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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
What is the presentation of endometrial cancer?
POSTMENOPAUSAL BLEEDING Other abnormal bleeding Haematuria Anaemia Raised platelet count
26
What is the referral criteria for a 2-week-wait urgent cancer referral for endometrial cancer?
Postmenopausal bleeding
27
What is the referral guidelines for transvaginal ultrasound in women over 55 for suspected endometrial cancer?
Unexplained vaginal discharge | Visible haematuria + raised platelets, anaemia or high glucose
28
What are the investigations in endometrial cancer?
Transvaginal US Pipelle biopsy Hysteroscopy
29
What is the management of endometrial cancer?
Stage 1 and 2: | Total abdominal hysterectomy with bilateral salpingo-oophorectomy.
30
What is the most common site and type of pancreatic cancer?
Head of the pancreas and adenocarcinoma
31
Where do pancreatic cancers spread to?
1. Liver 2. Peritoneum 3. Lungs 4. Bones
32
What is the presentation of pancreatic cancer?
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 ```
33
What is the presentation of cholangiocarcinoma?
Yellow skin and sclera Pale stools Dark urine Generalised itching
34
What is the referral guidelines for suspected pancreatic cancer?
>40 with jaundice - 2 week wait | >60 with weight loss + additional symptom - Direct access CT abdo
35
What are the investigations for pancreatic cancer?
DIAGNOSIS: CT + histology CA19-9 MRCP ERCP
36
What is the management of pancreatic cancer?
Total pancreatectomy Distal pancreatectomy Pylorus-preserving pancreaticoduodenectomy Radical pancreaticodudenoectomy (Whipple's procedure)
37
What is Whipple's procedure?
``` Removal of: Head of pancreas Pylorus of stomach Duodenum Gallbladder Bile duct Relevant lymph nodes ```
38
What is the epithelial cell tumours
Tumours arising from the epithelial cells of the ovary - MOST COMMON TYPE ``` Subtypes: Serous tumours (most common) ```
39
What are dermoid cysts/Germ cell tumours?
Benign ovarian tumours. Teratomas meaning they come from germ cells. Associated with ovarian torsion May cause raised a-FP and hCG
40
What are sex cord-stromal tumours?
Rare - can be benign or malignant Arise from the stroma or sex cords. Several types: Sertoli-leydig cell tumours and granulosa cell tumours
41
What are Krukenberg tumours?
Tumours (usually from gI tract) that mets at ovary. Signet-ring characteristic
42
What is the presentation of ovarian tumours?
``` Abdominal bloating Early satiety loss of appetite Pelvic pain Urinary symptoms Weight loss Abdo/pelvic mass Ascites ```
43
What are the 2-week-wait referral criteria for ovarian cancer?
Ascites Pelvic mass Abdominal mass
44
What are the investigations in ovarian cancer?
CA125 (>35 is significant) Pelvic US CT scan Histology Paracentesis
45
What is the management of ovarian tumuor?
Surgery and chemo
46
What are testicular cancers?
Arises from germ cells in the testes Two types: Seminomas Non-seminomas (teratomas)
47
What are the risk factors for testicular cancer?
Undescended testes Male infertility Family history Increased height
48
What is the presentation of testicular cancer?
``` PAINLESS LUMP Non-tender Arising from testicle Hard Irregular Not fluctuant No transillumination ```
49
What are the investigations of testicular cancer?
Initial to confirm diagnosis: Scrotal US Tumour markers: a-FP B-hCG LDH
50
What are the common places for testicular cancer to metastasise?
Lymphatics Lungs Liver Brain
51
What is the management of testicular cancer?
Surgery (radical orchidectomy) Chemo Radio Sperm banking
52
What are the investigations in prostate cancer?
Multiparametric MRI = First line TRUS/Transperineal biopsy = second line Isotope bone scan to look for mets
53
What is the management of prostate cancer?
``` Watchful waiting External beam radiotherapy] Brachytherapy Hormone therapy Surgery ```
54
What is myeloma?
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
What is the pathophysiology of anaemia in myeloma?
Bone marrow infiltration leads to suppression of the development of other blood lines and therefore: anaemia, neutropenia and thrombocytopenia.
56
What is myeloma bone disease?
Result of increased osteoclast activity and suppressed osteoblast activity. Patches of thin bone = osteolytic lesions. Can cause pathological fractures.
57
What is the pathophysiology behind myeloma renal disease?
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
What are the key features of myeloma?
CRAB Calcium elevated Renal failure Anaemia (normocytic, normochromic) Bone lesions/pain
59
What are the signs of myeloma?
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
What are the diagnostic investigations of myeloma?
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
What are the Xray signs in myeloma?
Punched out lesions Lytic lesions "Raindrop skull"
62
What is the management of myeloma?
1. Chemotherapy: - Bortezomid - Thalidomide - Dexamethasone 2. Stem cell transplantation 3. VTE prophylaxis
63
What is Hodgkin's lymphoma?
Caused by proliferation of lymphocytes. Bimodal age distribution: 20 and 75
64
What are the risk factors for hodgkin's lymphoma?
HIV EBV Autoimmune conditions Family history
65
What is the presentation of Hodgkin's lymphoma?
Lymphadenopathy (non tender and rubbery) B-symptoms: fever, weight loss, night sweats
66
What are the investigations in Hodgkin's lymphoma?
Lymph node biopsy = DIAGNOSTIC Reed-Sternberg cell LDH raised CT, MRI and PET
67
What is the management of Hodgkin's lymphoma?
Chemo and radio
68
What are the main types of non-Hodgkin's lymphoma?
Burkitt lymphoma: EBV, malaria, HIV related MALT lymphoma: H.pylori infection related Diffuse large B cell lymphoma: rapidly growing painless mass >65yr
69
What is the management of non-Hodgkin's lymphoma?
``` Watchful waiting Chemo Monoclonal antibodies e.g. rituximab Radiotherapy Stem cell transplantation ```
70
What are the types of oesophageal cancers?
Adenocarcinoma = COMMON | Squamous cell cancer
71
What is the epidemiology, location and risk factors of adenocarcinoma of the oesophagus?
Most common type in UK/US Lower third near gastroesophageal junction ``` GORD Barrett's oesophagus Smoking Achalasia Obesity ```
72
What is the epidemiology, location and risk factors of squamous cell carcinoma of the oesophagus?
Most common in developing world Upper two-thirds of the oesophagus ``` Smoking Alcohol Achalasia Plummer-Vinson syndrome Diets rich in nitrosamines ```
73
What are the features of oesophageal cancer?
Dysphagia Anorexia and weight loss Vomiting
74
What is the diagnosis of oesophageal cancer?
Upper GI endoscopy = 1st line CT staging
75
What is the treatment of oesophageal cancer?
Surgical resection | Chemo
76
Which cancer shows cotton wool calcification?
Chondrosarcoma
77
What are the features of a parotid gland adenocarcinoma?
Facial nerve palsy | Lump at angle of jaw
78
Features of liver mets?
Normal LFTs | Palpable liver mass
79
Which cancers are linked to BRCA2 mutation?
``` Breast Prostate Pancreatic Ovarian Melanoma ```
80
Which other cancers do HNPCC increase the risk of?
Pancreatic | Endometrial
81
What are the gene mutations associated with HNPCC?
MSH2 and MLH1
82
What is suspected with possible anaemia and abdominal mass?
? colorectal cancer
83
What is taken into account for the risk malignancy index (RMI) prognosis in ovarian cancer?
Menopausal status CA125 levels US findings

Finals (20 decks)

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