Cancers Flashcards
Young male testicular cancer - which one is more common?
Teratoma
- 20-30yo
- worse prognosis than seminoma
Older male testicular cancer - which one is more common?
Seminoma
- 35-45yo
- better prognosis than teratoma
Cancers that cause spinal metastases
Breast
Bronchus
Prostate
kidney (more common to metastasise to lung first than bone)
thyroid
Multiple myeloma
High grade non-Hodgkin’s lymphoma
Cancer that spread to lungs
Osteosarcoma
Cancer that spread to liver
Colorectal
? diagnosis - young child. Afro-Carribean. fever, irritability, reduced feeding. fingers and toes are swollen/tense.
strawberry tongue, dry cracked lips, rashes that are peeling
Kawasaki disease
Cancer of corpus uteri is known as
endometrial cancer
what increases iron absorption?
vitamin C
In ALL, what do the lymphocyte immature cells express?
they express a protein called TdT (terminal deoxynucleotide transferase)
what is pott’s disease
most dangerous form of musculoskeletal TB as it causes bone destruction, deformity and parapleia
poor prognostic factor of breast cancer
young patients
other prognosis factors: axillary nodal status, tumour type and grade, lymphatic/vascular invasion/proliferation markers, ethnicity and patient’s age of diagnosis, oestrogen/progesterone receptor status, HER2/neu overexpression
first line tx for CLL with 17p deletion or TP53 mutation
acalabrutinib
(also use this if no 17p deletion or TP53 mutation, but patient is not tolerating FCR and BR treatment)
FCR: fludarabine and cyclophosphamide and rituximab
BR: bendamustine and rituximab
best initial tx of AML
chemotherapy
what is the monitoing regimen for someone with gene for HNPPCC?
colonoscopy beginning 20-25yo
what is Hughes syndrome?
anti-phospholipid syndrome
indications for mastectomy
large tumour in small breast
multifocal tumour
central tumour
DCIS >4cm
tumour at nipple
patient’s request
what is the cytology stages for breast biopsy?
C1 (inadequtae)
C2 (benign)
C3 (atypia but probabbly benign)
C4 (suspicious of malignnacy)
C5 (malignant)
Prognosis factors for multiple myeloma
beta-2 microglobulin
?diagnosis - pregnant lady, AKI, confusion, fever, thrombocytopenia, microagiopathic haemolytic anaemia
Thrombotic thrombocytopenic purpura
how soon can radiation enteritis occur post-radiation to pelvis?
acute (within 2 weeks of tx): anorexia, diarrhoea, foaecal urgency, bloating, colicky abdo pain
chronic (18 months to 6 years later!) : weight loss, steatorrhoea, small bowel obstruction, nausea, anorexia
Tumour marker:
LDH
ALP
…used for what diseases?
LDH - testicular cancer
ALP - Paget’s disease, teratoma (not seminoma)
patient recently diagnosed with colorectal cancer - what disease must this patient be screened for?
Lynch syndrome
- autosomal dominant
- also increases risk of cancer in endometrial, stomach, breast, ovarian, small bowel, pancreatic, prostate, urinary, kidney, liver.
what does haptoglobin do?
bind to free Hb (released in haemolytic diseases)
THerefore, low levels of haptoglobin in haemolytic anaemias -> test to do is osmotic fragility test to look for RBC breaking down
basophilic stippling in blood film ? cause
toxic - eg lead poisoning
Types of hypersensitivity reaction
1 - allergic (IgE)
2 - antibody (complement, phagocytosis)
3 - immune complex
4 - Delayed (T-helper cells)
Graft rejection - what happens:
- Acute allograft reaction
- Hyperacute allograft reaction
- Chronic allograft reaction
Acute: lymphocyte, T-cell, cytokine activation. donor MHC 1 antigens react with host CD8 resulting in direct cytotoxic damage
Hyperacute: class 1 HLA antibody activation, granulocyte adhesion, thrombosis
Chronic: interstitial fibrosis
metastasis to the brain comes from where?
breast
lung
melanoma
what is paraneoplastic cerebellum disorder
rare
non-metastatic
immune mediated
complication of cancers : ovarian, breast, uterus, SCLC, Hodgkin’s lymphoma
CSF: elevated protein and presence of anti-neuronal antibodies
MRI may be normal in early stages
treatment of oestrogen-positive breast cancer - what medication to give patients?
post-menopausal women: aromatase inhibitors (eg anastrozole and letrozole) - to prevent peripheral oestrogen synthesis
pre-menopausal/young patients: tamoxifen - selective oestrogen receptor modulators (side effect: endometrial cancer, VTE, menstural disturbance)
Risk factors for bladder cancer
Transitional cell carcinoma:
smoking (most significant) x4
exposure to aniline dyes
rubber manufacture
cyclophosphamide
Squamous cell carcinoma:
schistosomiasis
smoking
how soon after xxxx can you do the PSA test?
- prostatitis
- prostate biopsy
- ejaculation
- vigorous exercise
- UTI
prostatitis : 1 month
prostate biopsy:
ejac/exercise: 48hrs
UTI: 4 weeks
DRE: 1 week
PSA test & sensitivity/specificty
low sensitivtiyt and specificity
what type of cancers are more prevalent in the following:
Chinese
Indian
White
Afro-Caribbean
Ashkenazi Jews
Chinese: nasopharyngeal?
Indian:
White:
Afro-Carribean: prostate
Ashkenazi Jews: breast and ovarian cancer (BRCA 1 and 2)
positive predictive value of faecal occult blood test
5-15%
Risk factor for ovarian cancer
Nulliparous
subfertile women
has a familial tendency
hormone therapy post menopause
fertility medication
obesity
Risk factor for breast cancer
female sex
obesity
lack of physical exercise
regular consumption of alcohol
ionising radiation
early age of menstruation
BRCA1, BRCA2 genes - 40% lifetime risk of breast/ovarian cancer
1st degree relative premenopausal relative with breast cancer (e.g. mother)
nulliparity, 1st pregnancy > 30 yrs (twice risk of women having 1st child < 25 yrs)
early menarche, late menopause
combined hormone replacement therapy (relative risk increase * 1.023/year of use), combined oral contraceptive use
past breast cancer
not breastfeeding
ionising radiation
p53 gene mutations
obesity
previous surgery for benign disease (?more follow-up, scar hides lump)
Risk factor for endometrial cancer
excess oestrogen
nulliparity
early menarche
late menopause
unopposed oestrogen. The addition of a progestogen to oestrogen reduces this risk (e.g. In HRT). The BNF states that the additional risk is eliminated if a progestogen is given continuously
metabolic syndrome
obesity
diabetes mellitus
polycystic ovarian syndrome
tamoxifen
hereditary non-polyposis colorectal carcinoma
