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4TH YEAR > CSIM solid organ malignancy > Flashcards

CSIM solid organ malignancy Flashcards

1
Q

what is the grading system for cytological samples?

A

C1 - C5 where 5 is definite malignancy

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2
Q

what is icterus?

A

jaundice in the scelera

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3
Q

which abdo organs move on respiration?

A

basically all of them

not so much bowel

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4
Q

cancer patient with confusion- what additional investigations should you always do?

A

LP - check for cancer cells in the fluid

calcium - bone cancer

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5
Q

why do you need to check clotting in cancer patients?

A

risk of bleeding in biopsy

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6
Q

what kind of anaemia in cancer?

A

normocytic or micro if there is an associated iron deficency

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7
Q

what is serum protein electrophoresis? when is it used?

A

measures specific proteins in the blood to help identify some diseases
looking for diseases that chuck out loads of protein (e.g. anti bodies) like myeloma

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8
Q

role of calcium in confusion ? how to investigate?

A

raised calcium causes confusion

need corrected calcium

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9
Q

what is B HCG diagnostic of?

A

CONTEXT:
germ cell cancer
molar pregnancy

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10
Q

what is corrected calcium and ionized calcium?

A

ionized - unbound ‘free’ calcium

corrected - takes into account the amount bound to albumin as well as the free atoms

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11
Q

what is the advantage of a colonoscopy over non invasive imaging techniques?

A

can do a biopsy too

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12
Q

what is PTT?

A

AKA APTT

activated partial thromboplastin time - measures the intrinsic clotting pathway

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13
Q

what is the tumour marker for colon cancer?

A

carcinoembryonic antigen

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14
Q

effect on MCV in suspected GI malignancy? why

A

decreased

chronic gi bleed -> iron deficiency

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15
Q

what is performance status?

A

scale from 1 - 5 where 1 is normal and 4 is bed bound (5 is dead)

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16
Q

when does breast cancer metastasize?

A

when grown to 1cm

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17
Q

what is transcoelomic spread

A

a route of tumour metastasis across a body cavity, such as the pleural, pericardial, or peritoneal cavity.

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18
Q

modes of cancer spread

A

lymph
local
transceolomic
blood

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19
Q

what nodes do testes / ovarian cancer spread to?

A

para-aortic

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20
Q

what nodes do genital tract cancers spread to?

A

femoral / inguinal

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21
Q

what are the 3 steps in the approach to carcinoma of unknown origin?

A
  1. search for primary site
  2. rule out potentially curable / treatable tumours
  3. characterise the pathology then treat
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22
Q

what is the biggest environmental factor in cancer predisposition?

A

diet

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23
Q

what % of lung cancers are associated with smoking?

A

90%

adenocarcinomas arent that strongly associated

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24
Q

how does smoking affect organs other than the lungs?

A

absorption of chemicals into other parts of the body leads to chronic inflammation

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25
Q

which lung is more likely to be effected by mesothelioma?

A

the right

right main bronchus is more vertical and these particles follow gravity

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26
Q

how does radiation lead to cancer?

A

high-frequency radiation dislodges electrons therefore damaging molecular structure

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27
Q

what % of cancer is caused by ionizing radiation?

A

5%

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28
Q

how does xeroderma pigmentsum predispose you to cancer?

A

minimal UV exposure will cause mutation

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29
Q

what viruses causes HCC?

A

HBV HCV

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30
Q

world wide most common cause of HCC?

A

HBV

here it is alcohol and therefore cirrhosis

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31
Q

what causes kaposi sarcoma?

A

HHV8

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32
Q

what hormonal causes of breast cancer are there?

A

anything that heightens exposure to estrogen:

  1. low parity
  2. late age of first birth
  3. early menarche and late menopause
  4. increased breast density
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33
Q

effect of post menopause estrogen Tx on endometrial cancer?

A

increases risk if given without progesterone

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34
Q

how do viruses cause cancer?

A

chronic inflammation

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35
Q

what is the difference between a germ line and a somatic mutation?

A

germ line - mutation that effects every cell in the body including all the gametes

somatic- only in that one cell

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36
Q

what characterizes li-fraumeni syndrome?

