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Finals > Oncology > Flashcards

Oncology Flashcards

1
Q

Where do bladder cancers arise from?

A

Endothelial lining (urothelium).

Majority are superficial at presentation

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2
Q

What are the risk factors for bladder cancer?

A

Smoking and increased age are the main

Dye factory workers = transitional cell carcinoma (90%)

Schistosomiasis = squamous cell carcinoma (5%)

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3
Q

What is the diagnosis of bladder cancer?

A

Cystoscopy

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4
Q

What are the treatment options for bladder cancer?

A

Early/non invasive: TURBT and single dose intravesicle chemo

Medium grade: TURBT and Intravesicle chemo 6 weeks

High grade: TURBT and BCG 6 weeks

Radical cystectomy
Chemotherapy and radiotherapy

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5
Q

What is urostomy?

A

Used to drain urine from the kidney, bypassing the ureters, bladder and urethra

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6
Q

What are the genetic involved in breast cancer?

A

BRCA genes are tumour suppressor genes

BRCA1 gene is on chromosome 17. If faulty:
70% will develop breast by 80
50% develop ovarian
Increased risk of bowel and prostate

BRCA2 is on chromosome 13. If faulty:
60% will develop breast by 80
20% will develop ovarian

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7
Q

What are the types of in situ breast cancers?

A

Ductal Carcinoma In Situ (DCIS)

  • localised to single area
  • picked up by mammogram
  • potential to invade
  • good prognosis if fully excised

Lobular Carcinoma In Situ (LCIS)

  • pre cancerous
  • not on mammogram
  • increased risk of invasion
  • managed with close monitoring
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8
Q

What are the types of invasive breast cancers?

A

Invasive ductal carcinoma (NST)

  • no specific type
  • mammogram
  • most invasive carcinomas

Invasive lobular carcinomas (ILC)
- not always mammogram

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9
Q

What is inflammatory breast cancer?

A
  • 1-3%
  • Presents similarly to breast abscess or mastitis
  • Worse prognosis
  • Does not respond to abs
  • Peau d’orange
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10
Q

What is Paget’s disease of the nipple?

A
  • Looks like eczema
  • Erythematous scaly rsh
  • Indicates breast cancer involving nipple
  • Requires biopsy, staging and treatment
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11
Q

What is the NHS breast cancer screening?

A

Offers a mammogram every 3 years to women 50-70yrs

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12
Q

What is chemoprevention?

A

May be offered for women at high risk

Tamoxifen if premenopausal
Anastrozole if postmenopausal

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13
Q

What is the presentation of breast cancer?

A
  • Lumps that are hard, irregular, painless or fixed in place
  • Lumps may be tethered to the skin or the chest wall
  • Nipple retraction
  • Skin dimpling or oedema (peau d’orange)
  • Lymphadenopathy, particularly in the axilla
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14
Q

What is triple diagnostic assessment in regards to breast screening?

A

Clinical assessment
Imaging
Biopsy

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15
Q

Where do breast cancers metastasis?

A

2Ls and 2Bs

Lungs
Liver
Bones
Brain

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16
Q

What are the hormonal treatments for breast cancer?

A

Oestrogen-receptor positive:
Tamoxifen for premenopausal
Aromatase inhibitors (anastrozole) for postmenopausal

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17
Q

What are the targetted treatments in breast cancer

A

Trastuzumab (Herceptin) targets HER2 receptor.

Also used in HER2 positive:
Pertuzumab
Neratinib

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18
Q

What are the types of cervical cancers?

A 
Squamous cell (most common)
Adenocarcinoma
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19
Q

What is the presentation of cervical cancers?

A

Abnormal vaginal bleeding
Vaginal discharge
Pelvic pain
Dyspareunia

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20
Q

What is the management of cervical cancer?

A

Cervical intraepithelial neoplasia and early stage 1A: LLETZ or cone biopsy

Stage 1B-2A: Radical hysterectomy and removal of local lymph nodes with chemo and radio

Stage 2B-4A: chemo and radio

Stage 4B: combination of surgery, radio, chemo and palliative care

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21
Q

What are the operations in bowel cancer?

A

Right hemicolectomy: removal of caecum, ascending and proximal transverse colon

Left hemicolectomy: removal of distal transverse and descending colon

High anterior resection: removal of sigmoid colon

Low anterior resection: removing the sigmoid colon and upper rectum but sparing lower rectum and anus

Abdomino-perineal resection (APR): removing rectum and anus and suturing over anus leaving patient with permanent colostomy

Hartmann’s procedure: emergency that involves the removal of rectosigmoid colon and creation of a colostomy.

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22
Q

What is endometrial cancer?

A

Cancer of the endometrium, the lining of the uterus. (usually simple columnar epithelium)

80% are adenocarcinoma

Oestrogen-dependent cancer

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23
Q

What is endometrial hyperplasia and give the treatments?

A

Precancerous condition involving thickening of the endometrium but <5% go onto become cancerous

Treated using progestogens with either:
IUS
Continous oral progestogens

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24
Q

What are the risk factors for endometrial cancer?

