Corrections 2

Question 1

What is the most common cancer globally?

Answer 1

Basal cell carcinoma

Question 2

What are the 3 layers of the skin?

Answer 2

1) Epidermis
2) Dermis
3) Hypodermis

Question 3

What are the 5 layers of the epidermis?

Answer 3

1. Stratum basale (inner)
2. Stratum spinosum
3. Stratum granulosum
4. Stratum lucidum
5. Stratum corneum (outer)

Question 4

What are the principal cells of the epidermis?

Answer 4

Keratinocytes

Question 5

Describe the process of keratinsation

Answer 5

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.

Question 6

In which layer of the skin are adipose tissue and sweat glands found?

Answer 6

Hypodermis

Question 7

What genes are normally affected in BCC? (2)

Answer 7

1) PTCH
2) TP53

Question 8

What is the most common mechanism of spread of BCC?

Answer 8

Local invasion

Question 9

What are the 3 types of BCC?

Answer 9

1) Nodular (most common)
2) Superficial
3) Morpheaform

Question 10

What is the most common type of BCC?

Answer 10

Nodular

Question 11

What 2 topical creams may be used in the mx of BCC?

Answer 11

1) imiquimod
2) fluorouracil

Question 12

What layer of the skin does BCC occur in?

Answer 12

In the basal cell layer (the lowest part of the epidermis).

Question 13

What layer of the skin does SCC occur in?

Answer 13

In the stratum spinosum layer of the epidermis.

Question 14

Are BCC and SCC both cancers of keratinocytes?

Answer 14

yes - both BCC and SCC develop from keratinocytes in the epidermis

Question 15

What gene is often involved in SCC?

Answer 15

p53

Question 16

What is the most common skin cancer in Fitzpatrick skin types V and VI (brown and black skin)?

Answer 16

SCC

Question 17

What are 2 precancerous skin conditions that are considered pre-cursors to SCC?

Answer 17

1) Bowen’s disease
2) Actinic keratosis

Question 18

What are 2 biopsy options used in the diagnosis of SCC?

Answer 18

1) Excisional/shave

2) Incisional/punch

Question 19

When is an incisional/punch biopsy indicated in SCC?

Answer 19

If the SCC is;

a) large
b) in an inaccessible area
c) in a cosmetically sensitive area

Question 20

When is an excisional/shave biopsy indicated in SCC?

Answer 20

If the SCC is;

a) small
b) in an accessible area

Question 21

What does an excisional/shave biopsy involve?

Answer 21

Involves the removal of the whole lesion

Question 22

What does an incisional/punch biopsy involve?

Answer 22

Samples only part (usually 4mm) of the lesion.

Question 23

1st line mx of Bowen’s disease?

Answer 23

1) cryotherapy

2) topical 5-fluorouracil

Question 24

Mx of invasive SCC (i.e. growing beyond the epidermis)?

Answer 24

Conventional surgical excision with a minimum of 4mm margins

Question 25

What surgery is indicated in SCC in a cosmetically sensitive place (e.g. face)?

Answer 25

Mohs micrographic surgery (aka margin-controlled excision)

Question 26

What diametes defines low risk vs high risk SCC?

Answer 26

SCC with a diameter <20mm --> low risk SCC with a diameter >20mm --> high risk

Question 27

How does SCC being low vs high risk impact surgical excision?

Answer 27

Low risk SCC (<20mm) --> 4mm margins High risk SCC (>20mm) --> 6mm margins

Question 28

What diameter of SCC gives a poorer prognosis?

Answer 28

>20mm

Question 29

What depth of SCC gives a poorer prognosis?

Answer 29

>4mm

Question 30

What depth of SCC gives a better prognosis?

Answer 30

<2mm

Question 31

What are the 4 subtypes of melanoma?

Answer 31

1) superficial spreading 2) nodular 3) acral lentiginous 4) lentigo maligna melanoma

Question 32

Key features of SCC?

Answer 32

Ulcerating, crusting & bleeding

Question 33

Which type of melanoma is typically found on the palms, soles or under the nails?

Answer 33

Acral lentiginous melanoma

Question 34

What genetic condition has a skin cancer predisposition?

Answer 34

Xeroderma pigmentosum

Question 35

What diameter are most melanomas?

Answer 35

>6mm

Question 36

What is a differential for melanoma?

Answer 36

Seborrhoeic keratoses Have a waxy and 'stuck on' appearance

Question 37

How is a diagnosis of melanoma confirmed?

Answer 37

Full thickness excisional skin biopsy

Question 38

What are the main diagnostic features for melanoma (major criteria)?

Answer 38

1) change in shape 2) change in size 3) change in colour

Question 39

What is Breslow thickness?

Answer 39

Thickness of invasive melanoma in mm from the GRANULAR cell layer to the deepest tumour cell.

Question 40

What is the main mx of melanoma?

Answer 40

Wide local excision

Question 41

When is a sentinel lymph node biopsy indicated in melanoma?

Answer 41

Breslow thickness >0.8mm

Question 42

When is a sentinel lymph node biopsy normally completed?

Answer 42

Same time as surgival excision

Question 43

Inheritance of neurofibromatosis?