A
  1. pre-menopausal breast cancer
  2. childhood sarcoma
  3. brain tumours
  4. leukaemia
  5. lymphoma
  6. adrenocortico carcinoma
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37
Q

what is the defect in li-fraumeni syndrome?

A

germ line mutation in the p53 gene on chromosome 17p

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38
Q

clinical sign in the eye for retinoblastoma?

A

white pupil reflex

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39
Q

what are the clinical features of multiple endocrine neoplasia. inheritance?

A

mucosal nueromas on the tongue
medullary carcinoma of the thyroid
marfanoid features
skin pigmentation

autosomal dominant condition

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40
Q

what is lead time bias in relation to cancer screening?

A

in a screening programme you will detect cancer earlier therefore the survival time from detection is spuriously long in relation to those who didnt undergo screening

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41
Q

sens. and spec. of CA125?

A

high sensitivity

low specificity

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42
Q

why is the prevalence of lung cancer less than the incidence?

A

most people die very quickly after dignosis

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43
Q

why do some lung cancer patients get dysphagia?

A

tumour pressing on the oesophaus

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44
Q

why do some lung cancer patients get a hoarse voice?

A

pressing on the laryngeal nerve

this is very bad for prognosis

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45
Q

which lymph nodes does lung cancer typically drain to?

A

supraclavicular

axilla

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46
Q

which vessel can become compressed in lung cancer and constitutes a medical / oncological emergency?

A

sup. vena cava

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47
Q

signs of SVC obstruction

A

dilated / tortuous vessels of upper chest (nipples)
oedema of the face / neck / arms with distended veins
congested mucous membranes

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48
Q

what is Pancoasts syndrome?

A

apical malignant neoplasm in the lung leads to:

  1. Horners syndrome
  2. shoulder pain
  3. oedema secondary to vessel compression
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49
Q

what happens to trachea in pleural effusion?

A

normally nothing as fluid will be at base of lung

can shift it if MASSIE effusion

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50
Q

what is the role of sputum cytology in lung cancer ix?

A

not very useful but can hep rule out non-cancerous causes

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51
Q

what is the role of CT thorax in lung cancer?

A

used to assess size, spread, invasion and lymph node involvement

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52
Q

what further investigations are always done in SCC

A

CT head
CT upper abdo

to check for spread else where

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53
Q

what is the most important factor when considering treatment?

A

performance status

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54
Q

what does LDH tell you about cancer?

A

NOT an indication of cancer risk but high LDH suggests rapid growth of cancer cells so is a prognostic factor

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55
Q

why does LDH increase with cancer growth

A

cancer cells need increased glycolysis

cancer cells use anaerobic method of metabolism even when oxygen is sufficient

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56
Q

most common presentaion of brain mets?

A

headaches

also get cognitive dysfunction, neuro deficit and seizures

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57
Q

which lung cancer can present with large amounts of pink frothy sputum?

A

bronchoalveolar carcinoma

58
Q

what supportive treatment is useful in brain mets?

A

steroids to reduce oedema

anti convulsants

59
Q

why can you get a raised calcium in cancer?

A

tumour producing PTH-rP leads to increased calcium

60
Q

presentation of hypercalcaemia

A

rapid onset confusion, nausea / vomming, dehydration

61
Q

why is gynecomastia a feature of cancer?

A

in germ cell cancers (testes, ovaries) the tumour can produce gonadatrophins

62
Q

which lung cancer can cavitate?

A

squamous cell - can get a fluid level

63
Q

which lung cancer gets multiple bilateral pulmonary nodules?

A

bronchoalveolar carcinoma

64
Q

how does SCC look on CXR?

A

large, bulky central mass with hilar and mediastinal adenopathy

65
Q

what type of cancer is a biopsy often not necessary in ?

A

germ cell cancers

66
Q

what is the most common cancer in teenagers / young adults?

A

testicular germ cell in men

germ cell cancers are generally very rare

67
Q

what happens to testicularsize in germ cell cancer?

A

noramlly gets larger

can get smaller

68
Q

where is there pain in testicualr cancer?

A

testes (20%)

back (10%) due to para aortic lymphadenopathy

69
Q

why get gynaecomastia in germ cell cancer?

A

beta - HCG

70
Q

what tumour markers do you want to look for in testicular cancer?

