Onc Key Conditions Flashcards
BCC Risk factors
Increasing age
UV exposure
Fitzpatrick skin type 1
Immunosupression
Genetic predisposition
What does a BCC look like?
Shiny or pearly nodule
Rolled edges
Surface telangiectasia
Rodent ulcer
Types of BCC
Nodular (most common)
Superficial
Morphoeic
Basosquamous (more aggressive)
High risk BCC features
Young patients
Immunocompromised patients
Recurrent lesions
Site - nose, lips, eyes, ears
Non-Nodular sub type
BCC treatment
Excision
MOHs e sic ion for high risk areas
Cryotherapy
Imiqiumod cream
SCC Risk factors
Smoking
Chronic skin inflammation
Fitzpatrick skin type 1
UV exposure
Increasing age
Previous history of skin cancer
How is SCC diagnosed
Clinical appearance and biopsy results
What is bowens disease / SCC in situ
Pre-cancerous change
SCC is present but hasn’t breached the basement membrane.
Irregular scaly plaque on sun exposed area
SCC treatment
Excision
MOHs excision
Curettage
Cryotherapy
Malignant melanoma symptoms
Mole growth
Irregular edges
Multiple colours
Bleeding
Itching and irritation
Malignant melanoma RF
UV exposure
Fitzpatrick skin type 1
FH skin cancer
Malignant melanoma treatment
Excision
Radiotherapy
Immunotherapy
Malignant melanoma spread
Most likely skin cancer to spread
Bones, brain, lymph nodes
Bladder cancer RF
Smoking
Dye exposure (aromatic amines)
Previous cancer treatment eg radiation to pelvis
Schischosomatis (SCC)
Clinical features of bladder cancer
Haematuria
Dysuria, frequency, urgency
Suprapubic pain
Weightloss, reduced appetite, back pain
Types of bladder cancer
Transitional cell carcinoma (95%)
Squamous cell carcinoma
Muscle invasive
Non muscle invasive
Bladder cancer Ivx
Urine dip
FBC, U+E, PSA
USS KUB
Flexible cystoscopy +/- biopsy
CT KUB
Staging CT
Causes of haematuria
Bladder cancer
Bladder stones
Cystitis
RCC
Renal stones
Prostatitis
Urethral stricture
Bladder cancer treatment
TURBT -Transurethral resection of bladder tumour
Muscle invasive - radical treatment- cystectomy or radical radiotherapy
Superficial- regular cystoscopes 5yrs post treatment
Mitomycin C - left in bladder 1 hour post op - reduces risk of recurrence
BCG - superficial
Renal cancer RF
Von hippel lindau
Smoking
HTN
Obesity
Diabetes
RCC Symptoms
Triad = haematuria, loin pain, palpable mass
Bone pain, night sweats, fatigue
Left varicoecle
Lower limb oedema
Paraneoplastic syndromes associated with RCC
Anaemia (of chronic disease)
Polycythemia (ectopic EPO production)
Hypercalcaemia (Ectopic PTH production)
Cushing syndrome (ectopic ACTH production)
Which lymph nodes does RCC spread to
Hilar and Para-aortic
RCC IVX
Urine dip
FBC,U+E,PSA,LFT,Bone profile
USS KUB
CT Chest, abdo, pelvis
MRI
Biopsy
Lung sign indicative of RCC
Cannonball lesions
What is the Leibovich score
Predicts patients risk of developing metastatic cancer following nephrectomy
0-1 low risk
2-5 mod risk
6+ high risk
RCC Treatment
Radical nephrectomy
Radical partial nephrectomy
Surveillance
Cryotherapy
Immunotherapy (mets)
Nephro-ureterectomy (TCC)
Testicular cancer tumour markers
AFP
LDH
bHCG
RF testicular cancer
Age 20-45
Cryptochiadism
FH testicular cancer
Caucasian
Hx contralateral testicular cancer
HIV
Testicular cancer symptoms
Testicular lump/swelling
Feeling of fullness in scrotum
Scrotum feels firmer
Testicular lump differentials
Tumour
Haematoma
Abscess
Hernia
Epididymitis
Testicular cancer investigations
Scrotal USS
CXR (Mets)
Bloods Inc tumour markers
CT Chest abdo pelvis (ideally post orchidectomy)
Testicular cancer treatment
Orchidectomy
Sperm banking
Chemo
Breast cancer causes
Excess oestrogen
BRCA1/2 genes
Breast cancer symptoms
Breast lump
Blood stained nipple discharge
Skin changes - peu’d orange
Breast asymmetry + indrawing of breast
Swollen axilla lymph nodes
Breast lump differentials
Cancer - firm, irregular, usually tethered
Fat necrosis - often mimics cancer lump
Cysts - fluid filled, not fixed
Fibroadenoma - firm, non tethered, highly mobile
Abcess- painful, red,hot breast
Intraductal papilloma - benign warty leison behind areola
Breast cancer RF
Obese
Late menopause/early menarche/ nuliparity
FH
Female
Increasing age
What is ducal carcinoma in situ
Sometimes classed as cancer sometimes classed as pre-cancerous change
Arises from epithelial cells and doesn’t breach basement membrane
What is lobular carcinoma in situ
Doesn’t breach basement membrane
Arises from acini cells
What is pagets disease of the nipple?
