Oncology Flashcards
Used to identify families with Lynch Syndrome (HNPCC)
Amsterdam Criteria
Criteria needed for a diagnosis in Amsterdam criteria
3+ members of family with colorectal cancer (1 = 1st degree)
2 successive affected generations
1+ member with colon cancer < 50 years old
Familial adenomatous polyposis has been excluded
Familial adenomatous colorectal polyposis (FAP)
Multiple chronic polyps
Retroperitoneal desmond tumours (15%)
Associated with:
- skull osteoma
- thyroid cancer
- epidermoid cysts
Gardener’s Syndrome
Management of Gardener’s syndrome
Prophylactic colectomy to reduce risk
Gardener’s syndrome genetics
Autosomal dominant
- mutation of APC gene
- chromosome 5
Pheochromocytoma
RCC
Haemangioblastoma
Von-Hippel Lindau Disease
Sarcomas
Leukaemia
Breast cancer
Adrenal gland tumours
Li-Fraumeni Syndrome
Criteria to diagnose Li-Fraumeni syndrome
Sarcoma < 45 years old
1st degree relative has cancer < 45 year old
Another family member develops cancer < 45 year old
Genetics of Li-Fraumeni syndrome
Autosomal dominant
- germline mutations to p53 (tumour suppressor gene)
Genetics of BRCA 1
Chromosome 17
Genetics of BRCA 2
Chromosome 13
What cancers are associated with BRCA genes
Breast cancer ( both 60% risk) Ovarian cancer - BRCA 1 (55%) - BRCA 2 (25%) Prostate cancer (BRCA 2) Pancreatic Melanoma Young-onset colorectal cancer (BRCA 1)
Uses flurodeoxyglucose as a tracer
Shows 3d metabolic activity
Positive emission tomography (PET Scan)
Neutropenic sepsis is common in
- presents with fever
Adjuvant therapy (curative regimes)
- Breast cancer
- Germ cell cancers
Management of neutropenic sepsis
- Tazocin
- Teicoplanin/ Aztreonam (if Penicillin allergic) - Vancomycin
What are tumour markers
Monoclonal antibodies
Tumour antigens
Enzymes
Hormones
- Low specificity
Ovarian + testicular cancers drain to the
Para-aortic lymph nodes (via gonadal vessels)
Breast cancer drains to the
Axillary lymph nodes
Vulval, penile + anal cancers drain to the
Inguinal lymph nodes
Colon cancers drain to the
Mesenteric lymph nodes
Thoracic, breast + gastric cancers drain to the
Supraclavicular nodes
Oliguria (decreased urine output) Cardiac arrhythmia Seizure Confusion Hx of lymphoma/ germ cell cancer
Tumour lysis syndrome
Cancers associated with tumour lysis syndrome
Lymphoma
Germ cell cancer
Biochemistry in tumour lysis syndrome
Increased Potassium
Increased Phosphate
Management for tumour lysis syndrome
Calcium gluconate (cardio protection from potassium) Fluids
Most common causes of brain mets
Lung Breast Bowel Skin (Melanoma) Kidney
Most common causes of bone mets
BLT + Kosher pickle
Breast Lung Thyroid Kidney Prostate
Most common site of bone mets
Spine Pelvis Ribs Skull Long bones
Biochemistry in bone mets
Hypercalcaemia
Increased ALP
Investigations for bone mets
1st line: MRI
DEXA Scan: picks up lytic mets better then XR
Management for bone mets
Radiotherapy can be used as pain relief
Bone pain - worse with straining/ coughing - nocturnal - tender Pathological fractures - vertebral wedge compression
Bone metastasis
Back pain - worse when lying down + coughing Lower limb weakness Sensory changes (numbness) Disturbed bowel function Disturbed bladder function
Neoplastic spinal cord compression
- Oncological emergency
- 5 % of cancer patients
In neoplastic spinal cord compression lesions above L1 exhibit
UMN signs in the legs
In neoplastic spinal cord compression lesions below L1 exhibit
LMN signs in the legs + perianal numbness
In neoplastic spinal cord compression tendon reflexes are
increased below the level of the lesion
absent at the level of the lesion
Investigations for neoplastic spinal cord compression
Urgent MRI (whole spine) < 24 hours
Management for neoplastic spinal cord compression
Oral dexamethasone (high dose)
- reduce oedema
Consider radiotherapy/surgery
Causes of superior vena cava obstruction
Small cell lung cancer (right lobe) Lymphoma Metastatic seminoma Kaposi sarcoma Breast cancer Vein occlusion
Dyspnoea Swelling of face, neck + arms Eyes (conjunctival + peri-orbital oedema) Headache (worse in mornings) Visual disturbance Pulseless JVP distension
Superior vena cava obstruction
Tests for superior vena cava obstruction
Pemberton’s sign: positive
- Raise arms above head to exacerbate SVCO symptoms
Management for superior vena cava obstruction
Dexamethasone
Balloon venoplasty/ stenting
Radiotherapy/ surgery
Tumour marker for colorectal cancer
Carcinoembryonic antigen (CEA)
Tumour marker fo prostate cancer
Prostate specific antigen (PSA)
Tumour marker for ovarian cancer
CA 125 (monoclonal antibody)
Tumour marker for pancreatic cancer
CA 19-9
Tumour marker for HCC
Alpha-feto protein (AFP)
Tumour marker for testicular teratoma
Alpha-feto protein (AFP)
Beta hCG
Tumour marker for melanoma
S-100 (tumour antigen)
Tumour marker for gastric cancer
Bombesin (tumour antigen)
Tumour marker for schwannomas
S-100 (tumour antigen)
Tumour marker for neuroblastoma
S-100 (tumour antigen)
Familial causes of colorectal cancer
5% - Hereditary Non-polyposis colorectal carcinoma (HNPCC)
1 % - Familial adenomatous polyposis (FAP)
Familial causes of endometrial cancer
5% - Hereditary Non-polyposis colorectal carcinoma (HNPCC)
Cause of Kaposi’s sarcoma
Causes by Herpes Virus 8
- common in HIV
Purple papules on skin
Plaques on shin/ mucosa
Hx of HIV
Kaposi’s sarcoma
Management of kaposi’s sarcoma
Radiotherapy
Surgical resection
Chemo for bladder cancer
CMV
Cisplatin
Methotrexate
Vinblastine
Chemo for high-grade non-hodgkins lymphoma
R-CHOP
Cyclophosphamide
Hydroxydaunorubicin (doxorubicin)
Vincristine (Oncovin)
Prednisolone
Chemo for colorectal cancer
FOLFOX
5-FU
Leucovorin (colonic acid)
Oxaliplatin
Chemo for breast cancer
FEC
5-FU
Epirubicin
Cyclophosphamide
Chemo for hodgkins lymphoma
ABVD
Adriamycin (doxorubicin)
Bleomycin
Vinblastine
Dacarbazine
No red reflex
Age 18 months
Retinoblastoma
Retinoblastoma genetics
Autosomal dominant
10% hereditary
caused by loss of function of tumour suppressor gene on chromosome 13
Management of Retinoblastoma
External beam radiation
Chemo
Photocoagulation
Enucleation
90% survive
