Corrections - Oncology Flashcards
What cancer is Ca125 associated wtih?
Ovarian
What cancer is Ca 19-9 associated with?
Pancreatic
What cancer is Ca15-3 associated wtih?
Breast
What cancer is alpha-feta protein (AFP) associated wtih?
Hepatocellular carcinoma , teratoma (germ cell tumour)
What cancer is PSA associated wtih?
Prostatic carcinoma
What cancer is carcinoembryonic antigen (CEA) associated wtih?
Colorectal
What cancer is S-100 associated wtih?
Melanoma, schwannomas
What cancer is bombesin associated wtih?
Small cell lung carcinoma, gastric cancer, neuroblastoma
What is cisplatin?
a type of chemotherapy.
Mechanism of cisplatin?
Causes cross-linking in DNA –> prevents DNA strand separation and can thus act as absolute blocks to DNA replication and/or DNA transcription.
3 main adverse effects of cisplatin?
1) ototoxicity
2) peripheral neuropathy
3) hypomagnesaemia
Mechanism of methotrexate?
Inhibits dihydrofolate reductase and thymidylate synthesis
What are the 4 adverse effects of methotrexate?
1) myelosuppression
2) mucositis
3) liver fibrosis
4) lung fibrosis
Which chemo drug can cause lung fibrosis?
methotrexate
Which chemo drug can cause liver fibrosis?
methotrexate
Which chemo drug can cause ototoxicity?
Cisplatin
Which type of lung cancer has the strongest association with smoking?
Squamous cell carcinoma (a type of NSCLC)
Which type of lung cancer has the strongest association with hypercalcaemia?
Why
Squamous cell –> associated with parathyroid hormone-related protein (PTHrP) secretion which causes hypercalcaemia
Which type of lung cancer has the strongest association with finger clubbing?
Squamous cell
Which type of lung cancer is most common type in non-smokers?
Adenocarcinoma - although the majority of patients who develop lung adenocarcinoma are smokers
What is the most common and early feature of spinal cord compression?
Back pain
What may exacerbate back pain in spinal cord compression?
Coughing, lying down, movement
In suspected spinal cord compression, what is 1st line investigation?
What is time frame?
MRI whole spine - within 24 hours of presentation
What do neurological signs in metastatic spinal cord compression depend on?
Level of lesion
How do lesions ABOVE L1 in metastatic spinal cord compression present?
Usually result in UPPER motor neuron signs in the legs and a sensory level.
How do lesions BELOW L1 in metastatic spinal cord compression present?
Usually cause LOWER motor neuron signs in the legs and perianal numbness. Tendon reflexes tend to be increased below the level of the lesion and absent at the level of the lesion.
Management of metastatic spinal cord compression?
High dose oral dexamethasone (with PPI cover)
urgent oncological assessment for consideration of radiotherapy or surgery
What is the most common symptom of SVCO?
Dyspnoea
Give some features of SVCO
- Dyspnoea
- Swelling of face, neck and arms (conjunctival and periorbital oedema may be seen)
- Headaches (often worse in morning)
- Visual disturbance
- Pulseless jugular venous distension
What are the 2 most common malignancies causing SVCO?
- SCLC
- Lymphoma
What is given to suppress nausea and vomiting in patients with intracranial tumours, causing raised intracranial pressure?
Dexamethasone
Which cytotoxic drug is most likely to cause cardiomyopathy?
Doxorubicin
In women with bone mets, where are they most likely to originate from?
Breast
in a woman found to have an abdominal malignancy of unknown primary, what tumour marker should be done?
Ca-125
What are the carcinogenic subtypes of HPV?
16, 18 and 33
What are some UMN signs?
- Weakness
- Spasticity
- Clonus
- Hyperreflexia
What are the 3 most common tumours causing bone mets?
1) Prostate (most common)
2) breast
3) lung
Featrues of bone mets?
- Bone pain
- Pathological fractures
- Hypercalcaemia
- Raised ALP
Which 2 cytotoxic agents can cause lung fibrosis?
1) methotrexate
2) bleomycin
Which 2 tumour markers are most useful in detecting recurrence of testicular teratoma?
1) beta-hCG
2) Alpha-fetoprotein (AFP)
What is the most common site of bone metastases?
