Malignancy Flashcards
The six most common causes of death from cancer in Australia and the US are cancer of the 1 2 3 4 5 6
lung, bowel,
breast, prostate, lymphoma and pancreas
The so-called ‘silent’ malignancies that pose a special problem include cancer of the 1 2 3 4 5 6
ovary,
pancreas, kidney, caecum and ascending colon, liver
(hepatoma), melanoma and haematological tissue
Although uncommon in children under 15 years,
cancer is the _____ most common cause of death
in this age group
second
The most common cancers in children (in
order) are
- leukaemias, especially ________
- brain tumours, especially _____
- lymphomas, especially_____
- ; neuroblastoma; Wilms tumour;
- soft tissue tumours, especially ______;
- and bone tumours
acute lymphocytic leukaemia (34%);
astrocytoma (20%);
non- Hodgkin (13%)
rhabdomyosarcoma
Undiffentiated sx of cancer
- Tiredness/fatigue/weakness
- Anorexia and nausea
- Weight loss
- Fever
- Thirst (hypercalcaemia)
- Drowsiness (hyponatraemia)
The _____ effects or syndromes are very
important clinically because they may provide
an early clue to the presence of a specific type of
cancer, in addition to the possible lethal effect of the
metabolic or toxic effect
paraneoplastic
Paraneoplastic syndromes and associated
tumours: more common examples
Lung, kidney, adrenal, thymoma,
pancreas
Cushing
Paraneoplastic syndromes and associated
tumours: more common examples
Lung, kidney, thymoma, thyroid
ACTH
Paraneoplastic syndromes and associated
tumours: more common examples
Lung, hepatoma, choriocarcinoma
Gonadotrophins
Paraneoplastic syndromes and associated
tumours: more common examples
Lung, breast, kidney, multiple myeloma,
prostate, pancreas, adrenal, hepatoma
Hypercalcaemia
Paraneoplastic syndromes and associated
tumours: more common examples
Kidney, hepatoma, lymphoma,
pancreas, thymoma
Fever
Paraneoplastic syndromes and associated
tumours: more common examples
Lung, breast, thymoma, Hodgkin,
prostate
Neurologic
Paraneoplastic syndromes and associated
tumours: more common examples
Lung, breast, hepatoma, prostate,
pancreas
Coagulopathy
Paraneoplastic syndromes and associated
tumours: more common examples
Kidney, pancreas, prostate
Thrombophlebitis
Paraneoplastic syndromes and associated
tumours: more common examples
Kidney, hepatoma
Polycythaemia
Paraneoplastic syndromes and associated
tumours: more common examples
Lung, breast, pancreas
Dermatomyositis
What agent?
Occupation: Chemical industry
Cancer type: Lung, skin, liver
Arsenic
What agent?
Occupation: Glue worker,
varnisher
Cancer type: Leukaemia
Benzene
What agent?
Occupation: Chimney sweep
Cancer type: Skin
Soot, coal tar
What agent?
Occupation: Farmer, sailor, outdoor worker
Cancer type: Skin
Ultraviolet light
What agent?
Occupation: PVC manufacturing
Cancer type: Liver (angiosarcoma)
Vinyl chloride
MC familial cancers
1
2
3
colorectal, breast and
ovarian cancers.
A ______ is an abnormal characteristic that
is specific for a particular type of malignancy
tumour marker
CEA and AFP are not specific markers but are
elevated in certain tumours and are very useful in
_____
monitoring tumour activity
Tumour markers have a limited role in diagnosis
of malignant disease because several have low
sensitivity and specificity. The most valuable are
those associated with testis cancer—___ and _____
AFP and beta-
HCG.
What is the tumor marker?
Testicular cancer (non-seminomatous)
Hepatocellular carcinoma
GIT cancers with and without liver
metastases
CA 125
What is the tumor marker?
Breast
CA-15-3
What is the tumor marker?
Pancreas, colon, ovary
CA-19-9
What is the tumor marker?
Colorectal cancer
Pancreatic, breast, lung, small intestine,
stomach, ovaries
CEA
What is the tumor marker?
Prostate cancer
PSA*
What is the tumor marker?
Choriocarcinoma
Hydatidiform mole
Trophoblastic diseases
hCG
What is the tumor marker?
Multiple myeloma, some lymphomas
α-microglobulin
Apart from non-melanoma skin cancer, ______ is
the most common cancer in Australia in terms of both
incidence and death, accounting for at least 20% of
cancer deaths
lung cancer
Paraneoplastic syndromes associated with lung CA
hypercalcaemia,
Cushing syndrome, carcinoid syndrome,
dermatomyositis, visual loss progressing to blindness
from retinal degeneration, cerebellar degeneration
and encephalitis.