A

AFP
B-HCG
LDH

71
Q

why raised LDH in tumour growth?

A

it is an intra cellular enzyme that is released on tumour necrosis so goes up with chemotherapy

72
Q

what imaging in testicular cancer?

A

USS

CT

73
Q

what three things combine to be diagnostic for testicular cancer

A

testicular mass
raised B-HCG
AFP

this is one scenario where tumour markers are diagnostic of cancer

74
Q

what drug can give a false positive in B-HCG test?

A

regular cannabis use

75
Q

what gives false positive in AFP?

A

alcohol abuse

76
Q

what imaging is done after the histological diagnosis in germ cell cancer?

A

contrast CT chest, abdo and pelvis within 3 weeks

77
Q

what would prompt you to do CT head in germ cell cancer?

A

multiple lung mets

very high HCG (>10,000)

78
Q

how can HCG tell you about brain mets?

A

if CSF HCG > serum HCG then must be cancer in brain

if CSF HCG < serum HCG then it is seeping in from the blood

79
Q

what is tumour lysis syndrome? why does it happen

A

oncological emergency -> AKI, DIC, cardiac arrest

hyperuraemia
hyperkalaemia
hypOcalcaemia
hyperphosphataemia

when there is a large amount of tumour cell death (due to treatment) the products of this can be toxic to the liver

80
Q

when is tumour lysis syndrome often seen and why?

A 
large volume and sensitive tumours:
germ cell
sarcoma
burketts lymphoma
leukaemia
81
Q

when should contralateral teste be biopsied?

A

if < 30 yo

if small

82
Q

how are suspected residual masses investigated?

A

PET at least 2 weeks after end of chemo

83
Q

what must considered before biopsy of testes?

A

sperm banking

84
Q

effect of multiple pregnancies on ovarian cancer?

A

reduced

85
Q

effect of taking the mini pill on ovarian cancer?

A

none,

taking the COC for 10 years reduces it though

86
Q

why do animal fats increase ovarian cancer?

A

animals are fed oestrogen to make them fatter

87
Q

in a somatic mutation which cells have a mutation?

A

only the tumour cells

88
Q

why do 2/3 of ovarian cancer patients present late (stage 3 or 4)

A

early stage is asymptomatic

89
Q

signs symptoms of ovarian cancer?

A

bowel - distention, bloating, constipation, pain, loss of appetite

kidney - recurrent UTI, hydronephrosis secondary to ureteric obstruction, loin pain, renal failure

pleural effusion

constitutional

90
Q

what tumour markers are you looking for in ovarian cancer?

A

CEA
CA-125

in younger women:
AFP
B-HCG
LDH

91
Q

why can throtoxicosis be confused with ovarian cancer

A

non-specific symptoms
raised CA-125 in BOTH

ALWAYS BIOPSY

92
Q

how is ovarian cancer diagnosed?

A

histopathological study following exploratory laparotomy

93
Q

what is the first line imaging in ovarian cancer?

A

USS

94
Q

generally speaking, which advanced imaging techniques are good for the pelvis / abdo?

A

MRI good for pelvis

CT good for the abdo

95
Q

how is CT used in ovarian cancer?

A

in advanced disease it is used to assess extent of spread

96
Q

how is the Risk of Malignancy calculated for pelvic masses?

A

uss x menopause status x CA-125

97
Q

what are the most likely sources of malignant cells in the ascites?

A

any visceral site of carcinoma but most likely to be epithelial

98
Q

what three things cause CA-125 to be raised?

A

inflammation
infection
infarction

99
Q

how does draining ascites reduce CA-125?

A

extra cellular fluid acts as a reservoir

100
Q

what kind of investigation is best for diagnosing cancer/

A

anything that allows a biopsy

101
Q

how is CA-125 useful in ovarian cancer?

A

a rise of 25% indicates progression of the cancer

doubling almost confirms a relapse

102
Q

what is the origin or most ovarian cancers?

A

90% epithelial

103
Q

what are the complications of local invasion in ovarian cancer?

A

lymphoedema
vaginal discharge
bowel obstruction
ascites

104
Q

what are the non-metastatic complications of ovarian cancer?

A

pulmonary emboli

dermatomyositis

105
Q

what is dermatomyositis? how does it present?

