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CCC - LM > Common Cancers & Management > Flashcards

Common Cancers & Management Flashcards

1
Q

Which is the most common cancer in females?

A

Breast

1 in 12

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2
Q

Which are the two most common types of breast cancer

A

Invasive ductal carcinoma - 70-80%

Lobular carcinoma - 10%

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3
Q

What are the risk factors for breast cancer?

A

Increasing age
Oestrogen exposure: early menarche, late menopause, nulliparity
BRCA1/2
HER2

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4
Q

How is breast cancer diagnosed?

A

Fine needle biopsy

incisional or excisional biopsy

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5
Q

In breast cancer, what is meant when a tumour is described T3?

A

Invasive tumour size >5cm

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6
Q

In breast cancer, what is meant when a tumour is described T2?

A

Invasive tumour, size 2-5cm

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7
Q

In breast cancer, what is meant when nodes are described N3?

A

Internal mammary LN present

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8
Q

In breast cancer, what is meant when nodes are described N2?

A

Fixed axillary nodes present

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9
Q

What is stage 4 breast cancer?

A

Any T
Any N
M1 (distant mets)

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10
Q

BRCA2 increases the risk of which types of cancer?

A

Male & female breast cancer

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11
Q

BRCA1 increases risk of which types of cancer?

A

Breast & ovarian

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12
Q

What breast presentations would warrant urgent referral at any age?

A

Discrete hard lump with fixation +/- skin tethering

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13
Q

What breast presentation would warrant urge referral in women > 30

A

unexplained breast lump +/- pain

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14
Q

What must be assessed in all women having a lumpectomy? How does this affect treatment?

A

Sentinel LN biopsy

Determines use of adjuvant chemotherapy

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15
Q

Who with breast cancer will receive adjuvant chemotherapy?

A

All wide local excision pts
Large primary tumour >4cm
Presence of LN
Palliative - relieve sx E.g. bony mets

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16
Q

What treatment is available in breast cancer patients with an ER positive primary tumour?
What is the regimen?
NB: ER = oestrogen receptive

A

Tamoxifen

20mg per day for 2-5 years

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17
Q

Risk of endometrial cancer is increased with which drugs?

A

COCP
Tamoxifen
HRT

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18
Q

What are the 3 endocrine therapies available for breast cancer?

A

Tamoxifen
Aromatase inhibitors
Herceptin (trustazemab)

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19
Q

Which endocrine therapy is most beneficial for postmenopausal women with breast cancer?

A

Aromatase inhibitors - anastrazole, letrozole

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20
Q

What are the benefits + negatives of tamoxifen?

A

B: Decreased annual risk of recurrence & death
Decreased risk of contralateral breast cancer, even if initial cancer was not ER positive

N: inc. risk of thrombosis & endometrial cancer

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21
Q

What are the benefits + negatives of aromatase inhibitors

A

B: increased efficacy & decreased toxicity compared to tamoxifen
when switched from tamoxifen after menopause, further increased rates of disease free survival

N: osteoporosis

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22
Q

What are the 5 year survival rates of stage 1 breast cancer?

A

84%

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23
Q

What are the 5 year survival rates of stage 3 breast cancer?

A

48%

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24
Q

What are the 5 year survival rates of stage 2 breast cancer?

A

71%

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25
Q

What are the 5 year survival rates of stage 4 breast cancer?

A

18%

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26
Q

Chemotherapy reduces the risk of breast cancer recurrence by what %

A

28%

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27
Q

How common is colorectal cancer?

A

2nd most common after lung

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28
Q

What is the most common type of cololectal cancer?

A

Epithelial adenocarcinoma - 95%
Sigmoid - 2/3
Rectum - 1/3

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29
Q

What are the genetic risk factors for colorectal cancer?

A

HNPCC
FAP
APC
Gardner’s syndrome

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30
Q

What are the non-genetic risk factors for colorectal cancer?

A

High animal fat diet
Low fibre (increased transit time = increased exposure to carcinogens)
High red meat
UC/ Crohn’s

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31
Q

How does colorectal cancer usually spread?

A

local invasion
lymphatic
coelemic spread

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32
Q

Focal occult blood test is thought to reduce mortality by what %?

A

15-18%

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33
Q

What type of anaemia can be caused by colorectal ca?

A

Iron deficiency

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34
Q

What are the typical presentations for colorectal ca?

A 
Weight loss
Altered bowel habit
rectal bleeding 
Vague abdo pain
Obstruction/tenesmus
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35
Q

Which genetic mutations cause progression of benign adenomas to malignant in colorectal ca?