A

Unopposed oestrogen

Polycystic ovarian syndrome
Obesity
Tamoxifen
T2DM
HNPCC
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25
Q

What is the presentation of endometrial cancer?

A

POSTMENOPAUSAL BLEEDING

Other abnormal bleeding
Haematuria
Anaemia
Raised platelet count

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26
Q

What is the referral criteria for a 2-week-wait urgent cancer referral for endometrial cancer?

A

Postmenopausal bleeding

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27
Q

What is the referral guidelines for transvaginal ultrasound in women over 55 for suspected endometrial cancer?

A

Unexplained vaginal discharge

Visible haematuria + raised platelets, anaemia or high glucose

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28
Q

What are the investigations in endometrial cancer?

A

Transvaginal US
Pipelle biopsy
Hysteroscopy

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29
Q

What is the management of endometrial cancer?

A

Stage 1 and 2:

Total abdominal hysterectomy with bilateral salpingo-oophorectomy.

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30
Q

What is the most common site and type of pancreatic cancer?

A

Head of the pancreas and adenocarcinoma

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31
Q

Where do pancreatic cancers spread to?

A
  1. Liver
  2. Peritoneum
  3. Lungs
  4. Bones
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32
Q

What is the presentation of pancreatic cancer?

A

Painless obstructive jaundice

New onset diabetes or worsening of T2DM
Non-specific upper abdo/back pain
Unintentional weight loss
Palpable mass in epigastric region
Change in bowel habit
N+V
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33
Q

What is the presentation of cholangiocarcinoma?

A

Yellow skin and sclera
Pale stools
Dark urine
Generalised itching

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34
Q

What is the referral guidelines for suspected pancreatic cancer?

A

> 40 with jaundice - 2 week wait

>60 with weight loss + additional symptom - Direct access CT abdo

35
Q

What are the investigations for pancreatic cancer?

A

DIAGNOSIS: CT + histology

CA19-9
MRCP
ERCP

36
Q

What is the management of pancreatic cancer?

A

Total pancreatectomy
Distal pancreatectomy
Pylorus-preserving pancreaticoduodenectomy
Radical pancreaticodudenoectomy (Whipple’s procedure)

37
Q

What is Whipple’s procedure?

A 
Removal of:
Head of pancreas
Pylorus of stomach
Duodenum
Gallbladder
Bile duct
Relevant lymph nodes
38
Q

What is the epithelial cell tumours

A

Tumours arising from the epithelial cells of the ovary - MOST COMMON TYPE

Subtypes:
Serous tumours (most common)
39
Q

What are dermoid cysts/Germ cell tumours?

A

Benign ovarian tumours.

Teratomas meaning they come from germ cells.

Associated with ovarian torsion

May cause raised a-FP and hCG

40
Q

What are sex cord-stromal tumours?

A

Rare - can be benign or malignant

Arise from the stroma or sex cords.

Several types: Sertoli-leydig cell tumours and granulosa cell tumours

41
Q

What are Krukenberg tumours?

A

Tumours (usually from gI tract) that mets at ovary.

Signet-ring characteristic

42
Q

What is the presentation of ovarian tumours?

A 
Abdominal bloating
Early satiety
loss of appetite
Pelvic pain
Urinary symptoms 
Weight loss
Abdo/pelvic mass
Ascites
43
Q

What are the 2-week-wait referral criteria for ovarian cancer?

A

Ascites
Pelvic mass
Abdominal mass

44
Q

What are the investigations in ovarian cancer?

A

CA125 (>35 is significant)
Pelvic US

CT scan
Histology
Paracentesis

45
Q

What is the management of ovarian tumuor?

A

Surgery and chemo

46
Q

What are testicular cancers?

A

Arises from germ cells in the testes

Two types:
Seminomas
Non-seminomas (teratomas)

47
Q

What are the risk factors for testicular cancer?

A

Undescended testes
Male infertility
Family history
Increased height

48
Q

What is the presentation of testicular cancer?

A 
PAINLESS LUMP
Non-tender
Arising from testicle
Hard
Irregular
Not fluctuant
No transillumination
49
Q

What are the investigations of testicular cancer?

A

Initial to confirm diagnosis: Scrotal US

Tumour markers:
a-FP
B-hCG
LDH

50
Q

What are the common places for testicular cancer to metastasise?

A

Lymphatics
Lungs
Liver
Brain

51
Q

What is the management of testicular cancer?

A

Surgery (radical orchidectomy)
Chemo
Radio
Sperm banking

52
Q

What are the investigations in prostate cancer?

A

Multiparametric MRI = First line

TRUS/Transperineal biopsy = second line

Isotope bone scan to look for mets

53
Q

What is the management of prostate cancer?

A 
Watchful waiting
External beam radiotherapy]
Brachytherapy
Hormone therapy
Surgery
54
Q

What is myeloma?