Rough dry erythmatous skin surrounding nipple
Often mistaken for eczema
Usually associated with underlying cancer
Most common breast cancer
Invasive ducal carcinoma
What is triple assessment
History and breast exam
Radiology - USS under 40s, mammogram +/- USS over 40s
Biopsy if needed
Breast cancer management
Wide local excision/ mastectomy depending of cancer + boob size + staging
Adjuvant radiotherapy
Chemo
Tamoxifen, aromatise inhibitors
What is tamoxifen
SERM - blocks oestrogen receptors
Given to premenopausal women with ER+ cancer
Tamoxifen side effects
Vaginal bleeding
Endometrial cancer risk
What are aromatase inhibitors
Eg// Letrozole
Given to post menopausal women with ER+ cancer
Stop oestrogen production
Aromatase inhibitors side effects
Hot flushes
Osteoporosis
Colorectal cancer RF
High alcohol intake
Poor diet - red meat, low fibre, lots processed foods
IBD
FH - lynch syndrome
Inc age
Obesity
Vit D deficiency
Bowel cancer screening
FIT testing - 60-74 year olds every 2 years
Stool sample in post
Uses antibodies against haemoglobin to look for blood in stool
Who gets enhanced bowel cancer screening
Lynch syndrome
Familial adenomatous polyposis
FH early bowel cancer
IBD
Bowel cance 2WW criteria
Rectal mass
Positive FIT test
Right sided bowel cancer symptoms
Weight loss
Iron deficiency anaemia
Abdo pain
Abdo mass
Left sided bowel cancer symptoms
PR Bleed
Tenesmus
Obstruction
Bloating
Change in bowel habit - constipation or diarrhoea
Bowel cancer emergency presentations
Obstruction
Perforation (usually caecal due to Ileo-caecal valve)
PR bleed
Bowel cancer IVX
Colonoscopy (not if obstruction)
Biopsy
CT CAP
CEA tumour marker
Rectal cancer MRI
Indicators of high risk bowel cancers
Bigger than 3cm
More than 30% bowel circumference involved
Poorly differentiated
Bowel cancer follow up
2x CT CAP in first 3 years
6 monthly CEA tests
Oesophageal cancer 2ww criteria for endoscopy
Dysphagia or
age >55 + weightloss + 1 of upper abdo pain, reflux or dyspepsia
Causes of dysphagia
GORD, Oesophageal cancer, oesophageal stricture, Stroke, MS, MND, Oesophagitis
Oesophageal cancer Ivx
Endoscopy /OGD
Bloods
X-ray
Barium swallow
Biopsy
Types of oesophageal cancer
Adenocarcinoma - bottom 1/3 most common
SCC - African population, top 2/3rds
Oesophageal cancer RF
Smoking
Alcohol
Hot drinks
Barrett’s oesophagus
GORD
FH
Surgical management of oesophageal cancer
Mckeown oesophagectomy - higher lesions, 3 incisions
Ivor-Lewis oesophagectomy - lower leisons, 2 incisions
Oesophageal cancer symptoms
Dysphagia (usually progressive)
Dyspepsia
Reflux
Weightloss
Upper abdo pain
Gastric cancer symptoms
Early satiety
Haematemesis
Upper abdo pain
Weightloss
Anorexia
Dyspepsia
Gastric cancer signs
Virchows node, Acanthodii’s nigricans, epigastric mass, jaundice
Gastric cancer RF
Inc age
Male
H.pylori
Smoking
Pernicious anaemia
High salt diet
FH
Gastric cancer 2WW criteria
Upper abdo mass consistent with stomach cancer.
