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Cancer Care > Onc Key Conditions > Flashcards

Onc Key Conditions Flashcards

1
Q

BCC Risk factors

A

Increasing age
UV exposure
Fitzpatrick skin type 1
Immunosupression
Genetic predisposition

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2
Q

What does a BCC look like?

A

Shiny or pearly nodule
Rolled edges
Surface telangiectasia
Rodent ulcer

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3
Q

Types of BCC

A

Nodular (most common)
Superficial
Morphoeic
Basosquamous (more aggressive)

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4
Q

High risk BCC features

A

Young patients
Immunocompromised patients
Recurrent lesions
Site - nose, lips, eyes, ears
Non-Nodular sub type

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5
Q

BCC treatment

A

Excision
MOHs e sic ion for high risk areas
Cryotherapy
Imiqiumod cream

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6
Q

SCC Risk factors

A

Smoking
Chronic skin inflammation
Fitzpatrick skin type 1
UV exposure
Increasing age
Previous history of skin cancer

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7
Q

How is SCC diagnosed

A

Clinical appearance and biopsy results

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8
Q

What is bowens disease / SCC in situ

A

Pre-cancerous change
SCC is present but hasn’t breached the basement membrane.
Irregular scaly plaque on sun exposed area

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9
Q

SCC treatment

A

Excision
MOHs excision
Curettage
Cryotherapy

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10
Q

Malignant melanoma symptoms

A

Mole growth
Irregular edges
Multiple colours
Bleeding
Itching and irritation

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11
Q

Malignant melanoma RF

A

UV exposure
Fitzpatrick skin type 1
FH skin cancer

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12
Q

Malignant melanoma treatment

A

Excision
Radiotherapy
Immunotherapy

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13
Q

Malignant melanoma spread

A

Most likely skin cancer to spread
Bones, brain, lymph nodes

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14
Q

Bladder cancer RF

A

Smoking
Dye exposure (aromatic amines)
Previous cancer treatment eg radiation to pelvis
Schischosomatis (SCC)

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15
Q

Clinical features of bladder cancer

A

Haematuria
Dysuria, frequency, urgency
Suprapubic pain
Weightloss, reduced appetite, back pain

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16
Q

Types of bladder cancer

A

Transitional cell carcinoma (95%)
Squamous cell carcinoma
Muscle invasive
Non muscle invasive

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17
Q

Bladder cancer Ivx

A

Urine dip
FBC, U+E, PSA
USS KUB
Flexible cystoscopy +/- biopsy
CT KUB
Staging CT

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18
Q

Causes of haematuria

A

Bladder cancer
Bladder stones
Cystitis
RCC
Renal stones
Prostatitis
Urethral stricture

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19
Q

Bladder cancer treatment

A

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

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20
Q

Renal cancer RF

A

Von hippel lindau
Smoking
HTN
Obesity
Diabetes

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21
Q

RCC Symptoms

A

Triad = haematuria, loin pain, palpable mass
Bone pain, night sweats, fatigue
Left varicoecle
Lower limb oedema

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22
Q

Paraneoplastic syndromes associated with RCC

A

Anaemia (of chronic disease)
Polycythemia (ectopic EPO production)
Hypercalcaemia (Ectopic PTH production)
Cushing syndrome (ectopic ACTH production)

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23
Q

Which lymph nodes does RCC spread to

A

Hilar and Para-aortic

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24
Q

RCC IVX

A

Urine dip
FBC,U+E,PSA,LFT,Bone profile
USS KUB
CT Chest, abdo, pelvis
MRI
Biopsy

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25
Q

Lung sign indicative of RCC

A

Cannonball lesions

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26
Q

What is the Leibovich score

A

Predicts patients risk of developing metastatic cancer following nephrectomy
0-1 low risk
2-5 mod risk
6+ high risk

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27
Q

RCC Treatment

A

Radical nephrectomy
Radical partial nephrectomy
Surveillance
Cryotherapy
Immunotherapy (mets)
Nephro-ureterectomy (TCC)

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28
Q

Testicular cancer tumour markers

A

AFP
LDH
bHCG

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29
Q

RF testicular cancer

A

Age 20-45
Cryptochiadism
FH testicular cancer
Caucasian
Hx contralateral testicular cancer
HIV

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30
Q

Testicular cancer symptoms

A

Testicular lump/swelling
Feeling of fullness in scrotum
Scrotum feels firmer

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31
Q

Testicular lump differentials

A

Tumour
Haematoma
Abscess
Hernia
Epididymitis

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32
Q

Testicular cancer investigations

A

Scrotal USS
CXR (Mets)
Bloods Inc tumour markers
CT Chest abdo pelvis (ideally post orchidectomy)

