Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Surgery > Malignant disease > Flashcards

Malignant disease Flashcards

(76 cards)

Start Studying
1
Q

What principles must a screening programme adhere to for it to be successful?

A
  1. the cancer being detected must be common enough for it to represent an important health problem.
  2. The natural history of the cancer should be know. So that people know the latent phase and when it will become symptomatic
  3. A test to be carried out and detect latent disease, that is specific and sensitive to cancer and safe and acceptable to the patient.
  4. early detection should lead to benefit in terms of cost of treatment and survival of the patient.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some examples of premalignant skin disease?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are some examples of premalignant GI disease?

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some examples of premalignant GU disease?

A

Leukoplakia of the bladder

Bilharzia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How should the symptoms of cancer be classified?

A

Symptoms from the primary tumour, the metastases and generalised systemic symptoms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Please give some examples of symptoms causes by a primary tumour:

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Please give some examples of symptoms caused by metastases:

A

Enlarged lymph nodes
Hepatomegaly
Jaundice
Ascites
Pathological fractures - breast, bronchus, thyroid, prostate, kidney
Pleural effusions
Fits, confusion, personality changes due to cerebral mets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the general manifestations of cancer?

A

Cachexia, pyrexia of unknown origin, hypertrophic pulmonary osteoarthropathy, thrombophlebitis migrans (pancreatic cancer)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How are malignancies staged?

A

Extent of the tumour (T)
Node status (N)
Presence of mets (M)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is Dukes’ classfification?

A

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%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the grade of the tumour?

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Tumour markers.

List them and what cancer they are specific for.

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is Familial adenomatous polyposis and how is it managed?

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Where are the most common sites for colorectal cancer?

A

Rectum - 40%, sigmoid colon - 25%, descending colon - 5%, transverse colon - 10%, caecum and ascending colon - 20%.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the occurrence of synchronous and metachronous tumours?

A

2.5% synchronous - two cancers at the same time

1% metachronous - two cancers occurring at different times

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What symptoms do people with bowel cancer present with?

A

Left sided - bleeding, altered bowel habit, obstruction
Right sided - anaemia, palpable mass, weight loss, abdominal pain.
Rectum - frequency of defecation, tenesmus,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How to colorectal cancers spread?

A

Local, lymphatic, by blood (liver, lung and bone) or transcoelomic.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is more common? Adenocarcinoma or squamous cell carcinoma of the oesophagus?

A

Squamous cell - it occurs in the upper 2/3 of the oesophagus

Adenocarcinoma is increasing due to the increased GORD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the risk factors for squamous cell carcinoma of the oesophagus?

A

Smoking, alcohol, plummer-visons syndrome, achalasia, corrosive strictures, coeliac disease, tylosis (howel - evans syndrome) low vitamin A&C, nitrosamine exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the risk factors for adenocarcinoma of the oesophagus?

A

long standing heart burn, Barrett’s, smoking, obesity, increased age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How does oesophageal cancer spread?

A

Local into surrounding structures - trachea, lung, aorta
Lymphatic spread to nodes
Blood stream to liver and lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What pathology is pancreatic cancer most likely to be and where in the pancreas is the tumour normally found?

A

Ductal adenocarcinoma

60% in pancreas head, 25% in the body and 15% in the tail,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What gene is associated with pancreatic cancer?

A

KRAS2 gene is mutated in 95% of cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the risk factors for pancreatic cancer?