Endoscopy- dysphagia or age > 55 with weightloss + one of reflux, dyspepsia, upper abdo pain
Gastric cancer management
Surgical- total gastrectomy, roux en y reconstruction
Nutrition support
Chemo
What is covossias law?
Painless jaundice + RUQ mass = likely to be Ca
Causes of pre-hepatic jaundice
Haemolytic anaemia - sickle cell, hereditary spherocytosis, G6PD deficiency, thalessemia
Malaria
Gilbert syndrome
Causes of hepatic jaundice
Liver cirrhosis
Hepatitis- alcoholic, autoimmune, ABCDE
Non alcoholic fatty liver disease
Wilson’s disease
Hereditary haemochromatosis
Hepatocellular carcinoma
Post hepatic causes of jaundice
Obstruction- pancreatic cancer, strictures
Gallstones, ascending cholangitis
Pancreatic cancer 2WW Criteria
Age >40 jaundice
Age >60 diarrhoea, abdo pain, back pain, N+V, constipation
New onset diabetes
Pancreatic cancer symptoms
Steatorrhea
Back pain, epigastric pain
Dark urine
Jaundice
Pancreatic cancer RF
Increased age
Male
Smoking
Obesity
Chronic pancreatitis
FH
Pancreatic cancer treatment
If ressectable - surgery - whipples procedure
Adjuvant chemo or if unressectable
Pancreatic cancer tumour marker
CA19-9
Most common type + area of prostate cancer
Adenocarcinoma
Peripheral zone
Causes of prostate cancer
Driven by prolonged exposure to testosterone
Prostate cancer symptoms
LUTS - nocturia, hesitancy, weak stream, polyuria, post micturion dribbling, double voiding
Back pain common in mets
Causes of raised PSA
Prostate cancer
BPH
Prostatitis
DRE
Recent ejaculation
Prostate cancer Ivx
MP MRI
Prostate biopsy - US guided transrectal or transperineal
Bone scan
CT CAP
Prostate cancer treatment
Active surveillance
Radiotherapy
Prostatectomy
Anti-androgen therapy
TURP
MSCC symptoms
Back pain/ back ache is most common
Neurological changes - motor weakness, parathesia
Urinary retention or incontinence
MSCC on examination
Increased tone
Increased plantars
Hypereflexia
Leg weakness
Loss of sensation
Changes in anal tone
MSCC treatment
16mg Dexamethasone ASAP
bed rest
PPI
LMWH
Some patients will have surgery
Radiotherapy
Most common cancers to cause MSCC
Breast
Prostate
Lung
Myeloma
What is SVCO
Obstruction to the flow of blood through the superior vena cava secondary to a cancer
Causes of SVCO
Non small cell lung cancer
Small cell lung cancer
Non Hodgkin’s lymphoma
Non malignant causes - syphilis
SVCO symptoms
Dyspnoea
Facial swelling
Cough
Head fullness
Dysphagia
Symptoms exacerbated by bending forwards or lying down
SVCO Signs
Facial swelling
Distended neck + chest wall veins
Upper limb oedema
Cyanosis
Cognitive dysfunction
What is pembertons sign
Test for SVCO
elevate both arms above head for 1-2 mins
If it cause’s congestive, cyanosis or resp distress = positive
Due to increased venous return exacerbating obstruction
SVCO IVX
CXR - mediastinal widening and pleural effusion
CT CAP
Duplex USS
SVCO treatment
Dexamethasone
Endovascular stenting
Radiotherapy
Chemo
Elevate head + neck
O2
What is neutropenic sepsis
Fever>38 or features of sepsis in patients with a neutrophil count of less than 0.5
Neutropenic sepsis symptoms
Often very vague - feel generally unwell
Fever
Confusion
Tachycardia
Tachypnoea
Low BP
Neutropenic sepsis management
Sepsis 6
Broad spectrum abx - tazocin / meropenem ASAP
