CBL 3 Flashcards
Does serum amylase determine severity?
No
Explain the glasgow score
PaO2
Age >55
Neutrophils
Calcium
Renal function
Enzymes
Albumin
Sugars (glucose)
Explain screening in colorectal cancer
Everyone aged 60 to 74 who is registered with a GP and lives in England is automatically sent a bowel cancer screening kit, faecal immunochemical test (FIT) - every 2 years.
The programme is expanding to include 56 year olds in 2021.
Patients over 75 can ask for a kit every 2 years by phoning the free bowel cancer screening hotline.
- Screening has a missrate
Bowel scope screening
Previously, some people aged 55 were invited for a one-off test (Flexible sigmoidoscopy).
Bowel scope screening is no longer offered.
Red flag symptoms of colorectal cancer
- Change in bowel habit (towards loose stools)
- Rectal bleeding (common piles → lumps inside and around your bottom (anus), fissures, diverticular disease)
- Wt loss
- Iron deficiency anaemia (Anaemia with low MCV/ferritin)
- Abdominal pain
- Abdominal mass
- Rectal mass
- Tenesmus (feel like they cant empty their bowels have to keep going back) → the feeling that you need to pass stools, even though your bowels are already empty
Iron deficiency anaemia
- Low MCV
- Low Hb
- Low ferritin
Investigations for colorectal cancer
- Blood tests (FBC → test if anaemic/U&Es → because contrast for CT need to check levels/CEA → not diagnostic test, but good monitor)
- Colonoscopy and biopsy
- (CT colonoscopy/flexible sigmoidoscopy/Barium enema)
- CT (chest/abdomen/pelvis)
- Local disease
- Distant metastases
- MRI (staging of rectal cancer)
Who is involved in MDT discussion in colorectal cancer?
- Surgeons
- Oncologists
- Radiologists
- Pathologists
- Gastroenterologists
- Colorectal Nurse Specialists
What are the treatment options for colorectal cancer?
- Curative•Surgery (Laparoscopic/Robotic/Open)
- Long/short course chemo radiotherapy (neo-adjuvant)
- Post-op chemotherapy (adjuvant)•
- Neoadjuvant therapies are delivered before the main treatment, to help reduce the size of a tumor or kill cancer cells that have spread. Adjuvant therapies are delivered after the primary treatment, to destroy remaining cancer cells.
- Palliative
- Chemotherapy
- Radiotherapy
- Surgery
- Best supportive care
Explain the link with family history and colorectal cancer
- Familial Adenomatous Polyposis
FAP occurs in 1 in 10,000 people. It is caused by mutations in the APC gene (autosomal dominant)
Familial adenomatous polyposis (FAP) is a rare, hereditary condition in which a person develops numerous precancerous polyps (adenomas) in the colon and rectum.
Polyps develop in teen years or early 20s.
The number of polyps varies from less than 100 to thousands, and with increasing age the polyps get larger and more problematic.
Eventually, one or more of these adenomas will become cancerous.
Without treatment, patients with FAP have a nearly 100% lifetime risk of colorectal cancer. The chance of developing colorectal cancer increases with age; the average age at which people are diagnosed with cancer is 39.
-
Lynch Syndrome
- Lynch syndrome, also known as hereditary non-polyposis colorectal cancer (HNPCC), is the most common cause of hereditary colorectal (colon) cancer.
- Taking aspirin daily can help
- People with Lynch syndrome are more likely to get colorectal cancer and other cancers, and at a younger age (before 50), including
- Uterine (endometrial)
- Stomach
- Liver
- Kidney
- Brain, and
- Certain types of skin cancers.
Epidemiology of breast cancer
- Commonest cancer in women
- 1 in 13 women (lifetime)
- 25,000 new cases/year
- 15,000 deaths/year
- 1% of breast cancers occur in men
Explain breast cancer screening
- Anyone registered with a GP as female will be invited for NHS breast screening every 3 years between the ages of 50 and 71.
- 71 or over will not automatically be invited for breast screening but can still have breast screening every 3 years if requested.
- Mammography
What are the clinical features of breast cancer?
- Firm, irregular painless lump (may be mobile or fixed it skin or muscle)
- Pain (10%)
- Axillary LN involvement
- Nipple retraction/bloody discharge
- Paget’s disease (looks like eczema around nipple)
- Peau d’orange (decrease lymph node drainage → disease in lymph nodes)
- signs of metastatic disease (wt loss)
- Asymptomatic following screening
What are the investigations in breast cancer?
- Mammography (80-95% accurate)
- less accurate in younger patients
- Ultrasound
- often used to guide biopsy
- Fine needle aspiration cytology (FNAC)
- Tru-Cut biopsy
- Under LA for larger lumps
- Excision biopsy
- If other investigations have failed to give a diagnosis
- CT/MRI/Chest X-Ray/Bone scan
Explain control of local diseases in breast cancer
- Surgery
- Wide local excision + DXT
- Mastectomy
- Reconstruction
- No difference in 5-10 year survival
- Most likely now do lobectomy to just remove the lump so less disfigurement
Explain treating the axilla in breast cancer
- Failure to treat the axilla does not confer worse prognosis, node involvement is an expression of poor outcome rather than determinant
- Sentinel LN biopsy
- If nodes are positive then axillary lymph node clearance is performed
- Morbidity (Upper limb oedema)