The most important tumours of the kidney are
_______ and ______
adenocarcinoma (80% of all kidney tumours) 3 and
nephroblastoma (Wilms tumour
haematuria + loin pain + palpable
kidney mass
kidney cell cancer
________is responsible for 10% of all childhood
malignancies
Wilms tumour
Clinical features of Wilms
- peak incidence ____ years
- general symptoms of neoplasia
- _______ 80%
- _______ 30%
- ________ 25
2–3
palpable mass
abdominal pain
haematuria
Wilms:
Early diagnosis with nephrectomy and chemotherapy
leads to a very favourable prognosis_____
(90%
5-year survival
It is a
tumour of the adrenal medulla (50%) and sympathetic
nervous system, especially _________but also in chest and neck
retroperitoneal neural tissue in abdomen (30%)
Dxtics for NB
CT scan, skeletal survey; biopsy required
Tx of NB
Treatment is based on surgical resection then
chemotherapy ± localised radiotherapy
______ has the highest mortality rate of all
the gynaecological cancers because the majority
of patients present in the late stage of the disease
Ovarian cancer
_____ are the most common
of malignant ovarian tumours.
Epithelial tumours
New test for ovarian CA
A new test is the
OvPlex ™ serum test, which measures five serum
markers.
Malignancy in this area is more likely to present with
symptoms of anaemia without the patient noting
obvious blood in the faeces or alteration of bowel
habit
Carcinoma of caecum and
ascending colon
This is another cancer with vague symptoms,
metastasising early and late presentation
Pancreatic cancer
MC typre of pancreatic Ca
ductal adenocarcinoma
Presentation of ductal adenoCA of the head of the pancreas?
presents with painless jaundice and if in
the body and/or tail presents with epigastric pain
radiating to the back, relieved by sitting forward
jaundice + anorexia + abdominal
discomfort / pain
pancreatic cancer
_______has a rapidly fatal course
if untreated, while _______ has a variable
chronic course with an inevitable fatal outcome
Acute leukaemia
chronic leukaemia
The usual age range for acute lymphatic leukaemia
(ALL) is ______years with a second peak at about ______ years
2–10
40
The median age of presentation of acute myeloid leukaemia (AML) is\_\_\_\_\_\_ years
55–60
Symptoms due to infiltration of tissues with blast
cells (e.g. gingival hypertrophy in______
AML)
Bone pain (notably in children with\_\_\_\_\_ and joint pain
ALL)
Dxtcs for Leukemia
1
2
3
4
- FBE and film
- Bone marrow examination
- PCR studies
- Cytogenetics
As a rule, relapse of acute leukaemia means
imminent death unless _____
bone marrow transplantation
is successful.
The mean 5-year survival rate for
childhood ALL is about _______, for adult ALL _____
for AML it varies with age with poorer survival, about
____ over 55 years of age
75–80%
30%;
20%,
- A disorder of middle age, typically 40–60 years
* Insidious onset
CML
Sx of CML
• Constitutional symptoms: malaise, weight loss, fever, night sweats • Symptoms of anaemia • Splenomegaly (very large); abdominal discomfort • Priapism • Gout
Dxtics of CML
- Markedly elevated _____
- Marked left shift in ___
- Presence of _____
white cell count (granulocytes)
myeloid series
Philadelphia chromosome
fatigue + fever / night sweats + abdominal fullness ( splenomegaly )
CML
• A disorder of late middle age and elderly
• Insidious onset
• Constitutional symptoms: malaise, weight loss,
fever, night swea
Chronic lymphocytic leukaemia
CLL
PE of CLL
1
2
• Lymphadenopathy (large rubbery nodes)—neck,
axilla, groin (80%)
• Moderately enlarged spleen and liver (about 50%)
Labs of CLL
- Lymphocytosis >15 × 10 9 /L
- _____ appearance of lymphocytes
- Consider_____
‘Mature’
cytogenetics
T or F
in CLL
Most cases require no specific therapy but
observation.
T
Clinical features of CLL
• Painless (rubbery) lymphadenopathy, especially
______
• Constitutional symptoms (e.g. malaise, weakness,
weight loss)
• Fever and drenching night sweats—undulant
_____
• Pruritus
• _____ pain in any enlarged lymph
nodes
• Possible enlarged spleen and liver
cervical nodes
(Pel–Ebstein) fever
Alcohol-induced
dx of CLL
Diagnosis is by lymph node biopsy with
histological confirmation
Other dxtics for CLL
FBE, CXR,
CT/MRI (to stage), bone marrow biopsy, functional
isotopic scanning.
Staging of CLL
Staging is by using Ann Arbor
nomenclature (IA to IVB).