A

inflammation of the skin and underlying muscle tissue

proximal myopathy
skin changes
systemic:
cardio-pulmonary
retinopathy
arthralgias
106
Q

how is malignant hypertension treated?

A

usually with paracentesis

tx revolving around reducing Na retention DO NOT work e.g. loop diuretics, salt restriction etc

107
Q

three blood tests that indicate dermatomyositis

A

aldolase
LDH
CK

all raised

108
Q

how is imaging used in malignant ascites?

A

USS, CT or MRI used to guid drainage

109
Q

what is the most common site for breast cancer?

A

left breast

upper out quadrant or retro areolar region

110
Q

what are the risk factors for breast cancer associated with oestrogen?

A

early menarche / late menopause
nulliparous / late (>35) pregnancy
OCP
HRT

111
Q

how often is a hereditary predisposition indicated in breast cancer?

A

10% of cases

112
Q

what re the three most common breast cancer genes?

A

BRCA 1
BRCA 2
p53 (Li Fraumeni)

113
Q

what are the characteristics associated with BRCA breast cancer?

A

worse histology
early onset
more likely to be bi-lateral

114
Q

most common ways breast cancer presents?

A

lump in up to 75%
Pagets disease
mammograpic findings on screening

115
Q

what is Pagets disease?

A

associated with intraductal carcinoma

involves terminal ductuals of the breast (may be invasive)

116
Q

how does pagets disease present?

A

eczematoid change in nipple

117
Q

where might there be lymphadenopathy in breast cancer?

A

neck and axilla

118
Q

3 most common distant mets in breast cancer?

A

bone lung liver

119
Q

recommendation for self breast check?

A

monthly from 20 yo

120
Q

how is a cystic mass investigated?

A

fine needle aspiration- this should result in full resolution
USS - to determine weather it is solid or cystic
biopsy - only if the fluid is bloody or is not resolved after FNA

121
Q

how common is cystic carcinoma of the breast?

A

rare - < 1% of breast cancer

122
Q

investigations in solid mass in breast?

A

mammography - of both breasts
FNA
core biopsy

123
Q

what is the disadvantage of FNA in breast cancer?

A

small chance of false positive findings

up to 25% chance of false negative findings

124
Q

advantage of core biopsy in breast cancer?

A

can assess architecture as well as cytology

125
Q

4 ways to investigate a non palpable breast lump?

A

MRI
wire excision
US guided core biopsy
stereotactic guided core biopsy

stereotactic = precisely positioning patient

126
Q

is CA 15.3 used in breast cancer screening? why?

A

no, low sensitivity for early disease

127
Q

what is the use of CA 15.3 in breast cancer?

A

rising levels in follow up are associated with relapse

128
Q

most common type of breast cancer?

A

70% are invasive ductal carcinoma

129
Q

what are the three components of breast cancer triple assessment?

A

exam
imaging
needle biopsy

130
Q

4 things on a mammogram that indicate malignancy?

A

microcalcification
mass
distorted architecture
asymmetry

131
Q

non metastatic complication of breast cancer?

A

hypercalaemia

132
Q

what are the complications of local invasion in breast cancer?

A

ascites / pleural effusion

lymphoedema

133
Q

most common distant mets in breast cancer

A

bone liver lung brain

spinal cord compression

134
Q

best investigation for suspected spinal cord compression?

A

MRI

will see compression but not the associated bone destruction

bone is invisible to MRI

135
Q

what clinical finding indicates cord compression?

A

bi lateral UMN signs

136
Q

who gets further investigations into mets in breast cancer? and what are these?

A

t > 5cm
n > 3
clinical suspicion

CXR
bone scan
USS

137
Q

when are CT / MRI used in looking for mets in breast cancer?

A

if there is still clinical suspicion AFTER CXR, bone scan and USS

138
Q

which type of breast cancer does tamoxifen reduce the risk of?

A

oestrogen receptive+ tumours

139
Q

disadvantages of tamoxifen?

A

increased DVT and PE risk
increased incidence of endometrial cancer

no over all increase in survival

140
Q

what do aromatase inhibitors do and how are they used in cancer?

A

stop production of oestrogen in post menopausal women

used to treat early stage of ER+ breast cancer

4TH YEAR (12 decks)

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