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33
Q

Testicular cancer treatment

A

Orchidectomy
Sperm banking
Chemo

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34
Q

Breast cancer causes

A

Excess oestrogen
BRCA1/2 genes

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35
Q

Breast cancer symptoms

A

Breast lump
Blood stained nipple discharge
Skin changes - peu’d orange
Breast asymmetry + indrawing of breast
Swollen axilla lymph nodes

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36
Q

Breast lump differentials

A

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

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37
Q

Breast cancer RF

A

Obese
Late menopause/early menarche/ nuliparity
FH
Female
Increasing age

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38
Q

What is ducal carcinoma in situ

A

Sometimes classed as cancer sometimes classed as pre-cancerous change
Arises from epithelial cells and doesn’t breach basement membrane

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39
Q

What is lobular carcinoma in situ

A

Doesn’t breach basement membrane
Arises from acini cells

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40
Q

What is pagets disease of the nipple?

A

Rough dry erythmatous skin surrounding nipple
Often mistaken for eczema
Usually associated with underlying cancer

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41
Q

Most common breast cancer

A

Invasive ducal carcinoma

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42
Q

What is triple assessment

A

History and breast exam
Radiology - USS under 40s, mammogram +/- USS over 40s
Biopsy if needed

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43
Q

Breast cancer management

A

Wide local excision/ mastectomy depending of cancer + boob size + staging
Adjuvant radiotherapy
Chemo
Tamoxifen, aromatise inhibitors

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44
Q

What is tamoxifen

A

SERM - blocks oestrogen receptors
Given to premenopausal women with ER+ cancer

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45
Q

Tamoxifen side effects

A

Vaginal bleeding
Endometrial cancer risk

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46
Q

What are aromatase inhibitors

A

Eg// Letrozole
Given to post menopausal women with ER+ cancer
Stop oestrogen production

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47
Q

Aromatase inhibitors side effects

A

Hot flushes
Osteoporosis

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48
Q

Colorectal cancer RF

A

High alcohol intake
Poor diet - red meat, low fibre, lots processed foods
IBD
FH - lynch syndrome
Inc age
Obesity
Vit D deficiency

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49
Q

Bowel cancer screening

A

FIT testing - 60-74 year olds every 2 years
Stool sample in post
Uses antibodies against haemoglobin to look for blood in stool

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50
Q

Who gets enhanced bowel cancer screening

A

Lynch syndrome
Familial adenomatous polyposis
FH early bowel cancer
IBD

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51
Q

Bowel cance 2WW criteria

A

Rectal mass
Positive FIT test

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52
Q

Right sided bowel cancer symptoms

A

Weight loss
Iron deficiency anaemia
Abdo pain
Abdo mass

53
Q

Left sided bowel cancer symptoms

A

PR Bleed
Tenesmus
Obstruction
Bloating
Change in bowel habit - constipation or diarrhoea

54
Q

Bowel cancer emergency presentations

A

Obstruction
Perforation (usually caecal due to Ileo-caecal valve)
PR bleed

55
Q

Bowel cancer IVX

A

Colonoscopy (not if obstruction)
Biopsy
CT CAP
CEA tumour marker
Rectal cancer MRI

56
Q

Indicators of high risk bowel cancers

A

Bigger than 3cm
More than 30% bowel circumference involved
Poorly differentiated

57
Q

Bowel cancer follow up

A

2x CT CAP in first 3 years
6 monthly CEA tests

58
Q

Oesophageal cancer 2ww criteria for endoscopy

A

Dysphagia or
age >55 + weightloss + 1 of upper abdo pain, reflux or dyspepsia

59
Q

Causes of dysphagia

A

GORD, Oesophageal cancer, oesophageal stricture, Stroke, MS, MND, Oesophagitis

60
Q

Oesophageal cancer Ivx

A

Endoscopy /OGD
Bloods
X-ray
Barium swallow
Biopsy

61
Q

Types of oesophageal cancer

A

Adenocarcinoma - bottom 1/3 most common
SCC - African population, top 2/3rds

62
Q

Oesophageal cancer RF

A

Smoking
Alcohol
Hot drinks
Barrett’s oesophagus
GORD
FH

63
Q

Surgical management of oesophageal cancer

A

Mckeown oesophagectomy - higher lesions, 3 incisions
Ivor-Lewis oesophagectomy - lower leisons, 2 incisions

