Oncology Flashcards
Where do bladder cancers arise from?
Endothelial lining (urothelium).
Majority are superficial at presentation
What are the risk factors for bladder cancer?
Smoking and increased age are the main
Dye factory workers = transitional cell carcinoma (90%)
Schistosomiasis = squamous cell carcinoma (5%)
What is the diagnosis of bladder cancer?
Cystoscopy
What are the treatment options for bladder cancer?
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
What is urostomy?
Used to drain urine from the kidney, bypassing the ureters, bladder and urethra
What are the genetic involved in breast cancer?
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
What are the types of in situ breast cancers?
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
What are the types of invasive breast cancers?
Invasive ductal carcinoma (NST)
- no specific type
- mammogram
- most invasive carcinomas
Invasive lobular carcinomas (ILC)
- not always mammogram
What is inflammatory breast cancer?
- 1-3%
- Presents similarly to breast abscess or mastitis
- Worse prognosis
- Does not respond to abs
- Peau d’orange
What is Paget’s disease of the nipple?
- Looks like eczema
- Erythematous scaly rsh
- Indicates breast cancer involving nipple
- Requires biopsy, staging and treatment
What is the NHS breast cancer screening?
Offers a mammogram every 3 years to women 50-70yrs
What is chemoprevention?
May be offered for women at high risk
Tamoxifen if premenopausal
Anastrozole if postmenopausal
What is the presentation of breast cancer?
- 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
What is triple diagnostic assessment in regards to breast screening?
Clinical assessment
Imaging
Biopsy
Where do breast cancers metastasis?
2Ls and 2Bs
Lungs
Liver
Bones
Brain
What are the hormonal treatments for breast cancer?
Oestrogen-receptor positive:
Tamoxifen for premenopausal
Aromatase inhibitors (anastrozole) for postmenopausal
What are the targetted treatments in breast cancer
Trastuzumab (Herceptin) targets HER2 receptor.
Also used in HER2 positive:
Pertuzumab
Neratinib
What are the types of cervical cancers?
Squamous cell (most common) Adenocarcinoma
What is the presentation of cervical cancers?
Abnormal vaginal bleeding
Vaginal discharge
Pelvic pain
Dyspareunia
What is the management of cervical cancer?
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
What are the operations in bowel cancer?
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.
What is endometrial cancer?
Cancer of the endometrium, the lining of the uterus. (usually simple columnar epithelium)
80% are adenocarcinoma
Oestrogen-dependent cancer
What is endometrial hyperplasia and give the treatments?
Precancerous condition involving thickening of the endometrium but <5% go onto become cancerous
Treated using progestogens with either:
IUS
Continous oral progestogens
What are the risk factors for endometrial cancer?
Unopposed oestrogen
Polycystic ovarian syndrome Obesity Tamoxifen T2DM HNPCC
What is the presentation of endometrial cancer?
POSTMENOPAUSAL BLEEDING
Other abnormal bleeding
Haematuria
Anaemia
Raised platelet count
What is the referral criteria for a 2-week-wait urgent cancer referral for endometrial cancer?
Postmenopausal bleeding
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
What are the investigations in endometrial cancer?
Transvaginal US
Pipelle biopsy
Hysteroscopy
What is the management of endometrial cancer?
Stage 1 and 2:
Total abdominal hysterectomy with bilateral salpingo-oophorectomy.
What is the most common site and type of pancreatic cancer?
Head of the pancreas and adenocarcinoma
Where do pancreatic cancers spread to?
- Liver
- Peritoneum
- Lungs
- Bones
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
What is the presentation of cholangiocarcinoma?
Yellow skin and sclera
Pale stools
Dark urine
Generalised itching
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
What are the investigations for pancreatic cancer?
DIAGNOSIS: CT + histology
CA19-9
MRCP
ERCP
What is the management of pancreatic cancer?
Total pancreatectomy
Distal pancreatectomy
Pylorus-preserving pancreaticoduodenectomy
Radical pancreaticodudenoectomy (Whipple’s procedure)
What is Whipple’s procedure?
Removal of: Head of pancreas Pylorus of stomach Duodenum Gallbladder Bile duct Relevant lymph nodes
What is the epithelial cell tumours
Tumours arising from the epithelial cells of the ovary - MOST COMMON TYPE
Subtypes: Serous tumours (most common)
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
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
What are Krukenberg tumours?
