HD3 Flashcards
What does the bowel screening FIT kit look for? (1 mark)
Blood in the faeces
The Gardasil vaccine protects against HPV16 and which other HPV member that with HPV16 accounts for 70% of cervical cancer? (1 mark)
HPV 18
During colposcopy one or two liquids can be applied to help identify abnormal cells. Name the two active ingredients of the liquids and what substance is being assessed as being present in normal cells or absent in abnormal cells? (3 marks)
Acetic acid (1 mark)
Iodine (1 mark)
Both are assessing the glycogen content of the cells (1 mark)
The symptoms of benign prostate hyperplasia can be remembered by the mnemonic WISE. What are these symptoms that are being referred to? (2 marks)
Weak flow, Intermittent flow, Straining, Emptying is incomplete (1/2 mark each)
Miriam had been diagnosed with CIN 1/2. How much of the surface layer is affected by dysplastic cells in CIN 2. (1 mark)
2/3rds of the surface layer
There are age related changes along the whole length of the gastrointestinal system. Name two changes to the small intestines that are seen with age. (2 marks)
2 from
Atrophy of the walls
Reduced villi height (reduced surface area for absorption)
Decreased production of digestive enzymes
Which is more carcinogenic: HPV 16 or 18? [1]
Which is more common? [1]
HPV 16: more common and carcinogenic
Describe screening regime of cervical cancer for 24.5-49 yrs [1]
and 50-64 yrs old [1]
i. Ages 24.5 – 49 years
1. Every 3 years
ii. Ages 50 – 64:
1. Every 5 years
State three stages of screening for potentially positive diagnosis of cervical cancer [3]
-
Test for HPV
a. Causes the abnormal cells -
Cytological test
a. ID if cells are abnormal -
Colposcopy
a. Take a biopsy
Describe diagnostic process that occurs during cervical screening programme
Describe basic pathophysiology of cervical cancer [2]
i. Cervical intra-epithelial neoplasia from HPV infection
ii. Commonly revert back to normal due to immune response and rapid turnover of cells
1. 60% of CIN-1 cells regress after a year
iii. CIN-2 / CIN-3 high risk for developing invasive cancer
What is the difference between micro and macro-invasive cervical cancer? [2]
Invasive cancer: breaches the epithelial basement membrane
- Micro-invasive: < 5 mm from surface of the epithelium
-
Macro-invasive: < 7 mm from surface
a. Formal stage required
Describe how established cervical cancer presents? [3]
- Symptoms of established cervical cancer:
a. Vaginal discharge
i. Intermittent or continuous
b. Bleeding
i. Spontaneous
ii. After sex
iii. After micturition
iv. After defecation
c. Vaginal discomfort
Late symptoms
1. Painless haematuria.
2. Chronic urinary frequency.
3. Painless fresh rectal bleeding.
State treatment methods for cervical cancer? [3]
i. Surgery
ii. Chemotherapy
iii. Radiotherapy
Describe the different types of surgery for cervical cancer [5]
a. Conisation or simple hysterectomy
b. Radical trachelectomy: remove the cervix, nearby tissue and upper part of vagina
c. Laparoscopic hysterectomy and lymphadenectomy
i. Doesn’t preserve fertility
d. Radical hysterectomy
e. Anterior, posterior or total pelvic exenteration: remove reproductive organs & bladder
What ages of women have breast cancer screening? [1]
How often? [1]
i. All women aged 50-70 every 3 years
State 5 reasons why women under 50 may have breast cancer screening
- Previous Hx breast cancer
- First degree relative had breast cancer
- Two or more relatives have had cancer
- Father or brother has had breast cancer
- Known to have BRCA1, BRCA2 or TP53 genes
i. Virtually all breast cancers are []
i. Virtually all breast cancers are adenocarcinomas
The most common type of breast cancer is [1]
a. Invasive ductal carcinoma
Risk factors for breast cancer? [5]
i. BRCA1 / 2 mutations
ii. Increased exposure to oestrogen
1. Obesity
2. Late menopause
3. HRT
4. Early menarche (earlier exposure to oestrogen)
5. Nulliparity and increasing age of first childbirth
iii. Age
iv. Female gender
v. Fx
vi. Radiation therapy to chest
State a protective factor for breast cancer? [1]
i. Being breast fed as a child
Describe endocrine management of breast cancer [2]
a. Tamoxifen:
i. Pre-menopausal women with ER+ (oestrogen receptor) cancer
ii. Blocks oestrogen receptors
b. Aromatase inhibitors
i. Only for postmenopausal women with ER+ cancer (oestrogen receptor)
State biological management of breast cancer [1]
- Herceptin
Breast cancer is commonly associated with what type of chemotherapy? [1]
Adjuvant
Describe three forms of surgical management of breast cancer [3]
-
Wide local excision
a. Removes breast cancer with a margin of healthy tissue around the cancer
b. Useful if cancer is small -
Mastectomy
a. Entire breast removal -
Sentinel node sampling
a. Axillary node sampling:
i. Inject radioactive technetium into nipple
ii. Travels to first draining lymph
iii. Targeted removal of effect lymph
What ages get bowel cancer screening? [1]
i. Every two years to men and women aged 60-74 using faecal immunochemical test kit
ii. Aged is being reduced to 50yrs
Describe method of screening for bowel cancer using a Faecal immunochemical home test [3]
Faecal immunochemical home test:
a. Only detects human Hb (FOB detected animal Hb would acquire through diet)
b. Method:
i. Scrape the tip of the stick along the bowel motion.
ii. Put the stick back into the bottle.
iii. Click the bottle shut.
iv. Put the used kit into the return freepost packaging and send for analysis.
c. Results:
i. Normal
ii. Abnormal:
1. Blood detected in individual
a. Triggers colonoscopy
Describe the pathophysiology of colon cancer [1]
Majority arise from dysplastic adenomatous polyps
Describe why prostate screening does not occur
ii. Prostate specific antigen screening
1. Not reliable
a. False positives
b. 1/7 with normal PSA levels have cancer (false negative)
- Can find aggressive cancer but may also miss slow-growing cancer that doesn’t cause symptoms
- Not given to avoid:
a. Overdiagnosis:
i. People diagnosed with cancer that would never cause symptoms or shorten life expectancy
b. Overtreatment
State 5 reasons why PSA may be raised [5]
- BPH
- UTI
- Ejaculation
- Vigorous exercise
- Urinary retention
b. Risk factors for prostate cancer? [3]
i. Age
ii. Black ethnicity
iii. Fx
c. Investigations used for prostate cancer [3]
- PSA
- Prebiopsy MRI
- Prostate biopsy