Answer 43

Autosomal dominant

Question 44

Which cancer can aromatic amines cause?

Answer 44

Bladder cancer

Question 45

Which cancer can vinyl chloride cause?

Answer 45

Angiosarcomas

Question 46

What 2 key conditions can cause a raised hCG in women?

Answer 46

1) pregnancy 2) germ cell tumour (choriocarcinoma)

Question 47

What type of cancer most commonly causes SVCO?

Answer 47

Small cell lung cancer

Question 48

What sign is examined for in suspected SVCO?

Answer 48

Pemberton's sign

Question 49

Where might a prominence be seen on a CXR in SVCO?

Answer 49

Right hilar prominence to indicate a mediastinal mass

Question 50

What is the imaging of choice in SVCO?

Answer 50

CT chest w/ contrast

Question 51

How many samples must be taken before diagnosing hypercalcaemia?

Answer 51

2 samples on 2 separate occasions

Question 52

What is the most common mechanism causing hypercalcaemia in malignancy?

Answer 52

PTHrP secretion

Question 53

What is calcitriol?

Answer 53

Active vitamin D

Question 54

Role of bisphosphonates?

Answer 54

Inhibit osteoclasts

Question 55

What is the most common cause of SVCO?

Answer 55

Small cell lung cancer

Question 56

What are the 2 most useful markers in detecting recurrence of testicular teratoma?

Answer 56

AFP & hCG These are often elevated in germ cell tumours (i.e. non-seminomas), including teratomas.

Question 57

In the UK, at what age can men request a PSA?

Answer 57

≥50 y/o

Question 58

What Likert score would indicate the need for a prostate biopsy?

Answer 58

≥3

Question 59

What scan is used to look for bony mets in prostate cancer?

Answer 59

Isotope bone scan

Question 60

What Gleason score is considered high risk for prostate cancer?

Answer 60

≥8

Question 61

What are the 2 classes of drugs used in hormone therapy in prostate cancer?

Answer 61

1) GnRH agonists e.g. goserelin 2) Androgen receptor blockers e.g. bicalutamide

Question 62

What are 2 key complications of a radical prostatectomy?

Answer 62

1) ED 2) Urinary incontinence

Question 63

What genes are involved in FAP?

Answer 63

Mutation of tumour suppressor gene APC (adenomatous polyposis coli)

Question 64

What is the bowel cancer screening programme in the UK?

Answer 64

People aged 60-74 are sent FIT tests to do every 2 years

Question 65

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)

Answer 65

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.

Question 66

What is Hartmann’s procedure? What is removed?

Answer 66

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.

Question 67

Describe Duke’s staging system for colorectal cancer

Answer 67

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

Question 68

Mx of Duke's C colon cancer?

Answer 68

Surgery + adjuvant chemo

Question 69

Which chemotherapy agent cause hypomagnesaemia?

Answer 69

Cisplatin

Question 70

What type of lung cancer is gynaecomastia associated with?

Answer 70

Adenocarcinoma

Question 71

What type of lung cancer is clubbing more associated with?

Answer 71

Adenocarcinoma

Question 72

A patient is found to have a suspicious lung mass on CXR. What investigation should be done next?

Answer 72

CT w/ contrast of chest, liver and adrenals

Question 73

What is retrograde ejaculation a common complication of? (2)

Answer 73

1) alpha blocker therapy 2) TURP (transurethral resection of the prostate)

Question 74

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?

Answer 74

Flutamide (a synthetic antiandrogen)

Question 75

What is the most appropriate 1st line treatment for classical Hodgkin’s lymphoma?

Answer 75

Chemo

Question 76

Where were aromatic amines used?

Answer 76

In dye & rubber industries

Question 77

1st line investigation in suspected bladder cancer?

Answer 77

Cystoscopy

Question 78

What may be used as a form of immunotherapy in the mx of bladder cancer?

Answer 78

Intravesical BCG

Question 79

What are the different types of testicular cancer?

Answer 79

1) Germ cell tumours (95%): - seminomas - non-seminomas 2) Non-germ cell tumours (5%): - leydig cell tumours - sarcomas

Question 80

Give 4 examples of non-seminomatous germ cell tumours (testicular cancer)

Answer 80

1) teratoma (most common) 2) yolk sac tumour 3) choriocarcinoma 4) embryonal carcinoma

Question 81

What genetic syndrome increases the risk of testiuclar cancer?

Answer 81

Klinefelter's

Question 82

Clinical features of testicular cancer?

Answer 82

- painless lump - hydrocele - gynaecomastia - testicular pain (occasionally)

Question 83

What type of testicular cancer can cause gynaecomastia?

Answer 83

Leydig cell tumour

Question 84

What type of testicular cancer is a raised AFP seen in?

Answer 84

Non-seminomas (most commonly teratomas) Note - a raised AFP rules out a seminomas

Question 85

What staging system is used for testicular cancer?

Answer 85

Royal Marsden staging system

Question 86

Describe stage 1-4 of the Royal Marsden staging system for testicular cancer

Answer 86

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

Question 87

Do seminomas or non-seminomas have a better prognosis?

Answer 87

Seminomas have a slightly better prognosis than non-seminomas.