Oncolocy Flashcards
Bladder cancer
Over 90% of cancers of the urinary bladder are urothelial carcinoma (previously termed transitional cell carcinoma; TCC). Non-muscle-invasive tumours are most common. Low-grade tumours are papillary and generally easy to visualise. High-grade tumours are often flat or in situ, and can be difficult to visualise. If muscle invasion occurs, transurethral resection is insufficient and radical cystoprostatectomy is usually advised.
Bladder cancer: symptoms and Ix
Risk factors include tobacco exposure, male gender, age >55 years, exposure to chemical carcinogens, pelvic radiation, systemic chemotherapy, and FHx positive for bladder cancer.
haematuria
dysuria
urinalysis Investigations to consider urine cytology renal and bladder ultrasound CT urogram cystoscopy intravenous urogram
Bladder cancer: Management
transurethral resection
immediate post-operative intravesical chemotherapy
concurrent transurethral resection of the prostate (TURP)
delayed intravesical bacille Calmette-Guérin (BCG) immunotherapy or intravesical chemotherapy
radical cystectomy
Bladder cancer: complications and prognosis
prostatic urethral transitional cell carcinoma (TCC)
upper tract TCC
hydronephrosis
urinary retention
Most patients present with low-grade, non-muscle-invasive bladder cancer (NMIBC). These patients are at high risk for tumour recurrence but low risk for disease progression and death. Once muscle invasion occurs, overall survival is in the range of 50% even with cystectomy.
Breast cancer
Epithelial tumours (includes invasive ductal carcinoma not otherwise specified, invasive lobular carcinoma, tubular carcinoma, medullary carcinoma, mucinous carcinoma and other tumours with abundant mucin, neuro-endocrine tumours, invasive papillary carcinomas, invasive micro-papillary carcinomas, apocrine carcinomas, and metaplastic carcinomas)
Myoepithelial lesions (includes myoepitheliosis, adenomyoepithelioma, and malignant myoepithelioma)
Mesenchymal tumours (includes haemangiopericytoma, angiosarcoma, and leiomyosarcoma)
Fibroepithelial tumours (includes fibroadenoma, phyllodes tumour, and low-grade periductal stromal sarcoma)
Tumours of the nipple (includes Paget’s disease of the nipple)
Malignant lymphoma (includes diffuse large B-cell lymphoma, Burkitt’s lymphoma, and follicular lymphoma)
Metastatic tumours
Tumours of the male breast (includes invasive and in situ carcinoma).
Breast cancer
risk factors include increasing age, white or black ethnicity, high socioeconomic class, positive family history, prolonged oestrogen/progestin exposure, high levels of alcohol consumption, history of radiation exposure, existing benign breast disease and increased breast density. breast mass nipple discharge axillary lymphadenopathy skin changes Red flag symptoms
Triple Assessment: mammograms and/or ultrasound, clinical examination and, biopsy.
breast MRI
biopsy
hormone receptor testing
HER2 receptor testing
Breast cancer: grade/staging
T- tumor
N - nodes
M - mets
Nottingham grading system for breast cancer.
Tubule formation
Nuclear grade:
Mitotic rate:
Total score = 3–5: G1 (Low grade or well differentiated)
Total score = 6–7: G2 (Intermediate grade or moderately differentiated)
Total score = 8–9: G3 (High grade or poorly differentiated)
Breast cancer: Rx
Treatment for primary invasive breast cancer in women is designed to accomplish the following goals:
Improve survival
Reduce the risk of both local and distant recurrence
Maintain long-term quality of life.
Multi-modality therapy combines complete surgical resection of the primary tumour with surgical staging of the axillary lymph nodes and adjuvant systemic chemotherapy, hormone therapy, or both following or preceding surgery
Breast cancer: Complications and prognosis
Mets
Chemo/Radio/Surgical releated
96% of women survive breast cancer for at least one year, and this is predicted to fall to 87%
CNS tumours
High-grade:
Gliomas and glioblastoma multiforme.
Primary cerebral lymphomas.
Medulloblastomas.
Low-grade: Meningiomas. Acoustic neuromas. Neurofibromas. Pituitary tumours. Pineal tumours. Craniopharyngiomas.
Secondaries:
Common malignancies spreading to the brain include lung cancer, breast cancer, stomach cancer, prostate cancer, thyroid cancer, colorectal cancer, melanoma and kidney cancer.
Headache, which is typically worse in the mornings.
Nausea and vomiting.
Seizures.
Progressive focal neurological deficits - eg, diplopia associated with a cranial nerve defect, visual field defect, neurological deficits affecting the upper and/or lower limb.
Cognitive or behavioural symptoms.
Symptoms relating to location of mass - eg, frontal lobe lesions associated with personality changes, disinhibition and parietal lobe lesions might be associated with dysarthria.
Papilloedema (absence of papilloedema does not exclude a brain tumour).
CNS tumors: Rx
Tumours should be resected whenever possible.
Corticosteroids (dex)should be used if cerebral oedema is present.
Surgery may be an option for patients with three or fewer brain metastases - provided the primary is controlled. This is associated with improved survival.
For metastases that are 3-3.5 cm in size, stereotactic radiosurgery may be an option.
CNS tumors: complications and prognosis
Acute haemorrhage into a tumour.
Hydrocephalus
Sudden increases in ICP may lead to life-threatening brain herniation through the foramen magnum or transtentorial foramina.
Complications of radiotherapy: acute toxicity is rare with modern schedules but subacute or chronic effects may occur:
- Subacute encephalopathy with somnolence and headaches may occur 6-16 weeks after radiation therapy.
- Prolonged radiation treatment may lead to impairment of intellectual capacity.
Brain tumours, both benign and malignant, are associated with morbidity relating to mass effect if they continue to increase in size.
Malignant brain tumours are the leading cause of death from solid tumours in children and the third most common cause in adolescents and young adults (up to the age of 34).
Cholangiocarcinoma
Cholangiocarcinoma is a carcinoma arising in any part of the biliary tree from the small intrahepatic bile ducts to the ampulla of Vater at the distal end of the common bile duct. More than 90% of cholangiocarcinomas are ductal adenocarcinomas and the remainder are squamous cell tumours
ulcerative colitis - develop primary sclerosing cholangitis are prone to cholangiocarcinoma.
Jaundice with hepatomegaly.
Pale-coloured stools, passage of dark urine, upper gastrointestinal pain (dull ache in the upper right quadrant), weight loss, anorexia and general malaise are common features.
Pruritus may be the presenting symptom
Splenomegaly.
The presence of a palpable gallbladder (Courvoisier’s sign) may occur with tumours distal to the cystic duct.
Cholangiocarcinoma: Ix
LFTs: Cholestatic picture with markedly elevated ALP and Billi
Prothrombin time and INR may be prolonged.
Tumour markers: CA 19-9 and CEA tumour markers may be raised
Ultrasound and CT scan: hilar tumours show dilatation of intrahepatic biliary tree.
Contrast MRI is the optimal imaging for diagnosis of cholangiocarcinoma
Cholangiocarcinoma: Rx
intrahepatic tumour
1st line: partial liver resection
adjunct: pre-operative portal vein embolisation or biliary drainage
adjunct: further resection or ablative therapy, or chemotherapy ± radiotherapy
extrahepatic tumour 1st line: surgical excision adjunct: pre-operative portal vein embolisation or biliary drainage adjunct: chemotherapy ± radiotherapy unresectable disease
liver transplant candidate
liver transplant non-candidate
1st line: chemotherapy ± radiotherapy
1st line: palliative therapy
