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
What are the M subcategories of the TNM staging system?
- M0 = no metastasis
- M1 = distant metastasis
Give an example of a targeted agent used in chemotherapy.
For which cancer is this targeted agent used?
Why are targeted agents less toxic than other chemotherapy drugs?
- e.g. Imatinib
- Used for CML
- They are delivered directly to the cancer or only affect specific tissues
What are the conventional cytotoxic agents for chemotherapy and how do they work?
- e.g. cis-platin, doxorubicin, 5-fluorouracil
- They target rapidly dividing cells but are relatively non-specific & therefore toxic
- They are successful so widely used
What is neo-adjuvant chemotherapy?
Shrinking tumours to encompass radiotherapy or to make surgery feasible, or to eliminate metastases before dealing with the primary tumour
What is adjuvant chemotherapy?
Deals with low volume residual disease following radiotherapy or surgery
