KCP: Cancer Flashcards

1
Q

What are the main features of cancer compared with healthy cells?

A
  • Uncontrolled proliferation
  • Self sufficiency in growth signals
  • Insensitivity to anti-growth signals
  • Avoiding cell death (apoptosis)
  • Establish blood flow (for oxygen and nutrients)
  • Tissue invasion
  • Metastasis i.e. can spread to other parts of the body
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2
Q

A 68 year old woman has three months with a cough. She has hypertension and takes lisinopril.

What additional questions would you like to ask?

A

Smoking history?

Occupation?

Haemopotysis?

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3
Q

A 68 year old woman has three months with a cough. She has hypertension and takes lisinopril.

You find out 40 pack smoking history
Yellow sputem no blood more tired and breathless walking to shops, dull left sided chest pain. worked in council administration

What investigations should be requested?

A

Chest X-Ray

Full blood count, urea and electrolytes, calcium

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4
Q

A 58 year old woman visits her GP with six months of increasing tiredness. She has had occasional lower abdominal pain and has lost 5 kg in weight. She is not taking any medication. She works as a teacher.

What additional questions would you ask?

A

Why are you here today?

Changes in bowel movements? Blood?

Family history?

Where is abdominal pain?

Change in appetite?

Cancer screening?

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5
Q

A 58 year old woman visits her GP with six months of increasing tiredness. She has had occasional lower abdominal pain and has lost 5 kg in weight. She is not taking any medication. She works as a teacher.

You find out pain is lower left side of abdomen and cramping. Loose stool with blood mixed in. Mother has had bowel cancer. Decline bowel screening.

What are the next steps?

A

Full blood count - aneamia due to blood loss in stool. If aneamia comes back colonoscopy.

Stool sample to rule out infection

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5
Q

Back pain red flags (9)

A
  • Weakness/numbness in both legs
  • Saddle anaesthesia
  • Urine retention or incontinence, faecal incontinence
  • Nocturnal pain
  • Weight loss
  • Fevers
  • Thoracic pain
  • Recent trauma
  • History of cancer or immunosuppression

The first three may indicate compression of spinal chord or cauda equina

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6
Q

A72 year old man has three months of gradually worsening back pain in his thoracic and lumbar spine. The pain is now keeping him awake at night and he has weakness in his legs. He has lost 4 kg in weight and has also been constipated for the last month. He has had nocturia and urinary urgency for the last 2 years. These have not changed.

He is tender over T4/5 and L3/4 verterbra. He has weakness of ankle dorsiflexion and knee flexion and extension in both legs. He has an enlarged, irregular, firm prostate on rectal examination.

What should you do next?

A

Urgent same day referal to medical emergency - likely spinal chord compression from tumour. They would then do…

Full blood count, urea, electrolytes, calcium and prostate specific antigen test (PSA test - for prostate cancer as coult metastasised)

MRI of spine

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7
Q

Who gets breast screening and how regularly?

A
  • Women aged 50-70
  • Mammogram every 3 years
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8
Q

What is a mammogram?

A

An X-Ray of the breast to screen for early signs of breast cancer

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9
Q

Where is the abnormality in this mammogram?

A
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10
Q

What happens after a positive mammogram?

A

Breast clinic review:

  • Examination
  • Magnified mammogram-Tomosynthesis
  • Breast ultrasound
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11
Q

Why is a positive mammogram not the end of diagnosis?

A

It is very common to get false positives and over-diagnosis

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12
Q

What is over-diagnosis?

How is it different from a false positive?

A

This is detecting a cancer that would not have caused harm to person in their lifetime

Estimated that 20% of all breast cancers detected in screening are over-diagnosis

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13
Q

Diagnostic signs of breast cancer that aren’t a positive mammogram?

A
  • Breast mass
  • Lymphadenopathy
  • Skin changes
  • Metastatic disease
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14
Q

Breast cancer histology markers (charicteristics that the cancer cells might have)

A
  • Oestrogen receptor (here oestroge is a growth factor) (ER)
  • Progesterone receptor (here progesterone is a growth factor) (PR)
  • Human epidermal growth factor receptor 2 (HER2)
  • Triple negative has none of these markers (worse prognosis)
  • Ki67- marker of proliferation (may respond better to chemotherapy but worse prognosis)
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15
Q

With regard to breast cancer histology what is a triple negative marker?

A

Triple negative has none of the following markers:

  • Oestrogen receptor (ER)
  • Progesterone receptor (PR)
  • Human epidermal growth factor receptor 2 (HER2)

It has a bad prognosis

16
Q

With regard to breast cancer histology what is a Ki67 marker and what does it mean?

A

Ki67- marker of proliferation (may respond better to chemotherapy but worse prognosis)

17
Q

What additional treatments can you do to cancers with the following markers: ER and PR

A

Hormone receptor positive cancer (ER/PR):
* Aromatase inhibitor e.g. letrozole, inhibits oestrogen and progesterone synthesis
* Tamoxifen-oestrogen receptor inhibitor

18
Q

What additional treatments can you do to cancers with the following marker: HER

A

HER2 positive:
* Trastuzumab-monoclonal antibody against the HER2 receptor

19
Q

General treatment for breat cancer?

A
  • Surgery: aim to remove all with a 1mm margin of healthy tissue
  • On the side: radiotherepy and chemotherepy
  • Any additional treatments if it has ER, PR or HER receptors
20
Q

Why don’t women get screened for breast cancer before 50 and after 70?

A

Before 50 the tissue is more dense so it’s harder to detect with a mammogram

After 70 overdiagnosis is very likely. They will likely die with the cancer rather than from it