Spine
Which ytypepe of cancer is calcitonin a tumour marker for?
Medullary thyroid cancer
A patient with lung cancer has a Positron Emission Tomography (PET) scan to evaluate possible metastatic disease. What does this type of scan demonstrate?
Glucose uptake
What non-surgical option is available to patients with breast cancer who present with clinically palpable lymphadenopathy?
Axillary node clearence is indicated at primary surgery (via axillary radiotherapy)
In patients with breast cancer undergoing sentinel node biopsy, if there are axillary lymph nodes involving only isolated tumour cells or micrometastases, what is the next step in management regarding axillary lymph nodes?
The axilla is considered clear - no further treatment to axillary is needed
The vast majority of patients who have breast cancer diagnosed will be offered surgery.
What may an exception to this be?
An exception may be a very frail, elderly lady with metastatic disease who may be better managed with hormonal therapy.
Prior to surgery, the presence/absence of axillary lymphadenopathy determines breast cancer management.
What is next step in women with no palpable axillary lymphadenopathy at presentation?
Should have a pre-operative axillary ultrasound before their primary surgery
If this is NEGATIVE –> they should have a sentinel node biopsy to assess the nodal burden
Prior to surgery, the presence/absence of axillary lymphadenopathy determines breast cancer management.
What is next step in women who present WITH palpable axillary lymphadenopathy?
axillary node clearance is indicated at primary surgery –> may lead to arm lymphedema and functional arm impairment
What is recommended after a woman has had a wide-local excision of breast cancer?
WHOLE breast radiotherapy –> can reduce risk of recurrence by 2/3
What is indicated at 1ary surgery in breast cancer patients who present with clinically palpable lymphadenopathy?
Axillary node clearance
What cancers can HRT increase the risk of
1) Breast cancer (this is increased by the addition of a progestogen)
2) Endometrial cancer (reduced by the addition of a progestogen but not eliminated completely –> oestrogen by itself should not be given as HRT to women with a womb)
can a family member act as a chaperone in intimate exams?
No - should usually be a health professional
When is surgical excision indicated in a breast fibroadenoma?
surgical excision is usual if >3cm
What may be raised in 2ary bone tumours?
ALP and serum calcium
What cancers can the COCP increase the risk of ?
Breast & cervical
What cancers can the COCP be protective against ?
Endometrial & ovarian
What endocrine disorder are people with Down Syndrome at an increased risk of ?
Hypothryoidiskm
What treatment is indicated in node positive breast cancer (i.e. cancer has spread into the lymphatic system)?
FEC-D chemo
Is tamoxifen a complete oestrogen receptor antagonist or selective?
Selective oestrogen receptor modulator (SERM)
Features of Kartagener syndrome?
- dextrocardia or complete situs inversus
- bronchiectasis
- recurrent sinusitis
- subfertility (secondary to diminished sperm motility and defective ciliary action in the fallopian tubes)
In what size tumours is a wide local excision in breast cancer favoured?
If the tumour is less than 4cm
Define premature ovarian failure (POF)
the cessation of menses for 1 year before the age of 40
Strong risk factors for premature ovarian failure (POF)?
- Positive FH
- Exposure to chemo/radiotherapy
- Autoimmune disease
In women < 30 years of age presenting with an unexplained breast lump with or without pain, what is appropriate next step?
Routine referral to breast clinic (i.e. not urgent)
What is the main risk factor for cholangiocarcinoma?
primary sclerosis cholangitis (PSC)
What screening tests are pregnant women offered at their booking appointment?
1) HIV
2) Syphilis
3) Hepatitis B
Tests for sickle cell disease and thalassemia are also offered at this stage.
Patients who have received an organ transplant are at risk of what cancer?
Skin cancer - particularly squamous cell carcinoma (due to long-term use of immunosuppressants)
What are the 2 most common cancers associated with HNPCC?
1) Colorectal (most common)
2) Endometrial (2nd most)
What are the 4 main causes of avascular necrosis of the hip?
1) long-term steroid use (e.g. asthma)
2) chemotherapy
3) alcohol excess
4) trauma
Describe the nipple discharge in duct ectasia
The discharge is often thick and green
Presentation of mammary duct ectasia?
