Common oncological cases Flashcards
cancer screening programmes
cervical
breast- mammograms
colon- stool samples
enhanced screening with regular colonoscopies if familial
serum biomarkers for screeing
prostate PSA
ovarian ca125
imaging screening
lung
constitutional symptoms
night sweats weight loss appetite loss fatigue recurrent infections
complications
MSCC (spinal cord compression)
seizure
SVCO (vena cava obstruction from lymphomas)
hypercalaemia
rare- paraneoplastic syndromes
coagulopathy (DVT/PE)
red-flag symptoms of cancer CRUK
persistent cough/hoarseness (lung, head and neck)
change in appearance of skin lesion (A-E criteria for melanoma)
change in bowel habit (blood in stool)
chronic mouth ulcer (oral cancer)
persistent dysphagia
unexplained weight loss
persistent urinary symptoms
(prostate/bladder)
unexplained mass (sarcoma, breast lump)
unexplained bleeding
unexplained chronic pain
breast cancer red flags
weight loss peu d'orange nipple changes / pagets/ retraction hard/fixed/painless (inflammatory breast cancer T4) lymph nodes asymmetrical
tripple assessment
examination
biopsy / FNA then targeted biopsy
imaging (mammogram/MRI/USS)
sentinel biopsy is done if nothing suspicious found on MRI
if it is picked up then you do a normal node biopsy
tripple assessment
examination
biopsy / FNA then targeted biopsy
imaging (mammogram/MRI/USS)
sentinel biopsy is done if nothing suspicious found on MRI
if involved nodes is seen on the scan then you will target that node with a normal biopsy
TNM staging in breast cancer
tumor <2cm is T1 >2cm is T2
N- nodes 1
M- o (if haven’t had scan then MX)
important history
tumor size
axillary node status
tumor histology
- grade
- ER/PR status (oestrogen and progesterone)
- LVI (lympho vascular invasion) (high risk feature if invading into the vessels)
- HER2 expression (HER2 receptor)
- mitotic rate (how quickly its proliferating/agressive)
- lobular/ductal (two most common cancers of the breast)
age co-morbidities (cardiac) previous cancer treatment previous use of anthracyclines (chemo/radio)
risk: prognostic indicators NPI (nottingham prognostic index) NHS PREDICT oncotype dx adjuvant online
HER2
marked 1-3
1= negative
2= unsure on immuno histochemistry so do a FISH assay
3= positive
management
curative/radical
net-adjuvant chemotherapy
HER2 targeted therapy
(treatment to increase risk of cure before definitive treatment)
definitive tx:
wide local insicion
adjuvant tx (afterwards) chemotherapy HER2 targeted therapy hormone blockade radiotherapy
adjuvant SACT (systemic anti cancer therapy) breast
aromatase inhibitors
letrozole/anastrozole
exemstatone
selective oestrogen receptor modulator
tamoxifen
HER2 directed therapy
trastuzumab
pertuzumab
‘British Columbia drug monographs’
prostate cancer investigations
PR exam (DRE)
PSA blood test prostate biopsy \+/- MRI prostate \+/- CT TAP \+/- bone scan \+/- PET CT