64
Q

Oesophageal cancer symptoms

A

Dysphagia (usually progressive)
Dyspepsia
Reflux
Weightloss
Upper abdo pain

65
Q

Gastric cancer symptoms

A

Early satiety
Haematemesis
Upper abdo pain
Weightloss
Anorexia
Dyspepsia

66
Q

Gastric cancer signs

A

Virchows node, Acanthodii’s nigricans, epigastric mass, jaundice

67
Q

Gastric cancer RF

A

Inc age
Male
H.pylori
Smoking
Pernicious anaemia
High salt diet
FH

68
Q

Gastric cancer 2WW criteria

A

Upper abdo mass consistent with stomach cancer.
Endoscopy- dysphagia or age > 55 with weightloss + one of reflux, dyspepsia, upper abdo pain

69
Q

Gastric cancer management

A

Surgical- total gastrectomy, roux en y reconstruction
Nutrition support
Chemo

70
Q

What is covossias law?

A

Painless jaundice + RUQ mass = likely to be Ca

71
Q

Causes of pre-hepatic jaundice

A

Haemolytic anaemia - sickle cell, hereditary spherocytosis, G6PD deficiency, thalessemia
Malaria
Gilbert syndrome

72
Q

Causes of hepatic jaundice

A

Liver cirrhosis
Hepatitis- alcoholic, autoimmune, ABCDE
Non alcoholic fatty liver disease
Wilson’s disease
Hereditary haemochromatosis
Hepatocellular carcinoma

73
Q

Post hepatic causes of jaundice

A

Obstruction- pancreatic cancer, strictures
Gallstones, ascending cholangitis

74
Q

Pancreatic cancer 2WW Criteria

A

Age >40 jaundice
Age >60 diarrhoea, abdo pain, back pain, N+V, constipation
New onset diabetes

75
Q

Pancreatic cancer symptoms

A

Steatorrhea
Back pain, epigastric pain
Dark urine
Jaundice

76
Q

Pancreatic cancer RF

A

Increased age
Male
Smoking
Obesity
Chronic pancreatitis
FH

77
Q

Pancreatic cancer treatment

A

If ressectable - surgery - whipples procedure
Adjuvant chemo or if unressectable

78
Q

Pancreatic cancer tumour marker

A

CA19-9

79
Q

Most common type + area of prostate cancer

A

Adenocarcinoma
Peripheral zone

80
Q

Causes of prostate cancer

A

Driven by prolonged exposure to testosterone

81
Q

Prostate cancer symptoms

A

LUTS - nocturia, hesitancy, weak stream, polyuria, post micturion dribbling, double voiding
Back pain common in mets

82
Q

Causes of raised PSA

A

Prostate cancer
BPH
Prostatitis
DRE
Recent ejaculation

83
Q

Prostate cancer Ivx

A

MP MRI
Prostate biopsy - US guided transrectal or transperineal
Bone scan
CT CAP

84
Q

Prostate cancer treatment

A

Active surveillance
Radiotherapy
Prostatectomy
Anti-androgen therapy
TURP

85
Q

MSCC symptoms

A

Back pain/ back ache is most common
Neurological changes - motor weakness, parathesia
Urinary retention or incontinence

86
Q

MSCC on examination

A

Increased tone
Increased plantars
Hypereflexia
Leg weakness
Loss of sensation
Changes in anal tone

87
Q

MSCC treatment

A

16mg Dexamethasone ASAP
bed rest
PPI
LMWH
Some patients will have surgery
Radiotherapy

88
Q

Most common cancers to cause MSCC

A

Breast
Prostate
Lung

Myeloma

89
Q

What is SVCO

A

Obstruction to the flow of blood through the superior vena cava secondary to a cancer

90
Q

Causes of SVCO

A

Non small cell lung cancer
Small cell lung cancer
Non Hodgkin’s lymphoma
Non malignant causes - syphilis

91
Q

SVCO symptoms

A

Dyspnoea
Facial swelling
Cough
Head fullness
Dysphagia
Symptoms exacerbated by bending forwards or lying down

92
Q

SVCO Signs

A

Facial swelling
Distended neck + chest wall veins
Upper limb oedema
Cyanosis
Cognitive dysfunction

93
Q

What is pembertons sign

A

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

94
Q

SVCO IVX

A

CXR - mediastinal widening and pleural effusion
CT CAP
Duplex USS

95
Q

SVCO treatment

A

Dexamethasone
Endovascular stenting
Radiotherapy
Chemo
Elevate head + neck
O2

96
Q

What is neutropenic sepsis

A

Fever>38 or features of sepsis in patients with a neutrophil count of less than 0.5

97
Q

Neutropenic sepsis symptoms

A

Often very vague - feel generally unwell
Fever
Confusion
Tachycardia
Tachypnoea
Low BP

