CLASP Flashcards
what is vertebraplasty?
used in palliative care
cement added to spine to hold it together again
E.G after high steroid dose has destroyed bone
when is O2 used in breathlessness?
only if they are hypoxic as well
what produces SiADH?
small cell lung cancer
what produces ACTH?
small cell (neuroendocrine)
what is lambert-eaton myasthenic syndrome?
muscles problems, antibody related in pre-synaptic membrane, not hormone-related
what indicates melanoma on histology?
brown pigments
what can be used to determine if mets are from lung, liver, stomach etc?
immunohistochemistry
If premalignant part of tumour is present
what is a carcinoid tumour?
neuroendocrine derived tumour usually in appendix/small bowel
yellow and assoc with serotonin
how is a carcinoid tumour diagnosed?
Urine 5-HIAA and plasma
what is required for carcinoid syndrome?
liver mets
chromogranin A
Lymphoma?
B cell MALT
assoc w/ coeliac disease
what cancer is kartageners syndrome associated with?
squamous cell carcinoma
cilia defect so affects lungs and fallopian tubes
what does BCL2 do?
evasion of apoptosis
what does P53 do?
spell checker
what tumour stage do you look for mets?
not T1, only T2-4
when is radio/chemotherapy used?
radio = local sit of malignancy chemo = systemic
what are the endpoints for cancer treatments?
overall survival progression free survival disease free survival local control NOT TOXICITY FREE
what is atelectasis?
lung collapse
what is seen with asbestos exposure?
pleural effusion rounded atelectasis pleural plaques asbestosis adenocarcinoma (esp. w/ smoking) mesothelioma
what is the worst indication with mesothelioma?
blue fibres (eg. amphipole)
how does HPV cause cancer?
E6 targets P53 production
E7 targets pRB
(does not directly cause mutations however)
can HIV cause cancer?
not directly
immunosuppressed making susceptible to cancer causing viruses
what is plummer vinson?
increased risk of dysphagia, webs and then oesophageal cancer (squamous cell)
what does lynch syndrome cause?
endometrial and colon cancer
who gets screened for lynch syndrome?
everyone with MSI (microsatellite instability = spelling mistakes)
example of hyperplasia?
lining of uterus
liver regeneration
testes
example of hypertrophy?
muscle (skeletal and cardiac)
example of atrophy?
leg in plaster cast
example of metaplasia?
barrets
change from ciliated pseudostratified columnar epithelium in bronchi to squamous in response to smoking
squamous carcinoma in lung can only occur with smoking, true or false?
true
usually isn’t any squamous epithelium unless metaplastic change
anything shiny that’s exposed to air?
non-keratinised
anything hard that’s exposed to air?
keratinised
“heaped, rolled up edges”?
malignancy (means lesion is not well defined etc)
what is more common on greater/lesser curvature?
lesser = malignancy greater = ulcer
signet rings?
nucleus pushed to the side
= adenocarcinoma
does exrcise increase cancer risk?
yes
bowel, breast and endometrial
breastfeeding cancer link?
reduced risk with breastfeeding
- linked to oestrogen
vit A carotenoid?
reduced in smokers
increases cancer risk when low
beta carotene?
anti-oxidant at low levels
pro-oxidant at high levels
dairy guidelines?
2-3 milk portions
700mg calcium per day
acrylamide?
forms in starchy foods when burnt
likely human carcinogen
transitional epithelium?
in bladder
epithelial tumour (carcinomas) almost never occur in children, true or false?
true
what cancers do children get?
blood
brain
bone
most common type of cancer?
carcinoma
older person with brain lesion?
metastatic carcinoma until proven otherwise
how does epithelial malignancy spread?
local growth
spreads via haematogenous and lymphatic routes
where will lung, breast, GI and prostate tumours spread haematogenously?
lung = bone, brain, adrenal, liver breast = similar to lung GI = liver Prostate = anywhere
what is a mesenchymal tumour?
derived of connective tissue
sarcomas
where do sarcomas occur?
bone cartilage fat fibrous tissue muscle blood vessels nerves
defining feature of sarcoma?
local growth but don’t often spread so can get very big
what do sarcomas lesions look like?
spindle cell lesions (cigar shaped)
diagnosis of sarcoma?
