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Cancer > Cancer of unknown origin > Flashcards

Cancer of unknown origin Flashcards

1
Q

Investigations for anaplastic carcinoma in cervical nodes

A

CXR; sputum cytology (most reliable in small cell lung cancer)
Thyroid scan + needle biopsy
Nasopharyngeal assessment
Consider diagnosis of undifferentiated lymphoma (exclude with immunophenotyping)

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2
Q

Investigations for SCC in inguinal nodes

A

Careful exmination of legs, vulva, penis, perneum for primary tumour
Pelvic exam
Protoscopy/colposcopy

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3
Q

Metastatic adenocarcinoma investigations

A

Oestrogen and progesterone receptor expression by tumour in females
Serum PSA + acid phosphatase in males
AFP and hCG
Poorly differentiated lymphoma? exclude with immunophenotyping

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4
Q

Overall unknown primaries type of cell cancer

A

60% adenocarcinoma
30% poorly differentiated carcinoma
5% above neoplasm
5% SCC

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5
Q

Light microscopy -> signet, melanin, mucin, psammoma bodies where orgiinate

A

Signet ring cells (favour gastric primary)
Presence of melanin (favour melanoma)
Presence of mucin is common in gut/lung/breast/endometrial cancers, less common in ovarian cancer and rare in renal cell or thyroid cancers
Presence of Psammoma bodies (calcospherites) is a feature of ovarian cancer (mucin positive) and thyroid cancer (mucin negative)

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6
Q

Germ cell tumour markers

A

AFP, HCG, ± PLAP (placental alkaline phosphatase)

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7
Q

Carcinoma tumour markers

A

Carcinoembryonic antigen (CEA), cytokeratin, epithelial membrane antigen (EMA)

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8
Q

Neuroendocrine tumour markers

A

Chromogranin, Neuron-specific enolase (NSE), synaptophysin

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9
Q

Thyroid cancer tumour markers

A

Thyroglobuylin - follicular + papillary thyroid carcinoma
Calcitonin - medullary thyroid carcinome

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10
Q

Melanoma tumour markers

A

S-100, vimentin, & NSE

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11
Q

Sarcoma tumour markers

A

Vimentin, Desmin, muscle-specific actin - rhabdomyosarcoma
Vimentin, Factor VIII antigen - angiosarcoma

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12
Q

Glioma marker

A

GFAP

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13
Q

Lymphoma tumour markers

A

CLA/CD45

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14
Q

How can immunophenotyping be done

A

mmunohistochemical staining, immunofluorescent staining or flow cytometr

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15
Q

Ways of originating cancers

A

Tumour markers from immunocytochemical staining
mmunophenotyping
Light miscriscopy
Electron microscopy
Histopathology

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16
Q

What immunohistochemical staining s\uggests HPV positive cerical cancer

A

p16

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17
Q

Investigations into metastatic cancer

A

liver and renal function tests, full blood count, chest radiography, CT of the abdomen and pelvis, and mammography in women. Depending on the clinical situation, additional studies might include sputum cytology, CT of the chest, breast ultrasonography, or gastrointestinal endoscopy.

18
Q

Median survival from unknown primary metastatic cancer

A

8 months

19
Q

Physical exams in metastatic cancer

A

History Palpate thyroid, breasts, lymph nodes, liver and prostate - PR exam
FIT test
Gential exam, pelvic and testes

20
Q

most common sites of mets

A

lung, bone, lymph nodes, and liver

21
Q

Cervical cancer treatemtn

A

Local excision using loop diathermy is performed for CIN 2/3 confined to the visible ectocervix
Loop biopsy is performed for CIN 3 with disease extending into cervical canal
Simple hysterectomy is performed for micro-invasive disease
Stage IB or 2 cervical cancers are treated by radical hysterectomy with pelvic lymphadenectomy or pelvic radiotherapy. Both methods are equally effective
Stage 2B and 3 should be treated with pelvic radiotherapy and patients treated with curative intent typically receive chemoradiotherapy with cisplatin as a radiation sensitizer
Stage 4 and recurrent disease are treated with chemotherapy. Radiotherapy can be used to treat specific site of metastasis.
Chemotherapy alone has no role in the adjuvant treatment of cervical cancer

