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MRCS part B- JMB > Oncology > Flashcards

Oncology Flashcards

1
Q

Bias of screening?

A

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

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2
Q 
Screening programmes:
Bowel
AAA
Breast
Cervical
A

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

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3
Q

What is grading?

A

Degree of differentiation

High grade is poorly differentiated

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4
Q

Types of BCC?

A

Nodular
Superficial
Infiltrative

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5
Q

Rx options for bcc

A

MDT
Medical
Surgery- excision- with appropriate margins
Moh’s micrographic surgery

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6
Q

Risk factors of squamous cell carcinoma of skin

A

Congenital- skin type, xeroderma pigmentosa
Exposure- UV, chemical-arsenic
Acquired- immunosuppression, age, marjolin ulcers

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7
Q

Pre malignant SqCC

A

AKs
Bowen’s
Leukoplakia

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8
Q

Rx of sqcc

A

Medical
Surgical- excision if <2cm 4mm margin
If >2cm 6mm + margin

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9
Q

Malignant melanoma risk factors

A

Congenital skin type, xeroderma pigmentosa, albinism, (li fraumeni), fhx
Acquired UV, immunosuppression

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10
Q

Subtypes of malignant melanoma

A 
Superficial 
Nodular
Lentigo maligna-elderly sun damaged
Acral lentiginous- dark skinned and appears on palms/soles
Amelanocytic- <5% nodular melanoma/mets
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11
Q

Management of melanoma

A

MDT
Excisional biopsy for dx and breslow’s thickness
TNM staging. Ct/SLNB
DEFINITIVE EXCISION AND GRAFTING

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12
Q

Types of thyroid cancer

A

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

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13
Q

Parotid gland cancer subtypes

A

Pleomorphic adenoma- slow growing, benign
Mucoepidermoid- low met/invasion- malignant
Warthin’s- papillary cystadenoma, facial nerve involvement, 10% bilateral, lymphoma association

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14
Q

Risk factors for breast cancer?

A

Congenital- age, fhx, brca
Previous breast ca
Increased oestrogen exposure- early menarche, late menopause, nulliparous, non breast feeding mothers, COCP/HRT

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15
Q

Investigation for breast cancer

A

Triple assessment
Assess for mets- liver, lung, brain, bone
Staging- TNM
Nottingham prognostic indicators

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16
Q

Types of breast cancer?

A

Non invasive- DCIS and LCIS

Invasive- ductal (70%) lobar, ductal papilloma

17
Q

Rx for breast cancer

A

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

18
Q

Types of benign liver cancers

A

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

19
Q

Malignant liver cancers

A

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

20
Q

Pancreas cancer types

A

80% adenocarcinoma- 60% in the head
Need whipples and chemo

Endocrine pancreas tumours
Glucagonoma
Insulinoma
VIPoma- carcinoid syndrome
Gastrinoma
21
Q

How to bladder cancer TCC spread?

A

Local- prostate and rectum
Lymphatics iliac/para-aortic
Haematogenous- liver, lung, bone and brain

22
Q

What is a wilm’s nephroblastoma?

A 
Commonest abdominal malignancy in kids
1-4 years old
Abdo mass and haematuria and hypertension
<5% bilateral
Surgery +- chemo/radio
23
Q

Types of colorectal cancer?

A

Epithelial- benign- tubular/villous/tubulovillous adenomas
Malignant- adenocarcinomas/carcinoid polyp

Mesenchymal- fibroma/lipomas/leiomyomas

Harmatomas

24
Q

What is the most likely benign colorectal cancer to undergo malignant transformation?

A

Villous-40%
Tubovillous- 20%
Tubular- 5%

25
Q

Difference between FAP and HNPCC

A

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

26
Q

How is colorectal cancer staged?

A 
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%
27
Q

Draw out location of colorectal tumour and operation required for removal

A
28
Q

Role of chemo and radio in colorectal cancer?

A

Chemo- adjuvant

Radio- palliative and rectal

29
Q

Highest anastomotic failure rates?

A

Colo rectal- anterior resection 5-10%

Oesophageal- 5-30%

30
Q

How to stage oesophageal cancer?

A

Endoscopic us and biopsy
Ct chest and abdo
Laparoscopy
Pet ct if +ve lap

31
Q

Treatment of oesophageal cancer

A

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

32
Q

When to refer a patient for urgent endoscopy?

A

Dyspepsia + dysphagia/ gi bleed/ Wt loss/ anaemia/ mass

Dysphagia + dyspepsia/mass/wt loss/jaundice

33
Q

Treatment for gastric cancers

A

Chemo- neo and adjuvant
Tumours 5-10 cm from Junction- sub total gastrectomy
Tumours < 5 cm from junction- total gastrectomy
Endoscopic sub mucosal resection

MRCS part B- JMB (10 decks)

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