L07 - Diagnosis & Treatment of Cancer Flashcards
What are the 4 most common cancers?
- Breast
- Prostate
- Lung
- Bowel
By which diagnostic pathways may patients arrive in the diagnosis of cancer?
- Symptoms – may be specific to one cancer, e.g. enlarged lymph nodes, or non-specific e.g. weight loss, anorexia etc.
- Screened – test given to person with no symptoms e.g. Pap smears, mammograms, PSA tests, colonoscopies
- Incidental – picked up whilst investigating another symptom
Which investigations are used in the diagnosis of cancer?
1 - History taking
2 - Clinical examination
3 - Imaging e.g. x-rays or CT scans
4 - Blood tests for cancer biomarkers (less often)
5 - Tissue biopsy and histological assessment (required before treatment is initiated)
What common symptoms may suggest cancer?
- Change in bowel or bladder habits
- A sore that does not heal
- Unusual bleeding
- Breast lump or thickening
- Indigestion or difficulty in swallowing
- Extreme fever with night sweats
- Persistent cough or hoarseness
What are the common presenting symptoms of lung cancer?
1 - Breathlessness
2 - Cough
3 - Pain
4 - Loss of appetite
5 - Haemoptysis
What are the common presenting symptoms of colorectal cancer?
1 - Changes in bowel habits
2 - Bright red or dark blood in the stool
3 - Discomfort in the abdomen
4 - Unexplained weight loss
5 - Anaemia (IDA)
6 - Tenesmus
What signs may be attributable to local spread of lung cancer?
- SVC obstruction
- Horner’s syndrome
- Pancoast syndrome
- Pleural effusion
What may be observed on examination of a patient with lung cancer?
- Signs of metastatic disease e.g. brain, bone, liver
- Signs attributable to local spread e.g. SVC obstruction, Horner’s syndrome, Pancoast syndrome, pleural effusion, LNs
- Signs attributable to ectopic hormone production e.g. Cushing’s from ACTH secretion
- Non-specific cancer-related symptoms e.g. weight loss, anorexia, fatigue, cachexia
What diagnostic tests may be done for lung cancer?
- CXR – detects position, size & number of tumours
- Lab analysis – detects changes in hormone production & haematological manifestations of lung cancer
- CT scan – detect chest wall invasion, mediastinal lymphadenopathy, distant metastases
- Bronchoscopy – precise location of tumour, obtain biopsy
- Mediastinoscopy – visualise & sample mediastinal LNs
What may be observed on examination of a patient with colorectal cancer?
- Palpable mass in abdomen or per-rectum
- Blood per-rectum
- Enlarged or lumpy liver
How is colorectal cancer staged?
- Staging according to depth of invasion & spread outside bowel
- Stage 0 – cancer located in mucosa
- Stage I – cancer grown through mucosa & invaded muscularis
- Stage II – cancer grown beyond muscularis but not spread to LNs -> risk of perforation
- Stage III – cancer spread to regional LNs
What is Ewing’s sarcoma and how is it managed?
- The second commonest bone tumour in childhood
- Surgery if resectable
- Chemo – multi-agent regimes e.g. vincristine, actinomycin D, adriamycin, alkylating agents, etoposide
- Radiotherapy
List 3 methods that encourage early diagnosis of cancer.
1 - National screening programmes
2 - Public awareness campaigns
3 - Faster referrals
What do the letters of the TNM staging system of cancer mean?
- T = size of the primary tumour (subcategories depend on the type of tumour)
- N = status of lymph node metastases
- M = presence or absence of metastases
- G = the histological grade of the tumour
What are the N subcategories of the TNM staging system?
- N0 = no node metastasis
- N1 = 1-3 regional nodes
- N2 = >3 regional nodes
- N3 = nodes at a distant site
