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UKMLA > Endocrinology & Cancer > Flashcards

Endocrinology & Cancer Flashcards

1
Q

what is the most common tumour type and location for pancreatic cancer?

A

Adenocarcinoma and head of pancreas

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2
Q

What are some risk factors for pancreatic cancer?

A

Increasing age, diabetics, smoking, chronic pancreatitis, HNPCC (men), MEN (multiple endocrine neoplasia) BRCA 2 gene, KRAS

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3
Q

What is Courvoisiers Law?

A

Palpable gallbladder in painless obstructive jaundice is unlikely to be caused by gallstones

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4
Q

What are some symtpoms to look out for in pancreatic cancer?

A

Painless jaundice
Pruritis
Pale stools
Dark urine

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5
Q

What other typical symtpoms/atypical symtpoms are seen

A

Epigastric pain
Back pain

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6
Q

What is the investigation of choice for pancreatic cancer?

A

Ultrasound
High resolution CT
DOUBLE-DUCT SIGN (bile duct and pancreatic duct dilation)

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7
Q

What is the management for pancreatic cancer?

A
  1. Whippels procedure but can causing dumping syndrome and peptic ulcers
  2. Adjuvant chemo following surgery
  3. PalliativeStenting with ERCP
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8
Q

5 Bs for metastatic tumour?

A

Bidney (kidney)
Bungs (lungs)
Breast
Bostate (prostate)
Byroid (thyroid)

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9
Q

What primary malignant tumours can cause pathological fractures?

A
  1. Osteosarcoma
  2. Chondrosarcoma
  3. Ewings tumour - long bone tumours
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10
Q

What is neoplasticism spinal cord compression? Causes, symptoms and lesion location relevance, what happens with tendon reflexes?, investigations, management

A

5 Bs, oncoogical emergency

Back pain, limb weakness, sensory changes - sensation loss or numbness

Increased tendon reflexes below lesion, absent above lesion

MRI urgent

High dose dexamethasone, ontological referral

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11
Q

What is multiple myeloma

A

Haematological disease due to the proliferation of PLASMA CELLS, which stem from b cells

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12
Q

What are the symptoms of myeloma?

A

CRABBI

C: hyperCalcaemia
R: renal deposition of light chains (bence jones, IgM/A antibodies)
A: anaemia (less space for erythropoiesis to occur)
B: bleeding due to thrombocytopenia
B: Bone pain (osteolytic lesions)
I: increased risk of infection due to less room for antibodies to fight against infection

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13
Q

What investigations are done for myeloma?

A
  1. FBC - anaemia
  2. U% E - renal function
  3. Bone profile - hypercalcaemia
  4. Peripheral blood smear - rouleaux formation (stacking coins RBC)
  5. Protein electrophoresis

MRI full body

Aspiration of bone marrow too

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14
Q

What is needed for diagnosis of myeloma?

A

1 major and 1 minor OR 3 minor symptoms

Major:
- >30% plasma cells on aspiration
- significantly elevated levels of IgM protein in blood/urine
- plasmacytoma seen

Minor:
- 10-30% of plasma cells on aspiration
- elevated but not majorly IgM protein in blood or urine
- osteolytic lesions
- low levels of other antibodies

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15
Q

Myeloma management?

A

Usually terminal, symptoms management control

Combination induction therapy can be used

Autologous stem cell transplant (remove and reintroduce own stem cells post chemo)

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16
Q

What cancer is cannon. Ball metastases seen in?

A

Renal cell cancer

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17
Q

What is cannonball metastases?

A

Multiple well defined rounded mets in the lungs

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18
Q

blatsic, lytic or mixed - what is most prone to spontaneous fracture?

A

Lytic

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19
Q

What region is most common and severe for spontaneous fracture?

A

Peritrochanteric

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20
Q

What is the scoring system to gauge spontaneous fracture risk?

A

Mirel scoring system

1- upper
2 - lower
3 - trochanteric

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21
Q

What is Back pain worse on lying down or coughing a risk of?

A

neoplasticism spinal cord compression

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22
Q

What are reed-sternberg cells and where are they seen in?

A

Often bilobed nucleated b-cells seen in Hodgkin lymphoma

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23
Q

What are the symptoms typically seen in Hodgkin lymphoma?

A

Proliferation of lymphocytes

Asymmetrical, not tender, painless lymph node in the cervical, supraclavicular, axillary or inguinal area.

