Malignant disease Flashcards
What principles must a screening programme adhere to for it to be successful?
- the cancer being detected must be common enough for it to represent an important health problem.
- The natural history of the cancer should be know. So that people know the latent phase and when it will become symptomatic
- A test to be carried out and detect latent disease, that is specific and sensitive to cancer and safe and acceptable to the patient.
- early detection should lead to benefit in terms of cost of treatment and survival of the patient.
What are some examples of premalignant skin disease?
Actinic keratoses - dry and scaly patches of skin due to skin exposure
Bowen’s disease - aka SCC in situ. well demarcated erthymematous plaque
erythroplasia of Queyrat (penis) - Bowen’s disease of the penis
What are some examples of premalignant GI disease?
leukoplakia - white patches on the mucosa
Plummer - Vinson syndrome - difficultly swallowing, oesephageal webs and iron deficiency aneamia. increased risk of SCC
Barrett’s oesophagus
Villous adenomas and polyposis
IBD
Menetrier’s syndrome - massive overgrowth of mucous cells in the stomach, results in large gastric folds.
What are some examples of premalignant GU disease?
Leukoplakia of the bladder
Bilharzia
How should the symptoms of cancer be classified?
Symptoms from the primary tumour, the metastases and generalised systemic symptoms.
Please give some examples of symptoms causes by a primary tumour:
Palpable swelling:
Usually painless unless it starts to invade other structures.
Examples: breast, caecum and thyroid cancer
Obstruction. dysphagia in oesphageal cancer, obstructive jaundice in head of he pancreas, large bowel obstruction is colon cancer, vomiting in gastric outlet obstruction from gastric antrum cancer
Bleeding:
Overt - haematemesis, haemoptysis, haematuria, rectal bleeding
Occult - carcinoma of the stomach or caecum where anaemia occurs.
Compression or invasion of surrounding structures:
SVC obstruction
Back pain in retroperitoneal pancreatic cancer
inavsion of nerves - facial palsy in parotid gland, or recurrent lryngeal nerve palsy n anaplastic carcinoma of the thyroid
Please give some examples of symptoms caused by metastases:
Enlarged lymph nodes
Hepatomegaly
Jaundice
Ascites
Pathological fractures - breast, bronchus, thyroid, prostate, kidney
Pleural effusions
Fits, confusion, personality changes due to cerebral mets
What are the general manifestations of cancer?
Cachexia, pyrexia of unknown origin, hypertrophic pulmonary osteoarthropathy, thrombophlebitis migrans (pancreatic cancer)
How are malignancies staged?
Extent of the tumour (T)
Node status (N)
Presence of mets (M)
What is Dukes’ classfification?
Staging of colorectal cancer:
A - confined to bowel wall (80% 5 yr survival)
B - Through wall into surrounding tissue (60% 5 yr survival)
C - Lymph node involvement (30% 5 yr survival)
if distant mets are present 5 yr survival is only 5%
What is the grade of the tumour?
The histological appearance of the tumour - how much like the orginal cells it looks like.
Proportion of cells in mitosis, degree of differentiation, degree of nuclear polymorphism etc.
Tumour markers.
List them and what cancer they are specific for.
Alpha fetoprotein (AFP):
Increases in hepatocellular cancer and germ cell tumours.
Useful in monitoring mets and response to treatment.
Can be high in cirrhosis, hepatitis, and pregnancy
Carcinoembryonic antigen (CEA):
High in colon, pancreas and stomach cancer.
Can be high in IBD, and cirrhosis
Human chorionic gonadothrophin (hCG):
High is choriocarcinoma and hydatidiform moles, and testicular cancer.
Prostate specific antigen (PSA):
If PSA is 4-10 20-30% will have prostate cancer.
Can be high in BPH and prostatitis
CA 19-9:
High in GI malignancy - especially pancreas.
Can be high in pancreatitis, gall stones, cholecystitis, and cirrhosis
CA 125:
High in ovarian malignancy
Can be high in pregnancy, endometriosis, and cirrhosis, and other non ovarian malignancies
CA 15-3:
Mucin marker used in breast cancer assessment, used for prognosis as the higher the levels the higher cancer of recurrence.
What is Familial adenomatous polyposis and how is it managed?
Autosomal dominant condition - multiple polyps in the rectum and colon, that progress to malignancy if not treated at around 40 yrs.
Treated with subtotal colectomy and iliorectal anastomosis. regular survallience is needed for the duodenal and ampular as they can develop adenomas.
Where are the most common sites for colorectal cancer?
Rectum - 40%, sigmoid colon - 25%, descending colon - 5%, transverse colon - 10%, caecum and ascending colon - 20%.
What is the occurrence of synchronous and metachronous tumours?
2.5% synchronous - two cancers at the same time
1% metachronous - two cancers occurring at different times
What symptoms do people with bowel cancer present with?
Left sided - bleeding, altered bowel habit, obstruction
Right sided - anaemia, palpable mass, weight loss, abdominal pain.
Rectum - frequency of defecation, tenesmus,
How to colorectal cancers spread?
Local, lymphatic, by blood (liver, lung and bone) or transcoelomic.
What is more common? Adenocarcinoma or squamous cell carcinoma of the oesophagus?
Squamous cell - it occurs in the upper 2/3 of the oesophagus
Adenocarcinoma is increasing due to the increased GORD
What are the risk factors for squamous cell carcinoma of the oesophagus?
Smoking, alcohol, plummer-visons syndrome, achalasia, corrosive strictures, coeliac disease, tylosis (howel - evans syndrome) low vitamin A&C, nitrosamine exposure
What are the risk factors for adenocarcinoma of the oesophagus?
long standing heart burn, Barrett’s, smoking, obesity, increased age
How does oesophageal cancer spread?
Local into surrounding structures - trachea, lung, aorta
Lymphatic spread to nodes
Blood stream to liver and lung
What pathology is pancreatic cancer most likely to be and where in the pancreas is the tumour normally found?
Ductal adenocarcinoma
60% in pancreas head, 25% in the body and 15% in the tail,
What gene is associated with pancreatic cancer?
KRAS2 gene is mutated in 95% of cases
What are the risk factors for pancreatic cancer?
Smoking, alcohol, carcinogens, DM, chronic pancreatitis, ? high fat diet
Describe how patients with pancreatic cancer normally would present:
Painless jaundice if tumour in head of pancreas
Epigastric pain if tumour in the tail or body of pancreas
Anorexia, weight loss, new diabetes, acute pancreatitis
rarely: thrombophelbitis migrans (a vein in the arm becomes swollen and red, and then the same happens to a vein in the leg), hypercalcemia, marantic endocarditis (non bacterial), portal hypertension, nephrosis
What percentage of patients are suitable for surgery for pancreatic cancer?
What is the mean survival for pancreatic cancer?
Describe three of the cystic tumours of the pancreas:
75% of cysts in the pancreas are pseudocysts.
Serous cyst adenomas - multiple small cyst cavities, if they are over 5cm they can cause compression
Mucinous cyst adenomas - occur in 5th anf 6th decade. 20% are malignant on presentation
Intraductal papillary mucinous tumours - pancreatic cystic neoplasm, occurs more in men 60-70. transformation to malignancy is common.
What are the risk factors for gastric carcinoma?
Pernicious anaemia Blood group A H.Pylori Atrophic gastritis Adenomatous polyps lower social class smoking diet - high nitrate, high salt, pickling, low vitamin c nitrosamine exposure e.cadherin abnormalities
Describe the Borrmann classification of gastric tumours:
i) polypoid/ fungating
ii) excavating
iii) ulcerating and raised
iv) linitis plastica (leather bottle like uniform thickening of the stomach wall)