- Patients usually present with nipple discharge, which may be from single or multiple ducts (usually present age >50 years)
- The discharge is often thick and green
What is the most common cause of brown-green nipple discharge in women?
Duct ectasia
Imaging of choice in fibroadenoma?
US of lump (if woman <35)
In women with breast cancer and no palpable lymphadenopathy, if a pre-operative axillary ultrasound is negative what is next step?
they should have a sentinel node biopsy to assess the nodal burden
What is chance of inheriting BRCA 1 mutation?
50% (boys and girls)
What is a galactocele?
Galactocele typically occurs in women who have recently stopped breastfeeding and is due to occlusion of a lactiferous duct.
A build up of milk creates a cystic lesion in the breast.
Who is a galactocele most common in?
Women who have recently stopped breastfeeding
Define transcoelomic spread
The spread of a primary tumour through the PERITONEAL CAVITY and onto the surface of organs covered by the peritoneum.
Relatively rare type of metastasis.
Most commonly seen in a) ovarian cancer, b) mesothelioma
Class of drug used for intractable N&V in end of life patients?
Neurokinin-1 (NK1) receptor antagonists e.g. aprepitant
What class of drug is Ondesantron?
5-HT3 receptor antagonist
What is the most common route of metastasis?
Haematogenous spread e.g. prostate to spine
Effect of tamoxifen on endometrial tissue?
Stimulates oestrogen receptors in endometrium:
a) can increase risk of endometrial cancer
b) can result in endometrial proliferation and cause abnormal vaginal bleeding
what chemo drug is most associated with peripheral neuropathy?
vincristine
In patients taking cisplatin, what is it important to monitor?
Kidney function - can cause nephrotoxicity (and ototoxicity)
Immediate management of MSCC?
Dexamethasone THEN urgent MRI
Gastric outlet obstruction is a common cause of vomiting in patients with pancreatic cancer (tumour may invade or compress the area where the stomach empties into the duodenum).
Symptoms?
- Severe vomiting
- Abdo discomfort
- Weight loss
Presentation of hepatocellular carcinoma?
- jaundice
- deranged LFTs
- ascites
- oedema
- raised serum AFP
What is leptomeningeal metastases (carcinomatous meningitis)?
When cancer cells spread to the meninges.
E.g. breast cancer
Symptoms:
- confusion
- dizziness
- fatigue
- neurological deficits
What is the most common side effect of doxorubicin?
Fatigue
Management of hyperkalaemia in patients with EKG changes or severe hyperkalemia?
10% calcium gluconate - to protect cardiomyocytes
What is MEN1 syndrome?
Combination of:
1) parathyroid tumour
2) pituitary tumour
3) pancreatic tumour
2 week referral for oral cancer?
patients with unexplained ulceration in the oral cavity lasting for more than 3 weeks
Which infection increases the risk of HCC?
Chronic hep B
What is tumour lysis syndrome?
The tumor lysis syndrome occurs when tumor cells release their contents into the bloodstream, either spontaneously or in response to therapy.
Findings in tumour lysis syndrome?
1) potassium
2) calcium
3) urea
4) phosphate
1) hyperkalaemia
2) hypocalcaemia
3) increased blood urea nitrogen (BUN)
4) hyperphosphataemia
What is mucositis?
Mucositis is inflammation of the mucosa, the mucous membranes that line your mouth and your entire gastrointestinal tract.
Common side effect of radiotherapy or chemo.
Common cause of line infections (particularly in neutropenic patients)?
Staph. epidermis
1st line antiemetic for end of life patients with obstructive bowel disorders?
cyclizine
can also give hyoscine butylbromide to reduce colicky abdominal pain
1st line management of neutropenic sepsis?
IV tazocin
Which chemo drug can cause haemorrhagic cystitis?
Cyclophosphamide
What is hereditary breast and ovarian cancer (HBOC) syndrome?
Inherited condition that increases the risk of developing breast, ovarian, and other types of cancer.
Most commonly associated with mutations in BRCA1 and BRCA2 genes.
What cancer can elevated AFP be associated with?
HCC
Can also indicate non-seminoma germ cell tumour
Presentation of tumour lysis syndrome?
- Dysuria/oliguria
- Abdo pain
- Weakness
Often days within receiving chemo.
Management –> fluids
Prophylaxis of tumour lysis syndrome?
