O&S Flashcards
Most common breast cancer
IDC
Age of breast cancer screening
50-71
Most common method of obtaining biopsy in breast cancer
Core biopsy
Prognosis in fibroadenoma
Good. Around half regress spontaneously
Indications for surgery in fibroadenoma
Large or fast growing. Persistently painful. Difficult to differentiate from a tumour
Age associated with breast cysts
Peri-menopausal
Investigation of breast cyst
The cyst will be aspirated and if there is blood in the aspirate, this will be sent for cytology studies to exclude cancer. If there’s a residual mass after aspiration a biopsy is taken to check for cancer
Management of breast cyst
Reassurance and aspiration
Age of colorectal cancer screening
60-75
Risk factors for anal cancer
IV drug use, HPV, multiple sexual partners, young first sexual intercourse, receptive anal sex, immunosuppression, and anal intra-epithelial neoplasia (a premalignant condition)
What is anal intra-epithelial neoplasia?
A pre-malignant condition of cellular changes on cells of the anus
First line treatment in anal cancer
Chemo or radio therapy
Management of lynch syndrome
Prophylactic aspirin, H pylori eradication, 2-yearly colonoscopy screening, some patients may have prophylactic salpingo-oopherectomy
Asymptomatic reducible inguinal hernia management
Education on signs of complications
Gold standard for diagnosis of achalasia
Manometry
Treatments for achalasia
Heller’s cardiomyotomy
Balloon dilation
Botulinum injection
What is hereditary diffuse gastric cancer?
autosomal dominant condition with a high risk of gastric cancer at a young age. Patients with this condition usually have a prophylactic gastrectomy in early adulthood
Who is offered screening for liver cancer?
Patients with cirrhosis
What does screening for liver cancer consist of?
USS twice per year and CT/MRI to follow up on abnormalities
When is biopsy needed to diagnose liver cancer?
No cirrhosis or diagnostic uncertainty
Treatment options in liver cancer
Resection Percutaneous radiofrequency ablation Arterial embolisation to reduce blood supply Chemo administered via local arteries Transplant Chemo / radiotherapy / immunotherapy Palliative
Treatment options in cholangiocarcinoma
Surgery (+/- liver resection). May have adjuvant chemo or radiotherapy
Percutaneous radiofrequency ablation
Arterial embolisation to reduce blood supply
Chemo administered via local arteries
Stenting (symptom control)
Chemo / radiotherapy / immunotherapy
Palliative
Who is screened for pancreatic cancer?
High risk patients (e.g. certain mutations, strong family history)
Types on non-small cell lung cancer
Adenocarcinoma, squamous cell lung cancer, large cell lung cancer
Where in the lungs is adenocarcinoma more common?
Peripheries
Where in the lungs is squamous cell carcinoma more common?
Centrally
Prognosis in large cell lung cancer
Poor
What is a pancoast tumour?
Apical tumour
Complications of pancoast tumour
SVC obstruction
Horners syndrome
Brachial plexus involvement (upper limb weakness)
Cancer caused by asbestos exposure
Mesothelioma
Site of mesothelioma
Pleura
Main risk factor for empyema
Recent pneumonia that hasn’t responded to antibiotics
Management of empyema
Broad spectrum abx
Chest drain
If unsuccessful, surgery
Risk factors for renal cell cancer
The main risk factors are older age, smoking, hypertension, obesity and family history. Lots of hereditary syndromes increase risk including Von-Hippel Lindau syndrome, tuberous sclerosis, Birt-Hogg-Dube syndrome and hereditary papillary renal cell carcinoma
Age of testicular torsion
First year of life or adolescence
What is Prehn’s sign and what does it indicate?
Pain on lifting testicle. Testicular torsion
What is extra-vaginal torsion?
Extra-vaginal torsion is when the tunica vaginalis can tort with the spermatic cord as it isn’t yet attached, which affects boys in utero and the first year of life.
What is intra-vaginal torsion?
Intra-vaginal torsion is if the spermatic cord torts within the tunica vaginalis, which is seen primarily in adolescence
Management of CLL
May use “watch and wait” approach. Medications that may be used include chemotherapies, tyrosine kinase inhibitors, monoclonal antibodies and steroids (used in frail patients). In patients with few comorbidities, allogenic stem cell transplant can be used
What may be seen on blood film in CLL?
Smudge cells
Natural progression of CML
Typically, there is a chronic phase of 3-5 years with few symptoms and the patient is stable. This is followed by an accelerated phase of around a year where symptoms become more severe and finally a blast crisis, which is severe and resembles acute leukaemia with poor prognosis
Age associated with AML
Older adults
Which malignancy is associated with auer rods on blood smear?
AML
Management of AML
Supportive (treat anaemia, treat thrombocytopaenia, treat infections, consider allopurinol / raspuricase, hydroxycarbamide to for cytoreduction if needed)
Induction chemo
Maintenance chemo
Stem cell transplant
Most common type of non-Hodgkin lymphoma
Diffuse large B cell lymphoma
Presentation of diffuse large B cell lymphoma
more common in younger people and usually presents as a rapidly enlarging mass
First line test for lymphoma diagnosis
Excisional biopsy (core biopsy if patient not fit)
Most common type of Hodgkin lymphoma
Nodular sclerosis
Prognosis in Hodgkin lymphoma
Good
Treatment of lymphoma
Varies depending on type and patient but chemo is key
How is a biopsy for thyroid cancer obtained?
Fine needle aspiration
Monitoring for recurrence of thyroid cancer
Thyroglobulin levels
What does superficial BCC look like?
red, scaly, irregular plaque with micro-erosions and a thin, clear, border
What does morphoeic BCC look like?
irregular boarders and a scar like plaque
What does basosquamous BCC look like?
Lesions may have central crusting and are often large and fast growing
What does Gorlin syndrome predispose to?
BCC
What does an SCC lesion look like?
ulcerating with raised, crusted edges
What does Bowen disease predispose to?
SCC
Most common type of melanoma
Superficial spreading
Characteristics of lentigo melanoma
slow growth in sun exposed areas
Characteristics of acral lentiginous melanoma
Occurs under nails or on palms or soles
Most common brain tumour in adults
Glioblastoma multiforme
Complications of ovarian cancer
Complications include ascites, pleural effusions and adhesions leading to bowel obstruction.
Most common type of cervical cancer
Squamous cell carcinoma
When does neutropaenic sepsis usually present?
1-2 weeks after last cycle of chemo
Mechanism of SVCO
direct tumour growth, thrombosis within the vena cava or lymphadenopathy
Symptoms of SVCO
The main symptoms are dyspnoea, facial swelling, head fullness and cough. Other symptoms include dysphagia, distended chest and neck veins, upper limb oedema, facial plethora, cyanosis and confusion. These are worse when bending forwards, lying down or raising the arms above the head for 1-2 minutes
What is Pemberton’s sign?
Symptoms of SVCO are worse when the arms are raised above the head for a couple of mins
Diagnostic imaging in SVCO
CT
Management of acute SVCO with stridor
ABCDE
Sit patient upright
Stenting / shunting / thrombolysis
Options for management of SVCO
ABCDE with O2 and patient sitting upright Treat underlying cancer Dexamethasone Stenting or shunting Thrombolysis
Common presentations of immunotherapy toxicity
Common presentations include thyroid disease, vitiligo, rash, pneumonitis, colitis, hepatitis, nephritis, uveitis and neuropathy
Management of immunotherapy toxicity
High dose steroids
Phosphate levels in hypercalcaemia of malignancy
Low