22
Q

What is neutropenic sepsis defined as

A

Pyrexia >38 degrees on one reading
>37.5 on 2 readings over an hour
Rigor
Unexplained hypotension or tachycardia
Neutrophil count <1 x 10^9

23
Q

Initial management of neutropenic sepsis

A

Blood cultures - peripheral and from hickman if present
MSU, CXR swab for culture - throat, Hickman site etc
Commence empirical antibiotics - taz/gentamycin
FBC, biochem, coag screen
Keep platelets >20 x109L

24
Q

Worse outcome features of neutropenic sepsis

A

Diarrhoea
Hypotension
Coagulopathy
Presence of more than one organ failure

25
Q

10 red flag symptoms of cancer

A

Persistent cough or hoarseness
Change in appearance of a mole
Persistent chang in bowel habit
Sore that doesnt heal
Persistent difficulty swallowing
UNexplained weight loss
Persistent change in bladder habbits
Unexplained lump
Persistent unexplained pain
Unexplained bleeding

26
Q

Which tests can be useful on ascitic fluid

A

Albumin
Amylase
Cytology
Glucose
LDH
Microscopy, culture and sensitivity
pH

27
Q

How is analgesia often given in cancer

A

Subcutaneously

28
Q

What medication can improve bowel obstruction symptons ad why

A

Steroids - reduce inflammation and oedmea at sight

29
Q

What drug can be used for nausea in bowel obstruciton and what cant

A

Haloperidol SC
Metoclopramide CNAT use - promimetic, stimulates GI peristalsis

30
Q

What is a carcinoma of unknown origin

A

Unique entity where a primary tumour is able to metastases before primary tumouyr large enough to be identified
Malignant tumour from epithelial system of body
Adenocarcinoma of uncertain origin, occult primary malgnancy

31
Q

Unknown origin vs known praimary tumours

A

Early dissemination
Clinical absence primary tumour
UNpredicatble metastatic pattern
Greater aggressiveness
Absence of symptoms due to primary tumour

32
Q

Epide miology of cancer of unknwon origin

A

2.3-4.5% of all cancers are from an unknown primary
8-20 patients per 100,000 population per year
7th-8th most frequent form of cancer
Median age at presentation is 60 years
4th commonest cause of cancer death in both males and females
50% of patients present with multiple sites of involvement
The rest have a single site:
liver, bones, lungs, lymph nodes

33
Q

Primary site diagnsosi

A

Most never found even at autospy
Most frequently lung, panreas, GI and gyane

34
Q

Prognostic factors cancer of unknown origin

A

Poorly differentiated carcinoma, SCC, neuroendocrine
Lymph node involvement
No. metastatic sites
Female sex - men worse
Performance status
Weight loss >10%
Serum markes eg alk phos, LDH, CEA

35
Q

Approach to cancer of unkown primary

A

Search for primary site
Rule out potnetially treatable or curable tumours
CHARAVTERISE SPECIFIC CLINOPATHOLogical entity
Treat th patient - favourable subset -> curative intent
Unfavourable -> palleative intent

36
Q

What patients should not be missed because of potential curative intent

A

Predominantly nodal metastases of poorly differentiated carcinomas
Females with peritoneal carcinomatosis of high grade serous histological type adenocarcinoma

37
Q

Common causes of transudate

A

Failure - heart failure
Liver failure
Kidney failure
Thyroid failure
Resp fairure - rare
Meigs syndrome

38
Q

Factors influencing treatment choice in metastatic cancer

A

Age
Perfomrance status
Comobidities
Organ impairment
Paitent priorities

39
Q

What is pleurocentesis

A

Chest drain for pleural effusion

40
Q

Staging of unknown primary cancer

A

Whole body PET-CT scan

41
Q

What is meigs syndrome

A

triad of benign ovarian tumor (usually a fibroma), ascites (accumulation of fluid in the abdominal cavity), and pleural effusion (fluid around the lungs).
Resecting th eovarian tumour resolves symptoms

Cancer (22 decks)

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