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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
What are the 5 year survival rates of stage 4 breast cancer?
18%
26
Chemotherapy reduces the risk of breast cancer recurrence by what %
28%
27
How common is colorectal cancer?
2nd most common after lung
28
What is the most common type of cololectal cancer?
Epithelial adenocarcinoma - 95% Sigmoid - 2/3 Rectum - 1/3
29
What are the genetic risk factors for colorectal cancer?
HNPCC FAP APC Gardner's syndrome
30
What are the non-genetic risk factors for colorectal cancer?
High animal fat diet Low fibre (increased transit time = increased exposure to carcinogens) High red meat UC/ Crohn's
31
How does colorectal cancer usually spread?
local invasion lymphatic coelemic spread
32
Focal occult blood test is thought to reduce mortality by what %?
15-18%
33
What type of anaemia can be caused by colorectal ca?
Iron deficiency
34
What are the typical presentations for colorectal ca?
``` Weight loss Altered bowel habit rectal bleeding Vague abdo pain Obstruction/tenesmus ```
35
Which genetic mutations cause progression of benign adenomas to malignant in colorectal ca?
p53 RAS DCC
36
What is offered to 55 year olds as part of the screening process for colorectal ca?
Sigmoidoscopy
37
What investigation is used to visualise the bowel in colorectal ca? What is used to biopsy lesions?
Rigid sigmiodoscopy to 25cm Flexible sigmoidoscopy & colonoscopy for biopsy
38
What tumour marker is raised in colorectal ca | What else can raise this marker?
CEA - carcino-embreyonic antigen Smoking, IBD, hepatitis, gastritis, pancreatitis
39
What imaging is used to stage colorectal ca?
CT
40
What criteria is used in the staging of colorectal ca?
Duke's
41
What age group is associated with an adverse prognosis in colorectal ca?
<40s | Associated with more aggressive form of cancer
42
What is the first line management of colorectal ca?
radical resection - may be curative for primary tumours | Improves survival in advanced disease
43
What surgery can be used to prevent obstructive lesions in colorectal ca?
Stent (palliative)
44
radiotherapy is used in which type of colorectal ca?
Rectal ca - can be used as primary treatment | Also used as neo-adjuvant/ adjuvant
45
Why is radiotherapy not used in colon cancer?
toxic to adjacent organs
46
Which chemotherapy agent is most used in colorectal ca?
5-FU
47
Which Duke's stage uses adjacent chemotherapy?
C
48
Men of any age with unexplained iron deficiency anaemia should be investigated for colorectal ca if their Hb is below what?
110
49
Non-menstruating women with unexplained iron deficiency anaemia should be investigated for colorectal ca if their Hb is below what?
100
50
Over 40s should be investigated for colorectal ca if their change in bowel habit has persisted for how long?
≥ 6 weeks
51
What are the common sites of metastasis in colorectal cancer?
Lung Liver Bone
52
What are the common sites of metastasis in breast cancer?
Bone Lung Liver Brain
53
What are the occupational causes of lung cancer?
Asbestos Uranium Ship building Petroleum refining
54
Is small cell or non-small cell LC more common?
Non-small cell 82%
55
What are the types of Non-small cell LC in order of most common?
Squamous cell carcinoma - 32% Adenocarcinoma - 26% Large cell carcinoma - 10% Others
56
Which lung ca has the worst prognosis?
small cell
57
Mutations in EGFR (epidermal growth factor receptor) is associated mostly with which type of lung cancer?
Adenocarcinoma
58
Adenocarcinoma is more common in which gender?
Women
59
Brachial plexus invasion is most associated with which tumour? How does it present?
Pancoast tumour | Associated with Horner's syndrome - unilateral ptosis, meiosis & anhydrosis
60
Pancoast tumour is usually which type of lung tumour?
Non-small cell
61
Small cell cancer is derived from which cells?
Neuro-endocrine cells within the lung
62
Secretion of ADH & ACTH is associated with which tumour?
small cell lung ca
63
Non-small cell or small cell are likely to metastasis early?
small cell
64
What on a CxR would be suggestive of lung ca?
Pleural effusion Slow resolving consolidations Lesion/ mass
65
Urgent lung cancer referral should be to all >40 who present with what?
heamoptysis
66
Mediastinal disease can present how?
SVCO | Recurrent laryngeal nerve palsy - voiceless
67
Clubbing occurs more frequently with which type of lung ca?
squamous cell carcinoma
68
What investigations are important when suspecting lung ca?
