Oncology Flashcards
Bias of screening?
Lead time- early detection leads to improved Kaplan Meier
Lag time- early detections leads to no better survival than latter detection- long latent phase
Selection
Over diagnosis
Screening programmes: Bowel AAA Breast Cervical
Men and women- 60-74 (maybe 50-74) FIT every 2 years
Men one off US at 65 years old then follow up as appropriate
Breast 50-70 mammogram every 3 years
Cervical 25-50 smear every 3 years
50-64- smear every 5 years
What is grading?
Degree of differentiation
High grade is poorly differentiated
Types of BCC?
Nodular
Superficial
Infiltrative
Rx options for bcc
MDT
Medical
Surgery- excision- with appropriate margins
Moh’s micrographic surgery
Risk factors of squamous cell carcinoma of skin
Congenital- skin type, xeroderma pigmentosa
Exposure- UV, chemical-arsenic
Acquired- immunosuppression, age, marjolin ulcers
Pre malignant SqCC
AKs
Bowen’s
Leukoplakia
Rx of sqcc
Medical
Surgical- excision if <2cm 4mm margin
If >2cm 6mm + margin
Malignant melanoma risk factors
Congenital skin type, xeroderma pigmentosa, albinism, (li fraumeni), fhx
Acquired UV, immunosuppression
Subtypes of malignant melanoma
Superficial Nodular Lentigo maligna-elderly sun damaged Acral lentiginous- dark skinned and appears on palms/soles Amelanocytic- <5% nodular melanoma/mets
Management of melanoma
MDT
Excisional biopsy for dx and breslow’s thickness
TNM staging. Ct/SLNB
DEFINITIVE EXCISION AND GRAFTING
Types of thyroid cancer
Papillary- commonest, psammoma bodies, orphan Annie neuclei, lymphatic spread. FNA
Follicular- solitary nodule, haematogenous spread, fna and hemi thyroidectomy
Medullary- Calcitonin, Men 2
Anaplastic- elderly females, locally invasive
Lymphoma- needs a core biopsy
Parotid gland cancer subtypes
Pleomorphic adenoma- slow growing, benign
Mucoepidermoid- low met/invasion- malignant
Warthin’s- papillary cystadenoma, facial nerve involvement, 10% bilateral, lymphoma association
Risk factors for breast cancer?
Congenital- age, fhx, brca
Previous breast ca
Increased oestrogen exposure- early menarche, late menopause, nulliparous, non breast feeding mothers, COCP/HRT
Investigation for breast cancer
Triple assessment
Assess for mets- liver, lung, brain, bone
Staging- TNM
Nottingham prognostic indicators
Types of breast cancer?
Non invasive- DCIS and LCIS
Invasive- ductal (70%) lobar, ductal papilloma
Rx for breast cancer
MDT
Medical- hormone- if oestrogen receptor positive- tamoxifen for pre menopause, letrozole for post menopause
Chemotherapy- down staging of advanced tumours pre op, high grade/axillary disease post op
Radio- post mastectomy of high grade/big
Surgery- mastectomy + radio if LN involved
WLE- always with radio
Types of benign liver cancers
Haemangiomas- middle age females, conservative
Focal nodular hyperplasia- solitary stellate lesion, benign. Look similar to adenoma
Adenoma- young females- COCP association. Risk of malignant transformation, surgical excision indicated
Malignant liver cancers
HCC- hep b/c / cirrhosis/ aflatoxin association
Afp as marker
Not for biopsy- seeding
Rx is preventative, medical and transplant
Cholangiocarcinoma- liver flukes/psc/obstructive jaundice
Angio sarcoma- v malignant
Hepatoblastoma- kids with abdo mass. Chemo + excise
Mets- commonest liver tumour!
Breast, gi, lung, ovary, renal, prostate
Pancreas cancer types
80% adenocarcinoma- 60% in the head
Need whipples and chemo
Endocrine pancreas tumours Glucagonoma Insulinoma VIPoma- carcinoid syndrome Gastrinoma
How to bladder cancer TCC spread?
Local- prostate and rectum
Lymphatics iliac/para-aortic
Haematogenous- liver, lung, bone and brain
What is a wilm’s nephroblastoma?
Commonest abdominal malignancy in kids 1-4 years old Abdo mass and haematuria and hypertension <5% bilateral Surgery +- chemo/radio
Types of colorectal cancer?
Epithelial- benign- tubular/villous/tubulovillous adenomas
Malignant- adenocarcinomas/carcinoid polyp
Mesenchymal- fibroma/lipomas/leiomyomas
Harmatomas
What is the most likely benign colorectal cancer to undergo malignant transformation?
Villous-40%
Tubovillous- 20%
Tubular- 5%
Difference between FAP and HNPCC
Fap is APC gene mutation. Leads to multiple polyps. AD.
HNPCC- mutation of DNA mismatch repair gene mutation. AD. increased risk of cancer- 80% lifetime
How is colorectal cancer staged?
TNM Dukes A confined to intestinal wall- 90% survival at 5 years B muscle involvement- 75% C lymph node invasion- 40% D distal mets- 5%
Draw out location of colorectal tumour and operation required for removal
Role of chemo and radio in colorectal cancer?
Chemo- adjuvant
Radio- palliative and rectal
Highest anastomotic failure rates?
Colo rectal- anterior resection 5-10%
Oesophageal- 5-30%
How to stage oesophageal cancer?
Endoscopic us and biopsy
Ct chest and abdo
Laparoscopy
Pet ct if +ve lap
Treatment of oesophageal cancer
MDT
If mets then palliative- stent, chemo, transtuzumab
Neoadjuvant chemoradiotherapy- for localised SqCC
Surgical- endoscopic mucosal resection for locally confined cancer
Proximal- Mckeown’s
Middle- Ivor Lewis
Oesophageal junction- transhiatial/gastrectomy
When to refer a patient for urgent endoscopy?
Dyspepsia + dysphagia/ gi bleed/ Wt loss/ anaemia/ mass
Dysphagia + dyspepsia/mass/wt loss/jaundice
Treatment for gastric cancers
Chemo- neo and adjuvant
Tumours 5-10 cm from Junction- sub total gastrectomy
Tumours < 5 cm from junction- total gastrectomy
Endoscopic sub mucosal resection
