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Cancers Flashcards

1
Q

What is the most common cancer in women?

A

Breast cancer

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2
Q

What are the risk factors for breast cancer?

A 
Age
Increased Oestrogen exposure 
Ionising radiation 
Family History 
BRCA1 & BRCA2
Smoking
Alcohol > 14 units per week
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3
Q

What can increase a woman exposure to oestrogen over her lifetime?

A 
Early Menarche
Nulliparity 
Late childbearing 
Late menopause
HRT
Obesity
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4
Q

What is involved in the triple assessment?

A

Clinical Examination
Radiology - Mammography
Histology - Biopsy

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5
Q

What factors indicate a poorer prognosis for breast cancer?

A 
Large size > 5cm
Higher grade (3 > 2 >1)
ER negative disease
Her-2 positive disease
Lymph node involvement
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6
Q

What surgical options are available for breast cancer?

A

Wide local excision
Simple or total mastectomy
Modified radical mastectomy
Radical mastectomy

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7
Q

What is involved in a simple or total mastectomy?

A

Removal of the entire breast but no axillary lymph nodes or chest wall muscles

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8
Q

What is involved in a modified radical mastectomy?

A

Removal of the entire breast
Axillary node dissection levels I and II
No muscles are removed

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9
Q

What is involved in a radical mastectomy?

A

Removal of the entire breast
Axillary node dissection levels I, II and II
Removal of chest wall muscles

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10
Q

What are the three mechanisms of action of hormonal therapies for ER positive breast cancer?

A

Block oestrogen receptors
e.g. Tamoxifen

Block oestrogen production
e.g. Oophrectomy in pre-menopausal woman

Block extra-ovarian oestrogen production

  • Better in post-menopausal women
  • Aromatase inhibitors eg. Anastrozole, Letrozole and Exemestane
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11
Q

What is Trastuzamab and when is it used?

A

Therapy with Trastuzamab (Herceptin®) is effective in metastatic and localize disease where the cancer over-expresses the target epithelial growth factor receptor (HER-2).

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12
Q

What should all women who have conservative breast surgery receive?

A

Adjuvant radiotherapy

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13
Q

What is the fourth most common malignancy in the UK?

A

Colorectal carcinoma

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14
Q

What are the risk factors for colorectal carcinoma?

A

Poor Diet - low in fibre, high in fat
Ulcerative colitis - cumulative risk of 7 -15 % at 20 years
Family History

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15
Q

What are the familial conditions associated with colorectal cancer?

A

Hereditary non-polyposis colon cancer (HNPCC)
Familial adenomatous polyposis (FAP)
Gardner’s syndrome

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16
Q

What is the histology and location of most colorectal carcinomas?

A 
90-95% of tumours are adenocarcinomas, 
40% of large bowel cancers occur in the rectum, 
20% in the sigmoid colon, 
6% in the caecum, 
the rest in the remaining colon.
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17
Q

How might a tumour on the right side of the colon or caecum present?

A

with Iron deficiency anaemia

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18
Q

What are the classical presenting complaints of colorectal cancer?

A

Altered bowel habit,
Weight loss,
Rectal bleeding,
vague abdominal pain

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19
Q

Investigations for suspected colorectal cancer:

A 
Bedside - PR examination 
Bloods - FBC, U&E, LFT, CRP, Ferritin 
Imaging - 
Special - Sigmoidoscopy, Colonoscopy 
- CT staging
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20
Q

What can tumour marker CEA (carcino-embryonic antigen) be used for?

A

CEA elevation is not diagnostic of colorectal cancer but can be used to monitor progression of disease

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21
Q

What are the DUKE stages and their 5 year survivals?

A

5 year survival by stage
Stage 1 - confined to the bowel wall- 95%
Stage 2 - through bowel wall doesn’t involve nodes - 80-90%
Stage 3 - involves local lymph nodes- 65%
Stage 4 - distant metastases - 5-10%

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22
Q

What is the options for surgical management of a colon cancer?

A

Lower anterior resection

Hemicolectomy

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23
Q

What are the options for surgical management of a rectal cancer?

A

Lower anterior resection
Abdominoperineal resections (APRs)
Proctosigmoidectomy (Hartmann’s procedure)

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24
Q

What are the commonest cancers in the UK?

A

1st - Breast cancer (15%)
2nd - Prostate (13%), 1st in Men
3nd - Lung (13%),
4th - Bowel (12%).

together account for more than half (53%)

