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CCC > Cancers > Flashcards

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
Q

What are the main risk factors for lung cancer?

A

Age
Smoking
Occupation

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26
Q

What are the histological types of lung cancer

A 
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)
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27
Q

What are the common presenting symptoms of lung cancer?

A 
Cough, 
Dyspnoea, 
Haemoptysis, 
Weight loss,
Chest pain, 
Recurrent chest infection.
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28
Q

What is Horner’s syndrome?

A

Partial Ptosis - upper eyelid drooping
Miosis - constricted pupil
Anhidrosis - loss of hemifacial sweating

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29
Q

What is Pancoat’s syndrome?

A

Weakness of the hands
Pain in the arm, shoulder or shoulder blade
Caused by apical tumour pressing on brachial plexus

30
Q

Investigation of suspected lung cancer:

A

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
Q

What would give a T1 score for lung cancer TNM staging?

A

3cm or less, surrounded by lung or visceral pleura and not invading a main bronchus

32
Q

What would give a T2 score for lung cancer TNM staging?

A

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
Q

What would give a T3 score for lung cancer TNM staging?

A

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
Q

What would give a T4 score for lung cancer TNM staging?

A 
Organ invasion (inoperable): 
mediastinum, heart, great vessels, recurrent laryngeal nerve, oesophagus, vertebral body, carina or separate tumour nodules in a different ipsilateral lobe
35
Q

What would give a N1 score for lung cancer TNM staging?

A

Ipsilateral bronchopulmonary and hilar nodes

36
Q

What would give a N2 score for lung cancer TNM staging?

A

Ipsilateral mediastinal node (operable) or subcarinal

37
Q

What would give a N3 score for lung cancer TNM staging?

A

Contralateral mediastinal or contralateral hilar nodes, or supraclavicular nodes (inoperable)

38
Q

Management of SCLC:

A

Chemotherapy
Adjuvant radiotherapy
Prophylactic cranial irradiation
Surgery only in very early, localised disease

39
Q

Which type of lung cancer is clubbing most associated with?

A

Squamous cell lung cancer

40
Q

Which type of lung cancer is most associated with excessive sputum production?

A

bronchiolo-alveolar carcinoma

41
Q

Which type of lung cancer can often present with paraneoplastic syndromes?

A

SCLC

42
Q

What is CHART and when might it be used?

A

NSCLC

Continuous, hyperfractionated accelerated radiotherapy (CHART) is given three times a day for 12 consecutive days

43
Q

Management of NSCLC:

A 
Surgery in 30% with localised disease
Radical Radiotherapy - e.g. CHART
Adjuvant Chemotherapy 
Adjuvant radiotherapy 
Tyrosine Kinase inhibitors
44
Q

What is the most common histology of prostate cancers?

A

Over 95% of tumours are adenocarcinomas developing in glandular tissue in the posterior or peripheral part of the prostate gland

45
Q

Where does benign prostatic most commonly arise in the prostate ?

A

in the centre of the gland.

46
Q

How is prostate cancer graded?

A

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
Q

How does prostate cancer commonly present?

A 
Poor stream
Dribbling
Nocturia, 
Increased frequency
Bone pain or fracture
48
Q

What is characterised felt on PR examination of the prostate witch cancer?

A

Enlarged, hard, craggy gland is felt, with obliteration of the median sulcus.

49
Q

Investigation of suspected prostate cancer:

A

Bedside - Urine dip to rule out UTI
Bloods - PSA
Imagining - MRI
Special - Transrectal biopsy

50
Q

Management of prostate cancer:

A 
Observation 
Transurethral resection of the prostate (TURP)
Radical prostatectomy 
Radical or adjuvant radiotherapy
Brachytherapy 
Hormonal therapy
51
Q

What are the hormonal therapies used to treat prostate cancer?

A

Luteinizing-hormone releasing hormone (LHRH) agonists
e.g.. goserelin and buserelin

Anti-androgens - androgen receptor antagonists

52
Q

What are the side effects of LHRH agonists?

A

Tumour flare on initiation of treatment
Impotence
loss of libido

53
Q

Which cancers commonly metastasise to the liver?

A

colon, lung, breast

54
Q

Which cancers commonly metastasise to the lung?

A

breast, lung, kidney

55
Q

Which cancers commonly metastasise to the brain?

A

lung, breast, melanoma

56
Q

Which cancers commonly metastasise to the bone?

A

breast, bronchus, kidney, prostate, thyroid

57
Q

Which cancers commonly metastasise to the peritoneum?

A

ovary, GI tract (esp. stomach), pancreas

58
Q

Which cancers commonly metastasise to the high cervical lymph nodes?

A

head and neck, thyroid, lung

59
Q

Which cancers commonly metastasise to the low cervical lymph nodes?

A

head and neck, lung, breast, GI tract

60
Q

Which cancers commonly metastasise to the axillary lymph nodes?

A

breast, lung, melanoma

61
Q

Which cancers commonly metastasise to the inguinal lymph nodes?

A

ovary, prostate, ano-rectal, vulva

62
Q

What is the likely primary of an adenocarcinoma metastasis?

A

GI tract (including pancreas), breast, ovary, lung

63
Q

What is the likely primary of an squamous cell metastasis?

A

lung, head and neck

64
Q

What are the common histologies of testicular cancer?

A

95% Germ cell

  • Seminoma 40%
  • Non-seminomatous germ cell tumours (NSGCT) 60%
    e. g.. Malignant teratoma, Yolk sac tumour
65
Q

How does testicular cancer present?

A

Painless testicular swelling.

or cough or dyspnoea due to lung metastases,
or as low back pain due to para-aortic involvement.

66
Q

What is the investigation for suspected testicular cancer?

A

Bedside
Bloods
Imagining - Ultrasound
Special

67
Q

When is beta-human chorionic gonadotrophin (bHCG) raised?

A

in both seminomas and non-seminomas in up to 75% of patients

68
Q

What kind of testicular cancer raises Alpha-Fetoprotein (AFP)?

A

only raised in non-seminomatous elements

e.g.. Teratoma, Yolk sac

69
Q

What blood test is A useful marker to assess prognosis, response to treatment and detect relapse in testicular cancer?

A

Lactate dehydrogenase (LDH)

70
Q

Once testicular ultrasound has confirmed a suspicious lesion, what investigation should be performed?

A

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
Q

What are the risk factors for testicular cancer?

A

Maldescent of testes predisposes to germ cell tumours. Testicular atrophy
Family history

72
Q

Management of testicular cancer:

A

Orchidectomy
Adjuvant chemotherapy
Possibly radiotherapy

CCC (5 decks)

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