1) Aggressive IV hydration (promote urinary excretion of electrolytes and prevent AKI)
2) Allopurinol (reduce production of uric acid)
What triad is seen in serotonin syndrome?
1) mental state changes
2) autonomic hyperactivity (e.g. diarrhoea, pupil dilation)
3) tremor
Male side effect of radiotherapy for prostate acancer?
ED
Side effects of prostate radiotherapy?
- ED
- Leakage of urine
- Radiation cystitis
- Urethral stricture
- Changes to bowel habits
- Proctitis
- Increased risk of cancer of bladder and rectum
1st line for breathlessnes in end of life?
Morphine sulphate SC
Genetic testing for HNPCC?
MSH1 and MSH2 mutations
What type of lung cancer are cavitating lesions more common with?
Squamous cells
Given the site of colorectal cancers, what type of resection is most appropriate?
1) Caecal, ascending or proximal transverse colon
2) Distal transverse, descending colon
3) Sigmoid colon
4) Upper rectum
5) Lower rectum
1) Right hemicolectomy
2) Left hemicolectomy
3) High anterior resection
4) Anterior resection (TME)
5) Anterior resection (low TME)
Referral for people aged < 30 years with an unexplained breast lump with or without pain
Routine
Mechanism of GnRH agonists (e.g. goserelin) in prostate cancer?
Paradoxically result in lower LH levels longer term by causing overstimulation, resulting in disruption of endogenous hormonal feedback systems. The testosterone level will therefore rise initially for around 2-3 weeks before falling to castration levels.
Initially, what is therapy with GnRH agonists in prostate cancer covered with? Why?
An anti-androgen (e.g. cyproterone acetate) to prevent a rise in testosterone - ‘tumour flare’.
This flare may result in bone pain, bladder obstruction and other symptoms.
NICE advise that, as PSA levels may be increased, testing should not be done within how long of the following?
1) prostate biopsy
2) proven UTI
3) PR exam
4) vigorous exercise
5) ejaculation
1) 6 weeks
2) 4 weeks
3) 1 week
4) 48 hours
5) 48 hours
For patients undergoing breast-conserving surgery followed by radiotherapy, the findings of how many involved nodes (during sentinel lymph node biopsy) indicates further management of the axilla?
3 or more –> indicates need for axillary lymph node dissection
What is melanosis coli?
What is it most associated with?
Melanosis coli is a condition characterised by the presence of pigment-laden macrophages in the lamina propria of the colon
It is most commonly associated with chronic use or abuse of anthraquinone-containing laxatives, such as senna or cascara
What type of lung cancer is most associated with gynaecomastia?
Adenocarcinoma
What type of lung cancer is most associated with hypercalcaemia?
Squamous cell due to parathyroid hormone-related protein (PTH-rp) secretion
What type of lung cancer is most associated with clubbing?
Squamous cell
What type of lung cancer is most associated with hyperthyroidism?
Squamous cell due to ectopic TSH
Which cancer does coeliac disease increase the risk of?
enteropathy-associated T cell lymphoma
What triad can renal cell carcinoma present with?
1) ongoing loin pain
2) haematuria
3) pyrexia
Management of all patients with macroscopic haematuria?
2 week wait referral
What is the most common inheritable form of colorectal cancer?
HNPCC (Lynch syndrome)
What are the 3 most common paraneoplastic syndromes associated with small cell lung cancer?
1) Ectopic ACTH production
2) SIADH
3) Lambert Eaton syndrome
Does surgery normally play a role in small cell lung cancer?
No - chemotherapy (and then maybe radiotherapy) is normally the mainstay due to rapid progression
Give 3 mutations seen in non small cell lung cancer
1) Epidermal growth factor receptor (EGFR)
2) KRAS
3) TP53
Give some causes of PR bleeding
- Cancer
- Anal fissure
- Haemorrhoids
- Gastroenteritis
- Trauma
- Anticoagulants
What to look for on examination in colorectal cancer?
- Anaemia
- Abdo mass
- Mass on PR exam
- Weight loss
Is local recurrence more common in rectal or colon cancers?
Rectal
What can be done to reduce risk of local recurrence in moderate/high risk rectal cancers?
Consider neoadjuvant treatment prior to surgery e.g. radiotherapy or radio+chemo
All patients receiving 5FU (Fluorouracil) chemotherapy now receive testing for what?