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25
What are the main risk factors for lung cancer?
Age Smoking Occupation
26
What are the histological types of lung cancer
``` Small cell lung cancer (SCLC) 18% Non small cell lung cancer (NSCLC) 82% - Squamous cell carcinoma (32% of NSCLC) - Adenocarcinoma (26% of NSCLC) - Large cell carcinoma (10% of NSCLC) ```
27
What are the common presenting symptoms of lung cancer?
``` Cough, Dyspnoea, Haemoptysis, Weight loss, Chest pain, Recurrent chest infection. ```
28
What is Horner's syndrome?
Partial Ptosis - upper eyelid drooping Miosis - constricted pupil Anhidrosis - loss of hemifacial sweating
29
What is Pancoat's syndrome?
Weakness of the hands Pain in the arm, shoulder or shoulder blade Caused by apical tumour pressing on brachial plexus
30
Investigation of suspected lung cancer:
Bedside - Bloods - FBC, U&E, CRP Imaging - Chest x-ray Special - Bronchoscopy, CT staging Sputum cytology only ever offered if patient refuses to have a bronchoscopy
31
What would give a T1 score for lung cancer TNM staging?
3cm or less, surrounded by lung or visceral pleura and not invading a main bronchus
32
What would give a T2 score for lung cancer TNM staging?
More than 3cm but less than 7cm - or invading a main bronchus (but >2cm from the carina) - or invading visceral pleura - or causing atelectasis of some but not all of one lung
33
What would give a T3 score for lung cancer TNM staging?
More than 7cm - or local invasion of particular structures, irrespective of size of tumour: Chest wall, diaphragm, phrenic nerve, mediastinal pleura, parietal pericardium, main bronchus within 2cm of carina, atelectasis of entire lung or separate tumour nodule in same lobe
34
What would give a T4 score for lung cancer TNM staging?
``` Organ invasion (inoperable): mediastinum, heart, great vessels, recurrent laryngeal nerve, oesophagus, vertebral body, carina or separate tumour nodules in a different ipsilateral lobe ```
35
What would give a N1 score for lung cancer TNM staging?
Ipsilateral bronchopulmonary and hilar nodes
36
What would give a N2 score for lung cancer TNM staging?
Ipsilateral mediastinal node (operable) or subcarinal
37
What would give a N3 score for lung cancer TNM staging?
Contralateral mediastinal or contralateral hilar nodes, or supraclavicular nodes (inoperable)
38
Management of SCLC:
Chemotherapy Adjuvant radiotherapy Prophylactic cranial irradiation Surgery only in very early, localised disease
39
Which type of lung cancer is clubbing most associated with?
Squamous cell lung cancer
40
Which type of lung cancer is most associated with excessive sputum production?
bronchiolo-alveolar carcinoma
41
Which type of lung cancer can often present with paraneoplastic syndromes?
SCLC
42
What is CHART and when might it be used?
NSCLC | Continuous, hyperfractionated accelerated radiotherapy (CHART) is given three times a day for 12 consecutive days
43
Management of NSCLC:
``` Surgery in 30% with localised disease Radical Radiotherapy - e.g. CHART Adjuvant Chemotherapy Adjuvant radiotherapy Tyrosine Kinase inhibitors ```
44
What is the most common histology of prostate cancers?
Over 95% of tumours are adenocarcinomas developing in glandular tissue in the posterior or peripheral part of the prostate gland
45
Where does benign prostatic most commonly arise in the prostate ?
in the centre of the gland.
46
How is prostate cancer graded?
Gleason grading Major and minor tissue architecture and gland formation Graded 2-5 and then added together e.g. Gleason 3+3 (6) Low grade Gleason 4+4 (8) High grade
47
How does prostate cancer commonly present?
``` Poor stream Dribbling Nocturia, Increased frequency Bone pain or fracture ```
48
What is characterised felt on PR examination of the prostate witch cancer?
Enlarged, hard, craggy gland is felt, with obliteration of the median sulcus.
49
Investigation of suspected prostate cancer:
Bedside - Urine dip to rule out UTI Bloods - PSA Imagining - MRI Special - Transrectal biopsy
50
Management of prostate cancer:
``` Observation Transurethral resection of the prostate (TURP) Radical prostatectomy Radical or adjuvant radiotherapy Brachytherapy Hormonal therapy ```
51
What are the hormonal therapies used to treat prostate cancer?
Luteinizing-hormone releasing hormone (LHRH) agonists e.g.. goserelin and buserelin Anti-androgens - androgen receptor antagonists
52
What are the side effects of LHRH agonists?
Tumour flare on initiation of treatment Impotence loss of libido
53
Which cancers commonly metastasise to the liver?
colon, lung, breast
54
Which cancers commonly metastasise to the lung?
breast, lung, kidney
55
Which cancers commonly metastasise to the brain?
lung, breast, melanoma
56
Which cancers commonly metastasise to the bone?
breast, bronchus, kidney, prostate, thyroid
57
Which cancers commonly metastasise to the peritoneum?
ovary, GI tract (esp. stomach), pancreas
58
Which cancers commonly metastasise to the high cervical lymph nodes?
head and neck, thyroid, lung
59
Which cancers commonly metastasise to the low cervical lymph nodes?
head and neck, lung, breast, GI tract
60
Which cancers commonly metastasise to the axillary lymph nodes?
breast, lung, melanoma
61
Which cancers commonly metastasise to the inguinal lymph nodes?
ovary, prostate, ano-rectal, vulva
62
What is the likely primary of an adenocarcinoma metastasis?
GI tract (including pancreas), breast, ovary, lung
63
What is the likely primary of an squamous cell metastasis?
lung, head and neck
64
What are the common histologies of testicular cancer?
95% Germ cell - Seminoma 40% - Non-seminomatous germ cell tumours (NSGCT) 60% e. g.. Malignant teratoma, Yolk sac tumour
65
How does testicular cancer present?
Painless testicular swelling. or cough or dyspnoea due to lung metastases, or as low back pain due to para-aortic involvement.
66
What is the investigation for suspected testicular cancer?
Bedside Bloods Imagining - Ultrasound Special
67
When is beta-human chorionic gonadotrophin (bHCG) raised?
in both seminomas and non-seminomas in up to 75% of patients
68
What kind of testicular cancer raises Alpha-Fetoprotein (AFP)?
only raised in non-seminomatous elements | e.g.. Teratoma, Yolk sac
69
What blood test is A useful marker to assess prognosis, response to treatment and detect relapse in testicular cancer?
Lactate dehydrogenase (LDH)
70
Once testicular ultrasound has confirmed a suspicious lesion, what investigation should be performed?
Orchidectomy via the inguinal canal Trans-scrotal biopsy is contra-indicated, because of the risk of dissemination of the tumour. + or - Biopsy of the contralateral side
71
What are the risk factors for testicular cancer?
Maldescent of testes predisposes to germ cell tumours. Testicular atrophy Family history
72
Management of testicular cancer:
Orchidectomy Adjuvant chemotherapy Possibly radiotherapy

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