A

Smoking, alcohol, carcinogens, DM, chronic pancreatitis, ? high fat diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
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
26
What percentage of patients are suitable for surgery for pancreatic cancer?
27
What is the mean survival for pancreatic cancer?
28
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.
29
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 ```
30
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)
31
What investigations do women who present with a breath lump need to have done?
Triple assessment: Clincal - hx and examination Mammography or USS (if under 35yrs) Fine needle aspiration or core biopsy
32
What are the risk factors for developing breast cancer?
``` oestrogen exposure (unopposed by progesterone) nulliparous women mutations in BRAC1 BRAC2 early menarche/ late menopause family history saturated dietary fats previous benign atypical hyperplasia ```
33
How is breast cancer staged?
Stage 1: confined to breast mobile Stage 2: growth confined to breast mobile and ipsilateral nodes Stage 3: tumour fixed to muscle (but not chest wall) ipsilateral nodes matted and may be fixed, skin involvement larger than tumour Stage 4: Complete fixation of tumour to chest wall, distant mets
34
What is the sentinel node biopsy?
Blue dye is injected into the periareolar area or the tumour and the first node the dye reaches is detected (te sentinel node) this is then biopsied and sent to histology. It decreases needlee axillary clearence as if the sentinel node is clear from mets then it is VV likely that they others are clear too.
35
What are the tumour markers used to plan additional treatments?
If patients are eostrogen +ve then using an ER blocker like tamoxifen can increase survival time If tumours are HER2 +ve then herceptin can be used to reduce the micro metasases.
36
What are the 5 different types of thyroid cancer and their charcteristics?
1. PAPILLARY 60% in young. Spreads to nodes and lungs 2. FOLLICULAR
37
What factors increase the chance of developing renal cell carcinoma?
``` Smoking Drinking coffee Exposure to cadmium, lead, asbestos, aromatic hydrocarbons, Dialysis von Hippel-Lindau disease Obesity Anatomical: horseshoe kidney, PKD ```
38
How to renal cell carcinomas normally present?
Normally an incidental finding on a CT for something else. | The classic triad is loin pain, mass and haemturia - only occurs in 10%
39
What is the staging system for renal cell carcinoma?
``` Robson staging: I - confined to kidney II- involves perinephric fat but not beyond Garota's fascia III- spread to renal vein IV - spread to adjacent/ distant organs ```
40
What are the associations with TCC of the bladder?
``` Smoking Aromatic amines (working in the rubber industry) Chronic cystitis Schistomsomiasis (for SCC) Pelvic irradiation ```
41
How does TCC spread?
Local to pelvic structures Lymph to iliac and para-aortic nodes Haematogenous to liver and lungs
42
Describe the stages of T in the TNM staging for TCC:
``` Tis carcinoma in situ Ta Tumour confined to epithelium T1 Tumour in lamina propria T2 Superficial muscle involved T3 Deep muscle involved T4 Invasion beyond bladder ```
43
What is the treatment of TCC of the bladder?
Tis/Ta/T1 - diathermy of the tumour or intravesical chemo | T2/T3 - radical cystectomy is the gold standard
44
What different types of testicular cancer are there?
Seminoma (30-65yrs) Teratoma (20-30yrs) Tumour of Sertoli or Leydig cells Lymphoma
45
What are the risk factors for testicular cancer?
``` Age Cryptorchidism Race: more common in caucasians Previous testicular tumour FH Klinefelter's ```
46
How do testicular tumours spread?
Lymph - to the para aortic nodes NOT the ingunial | Haemtogenously to the lungs
47
How does prostate cancer spread?
Local - seminal vesicles, bladder and rectum Via lymph Haematogenously - sclerotic bone lesions)
48
What medication can be given to treat prostate cancer?
Gondaotrophinn releasing analogues, they at first stimulate and then inhibit the pituitary gonadotrophin.
49
What score is used for prognosis in prostate cancer?
Gleason score - is used to grade the tumours. the higher the score the worse prognosis. The pathologist looks at two areas and adds their score together 8-10 is a aggressive tumour, 5-7 intermediate, and 2-4 indolent.
50
What are the main causes of incontinence in men?
Enlargement of the prostate - chronic retention may cause urge incontinence TURP or pelvic surgery
51
What are the main causes of incontinence in women?
Stress incontinence: leakage due to an incompetent sphincter when abdominal pressure increases. Pelvic floor weakness, uterine prolapse is main cause Urge/ overactive bladder: caused by detrusor instability from central inhibitory pathway malfunction or sensitisation of peripheral afferent terminals of the bladder, or a bladder muscle problem. Need to check for organic brain problem (stroke, parkinsons, dementia) or urinary infection, diabetes, duretics, atrophic vaginitis, uretheritis,