DPD deficiency –> without enough DPD enzyme, these chemotherapy drugs build up in the body and cause more severe side effects than usual. In some situations, these side effects can be life threatening.
What 3 follow up investigations are done post colorectal cancer treatment?
1) CEA 6 monthly
2) CT scan 18m, 3y, 5y
3) Colonoscopy within 12m if not completed at diagnosis, 3y post last one
What are the surgery options in breast cancer?
1) Breast –> wide local excision, mastectomy
2) Axilla:
If axillary involvement has already been identified, need to do axillary clearance.
If axillary involvement has not be identified, must do a sentinel lymph node biopsy during surgery.
If biopsy found to be positive –> further treatment for axilla such as axillary clearance.
If biopsy found to be positive –> no further treatment.
Options for adjuvant systemic treatments in breast cancer?
1) Chemo
2) Radiotherapy
3) Targeted therapies (Her2)
4) Hormonal therapy (e.g. ER +ve)
What are the 2 most commonly used chemo drugs in breast cancer?
1) EC (Epirubicin and Cyclophosphamide)
2) Docetaxel
Typical chemo drug used in palliative setting in breast cancer?
Oral chemo (Capecitabine)
General side effects of chemo?
Fatigue
Hair loss
N&V
Mucositis
Gastritis
Diarrhoea/constipation
Myelosuppression (neutropenic sepsis)
Thrombocytopenia
Anaemia
Which type of chemo drug causes cardiomyopathy?
Anthracyclines e.g. doxorubicin, epirubicin
Which type of chemo drug causes nephrotoxicity, ototoxicity, and neuropathy?
Platinum drugs e.g. cisplatin
3 mechanisms of action of hormonal therapies in breast cancer:
1) Block oestrogen effect –> Tamoxifen (generally can be used in pre and post-menopausal women)
2) Block oestrogen production –> Oophrectomy in younger women, medical oophrectomy using goserelin (GnRH agonist)
3) Block extra-ovarian oestrogen production (in post-menopausal women) –> Aromatase inhibitors e.g. anastrozole, letrozole
Adverse effects of tamoxifen?
Vasomotor
Mood changes
Vaginal discharge
Loss of libido
Body image
Endometrial changes: benign/malignant
Thromboembolic episodes: DVT/stroke
Adverse effects of aromatase inhibitors?
Vasomotor
Mood changes
Vaginal dryness
Loss of libido
Body image
Arthralgia and myalgia
Decrease in bone density
What is HER2?
Cell surface receptor that controls cell growth and deivision
What is HER2+ breast cancer?
Too many HER2 receptors on cells send more signals, causing cells to grow too quickly
What drug is used in HER2 cancer?
Herceptin (Trastuzumab)
What is Trastuzumab?
Monoclonal Ab against HER2 protein (i.e. immunotherapy)
Poorer progonosis
- Higher TNM stage
- Higher grade
- Molecular markers
- ER negative disease
- HER2 positive disease
Sentinel lymph node biopsy vs axillary lymph node dissection?
Axillary dissection removes more axillary lymph nodes than a sentinel node biopsy does.
Most often, a sentinel lymph node biopsy is done, during which only a few lymph nodes are removed. In some cases, an axillary lymph node dissection, which removes more lymph nodes, might be needed.
When is axillary lymph node dissection indicated?
ALND is usually done at the same time as a mastectomy or breast-conserving surgery (BCS), but it can be done in a second operation.
ALND may be needed if a previous SLNB has shown 3 or more of the underarm lymph nodes have cancer cells.
How can pancoast tumours present?
- Horner’s syndrome
- Hoarseness (seen with Pancoast tumours pressing on the recurrent laryngeal nerve)
How are Pancoast tumours diagnosed?
CT chest
How can platelets be an indicator of lung cancer?
Raised platelets can be an indicator of lung cancer
wedge-shaped opacification on a CXR?
Consider PE
What ethnicity is prostate cancer more common in?
Afro-Caribbean population
In Cushing’s disease, what are the results of a dexamethasone suppression test?
Cortisol is not suppressed by low-dose dexamethasone but is suppressed by high-dose dexamethasone.
Urgent surgical treatment of a sigmoid tumour e.g. perforation?