Alcohol induced lymph node pain is a key symptom of Hodgkin lymphoma

B symptoms
- fever
- weight loss
- pruritis
- night sweats

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24
Q

What risk factors contribute towards Hodgkin lymphoma?

A

HV
EBV

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25
What investigations are done for suspected Hodgkin lymphoma”/
1. FBC - normocytic anemia 2. Biopsy - reed sternebrg cells
26
What is the mainstay imaging modality in staging Hodgkin lymphoma?
PET Scamn
27
What is the staging criteria called for Hodgkin lymphoma? What it is?
Ann-arbor Lugano 1 = single node 2 = 2 nodes on the same side of the diaphragm 3 = 2 or more nodes on both sides of the diaphragm 4 = metastatic disease A = no symptoms but itching B = fever, night sweats, weight loss S = spleen X = bulky tumours
28
What management regimes are used for Hodgkins lymphoma?
1. Chemotherapy mainstay treatment (ABVD OR BEACOPP) 2. Radiotherapy 3. Combined therapy 4. Haematopoietic stem cell transplant
29
What is non-hodgkins lymphoma
Every other lymphoma (including Burkitts) that isn’t Hodgkin’s lymphoma Lugano classification used More extranodal symptoms/systemic symptoms of organ inclusion Usually in elderley immunocompromised people and white people. Management = watch wait, chemo or radio. Chemo is usually RCHOP - rituixmab for R
30
What does R-CHOP stand for/
Treatment for non-hodgkins lymphoma R - Rituximab (hep b level needed) C= cyclophosphamide H = hydroxydaunorobocin O = vincristine P = prednisolone
31
High grade and low grade?
NHL High grade worse prognosis but better chance of cure Low grade better prognosis
32
What are brain metastases?
Secondary brain tumours Usually second to neoplasms in other areas of the body. Clinical presentation is altered mental state, seizures, focal neurological deficits, headaches Investigations is contrast mri Management is resection or total brain radiotherapy
33
What tumour marker is used to monitor breast cancer?
CA 15-3
34
Women with spinal mets is likely to have a primary tumour where?
Breasts Lungs if significant smoking history
35
Raised alpha foetoprotein is suggestive of what cancer?
Non-seminomatous testicular cancer (teratoma) Liver cancer
36
Elevated CA19-9 is suggestive of what cancer?
Pancreatic
37
S-100 marker is indicative of what cancer?
Melanoma, schwannoma
38
what is the pathophysiology behind graves diseasE?
autoimmune disease that causes production of TSI (hormone that mimics TSH) this binds to the thyroid receptors and increases the release of T4 and T3 this in turn stop TSH = low TSH but there is TSI that still causes production
39
what is the pathophysiology behind toxic multinodular?
they are autonomous and produce T3 AND T4 without the need for TSH
40
causes of primary hypothyroidism
hashimotos iodine deficiency thyroidectomy
41
hashimotos pathophysiology
anti-thyroid peroxidase and anti-thyroglobin antibodies that fight against the thyroid = n thyroid hormones
42
pathophysiology of iodine deficiency and relation to primary hypothyroidism?
iodine needed to synthesis and make t3 and t4
43
main cause of secondary hyperthyroidism?
tumour of the pituitary gland which secretes more TSH which stimulates the release of more T4/T3
44
Main cause of secondary hypothyroidism?
tumour - pituitary adenoma ca suppress the gland and lead to no TSH production
45
what is levothyroxine
a synthetic form of T4 (thyroxine) used to treat hypothyroidism
46
<0.5 TSH action?
decrease levothryoxine as negative feedback means there's too much t3/t4 and it is stopping TSHproduction
47
>5 TSH action?
increase levothyroxine dose
48
what is the normal TSH levels?
0.5-2.5
49
symptoms of hypothyroidism?
M- Memory loss/brain fog O = obesity/weight gain M = malar flush and menorrhagia S = slow and sluggish/lethargic O = oedema (non-pitting) myxoedema/waxy skin T = thinning of hair/tired I = cold intolerance and constipation R = raised BP low HR E = energy levels depleted D = depression and dry skin
50
physical sign of hashimotos?
goitre painless non-tender
51
starting dose of levothyroxine for non-pregnant average age adults?
50-100mcg (1.6mcg x bodyweight KG)
52
starting dose levothyroxine for adults 65+ and/or cardiovascular history ?
25-50mcg