A

p53
RAS
DCC

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36
Q

What is offered to 55 year olds as part of the screening process for colorectal ca?

A

Sigmoidoscopy

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37
Q

What investigation is used to visualise the bowel in colorectal ca?

What is used to biopsy lesions?

A

Rigid sigmiodoscopy to 25cm

Flexible sigmoidoscopy & colonoscopy for biopsy

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38
Q

What tumour marker is raised in colorectal ca

What else can raise this marker?

A

CEA - carcino-embreyonic antigen

Smoking, IBD, hepatitis, gastritis, pancreatitis

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39
Q

What imaging is used to stage colorectal ca?

A

CT

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40
Q

What criteria is used in the staging of colorectal ca?

A

Duke’s

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41
Q

What age group is associated with an adverse prognosis in colorectal ca?

A

<40s

Associated with more aggressive form of cancer

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42
Q

What is the first line management of colorectal ca?

A

radical resection - may be curative for primary tumours

Improves survival in advanced disease

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43
Q

What surgery can be used to prevent obstructive lesions in colorectal ca?

A

Stent (palliative)

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44
Q

radiotherapy is used in which type of colorectal ca?

A

Rectal ca - can be used as primary treatment

Also used as neo-adjuvant/ adjuvant

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45
Q

Why is radiotherapy not used in colon cancer?

A

toxic to adjacent organs

46
Q

Which chemotherapy agent is most used in colorectal ca?

A

5-FU

47
Q

Which Duke’s stage uses adjacent chemotherapy?

A

C

48
Q

Men of any age with unexplained iron deficiency anaemia should be investigated for colorectal ca if their Hb is below what?

A

110

49
Q

Non-menstruating women with unexplained iron deficiency anaemia should be investigated for colorectal ca if their Hb is below what?

A

100

50
Q

Over 40s should be investigated for colorectal ca if their change in bowel habit has persisted for how long?

A

≥ 6 weeks

51
Q

What are the common sites of metastasis in colorectal cancer?

A

Lung
Liver
Bone

52
Q

What are the common sites of metastasis in breast cancer?

A

Bone
Lung
Liver
Brain

53
Q

What are the occupational causes of lung cancer?

A

Asbestos
Uranium
Ship building
Petroleum refining

54
Q

Is small cell or non-small cell LC more common?

A

Non-small cell 82%

55
Q

What are the types of Non-small cell LC in order of most common?

A

Squamous cell carcinoma - 32%
Adenocarcinoma - 26%
Large cell carcinoma - 10%
Others

56
Q

Which lung ca has the worst prognosis?

A

small cell

57
Q

Mutations in EGFR (epidermal growth factor receptor) is associated mostly with which type of lung cancer?

A

Adenocarcinoma

58
Q

Adenocarcinoma is more common in which gender?

A

Women

59
Q

Brachial plexus invasion is most associated with which tumour?
How does it present?

A

Pancoast tumour

Associated with Horner’s syndrome - unilateral ptosis, meiosis & anhydrosis

60
Q

Pancoast tumour is usually which type of lung tumour?

A

Non-small cell

61
Q

Small cell cancer is derived from which cells?

A

Neuro-endocrine cells within the lung

62
Q

Secretion of ADH & ACTH is associated with which tumour?

A

small cell lung ca

63
Q

Non-small cell or small cell are likely to metastasis early?

A

small cell

64
Q

What on a CxR would be suggestive of lung ca?

A

Pleural effusion
Slow resolving consolidations
Lesion/ mass

65
Q

Urgent lung cancer referral should be to all >40 who present with what?

A

heamoptysis

66
Q

Mediastinal disease can present how?

A

SVCO

Recurrent laryngeal nerve palsy - voiceless

67
Q

Clubbing occurs more frequently with which type of lung ca?

A

squamous cell carcinoma

68
Q

What investigations are important when suspecting lung ca?

A

CxR - 95% are visible
Sputum cytology - 80% of malignant cells are detectible in sputum
Bronchoscopy - visualisation of the bronchial tree, biopsy & washings

69
Q

How is a biopsy taken when suspecting lung ca?

A

Bronchoscopy

70
Q

What are the 2 types of bronchoscopy?

A

Fibre optic

Rigid

71
Q

How are peripheral tumours biopsied when suspecting lung ca?

A

Trans-thoracic biopsy

72
Q

What imaging is used to assess extent of local and distant mets in lung ca?

A

PET-CT

PET can locate small mets not detected by CT

73
Q

What is limited disease in relation to lung ca?

What is extensive disease in relation to lung ca?

A

Tumour confined to 1 hemithorax + local extension confined to mediastinal or ipsilateral supraclavicular nodes

Disease beyond sites defined by limited disease

74
Q

What proportion of people present with extensive disease in lung ca?

A

2/3

75
Q

What is the first line treatment for SCLC?

A

Chemotherapy - most present with extensive disease

If disease = limited, then adjuvant radiotherapy

76
Q

Which lung ca is most chemo-sensitive?

What is the response rate?

A

Small cell

90%

77
Q

Which lung ca has the highest rate of relapse?

A

small cell

78
Q

What is the prognosis of SCLC with chemo and no chemo?

A

Chemo: 11 months

No chemo: 2-4 months

79
Q

In what proportion of those with SCLC is surgery appropriate?

A

10%

80
Q

What is the first line treatment of NSCLC?

A

Surgery + adjuvant chemo

81
Q

What percentage of NSCLC patients are suitable for primary radical surgery?

A

30%

82
Q

What type of radiotherapy is used in NSCLC?

A

CHART - continuous hyper-fractioned accelerated radiotherapy

83
Q

What targeted therapy is used in the palliative setting for NSCLC?
What does it target?

A

Tyrosine kinase inhibitors (TKAs)

Target EGFR

84
Q

What signs warrant immediate referral if suspecting lung ca?

A

SVCO obstruction

stridor

85
Q

What is the most common type of prostate cancer?

A

Adenocarcinoma - 95%

86
Q

BPH arises from the outer or centre of prostate?

A

centre

87
Q

Which genes increase the risk of prostate ca?

A

BRCA2

pTEN

88
Q

What are the symptoms of prostate cancer?

A 
Poor stream
Nocturia
Dribbling 
Frequency
Frequently asymptomatic
89
Q

What is the main mode of diagnosis with prostate ca?

A

PR

90
Q

Upon PR what would be felt if prostate ca is present?

A

Enlarged hard craggy prostate

obliterated median sulcus

91
Q

What common metastatic symptom do people present with if they have prostate ca?

A

pathological bone fracture

bone pain

92
Q

What investigation confirms diagnosis of prostate ca?

A

Ultrasound guided trans-rectal biopsy

93
Q

What tumour marker is raised in prostate ca?

A

PSA - not very specific

94
Q

How is prostate ca graded?

A

Gleason histological grade

95
Q

What is first line treatment of prostate tumours T2 or less?

A

Observation

96
Q

What is first line treatment of prostate tumours symptomatic T2?

A

radical surgery - perineal or retroperitoneal route

97
Q

What is used for palliative management of prostate ca?

A

TURP to relieve symptoms/ obstruction

98
Q

What hormonal therapies are available in the treatment of prostate ca?

A

LHRH agonists - goserelin, buserelin
Oestrogen therapy
Anti androgens

99
Q

What chemotherapy is available in treatment of prostate ca?

A

Docetaxel

100
Q

What is the 10 year survival for post-surgical prostate ca?

A

80-90%

101
Q

Name a complication of prostate ca?

A

MSCC

102
Q

What is the most common type of testicular cancer?

A

Germ cell - 95%

Lymphoma - 5%

103
Q

How would germ cell tumours of the testes be described in relation to their malignancy and response to treatment?

A

Highly malignant but highly responsive to treatment

104
Q

How are germ cell tumours of the testes spread?

A

para-aortic lymph nodes

Blood - lungs, liver, bone, brain

105
Q

How can germ cell tumours of the testes be further classified?

A

non-seminomaotus - 60%

seminomatous - 40%

106
Q

What are the 3 types of non-seminomatous germ cell tumours?

A

Malignant teratoma
Combined seminoma/ non-seminoma
Yolk sac tumour

107
Q

What are the risk factors for testicular cancer?

A

15-25 white male
Undescended testes
FH
Testicular atrophy

108
Q

What is the typical presentation of testicular cancer?

A

Painless testicular swelling/ lump in 90%

109
Q

What is more common, lytic or sclerotic bone metastases?

A

Lytic

110
Q

Which primary tumour most commonly causes sclerotic bone metastases?

A

Prostate

111
Q

Which primary tumours most commonly cause lytic bone metastases?

A

Thyroid
Melanoma
Renal cell
Multiple myeloma

CCC - LM (14 decks)

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