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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
Q

What investigations are done for suspected Hodgkin lymphoma”/

A
  1. FBC - normocytic anemia
  2. Biopsy - reed sternebrg cells
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26
Q

What is the mainstay imaging modality in staging Hodgkin lymphoma?

A

PET Scamn

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27
Q

What is the staging criteria called for Hodgkin lymphoma? What it is?

A

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

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28
Q

What management regimes are used for Hodgkins lymphoma?

A
  1. Chemotherapy mainstay treatment (ABVD OR BEACOPP)
  2. Radiotherapy
  3. Combined therapy
  4. Haematopoietic stem cell transplant
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29
Q

What is non-hodgkins lymphoma

A

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

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30
Q

What does R-CHOP stand for/

A

Treatment for non-hodgkins lymphoma

R - Rituximab (hep b level needed)

C= cyclophosphamide
H = hydroxydaunorobocin
O = vincristine
P = prednisolone

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31
Q

High grade and low grade?

A

NHL

High grade worse prognosis but better chance of cure
Low grade better prognosis

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32
Q

What are brain metastases?

A

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

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33
Q

What tumour marker is used to monitor breast cancer?

A

CA 15-3

34
Q

Women with spinal mets is likely to have a primary tumour where?

A

Breasts

Lungs if significant smoking history

35
Q

Raised alpha foetoprotein is suggestive of what cancer?

A

Non-seminomatous testicular cancer (teratoma)
Liver cancer

36
Q

Elevated CA19-9 is suggestive of what cancer?

A

Pancreatic

37
Q

S-100 marker is indicative of what cancer?

A

Melanoma, schwannoma

38
Q

what is the pathophysiology behind graves diseasE?

A

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
Q

what is the pathophysiology behind toxic multinodular?

A

they are autonomous and produce T3 AND T4 without the need for TSH

40
Q

causes of primary hypothyroidism

A

hashimotos
iodine deficiency
thyroidectomy

41
Q

hashimotos pathophysiology

A

anti-thyroid peroxidase and anti-thyroglobin antibodies that fight against the thyroid = n thyroid hormones

42
Q

pathophysiology of iodine deficiency and relation to primary hypothyroidism?

A

iodine needed to synthesis and make t3 and t4

43
Q

main cause of secondary hyperthyroidism?

A

tumour of the pituitary gland which secretes more TSH which stimulates the release of more T4/T3

44
Q

Main cause of secondary hypothyroidism?

A

tumour - pituitary adenoma ca suppress the gland and lead to no TSH production

45
Q

what is levothyroxine

A

a synthetic form of T4 (thyroxine) used to treat hypothyroidism

46
Q

<0.5 TSH action?

A

decrease levothryoxine as negative feedback means there’s too much t3/t4 and it is stopping TSHproduction

47
Q

> 5 TSH action?

A

increase levothyroxine dose

48
Q

what is the normal TSH levels?

A

0.5-2.5

49
Q

symptoms of hypothyroidism?

A

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
Q

physical sign of hashimotos?

A

goitre painless non-tender

51
Q

starting dose of levothyroxine for non-pregnant average age adults?

A

50-100mcg

(1.6mcg x bodyweight KG)

52
Q

starting dose levothyroxine for adults 65+ and/or cardiovascular history ?

A

25-50mcg

53
Q

side effects of levothyroxine therapy?

A
  1. reduced bone mineral density
  2. hyperthyroidism
  3. atrial fibrillation
  4. worsening angina
54
Q

how to monitor levothyroxine?

A

TSH levels every 3 months then when 2 consistent results similar annual review

55
Q

what is subacute thyroiditis (De Quervains)?

A

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
Q

what investigation is used for de quervains?

A

radioactive iodine scan (thyroid scintigraphy)

57
Q

what thyroid auto antibodies are seen in hypothyroidism (hashimotos)

A

anti-TPO and anti-Tg

anti thyroid peroxidase
anti thyroglobulin

58
Q

what is subclinical hypothyroidism?

A

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
Q
A
60
Q

What is the most common type of breast cancer?

A

Invasive ductal carcinoma

61
Q

What is NST (No Special Type) cancer?

A

Invasive ductal carcinoma

62
Q

What are examples of special type breast cancer?

A

Lobular carcinoma

Rarer types

63
Q

What are the 2 types of breast cancer/

A

Invasive and in situ

Lobular and ductal

64
Q

Examples of common breast cancers? (4)

A

Ductal carcinoma in situ
Lobular carcinoma in situ

Invasive lobular carcinoma
Invasive ductal carcinoma

65
Q

What is Paget’s disease of the nipple?

A

Eczematoid change to th nipple and mostly will be associated with a lump

They will usually have invasive carcinoma

66
Q

What is inflammatory breast cancer

A

Cancerous cells block the lymph drainage resulting in inflamed appearance of the breast

67
Q

What is the nHS breast screening programme?>

A

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
Q

When to refer if there is a familial breast cancer history?

A
  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
  5. Complicated patterns of multiple cancers at a young age
  6. Jewish
  7. Ovarian cancer
69
Q

What gene is associated with breast cancer?

A

BRCA1 BRCA 2

70
Q

When to refer using 2 week wait

A

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
Q

Women with no palpable axilla lumps need what before surgeyr?

A

Ultrasound if negative they must have a sentinel node biopsy to assess nodal burden

72
Q

If axillary node is palpable before breast cancer surgery then what?

A

Axillary node clearance this could lead to arm lyimphoedema

73
Q

What are the 2 surgical procedures offered in breast cancer surgery and what differentiates them?

A

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
Q

When is whole breast radiotherapy offered in women with breast cancer??

A

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
Q

What hormonal therapies are used in breast cancer?

A

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
Q

Tamoxifen side effects? (3)

A

Endometrial cancer
VTE
Menopausal symptoms

77
Q

HER2 Positive tumour, what medication would you use that is a biologic?

A

Herceptin (trastuzumab)

78
Q

When can trastuzumab not be used?

A

Cardiac hx

79
Q

When is chemo used in breast cancer?

A

Can be used pre-op to downsize a primary lesion

If there is axillary node involvement then FEC-D is used

80
Q

What does FEC-D stand for?

A

F : 5 Fluorouracil
E: Epirubicin
C: Cyclophosphamide

D: Docetaxel

81
Q

When is a DEXA scan indicated in hormonal therpay for breast cancer?

A

If on a aromatase inhibitor (anastrozole)

UKMLA (11 decks)

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