Hartmann’s procedure
Why is Hartmann’s indicated in emergencies?
Hartmann’s procedure involves resection of the relevant portion of bowel and formation of an end colostomy/ileostomy.
In the future patients can undergo a reversal of Hartmann’s procedure, whereby the end colostomy is closed following the formation of a colorectal anastomosis, restoring continuity of the bowels.
This makes it the ideal surgical procedure for emergency situations where the bowel has perforated and the risk of an anastomosis is much greater.
What are the 2 most common causes of bilateral hilar lymphadenopathy?
1) TB
2) Sarcoidosis
A patient who is >= 40 years old presenting with unexplained haemoptysis?
2 week wait referral
What cancer can pernicious anaemia predispose to?
Gastric carcinoma
What is 1ary hyperparathyroidism most commonly due to?
Solitary adenoma
Calcium and PTH levels in 1ary vs 2ary hyperparathyroidism?
1ary –> high PTH, high calcium, low phosphate
2ary –> high PTH, low calcium
3ary –> high phosphate
What is a cause of 2ary hyperparathyroidism?
Renal failure
How does renal failure cause 2ary hyperparathyroidism?
1) there is also decreased renal production of 1,25 (OH)2 vitamin D: responsible for aiding calcium absorption in the gut
2) increasing levels of serum phosphorus which complexes with serum calcium forming deposits
Why is PTH level low in squamous cell lung cancers producing PTHrP?
Parathyroid hormone-related protein mimics PTH resulting in high calcium levels. However, this protein is not detected in assays and the the PTH level is therefore low.
Why can long term mechanical ventilation in trauma patients lead to recurrent pneumonias?
Long term mechanical ventilation in trauma patients can result in tracheo-oesophageal fistula formation
What is a calcified Ghon complex?
May be seen on CXR in patients with latent TB.
This indicates that they have had a primary TB infection in the past, which became contained in a granuloma (the Ghon focus) and over time has calcified.
TB bacteria may still be present in the lesion and he could develop active disease, particularly if they become immunocompromised.
What is the most common cause of small bowel obstruction?
Adhesions e.g. following previous surgery (such as cesarian section)
What is Peutz-Jeghers syndrome?
An autosomal dominant condition characterised by numerous hamartomatous polyps in the gastrointestinal tract.
Features of Peutz-Jeghers syndrome?
1) pigmented lesions on lips, oral mucosa, face, palms and soles
2) hamartomatous polyps in the GI tract (mainly small bowel)
- small bowel obstruction is a common presenting complaint, often due to intussusception
- GI bleeding
Why is the main benefit of post-op analgesia being given via epidural compared to alternative forms?
Faster return of normal bowel function
What is the most appropriate management plan in patients with rectal cancer on the anal verge?
Abdomino-perineal excision of rectum
1st line investigation in suspected prostate cancer?
Multiparametric MRI (this has replaced TRUS biopsy)
What is the major adverse effect of bleomycin?
Pulmonary fibrosis
FAP vs Gardners syndrome?
Gardner syndrome is a variant of FAP.
Like in FAP, people with Gardner syndrome develop multiple adenomatous colon polyps, but in addition, they also develop other tumors outside the GI organs, e.g. skull osteoma, thyroid cancer, epidermoid cysts.
What is calcitonin a tumour marker in ?
Medullary thyroid cancer
What is beta-hCG and alpha feto protein tumour markeres in?
Non-seminomatous testitcular cancer (a raised alpha feto protein excludes a seminoma)
Main adverse effect of vincristine?
Peripheral neuropathy (may lead to urinary hesistancy 2ary to bladder atony)
How long must you wait to test PSA following proctitis?
4 weeks
Type of resection in anal verge cancers?
Abdomino-perineal excision of rectum (no anastomosis)
Patients are at increased risk of which cancers following radiotherapy for prostate cancer?
bladder, colon, and rectal cancer
How is chronic urinary retention characterised?
by being painless and insidious.
Cause of high pressure urinary retention?
Typically due to bladder outflow obstruction e.g. in BPH
Features of high pressure urinary retention vs low?
High:
- impaired renal function
- bilateral hydronephrosis
Low:
- normal renal function
- no hydronephrosis
What commonly occurs after catheterisation for chronic urinary retention?
Decompression haematuria due to the rapid decrease in the pressure in the bladder (no further treatment required)
Management options for localised prostate cancer (T1/T2)?
Depends on patient choice and life expectancy:
1) conservative: active monitoring & watchful waiting (particularly in patients with significant comorbidities)
2) radical prostatectomy
3) radiotherapy: external beam and brachytherapy
Which type of lung cancer is associated with hypertrophic pulmonary osteoarthropathy (HPOA)?
Squamous cell carcinoma
What is hypertrophic pulmonary osteoarthropathy (HPOA)?
the combination of clubbing and periostitis of the small hand joints (swelling)
Investigation for ensuring there are no leaks in a colorectal anastomosis?
Gastrogafin enema ( passing a water soluble radiopaque liquid into the rectum, then taking radiographs to assess the rectum)
In the emergency setting where the bowel has perforated, the risk of colon-colon anastomosis is much greater.
What is safest surgical procedure?
End colostomy
What happens in an emergency Hartmann’s?
1) resection of their rectosigmoid colon.
2) end colostomy is formed and rectal stump sewn
Indication for a Hartmann’s?
Perforation of the rectosigmoid bowel, and subsequent peritonitis.
Causes of perforation include colon cancer, diverticulitis, and trauma.
Colostomies are brought out on the left side of the abdomen, and sewn flush with the skin.
What is a life threatening complication that can occur after trans-rectal ultrasound guided prostate biopsy?
Urosepsis
What tumours are associated with myasthenia gravis?
thymomas
Eye feature of myasthenia gravis?
blurred vision that worsens throughout the day
Hypercalcaemia, renal failure, high total protein, what condition?
Myeloma
Facial rash plus lymphadenopathy ?
Sarcoidosis
What type of cancer can aflatoxin (produced by Aspergillus) cause?
Liver (HCC)
What type of cancer can aniline dyes cause?
Bladder (transitional cell carcinoma)
What carcinogen can cause hepatic angiosarcoma?
Vinyl chloride
What carcinogen can cause bladder cancer (transitional cell carcinoma(?
Aniline dyes
What type of cancer can asbestos cause?
Mesothelioma & bronchial carcinoma
What type of cancer can nitrosamines cause?
Oesophageal cancer & gastric cancer
What three criteria make up the Risk of Malignancy Index (RMI) for ovarian cancer?
1) US findings
2) Menopausal status (1 for pre, 3 for post)
3) Ca 125
What is the most common type of oral cancer?
Squamous cell carcinoma
What genetic condition is around 25% of medullary thyroid cancers associated with?
MEN type 2A and mutation of the RET proto-oncogene.
Mechanism of hyoscine hydrobromide?
Anticholinergic
Which 3 cancers are most likely to metastasise to the liver?
1) colorectal (via the portal circulation that drains the gut)
2) breast
3) lung
Management of puerperal mastitis?
Treatment with Abx (normally flucloxacillin) and continue breast feeding.
Can also try warm compresses, over the count pain relief, hydration & rest.
What is a strong risk factor for periductal mastitis?
Smoking - this reduces vitamin A which in turn causes chronic ductal inflammation.
What is periductal mastitis?
A condition that occurs when the ducts behind the nipple become infected.
Features of periductal mastitis?
1) Swelling of nipple
2) Bloody discharge from nipple
3) Inverted nipple
4) Mammary duct fistula
What is a well documented side effect of Trastuzumab (Herceptin)?
Cardiotoxicity: often resulting in HF
What is Trastuzumab used to treat?
HER2 positive breast cancer
At what age does a breast lump go from a routine referral to urgent?
> /= 30
Duke’s staging system may be used to stage bowel cancer.
Describe stages A, B, C, and D
A - The cancer is in the inner lining of the bowel. Or it is slightly growing into the muscle layer.
B - The cancer has grown through the muscle layer of the bowel.
C - The cancer has spread to at least 1 lymph node close to the bowel.
D - The cancer has spread to another part of the body, such as the liver, lungs or bones (same as stage 4 i.e. advanced)
initial investigation in suspected pancreatic cancer?
Direct access urgent CT scan abdomen
At what eGFR does dose of nitrofurantoin for UTI need to be reduced?
<45 mmol/l