A

Cancer of a specific type of plasma cell where genetic mutation causes it to rapidly and uncontrollably multiple.

They produce one type of antibody (immunoglobulin) which >50% time is IgG.

Multiple myeloma is when the myeloma affects multiple areas of the body

55
Q

What is the pathophysiology of anaemia in myeloma?

A

Bone marrow infiltration leads to suppression of the development of other blood lines and therefore: anaemia, neutropenia and thrombocytopenia.

56
Q

What is myeloma bone disease?

A

Result of increased osteoclast activity and suppressed osteoblast activity.

Patches of thin bone = osteolytic lesions. Can cause pathological fractures.

57
Q

What is the pathophysiology behind myeloma renal disease?

A

High levels of immunoglobulins can block from through tubules

Hypercalcaemia impairs renal function

Dehydration

Medications used to treat conditions e.g. bisphosphonates are harmful to kidneys.

58
Q

What are the key features of myeloma?

A

CRAB

Calcium elevated
Renal failure
Anaemia (normocytic, normochromic)
Bone lesions/pain

59
Q

What are the signs of myeloma?

A

Suspect myeloma in >60 with persistent bone pain, or an unexplained fracture.

FBC - low WBC
Calcium - high
ESR - high
Plasma viscosity - high
Blood film = rouleaux formation
60
Q

What are the diagnostic investigations of myeloma?

A

BLIP

B - Bence-Jones protein (urine electrophoresis)
L - Serum free Light chain assay
I - Serum Immunoglobulins
P - Serum Protein electrophoresis

Bone marrow biopsy = Confirm diagnosis

Imaging: Whole body MRI, whole body CT or skeletal survey

61
Q

What are the Xray signs in myeloma?

A

Punched out lesions
Lytic lesions
“Raindrop skull”

62
Q

What is the management of myeloma?

A
  1. Chemotherapy:
    - Bortezomid
    - Thalidomide
    - Dexamethasone
  2. Stem cell transplantation
  3. VTE prophylaxis
63
Q

What is Hodgkin’s lymphoma?

A

Caused by proliferation of lymphocytes.

Bimodal age distribution: 20 and 75

64
Q

What are the risk factors for hodgkin’s lymphoma?

A

HIV
EBV
Autoimmune conditions
Family history

65
Q

What is the presentation of Hodgkin’s lymphoma?

A

Lymphadenopathy (non tender and rubbery)

B-symptoms: fever, weight loss, night sweats

66
Q

What are the investigations in Hodgkin’s lymphoma?

A

Lymph node biopsy = DIAGNOSTIC
Reed-Sternberg cell

LDH raised
CT, MRI and PET

67
Q

What is the management of Hodgkin’s lymphoma?

A

Chemo and radio

68
Q

What are the main types of non-Hodgkin’s lymphoma?

A

Burkitt lymphoma: EBV, malaria, HIV related

MALT lymphoma: H.pylori infection related

Diffuse large B cell lymphoma: rapidly growing painless mass >65yr

69
Q

What is the management of non-Hodgkin’s lymphoma?

A 
Watchful waiting
Chemo
Monoclonal antibodies e.g. rituximab
Radiotherapy
Stem cell transplantation
70
Q

What are the types of oesophageal cancers?

A

Adenocarcinoma = COMMON

Squamous cell cancer

71
Q

What is the epidemiology, location and risk factors of adenocarcinoma of the oesophagus?

A

Most common type in UK/US

Lower third near gastroesophageal junction

GORD
Barrett's oesophagus
Smoking
Achalasia
Obesity
72
Q

What is the epidemiology, location and risk factors of squamous cell carcinoma of the oesophagus?

A

Most common in developing world

Upper two-thirds of the oesophagus

Smoking
Alcohol
Achalasia
Plummer-Vinson syndrome
Diets rich in nitrosamines
73
Q

What are the features of oesophageal cancer?

A

Dysphagia
Anorexia and weight loss
Vomiting

74
Q

What is the diagnosis of oesophageal cancer?

A

Upper GI endoscopy = 1st line

CT staging

75
Q

What is the treatment of oesophageal cancer?

A

Surgical resection

Chemo

76
Q

Which cancer shows cotton wool calcification?

A

Chondrosarcoma

77
Q

What are the features of a parotid gland adenocarcinoma?

A

Facial nerve palsy

Lump at angle of jaw

78
Q

Features of liver mets?

A

Normal LFTs

Palpable liver mass

79
Q

Which cancers are linked to BRCA2 mutation?

A 
Breast
Prostate
Pancreatic
Ovarian
Melanoma
80
Q

Which other cancers do HNPCC increase the risk of?

A

Pancreatic

Endometrial

81
Q

What are the gene mutations associated with HNPCC?

A

MSH2 and MLH1

82
Q

What is suspected with possible anaemia and abdominal mass?

A

? colorectal cancer

83
Q

What is taken into account for the risk malignancy index (RMI) prognosis in ovarian cancer?

A

Menopausal status
CA125 levels
US findings

Finals (20 decks)

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