Tumours (usually from gI tract) that mets at ovary.
Signet-ring characteristic
What is the presentation of ovarian tumours?
Abdominal bloating Early satiety loss of appetite Pelvic pain Urinary symptoms Weight loss Abdo/pelvic mass Ascites
What are the 2-week-wait referral criteria for ovarian cancer?
Ascites
Pelvic mass
Abdominal mass
What are the investigations in ovarian cancer?
CA125 (>35 is significant)
Pelvic US
CT scan
Histology
Paracentesis
What is the management of ovarian tumuor?
Surgery and chemo
What are testicular cancers?
Arises from germ cells in the testes
Two types:
Seminomas
Non-seminomas (teratomas)
What are the risk factors for testicular cancer?
Undescended testes
Male infertility
Family history
Increased height
What is the presentation of testicular cancer?
PAINLESS LUMP Non-tender Arising from testicle Hard Irregular Not fluctuant No transillumination
What are the investigations of testicular cancer?
Initial to confirm diagnosis: Scrotal US
Tumour markers:
a-FP
B-hCG
LDH
What are the common places for testicular cancer to metastasise?
Lymphatics
Lungs
Liver
Brain
What is the management of testicular cancer?
Surgery (radical orchidectomy)
Chemo
Radio
Sperm banking
What are the investigations in prostate cancer?
Multiparametric MRI = First line
TRUS/Transperineal biopsy = second line
Isotope bone scan to look for mets
What is the management of prostate cancer?
Watchful waiting External beam radiotherapy] Brachytherapy Hormone therapy Surgery
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
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.
What is myeloma bone disease?
Result of increased osteoclast activity and suppressed osteoblast activity.
Patches of thin bone = osteolytic lesions. Can cause pathological fractures.
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.
What are the key features of myeloma?
CRAB
Calcium elevated
Renal failure
Anaemia (normocytic, normochromic)
Bone lesions/pain
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
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
What are the Xray signs in myeloma?
Punched out lesions
Lytic lesions
“Raindrop skull”
What is the management of myeloma?
- Chemotherapy:
- Bortezomid
- Thalidomide
- Dexamethasone - Stem cell transplantation
- VTE prophylaxis
What is Hodgkin’s lymphoma?
Caused by proliferation of lymphocytes.
Bimodal age distribution: 20 and 75
What are the risk factors for hodgkin’s lymphoma?
HIV
EBV
Autoimmune conditions
Family history
What is the presentation of Hodgkin’s lymphoma?
Lymphadenopathy (non tender and rubbery)
B-symptoms: fever, weight loss, night sweats
What are the investigations in Hodgkin’s lymphoma?
Lymph node biopsy = DIAGNOSTIC
Reed-Sternberg cell
LDH raised
CT, MRI and PET
What is the management of Hodgkin’s lymphoma?
Chemo and radio
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
What is the management of non-Hodgkin’s lymphoma?
Watchful waiting Chemo Monoclonal antibodies e.g. rituximab Radiotherapy Stem cell transplantation
What are the types of oesophageal cancers?
Adenocarcinoma = COMMON
Squamous cell cancer
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
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
What are the features of oesophageal cancer?
Dysphagia
Anorexia and weight loss
Vomiting
What is the diagnosis of oesophageal cancer?
Upper GI endoscopy = 1st line
CT staging
What is the treatment of oesophageal cancer?
Surgical resection
Chemo
Which cancer shows cotton wool calcification?
Chondrosarcoma
What are the features of a parotid gland adenocarcinoma?
Facial nerve palsy
Lump at angle of jaw
Features of liver mets?
Normal LFTs
Palpable liver mass
Which cancers are linked to BRCA2 mutation?
Breast Prostate Pancreatic Ovarian Melanoma
Which other cancers do HNPCC increase the risk of?
Pancreatic
Endometrial
What are the gene mutations associated with HNPCC?
MSH2 and MLH1
What is suspected with possible anaemia and abdominal mass?
? colorectal cancer
What is taken into account for the risk malignancy index (RMI) prognosis in ovarian cancer?
Menopausal status
CA125 levels
US findings