FISH karyotyping (eg. ewings sarcoma = t11;22)
myeloid malignancy?
platelets
red cells
granulocytes
lymphoma presentation?
big lymph nodes in more than one area that doesn’t fit with anatomical drainage of one location/area
large liver and spleen
less white cells
how are lymphoma cells different than other cancer cells?
not pleomorphic
all look similar
glioma?
brain tumour
brain tumours don’t spread, true or false?
true
most common causes of prostatism?
benign prostatic hyperplasia
prostate cancer
what is PSA?
prostate specific antigen
type of tumour marker
can be high in prostate cancer of benign prostatic hyperplasia
sensitivity?
% of people with disease that have +ve test result
specificity?
where disease is absent, the % of people that will be diagnosed as healthy
positive predictive value?
likelihood of +ve test result meaning person has the disease
negative predictive value?
likelihood of a -ve test result meaning person is healthy
how is recurrence of prostate cancer checked?
PSA monitoring
ACG?
checks germ cells tumours and pregnancy
when does ALP rise?
cholestatic disease
pregnancy
cancer bone mets (osteoblasts make new bone after osteoclasts break it down, increasing ALP)
how are bone mets diagnosed?
isotope bone scan
failed ERCP?
possible malignancy
what causes more than1 area of pleural effusion (eg. bilateral)?
benign things
HF, nephrotic syndrome
hypercalcaemia common in malignancy, true or false?
true (>2.55)
- stones
- bones
- groans
- moans (depression)
result of high calcium?
dehydration
how is calcium levels controlled?
parathyroid glands via PTH
how does PTH control calcium?
causes bone absorption (calcium absorbed from skeleton)
more calcium reabsorbed from renal tubules
indirectly - activates Vit D causing gut absorption of calcium
what is PTHrP?
parathyroid hormone related peptide
same action as PTH but not picked up on in PTH assay
how is PTHrP detected?
really high calcium and very low PTH = presence of PTHrP
symptoms of cushings syndrome?
low K+ hypertension nocturia polydipsia truncal obesity plethora ankle oedema purpura of arms
what can cause cushings?
steroids ectopic ACTH (small cell lung cancer)
radical treatment?
curative intent - at expense of side effects
palliative treatment?
non-curative - aims to improve QoL but not at expense of side effects
adjuvant therapy?
after surgery
aimed at reducing recurrence
neo-adjuvant therapy?
before surgery
usually shrinking a tumour before removal
local control?
time without recurrence or progression at specific tumour site
brachytherapy?
injecting tiny pellets of radioisotopes into tumour killing it from inside
systemic anti-cancer therapy (SACT)?
cytotoxic chemo
targeted therapy
immunotherapy
haematological effects of chemo?
neutropenia
thrombocytopenia
GI chemo side effects?
diarrhoea
nausea
mucositis (mouth ulcers)
altered taste
how does external beam radiotherapy work?
breaks double strand causing cell to die
targeted cancer treatment?
monoclonal antibody
tractuzumab/Herceptin
what cancer is radiotherapy good for?
squamous cancers
length of time between decision to treat and first chemo/brachytherapy treatement?
31 days
how can cancer cause facial swelling?
if tumour obstructs head and neck drainage (e.g SVC)
treated with a stent
most common cancer inheritance?
multifactoral
most common mutation causing oncogene activation?
missence amino acid change
cancer is disease of somatic mosaicism?
yes
BRCA gene?
DNA strand breaks
hereditary colorectal cancer?
mismatched base
what does UV or chemical crosslinking cause?
xeroderma pigmentosa
what determines characteristic of cancer?
driver mutation
not origin site
how does BRAF mutation cause melanoma?
activates KRAS pathway
specific BRAF inhibitor effective
what is the Philadelphia chromosome?
genetic abnormality in chromosome 22 that causes leukaemia
how can driver mutations and genomic profiles of tumours be found?
NGS
what determines cancer behaviour?
somatic mutation
in a family with suspected inherited cancer gene, who would you test?
surviving affected relative
what is low cancer risk?
population risk
what is medium cancer risk?
3% 10 year risk
what is high cancer risk?
8% 10 year risk
what is MLH1 assoc with?
hereditary, nonpolyposis colorectal cancer
what does the MLH1 gene do?
DNA repair gene
what type of cancer is mesothelioma?
not a lung cancer
primary pleural malignancy
epithelial malignancy as mesothelial cells rest on basement membrane
how are asbestos fibres shown?
pearl stain (shows blue fibres)
rounded atelectasis?
asbestos
re-planning of stem cells?
metaplasia
name some viral carcinogens?
HPV
EBV
polyomavirus
HHV-8
how does plummer vinson syndrome present?
dysphagia
anaemia
oesophageal webs
risk of plummer vinson?
increased risk of oesophageal SCC
