Corrections 2 Flashcards
What is the most common cancer globally?
Basal cell carcinoma
What are the 3 layers of the skin?
1) Epidermis
2) Dermis
3) Hypodermis
What are the 5 layers of the epidermis?
- Stratum basale (inner)
- Stratum spinosum
- Stratum granulosum
- Stratum lucidum
- Stratum corneum (outer)
What are the principal cells of the epidermis?
Keratinocytes
Describe the process of keratinsation
The basal cells of the epidermis are undifferentiated, proliferating cells that migrate upwards through all the 5 layers.
It takes about 30 days for the cells to migrate from the basal layer to cross the stratum corneum where they are finally shed.
In which layer of the skin are adipose tissue and sweat glands found?
Hypodermis
What genes are normally affected in BCC? (2)
1) PTCH
2) TP53
What is the most common mechanism of spread of BCC?
Local invasion
What are the 3 types of BCC?
1) Nodular (most common)
2) Superficial
3) Morpheaform
What is the most common type of BCC?
Nodular
What 2 topical creams may be used in the mx of BCC?
1) imiquimod
2) fluorouracil
What layer of the skin does BCC occur in?
In the basal cell layer (the lowest part of the epidermis).
What layer of the skin does SCC occur in?
In the stratum spinosum layer of the epidermis.
Are BCC and SCC both cancers of keratinocytes?
yes - both BCC and SCC develop from keratinocytes in the epidermis
What gene is often involved in SCC?
p53
What is the most common skin cancer in Fitzpatrick skin types V and VI (brown and black skin)?
SCC
What are 2 precancerous skin conditions that are considered pre-cursors to SCC?
1) Bowen’s disease
2) Actinic keratosis
What are 2 biopsy options used in the diagnosis of SCC?
1) Excisional/shave
2) Incisional/punch
When is an incisional/punch biopsy indicated in SCC?
If the SCC is;
a) large
b) in an inaccessible area
c) in a cosmetically sensitive area
When is an excisional/shave biopsy indicated in SCC?
If the SCC is;
a) small
b) in an accessible area
What does an excisional/shave biopsy involve?
Involves the removal of the whole lesion
What does an incisional/punch biopsy involve?
Samples only part (usually 4mm) of the lesion.
1st line mx of Bowen’s disease?
1) cryotherapy
2) topical 5-fluorouracil
Mx of invasive SCC (i.e. growing beyond the epidermis)?
Conventional surgical excision with a minimum of 4mm margins
What surgery is indicated in SCC in a cosmetically sensitive place (e.g. face)?
Mohs micrographic surgery (aka margin-controlled excision)
What diametes defines low risk vs high risk SCC?
SCC with a diameter <20mm –> low risk
SCC with a diameter >20mm –> high risk
How does SCC being low vs high risk impact surgical excision?
Low risk SCC (<20mm) –> 4mm margins
High risk SCC (>20mm) –> 6mm margins
What diameter of SCC gives a poorer prognosis?
> 20mm
What depth of SCC gives a poorer prognosis?
> 4mm
What depth of SCC gives a better prognosis?
<2mm
What are the 4 subtypes of melanoma?
1) superficial spreading
2) nodular
3) acral lentiginous
4) lentigo maligna melanoma
Key features of SCC?
Ulcerating, crusting & bleeding
Which type of melanoma is typically found on the palms, soles or under the nails?
Acral lentiginous melanoma
What genetic condition has a skin cancer predisposition?
Xeroderma pigmentosum
What diameter are most melanomas?
> 6mm
What is a differential for melanoma?
Seborrhoeic keratoses
Have a waxy and ‘stuck on’ appearance
How is a diagnosis of melanoma confirmed?
Full thickness excisional skin biopsy
What are the main diagnostic features for melanoma (major criteria)?
1) change in shape
2) change in size
3) change in colour
What is Breslow thickness?
Thickness of invasive melanoma in mm from the GRANULAR cell layer to the deepest tumour cell.
What is the main mx of melanoma?
Wide local excision
When is a sentinel lymph node biopsy indicated in melanoma?
Breslow thickness >0.8mm
When is a sentinel lymph node biopsy normally completed?
Same time as surgival excision
Inheritance of neurofibromatosis?
Autosomal dominant
Which cancer can aromatic amines cause?
Bladder cancer
Which cancer can vinyl chloride cause?
Angiosarcomas
What 2 key conditions can cause a raised hCG in women?
1) pregnancy
2) germ cell tumour (choriocarcinoma)
What type of cancer most commonly causes SVCO?
Small cell lung cancer
What sign is examined for in suspected SVCO?
Pemberton’s sign
Where might a prominence be seen on a CXR in SVCO?
Right hilar prominence to indicate a mediastinal mass
What is the imaging of choice in SVCO?