98
Q

Neutropenic sepsis management

A

Sepsis 6
Broad spectrum abx - tazocin / meropenem ASAP
IV fluids
O2

ABG/VBG - Lactate
Blood cultures
Catheter - urine output

99
Q

What is DIC

A

serious disorder in response to illness or disease which results in dysregulated blood clotting

Can have simultaneous bleeding and thrombosis

100
Q

DIC causes

A

Shock
Sepsis
Major trauma or burns
Eclampsia + HELLP

101
Q

DIC symptoms

A

Bleeding from ears, nose, GI tract, respiratory (3 unrelated sites = v indicative)
New onset confusion
Widespread bruising

102
Q

DIC Signs

A

Petechiae
Live do reticularis
Localised infarction or gangrene eg didgits
Oliguria
Hypotension
Tachycardia

103
Q

DIC Ivx

A

FBC - thrombocytopenia
Coagulation screen - PT / APTT often prolonged
Fibrinogen - decreased
D-diner - typically raised

104
Q

DIC management

A

Treat underlying disorder
Platelet transfusion- try and keep above 50
FFP or cryoprecipitate transfusion

105
Q

DIC complications

A

Multi-organ failure
Life-threatening haemorrhage
Cardiac tampon are
Haemothorax
Digit loss

106
Q

Hypercalcaemia causes

A

Excess or ectopic PTH release - RCC, 1 or 3 hyperparathyoidism
Malignancy - myeloma, bone mets
Excess Vit D or Ca intake
Severe AKI
Thiazide diuretics

107
Q

How to tell the difference between hypercalcaemia due to malignancy and hyperparathyroidism

A

PTH is raised in hyperparathyroidism and suppressed in malignancy

108
Q

Hypercalcaemia symptoms

A

Confusion/hallucinations
Abdo pain
Renal stones - loin pain, haematuria
Constipation
Bone pain

109
Q

Hypercalcaemia management

A

IV fluids
IV bisphosphonates (zoledronic acid)

110
Q

Most common head and neck cancer

A

Tongue

111
Q

H+N cancer RF

A

Smoking
Alcohol
HPV
Older, male
Betal nut chewing
Southern china
Poor dental hygiene

112
Q

What is erythroplakia

A

Red, velvety patch on oral mucosa
Between 70-90% are precancerous

113
Q

Typical form of H+N cancer

A

SCC

114
Q

Radiotherapy side effects - skin

A

Skin soreness
Change in colour
Dry and itchiness
Blistering

115
Q

Radiotherapy side effects

A

Fatigue
Mucositis
Hair loss in treatment area
N+V
Diarrhoea
Stiff joints
Erectile dysfunction
Infertility

116
Q

Small cell lung cancer development

A

From neuroendocrine cells
Develop centrally
Quickly grow and metastasise

117
Q

Lung cancer RF

A

Smoking
Asbestos exposure (mesothelioma)
Air pollution
Ionising radiation

118
Q

Lung cancer features

A

Cough
Haemoptysis
SoB
Weightloss
Fatigue

119
Q

Pancoast tumour features

A

Apical lung cancer, compress on brachial plexus - upper limb weakness/parathesia or on sympathetic chain - horners

120
Q

SIADH + Small cell lung cancer

A

Small cell lung cancer may produce ADH causing SIADH - Hyponatraemia

121
Q

Paraneoplastic syndrome associated with small cell lung cancer

A

SIADH
Cushing syndrome - Inc ACTH
SVCO
Eaton-lambert syndrome

122
Q

Lung Adenocarcinoma Paraneoplastic syndrome

A

Pulmonary osteoarthropathy

123
Q

Ovarian cancer RF

A

Previous breast cancer
Smoking
Obesity + diabetes
FH
Previous ovarian disease
Pelvic radiotherapy

124
Q

Ovarian cancer symptoms

A

Non specific GI symptoms- bloating, indigestion
Abdo, pelvic or back pain
Abnormal vaginal bleeding
Altered bowel habit
Leg swelling
Systemic symptoms

125
Q

Ovarian cancer tumour marker

A

Ca-125

126
Q

Endometrial cancer RF

A

Prolonged exposure to unopposed oestrogen
Early menarche or late menopause
PCOS
Tamoxifen use
Older age

127
Q

Endometrial cancer features

A

Post menopausal bleeding

Clear/white vaginal discharge
Weightloss
Abdo pain

128
Q

Endometrial cancer IVX

A

Transvaginal USS -Endometrial thickness >5mm
Endometrial biopsy

Cancer Care (4 decks)

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