53
side effects of levothyroxine therapy?
1. reduced bone mineral density 2. hyperthyroidism 3. atrial fibrillation 4. worsening angina
54
how to monitor levothyroxine?
TSH levels every 3 months then when 2 consistent results similar annual review
55
what is subacute thyroiditis (De Quervains)?
hyperthyroidism followed by hypothyroidism and healed thyroid usually following a viral infection 4 phases 1 = hyperthyroidism (3-6wks) 2 = euthyroid (1-3 wks) 3 = hypothyroid (weeks-months) 4 = fixed
56
what investigation is used for de quervains?
radioactive iodine scan (thyroid scintigraphy)
57
what thyroid auto antibodies are seen in hypothyroidism (hashimotos)
anti-TPO and anti-Tg anti thyroid peroxidase anti thyroglobulin
58
what is subclinical hypothyroidism?
no symptoms, not clinical still raised TSH but normal T3/4 which is why it is not clinical if TSH >10 can trial levothyroxine if elderly or do not want to watch and wait can happen
59
60
What is the most common type of breast cancer?
Invasive ductal carcinoma
61
What is NST (No Special Type) cancer?
Invasive ductal carcinoma
62
What are examples of special type breast cancer?
Lobular carcinoma Rarer types
63
What are the 2 types of breast cancer/
Invasive and in situ Lobular and ductal
64
Examples of common breast cancers? (4)
Ductal carcinoma in situ Lobular carcinoma in situ Invasive lobular carcinoma Invasive ductal carcinoma
65
What is Paget’s disease of the nipple?
Eczematoid change to th nipple and mostly will be associated with a lump They will usually have invasive carcinoma
66
What is inflammatory breast cancer
Cancerous cells block the lymph drainage resulting in inflamed appearance of the breast
67
What is the nHS breast screening programme?>
50-70 They are offered a mammogram every 3 years 70+ they can still have mammograms but encouraged to make their own appointments if they want
68
When to refer if there is a familial breast cancer history?
1. Male breast cancer in the family 2. 2 or more breast cancers on the paternal side 3. Bilateral breast cancer history 4. First or second degree relative <40 at diagnosis 3. Complicated patterns of multiple cancers at a young age 4. Jewish 5. Ovarian cancer
69
What gene is associated with breast cancer?
BRCA1 BRCA 2
70
When to refer using 2 week wait
Aged 30+ and have unexplained breast lump with or without pain Aged 50+ with one of the following symptoms - discharge - retraction - inversion - dimpling - change in colour etc Consider it in people with - skin changes - 30+ unexplained lump in axilla
71
Women with no palpable axilla lumps need what before surgeyr?
Ultrasound if negative they must have a sentinel node biopsy to assess nodal burden
72
If axillary node is palpable before breast cancer surgery then what?
Axillary node clearance this could lead to arm lyimphoedema
73
What are the 2 surgical procedures offered in breast cancer surgery and what differentiates them?
Mastectomy Wide local excision Mastectomy - DCIS >4cm, large lesion in small breast, central tumour, multifocal Wide local excision - DCIS <4cm, smaller lesion in large breast, peripheral tumour, solitary tumour
74
When is whole breast radiotherapy offered in women with breast cancer??
Those with mastectomy if T3/4 and 4+ nodes then yes whole breast radiotherapy offered after Those with wide-local excision it is recommended anyway to prevent reoccurrence
75
What hormonal therapies are used in breast cancer?
Women <50 or pre/peri-menopasual = tamoxifen 5 years post surgery Women >50 anastrazole This is used if the tumour suggests hormone receptors if not then no need
76
Tamoxifen side effects? (3)
Endometrial cancer VTE Menopausal symptoms
77
HER2 Positive tumour, what medication would you use that is a biologic?
Herceptin (trastuzumab)
78
When can trastuzumab not be used?
Cardiac hx
79
When is chemo used in breast cancer?
Can be used pre-op to downsize a primary lesion If there is axillary node involvement then FEC-D is used
80
What does FEC-D stand for?
F : 5 Fluorouracil E: Epirubicin C: Cyclophosphamide D: Docetaxel
81
When is a DEXA scan indicated in hormonal therpay for breast cancer?
If on a aromatase inhibitor (anastrozole)

UKMLA (14 decks)

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