IV fluids
O2
ABG/VBG - Lactate
Blood cultures
Catheter - urine output
What is DIC
serious disorder in response to illness or disease which results in dysregulated blood clotting
Can have simultaneous bleeding and thrombosis
DIC causes
Shock
Sepsis
Major trauma or burns
Eclampsia + HELLP
DIC symptoms
Bleeding from ears, nose, GI tract, respiratory (3 unrelated sites = v indicative)
New onset confusion
Widespread bruising
DIC Signs
Petechiae
Live do reticularis
Localised infarction or gangrene eg didgits
Oliguria
Hypotension
Tachycardia
DIC Ivx
FBC - thrombocytopenia
Coagulation screen - PT / APTT often prolonged
Fibrinogen - decreased
D-diner - typically raised
DIC management
Treat underlying disorder
Platelet transfusion- try and keep above 50
FFP or cryoprecipitate transfusion
DIC complications
Multi-organ failure
Life-threatening haemorrhage
Cardiac tampon are
Haemothorax
Digit loss
Hypercalcaemia causes
Excess or ectopic PTH release - RCC, 1 or 3 hyperparathyoidism
Malignancy - myeloma, bone mets
Excess Vit D or Ca intake
Severe AKI
Thiazide diuretics
How to tell the difference between hypercalcaemia due to malignancy and hyperparathyroidism
PTH is raised in hyperparathyroidism and suppressed in malignancy
Hypercalcaemia symptoms
Confusion/hallucinations
Abdo pain
Renal stones - loin pain, haematuria
Constipation
Bone pain
Hypercalcaemia management
IV fluids
IV bisphosphonates (zoledronic acid)
Most common head and neck cancer
Tongue
H+N cancer RF
Smoking
Alcohol
HPV
Older, male
Betal nut chewing
Southern china
Poor dental hygiene
What is erythroplakia
Red, velvety patch on oral mucosa
Between 70-90% are precancerous
Typical form of H+N cancer
SCC
Radiotherapy side effects - skin
Skin soreness
Change in colour
Dry and itchiness
Blistering
Radiotherapy side effects
Fatigue
Mucositis
Hair loss in treatment area
N+V
Diarrhoea
Stiff joints
Erectile dysfunction
Infertility
Small cell lung cancer development
From neuroendocrine cells
Develop centrally
Quickly grow and metastasise
Lung cancer RF
Smoking
Asbestos exposure (mesothelioma)
Air pollution
Ionising radiation
Lung cancer features
Cough
Haemoptysis
SoB
Weightloss
Fatigue
Pancoast tumour features
Apical lung cancer, compress on brachial plexus - upper limb weakness/parathesia or on sympathetic chain - horners
SIADH + Small cell lung cancer
Small cell lung cancer may produce ADH causing SIADH - Hyponatraemia
Paraneoplastic syndrome associated with small cell lung cancer
SIADH
Cushing syndrome - Inc ACTH
SVCO
Eaton-lambert syndrome
Lung Adenocarcinoma Paraneoplastic syndrome
Pulmonary osteoarthropathy
Ovarian cancer RF
Previous breast cancer
Smoking
Obesity + diabetes
FH
Previous ovarian disease
Pelvic radiotherapy
Ovarian cancer symptoms
Non specific GI symptoms- bloating, indigestion
Abdo, pelvic or back pain
Abnormal vaginal bleeding
Altered bowel habit
Leg swelling
Systemic symptoms
Ovarian cancer tumour marker
Ca-125
Endometrial cancer RF
Prolonged exposure to unopposed oestrogen
Early menarche or late menopause
PCOS
Tamoxifen use
Older age
Endometrial cancer features
Post menopausal bleeding
Clear/white vaginal discharge
Weightloss
Abdo pain
Endometrial cancer IVX
Transvaginal USS -Endometrial thickness >5mm
Endometrial biopsy