CxR - 95% are visible Sputum cytology - 80% of malignant cells are detectible in sputum Bronchoscopy - visualisation of the bronchial tree, biopsy & washings
69
How is a biopsy taken when suspecting lung ca?
Bronchoscopy
70
What are the 2 types of bronchoscopy?
Fibre optic | Rigid
71
How are peripheral tumours biopsied when suspecting lung ca?
Trans-thoracic biopsy
72
What imaging is used to assess extent of local and distant mets in lung ca?
PET-CT | PET can locate small mets not detected by CT
73
What is limited disease in relation to lung ca? | What is extensive disease in relation to lung ca?
Tumour confined to 1 hemithorax + local extension confined to mediastinal or ipsilateral supraclavicular nodes Disease beyond sites defined by limited disease
74
What proportion of people present with extensive disease in lung ca?
2/3
75
What is the first line treatment for SCLC?
Chemotherapy - most present with extensive disease If disease = limited, then adjuvant radiotherapy
76
Which lung ca is most chemo-sensitive? | What is the response rate?
Small cell | 90%
77
Which lung ca has the highest rate of relapse?
small cell
78
What is the prognosis of SCLC with chemo and no chemo?
Chemo: 11 months | No chemo: 2-4 months
79
In what proportion of those with SCLC is surgery appropriate?
10%
80
What is the first line treatment of NSCLC?
Surgery + adjuvant chemo
81
What percentage of NSCLC patients are suitable for primary radical surgery?
30%
82
What type of radiotherapy is used in NSCLC?
CHART - continuous hyper-fractioned accelerated radiotherapy
83
What targeted therapy is used in the palliative setting for NSCLC? What does it target?
Tyrosine kinase inhibitors (TKAs) | Target EGFR
84
What signs warrant immediate referral if suspecting lung ca?
SVCO obstruction | stridor
85
What is the most common type of prostate cancer?
Adenocarcinoma - 95%
86
BPH arises from the outer or centre of prostate?
centre
87
Which genes increase the risk of prostate ca?
BRCA2 | pTEN
88
What are the symptoms of prostate cancer?
``` Poor stream Nocturia Dribbling Frequency Frequently asymptomatic ```
89
What is the main mode of diagnosis with prostate ca?
PR
90
Upon PR what would be felt if prostate ca is present?
Enlarged hard craggy prostate | obliterated median sulcus
91
What common metastatic symptom do people present with if they have prostate ca?
pathological bone fracture | bone pain
92
What investigation confirms diagnosis of prostate ca?
Ultrasound guided trans-rectal biopsy
93
What tumour marker is raised in prostate ca?
PSA - not very specific
94
How is prostate ca graded?
Gleason histological grade
95
What is first line treatment of prostate tumours T2 or less?
Observation
96
What is first line treatment of prostate tumours symptomatic T2?
radical surgery - perineal or retroperitoneal route
97
What is used for palliative management of prostate ca?
TURP to relieve symptoms/ obstruction
98
What hormonal therapies are available in the treatment of prostate ca?
LHRH agonists - goserelin, buserelin Oestrogen therapy Anti androgens
99
What chemotherapy is available in treatment of prostate ca?
Docetaxel
100
What is the 10 year survival for post-surgical prostate ca?
80-90%
101
Name a complication of prostate ca?
MSCC
102
What is the most common type of testicular cancer?
Germ cell - 95% | Lymphoma - 5%
103
How would germ cell tumours of the testes be described in relation to their malignancy and response to treatment?
Highly malignant but highly responsive to treatment
104
How are germ cell tumours of the testes spread?
para-aortic lymph nodes | Blood - lungs, liver, bone, brain
105
How can germ cell tumours of the testes be further classified?
non-seminomaotus - 60% | seminomatous - 40%
106
What are the 3 types of non-seminomatous germ cell tumours?
Malignant teratoma Combined seminoma/ non-seminoma Yolk sac tumour
107
What are the risk factors for testicular cancer?
15-25 white male Undescended testes FH Testicular atrophy
108
What is the typical presentation of testicular cancer?
Painless testicular swelling/ lump in 90%
109
What is more common, lytic or sclerotic bone metastases?
Lytic
110
Which primary tumour most commonly causes sclerotic bone metastases?
Prostate
111
Which primary tumours most commonly cause lytic bone metastases?
Thyroid Melanoma Renal cell Multiple myeloma

CCC - LM (14 decks)

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