CT chest w/ contrast
How many samples must be taken before diagnosing hypercalcaemia?
2 samples on 2 separate occasions
What is the most common mechanism causing hypercalcaemia in malignancy?
PTHrP secretion
What is calcitriol?
Active vitamin D
Role of bisphosphonates?
Inhibit osteoclasts
What is the most common cause of SVCO?
Small cell lung cancer
What are the 2 most useful markers in detecting recurrence of testicular teratoma?
AFP & hCG
These are often elevated in germ cell tumours (i.e. non-seminomas), including teratomas.
In the UK, at what age can men request a PSA?
≥50 y/o
What Likert score would indicate the need for a prostate biopsy?
≥3
What scan is used to look for bony mets in prostate cancer?
Isotope bone scan
What Gleason score is considered high risk for prostate cancer?
≥8
What are the 2 classes of drugs used in hormone therapy in prostate cancer?
1) GnRH agonists e.g. goserelin
2) Androgen receptor blockers e.g. bicalutamide
What are 2 key complications of a radical prostatectomy?
1) ED
2) Urinary incontinence
What genes are involved in FAP?
Mutation of tumour suppressor gene APC (adenomatous polyposis coli)
What is the bowel cancer screening programme in the UK?
People aged 60-74 are sent FIT tests to do every 2 years
What is removed in the following colorectal surgeries:
a) right hemicolectomy
b) left hemicolectomy
c) high anterior resection
d) low anterior resection
e) abdomino-perineal resection (APR)
a) caecum, ascending colon & proximal transverse colon
b) distal transverse colon & descending colon
c) sigmoid colon
d) sigmoid colon and upper rectum (but sparing rectum and anus)
e) rectum and anus (plus or minus sigmoid colon) and suturing over the anus.
What is Hartmann’s procedure?
What is removed?
Is usually an emergency procedure that involves the removal of the rectosigmoid colon and creation of an colostomy.
The rectal stump is sutured closed.
The colostomy may be permanent or reversed at a later date.
Describe Duke’s staging system for colorectal cancer
Duke’s A - cancer is in inner lining of bowel, or slightly growing into muscle layer
Duke’s B - cancer has grown through muscle layer of bowel
Duke’s C - cancer has spread to at least 1 lymph node close to the bowel
Duke’s D - cancer has spread to another part of the body, such as the liver, lungs or bones
Mx of Duke’s C colon cancer?
Surgery + adjuvant chemo
Which chemotherapy agent cause hypomagnesaemia?
Cisplatin
What type of lung cancer is gynaecomastia associated with?
Adenocarcinoma
What type of lung cancer is clubbing more associated with?
Adenocarcinoma
A patient is found to have a suspicious lung mass on CXR.
What investigation should be done next?
CT w/ contrast of chest, liver and adrenals
What is retrograde ejaculation a common complication of? (2)
1) alpha blocker therapy
2) TURP (transurethral resection of the prostate)
During the first stages of treatment, goserelin may cause a transient increase in symptoms of prostatic cancer (‘flare effect’).
What can be given to help avoid this?
Flutamide (a synthetic antiandrogen)
What is the most appropriate 1st line treatment for classical Hodgkin’s lymphoma?
Chemo
Where were aromatic amines used?
In dye & rubber industries
1st line investigation in suspected bladder cancer?
Cystoscopy
What may be used as a form of immunotherapy in the mx of bladder cancer?
Intravesical BCG
What are the different types of testicular cancer?
1) Germ cell tumours (95%):
- seminomas
- non-seminomas
2) Non-germ cell tumours (5%):
- leydig cell tumours
- sarcomas
Give 4 examples of non-seminomatous germ cell tumours (testicular cancer)
1) teratoma (most common)
2) yolk sac tumour
3) choriocarcinoma
4) embryonal carcinoma
What genetic syndrome increases the risk of testiuclar cancer?
Klinefelter’s
Clinical features of testicular cancer?
- painless lump
- hydrocele
- gynaecomastia
- testicular pain (occasionally)
What type of testicular cancer can cause gynaecomastia?
Leydig cell tumour
What type of testicular cancer is a raised AFP seen in?
Non-seminomas (most commonly teratomas)
Note - a raised AFP rules out a seminomas
What staging system is used for testicular cancer?
Royal Marsden staging system
Describe stage 1-4 of the Royal Marsden staging system for testicular cancer
Stage 1 – isolated to the testicle
Stage 2 – spread to the retroperitoneal lymph nodes
Stage 3 – spread to the lymph nodes above the diaphragm
Stage 4 – metastasised to other organs
Do seminomas or non-seminomas have a better prognosis?
Seminomas have a slightly better prognosis than non-seminomas.