52
What is a carcinoid tumour?
A tumour with origins of the enterchromaffin cells (neural crest) which are capable of making 5HT.
53
Where do carcinoid tumours present?
Appendix Ileum Rectum (ovary, testis, bronchi) then metastasize to the liver
54
What is carcinoid syndrome
When the carcinoid tumour is in the liver | Bronchoconstriction, paroxysmal flushing, diarrhoea, CCF, pulmonary fibrosis
55
What is a carcinoid crisis?
When a carcinoid tumour outgrows its blood supply and mediators flood out. Life threatening vasodilatation, hypotension, tachycardia,, bronchoconstriction and hyperglycaemia Treated with high dose octreotide and supportive measures
56
What is the proportion of different histology in lung cancer?
Squamous cell - most common Adenocarcinoma - 27% Small (oat) cell - 20% Large cell- 10%. Clinically most important distinction is small cell vs non small cell.
57
Where do Lung mets come from?
Kidney, prostate, breast, bone, GI, cervix, ovary
58
Whats better prognostically small cell or non small cell lung cancer?
Non small cell - can be excised if peripheral or have curative radiotherapy Small cell are almost always dissemination on presentation. Secrete hormones, and metastasise early.
59
Which hormones are produced by which lung cancer?
Small cell - ADH and ACTH resulting in SIADH and cushings Squamous - PTH resulting in high Ca
60
What is a Krukenberg tumour?
A secondary tumour in the ovary from a GI primary, particularly the stomach
61
What are the risk factors for ovarian tumours?
The more ovulations the more at risk you are: Late menopause, nullipara COCP, breast feeding decrease the risk
62
What are the symptoms that suggest ovarian cancer?
``` Bloating and abdominal distension Early satiety Loss of appetite Unexplained weight loss Change in bowel habit Fatigue Onset of IBS >50yrs Urinary frequency or urgency Abdominal pain or pelvic pain ``` Very Vague!
63
How do patients with malignancy gets spinal cord compression?
1. haematogoneous spread of the cancer to the spine and then extend into the epidural space 2. direct invasion into the spinal canal by primary
64
What is the commonest site of spinal cord compression?
Thoracic spine - 60% Lumbosacral - 30% Cervical - 10% But most patients have multiple levels of compression so need FULL MRI
65
What are the symptoms of spinal cord compression
``` Progressive back pain Pain increased by coughing or sneezing Progressive weakness of limbs Numbness and paraesthesia Loss of bladder and bowel function - DO NOT NEED TO WAIT FOR THIS May not have a sensory level ```
66
How do you treat spinal cord compression?
High dose steroids - 8mg dexamethasone BD (need to monitor BMS, give PPI and nystatin) MRI spine within 24hrs Keep flat on bed until images are discussed with the neurosurgeons Radiotherapy - within 24hrs of MRI diagnosis, Chemo is sensitive Physiotherapy
67
What are the contraindications to surgery for spinal cord compression?
Multiple levels Severe/ multiple co morbidities Paralysis for > 24hrs Life expectancy
68
What are the causes of superior vena cava obstruction?
Thrombosis Direct invasion Extrinsic compression of SVC - by primary tumour or lymph node mets
69
Which cancers more commonly cause SVC obstruction?
``` Lung cancer (small cell) Lymphomas Germ cell tumours Thymoma Mesothelioma Mets - from breast Ca ```
70
What are the symptoms and signs of SVC obstruction?
``` Symptoms: SOB Feeling of fullness in head and dizziness Swelling of face/ neck and upper limbs Headache/ chest pain Hoarse voice ``` Signs: Pemberton's sign - when you raise your arms it gets worse Chest wall superficial venous distension Distended neck veins facial oedema Plethora and cyanosis Oedema of upper extremities
71
How do you treat SVC obstruction?
Symptom relief - high dose dexamethasone and then endovascular stent Treat underlying malignancy
72
What causes malignant hypercalcaemia?
Bone mets - osteolysis releasing calcium | Parathyroid hormone related peptide secretion
73
What are the symptoms of hypercalcaemia?
``` Bones, stones, groans and psychic moans Nausea and vomiting, constipation, anxiety, depression, cognitive dysfunction Muscle weakness Arrhythmias - cardiac arrest Coma ```
74
How do you treat malignancy hypercalcaemia?
Rehydrate - 5L per day Bisphosphonates Stop any calcium supplements or thiazides
75
Which cancers most commonly cause brain mets that lead to raised ICP?
Lung Breast Melanoma, renal cell, testicular etc .....
76
What are the risk factors for hepatocellular carcinoma?
Viral hepatitis Cirrhosis - alcohol, haemochromatosis, PBC Parasites Anabolic steroids

Surgery (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions