy!
In bladder cancer most present with painless gross hematuria. Small percentage present with microscopic hematuria and infection should be excluded
Tb may present with cough weight loss night sweats
Lung cancer may have history of smoking, CXR could show a central mass
How could lung abscess present?
Lung abscess - fever, foul smelling sputum.!! Risk factors -dysphagia or altered consciousness levels. Typically follows aspiration pneumonia
Tb
Voice hoarseness. 2 months. Ent found no cause. History of smoking. Cxr clear.
What investigation is likely to be diagnostic
CT chest - pancoast tumour
Prior to surgery, how is axillary lymphadebopathy assessed? And what is the management if lymphadenopathy is or is not noted?
women with no palpable axillary lymphadenopathy at presentation should have a pre-operative axillary ultrasound before their primary surgery
if negative then they should have a sentinel node biopsy to assess the nodal burden
in patients with breast cancer who present with clinically palpable lymphadenopathy, axillary node clearance is indicated at primary surgery.
this may lead to arm lymphedema and functional arm impairment
(if impossible then axillary radiotherapy)
Essentially you’d always do a lymph node biopsy or node clearance
Indications for mastectomy vs wide local excision?
,Mastectomy = multi focal, = al, central, large lesion in small breast, DCIS > 4 cm
Wide local excision = solitary lesion, peripheral tumour, small lesion in large breast. DCIS less than 4
What hormonal therapy is added on in ER positive breast cancers in pre and post menopausal women?
Pre or peri = tamoxifen
Post = anastrozole
What biological therapy is used in HER 2 positive breast cancers?
Trastuzumab
When is chemotherapy used to treat breast cancer?
neo-adjuvant to downgrade primary tumours before surgery or when there is axillary node disease found.
A 56-year-old woman is diagnosed with left breast cancer and undergoes wide local excision with sentinel node biopsy. The sentinel node is negative for cancerous cells.
What would be the next step in management?
Whole breast radiotherapy!!
It is recommending after wide local excision
No chemo needed as no lymph node involvement
bladder cancer treatment?
in situ = transurethral resection of superficial lesions
invasive = radical cystectomy or radical radiotherapy
hypercalcemia effect on QT interval?
shortens
what is the first line *imaging in multiple myeloma?
whole body MRI
A 73-year-old male with a background history of prostate cancer treated by external beam radiation therapy 5 years ago presents with a 3-month history of urgency, diarrhoea, and crampy abdominal pain.
On examination, the patient appears thin with conjunctival pallor. The abdomen is soft and non-tender, with no blood or mucus on digital rectal examination. most likely diagnosis?
colorectal cancer
patients may develop proctitis ( inflammation of the rectum bloody diarrhoea, tenesmus, and painful diarrhoea) and are also at increased risk of bladder, colon, and rectal cancer following radiotherapy for prostate cancer
diagnostic investigation for pancreatic cancer?
name the sign that may be seen
CT pancreas
double duct sign
palpable gallbladder
66 yo man presenting with dysphagia to solids and liquids. most important 1st line test?
Upper GI endoscopy within 2 weeks! to rule out oesophageal cancer
(if cancer then you then do endoscopic ultrasound for staging)
*check out your oncology flashcards from last year + do remaining 6 qs on passmed
in lung ccancer what finding may be seen on blood tests
raised platelets
what may interfere with PSA level in a test?
ejaculation or vigorous exercise in last 48 hours
urinary retention NOT constipation
prostatitis and urinary tract infection
small cell lung cancer manaegement?
chemo + radiotherapy
surgery only considered for up to T2N0M0
HNPCC is associated with increased risk of what cancer in a man? , aside from colorectal cancer
pancreatic cancer
role of the anti-androgen, cyproterone acetate in treatment of prostate cancer?
Prevent paradoxical increase in symptoms with GnRH agonists
67%
A 56-year-old man presents with a 6-week history of progressively worsening hoarse voice, difficult and painful swallowing and weight loss. He has a past medical history of gastro-oesophageal reflux disease (GORD) and his BMI is 31kg/m². He takes no regular medication and reports having never drunk alcohol, but he is a current smoker with a 30 pack-year history.
most likely diagnosis?
Adenocarcinoma of oesophagus !! = associated with GORD!!!! obesity and smoking(although smoking more associated with squamous)
reffered otalgia, difficulty breathing and stridor are not mentioned so squamous cell carcinoma of larynx less likely
anastrazole mechanism of action
inhibits peripheral eostrogen synthesis
normal psa but examination findings consistent with prostate cancer, what is next step in investigation?
multiparametric MRI
A 73-year-old man presents to his general practice with episodes of fever over the last 5 days. He has also noticed he has lost weight over the last month. On further questioning, he mentions a cough productive of white sputum which he has had for about 2 years. He also remembers having a sore throat about 2 weeks ago, which has now improved.
Past medical history consists of of chronic obstructive pulmonary disease, chronic lymphocytic leukaemia, hypertension, and type 2 diabetes.
On examination, his chest has mild wheeze without crackles. His throat appears clear and he has some lymph nodes palpable in his neck which are non-tender.
What investigation is most likely to reveal the diagnosis?
Lymph node biopsy!!
new b symptoms in CLL => richter transformation
what is the key reason why neo-adjuvant chemotherapy is used in breast cancer?
to downsize the tumour before surgery and allow breast conserving surgery rather than mastectomy
effects on overall survival has been mixed.
non hodgkins lymphoma diagnostic investigation?
EXCISIONAL lymph node biopsy
rituximab treatment
what hormone is eleveated in testicular seminomas?
in testicular non seminomas?
seminomas: seminomas: hCG may be elevated in around 20%
non-seminomas: AFP and/or beta-hCG are elevated in 80-85%
with gleason score, what is the best prognosis? worst?
2 is best prognosis and 10 the worst.
achalasia increases risk of what oesophageal cancer?
squamous cell carcinoma
plummer vinson syndrome also increases risk
do seminomas have better prognosis to teratomas?
yes
management of a patient who is >= 40 years old presenting with unexplained haemoptysis?
2WW
what are the complications of a radical prostatectomy?
erectile dysfunction
incontinence
NSAIDs may precipitate renal failure in patients with multiple myeloma
key side effects of immunotherapy?
how to treat?
Hepatitis - bloods/liver screen, treat with steroids
treatment of radiotherapy induced mucositis?
mouthwash, fluids etc
key side effect of platinums eg cisplatin?
vomiting
- give fluids and electrolytes and anti-emetics
chemo induced diarrhea management?
investigations - stool culture, endoscopy
treatment - LOPERAMIDE, fluid and electrolyte replacement
consider dose reduction of chemo
tumour lysis syndrome management?
high phosphate - give phosphate binder
high potassium - give insulin and desxtrose + Ca gluconate
high uric acid - give allopurinol or rasburicase
Side effects of chemotherapy?
- febrile neutropenia -> prophylactic GCSF, dose reduction of chemotherapy to prevent.
Signs of morphine overdose?
reduced conscious level, slow respiratory rate, myoclonic jerks, and pinpoint pupils.
Options for metastatic bone pain?
Analgesia, bisphosphonates, radiotherapy
Dex only considered for metastatic spinal cord compression
which lung cancer is most common in non smokers
adenocarcinoma
ovarian cancer investigation
ca125
most common tumour causing bone mets?
- prostate
- breast
- lung
SVC obstruction management?
give dex, followed by stent. give chemo for tumour
dex often prescribed with PPI
what do you monitor in breast cancer?
CA 15-3
Key side effect of cisplatin?
methotrexate?
doxorubicin?
cyclophosphamide?
Bleomycin?
Vincristine?
tyrosin kinase inhibitors eg imatinib?
cisplatin = hypomagnesemia
methotrexate = myelosupression, liver fibrosis, oral mucositis
doxorubicin (and other anthracyclines eg idarubicin) = cardiomyopathy
cyclophosphamide = hemorrhagic cystitis
bleomycin = lung fibrosis, pneumonitis (treat with steroids)
vincristine = peripheral neuropathy
tyrosine kinase inhibitors = rash
Cervical cancer management?/positive pap smear?
If positive for HPV 16, 18, or 33 specifically = refer for colposcopy
spinal cord compression management
high dose oral dex + mri whole spine
as PSA levels may be increased, testing should not be done within at least:
6 weeks of a prostate biopsy
4 weeks following a proven urinary infection
1 week of digital rectal examination
48 hours of vigorous exercise
48 hours of ejaculation
contraindications to lung cancer surgery?
SVC obstruction, FEV < 1.5, MALIGNANT pleural effusion, and vocal cord paralysis
lower number of immunoglobulins in multiple myeloma increaes risk of infections eg lung infections
pain on alcohol consumption and lymphadenopathy is a feature of ?
hodgkins lymphoma
after CXR for suspected lung cancer,
what is the gold standard investigation?
contrast enhanced! ct scan
prostate cancer typically asymptomatic, when symptomatic, what signs typically seen?
bladder outlet obstruction: hesitancy, urinary retention
haematuria, haematospermia
pain: back, perineal or testicular
when starting a gnrh analogue for prostate cancer, what must you co prescribe in 1st 3 weeks?
Anti-androgen treatment such as cyproterone acetate, flutamide
greatest risk factor for urothelial (transitional cell) carcinoma of the bladder?
for squamous cell carcinoma?
smoking
shistomiasis
A 78-year-old gentleman has been unable to pass urine for the last 5 hours. He is extremely uncomfortable. You insert a catheter, which drains 1 litre of urine. The patient feels much better after this. You perform a PR examination and find an enlarged, hard nodular feeling prostate. The Urology Registrar recommends to admit the patient and observe for 24 hours; he warns that following an episode of acute urinary retention a complication may occur. Which test is most important to (re)check in the next 12 hours to help identify such a complication?
serum creatinine!!!
AKI may develop after acute urinary retention
tamoxifen mechanism of action?
oestrogen receptor selective antagonsim
patient with hemoptysis, weigh loss, history of smoking, CXR show cavitating lesions. most likely diagnosis?
squamous cell carcinoma!!
- strongly associated with cavitating lesions
management option for patients with low-grade prostate cancer, and significant co-morbidities?
watchful waiting
75 YO man. lung cancer. cord compression. too weak for surgical decompression and has lesion to multiple vertebral bodies.
what is the best treatment option to preserve neurological function?
external beam radiotherapy!!!
A 45 year old man with pain caused by cancer has been using opioids to
control his pain very successfully. He is taking a regular dose of MST
Continus® 60 mg 12-hourly orally. He has been using three breakthrough
doses (oral morphine 20 mg) per day for the past week
what is the most appropriate opiate prescription?
first step = calculate total daily morphine
The breakthrough dose should be one-sixth of
the total daily dose. The current daily morphine dose is 180 mg, hence MST
continous at 90 mg 12 hourly and the breakthrough at morphine 30 mg.
first step in treatment for spinal cord compression?
IV dex!!!
spinal decompression comes later
glycoporrunium bromide, butylbromide, Hyoscine bromide = secretions
Midazolam = agitation
Haloperidol = nausea
End of life stop all oral medication and then prophylactic meds eg statin, LMWH( subcut as well which is painful) keep subcut insulin as is treating critical medical condition
Breathlessness = midazolam or morphine
Pain with renal impairment = oxycodone. Learn coversion from morphine to oxycodone