Tx of CLL
Treatment includes
chemotherapy, immunotherapy and radiotherapy.
malaise + f ever/ night s weats + p ruritus
Hodgkin
In Hodgkins Lymphoma
• Painless lymphadenopathy—localised or widespread • Constitutional symptoms possible, especially \_\_\_\_\_ • \_\_\_\_\_is uncommon
sweating
Pruritus
In Hodgkins Lymphoma
- Extra nodal sites of disease ______
- Possible enlarged liver and spleen
- Possible nodular infiltration of skin_____
(e.g. CNS, bone, skin, GIT)
(e.g. mycosis
fungoides)
malaise + fever / night sweats +
lymphadenopathy
non - Hodgkin lymphoma
_______ is a clonal malignancy of the
differentiated β lymphocyte—the plasma cell.
Multiple myeloma
MM
It is
regarded as a disease of the elderly, the mean age
of presentation being_____ years.
65
MM
It is asymptomatic in_____ of patients.
20%
The classic presenting triad in
an older person is anaemia, back pain and elevated
ESR which helps to differentiate it from ____
monoclonal
gammopathy of uncertain significance (MGUS
weakness + unexplained back pain +
susceptibility to infection
MM
Features of MM
Replacement of bone marrow by malignant
_____
Kidney failure
Associated with______
plasma cell
amyloidosis
Dx criteria of MM
- _____ in serum (on electrophoresis)
- _____ protein in urine
- bony_____ on skeletal survey
paraprotein
Bence–Jones
lytic lesions
Tx of MM
Treatment is with chemotherapy including
thalidomide or lenalidomide: 5-year median survival
_____ involves the production of
paraprotein (M protein) by non-cancerous cells in the
absence of other clinical manifestations of multiple
myeloma.
Monoclonal gammopathy of undetermined
significance (MGUS)
MGUS is usually asymptomatic but _______ can occur. No chemotherapy treatment is
recommended.
peripheral
neuropathy
Classic triad: skin flushing (especially face),
diarrhoea (with abdominal cramps), valvular
heart disease
Carcinoid syndrome
Site of tumors for carcinoid
appendix/ileum, stomach,
bronchi
Dx labs of carcinoid
1
2
- 24 hour urine 5-hydroxyindoleacetic acid
* plasma chromogranin A/hepatic ultrasound
This is a malignant proliferation of RBCs and also
WBCs and platelets.
PV
Investigations for PV
1
2
3
- FBE and haematocrit
- Bone marrow biopsy
- Genetic mutations—JAK2 mutation
Potentially curable malignant tumours
Haematological tumours
1
2
3
- Hodgkin lymphoma
- Acute lymphatic leukaemia
- Acute myeloid leukaemia
Potentially curable malignant tumours
Solid tumours
1 2 3 4 5 6
- Choriocarcinoma
- Testicular teratoma
- Neuroblastoma
- Wilms tumour (nephroblastoma)
- Burkitt tumour
- Embryonal rhabdomyosarcoma
Tumours curable by adjuvant chemotherapy
1
2
3
4
- Breast cancer
- Osteogenic cancer
- Soft tissue cancer
- Colorectal cancer
Common sites of metastatic presentation are the 1 2 3 4 5
lymph nodes, liver, lung, mediastinum and bone
Impt site of mets
Breast, prostate, lung, Hodgkin lymphoma,
kidney, thyroid, melanoma
Bone
Impt site of mets
Breast, lung, colon, lymphoma, kidney,
melanoma, prostate
Brain
Impt site of mets
Colon, pancreas, liver, stomach, breast,
lung, melanoma
Liver
Impt site of mets:
Breast, lung, colon,
kidney, testes, cervix/uterus, Hodgkin
lymphoma, melanoma
Lung and mediastinum
Impt site of mets:
Hodgkin lymphoma, lymphoma,
squamous cell carcinoma, oropharynx,
nasopharynx
High cervical
Impt site of mets:
Lung, stomach, lymphoma,
Hodgkin lymphoma, oropharynx, larynx,
skin, tongue
Low cervical
Impt site of mets:
Breast, lung, lymphoma
Axillary
Impt site of mets:
Lymphoma, ovary, uterus, vulva,
prostate, skin
Inguinal
Impt site of mets:
Lymphoma, Hodgkin
lymphoma, ovary, uterus, testes, prostate
Retroperitoneum
Impt site of mets:
Lung, colon, melanoma, Kaposi sarcoma
Skin
Cancer without a clear primary source is present in
about ______of all cases
5%
The mean
survival time in patients with an unknown primary
is____
6 months
anorexia + weight loss + jaundice
± epigastric pain
pancreatic cancer
fatigue + dysphagia + weight loss
oesophageal cancer
HIV is a retrovirus with two known strains that
cause a similar spectrum of syndromes: HIV-1 and
HIV-2 (mainly confined to West Africa). It infects
_____ cells bearing the _____receptor
T-helper
CD 4
