Oncology Flashcards
1
Q
What is the most common type of malignancy found in bone?
A
Secondary tumours arising from metastatic disease (primary bone tumours are rare)
2
Q
What is the most common type of primary bone malignancy?
A
Osteosarcoma
3
Q
Which type of patients typically get osteosarcoma?
A
Adolescent males
4
Q
How does osteosarcoma present?
A
Warm, painful swelling - most commonly at the knee
5
Q
What imaging is done in osteosarcoma, Ewing’s sarcoma and chondrosarcoma?
A
X-ray
6
Q
How does osteosarcoma look on an X-ray?
A
Periosteal reaction with Codman triangle and a sunburst appearance
7
Q
Which patients are affected by Ewing’s sarcoma?
A
Adolescents
8
Q
How does Ewing’s sarcoma present?
A
Painful, warm, enlarging mass along long bone diaphysis e.g. anterior thigh swelling
Systemic symptoms - fever, anaemia, fatigue
9
Q
What will blood tests show in Ewing’s sarcoma?
A
Raised ESR and WCC
10
Q
How does Ewing’s sarcoma look on an x-ray?
A
Onion skin periosteal reaction
11
Q
Which patients are affected by chondrosarcoma (cartilaginous malignancy)?
A
Older patients > 40
12
Q
How does chondrosarcoma present?
A
Pain and a lump
13
Q
What do many chondrosarcomas arise from?
A
Previous chondromas that have undergone malignant change
14
Q
What does chondrosarcoma look like on an X-ray?
A
Lytic lesion with fluffy popcorn calcification
15
Q
What is an osteoid osteoma?
A
Benign bone-forming tumour with no potential to become malignant
16
Q
How can bone malignancy be definitively diagnosed?
A
Biopsy and histopathological analysis
17
Q
What is key about ovarian cancer symptoms in the early stages?
A
Usually vague - patients usually describe discomfort rather than pain
18
Q
How does ovarian cancer typically spread?
A
Via the lymph nodes and peritoneum
19
Q
Why is vaginal bleeding very rarely seen in ovarian cancer?
A
Bc ovarian cancer does not erode into the surrounding structures
20
Q
What two factors reduce the risk of ovarian cancer?
A
1) Multiparity
2) Oral contraceptive pill
21
Q
What is five and ten year survival of gastric cancer?
A
20%, 11% (poor prognosis)
22
Q
What are the two types of gastric cancer?
A
1) Intestinal
2) Diffuse
23
Q
What are the features of intestinal gastric cancer?
A
1) Associated with H. pylori, tobacco smoking, achlorhydria and chronic gastritis
2) Commonly on lesser curvature of the stomach
24
Q
What are the features of diffuse gastric cancer?
A
1) Not associated with H. pylori
2) Associated with signet cells
25
What are four specific forms or precancerous forms of gastric cancer?
1) Menetrier's disease (pre-cancerous)
2) Krukenberg tumour
3) Sister Mary Joseph nodule
3) Linitis plastica
26
What are the features of Menetrier's disease (pre-cancerous form of gastric cancer)?
1) Hyperplasia of gastric mucosa (unknown cause)
2) Large, gastric folds on the body and stomach associated with increased mucus production
3) Associated with parietal cell atrophy and thus reduced acid production
27
What are the features of Krukenberg tumour (gastric cancer)?
1) 'Signet ring' tumour - due to pathological appearance of signet ring cells
2) Signet ring cells readily secrete mucin and readily metastasise to the ovaries
3) Often presents with abdo bloating, ascites or pain during intercourse
4) Most common primary site is the stomach and colon (breast, lung and contralateral ovary less common)
28
Which type of tumour typically metastasises to the ovaries?
Krukenberg tumour (stomach)
29
What is a Sister Mary Joseph nodule (gastric cancer)?
Subcutaneous peri-umbilical metastasis associated with intestinal type of gastric cancer
30
What is linitis plastica (leather bottle stomach)?
1) Diffuse malignant infiltration of stomach
2) Muscles of stomach wall become thicker and more rigid - stomach holds less food as cannot stretch and transition of food is slower due to decrease relaxation of stomach
31
What are the 5 key risk factors for gastric cancer?
1) Smoking
2) Pernicious anaemia
3) H. pylori infection
4) High alcohol intake > 6 units/day
5) Dietary nitrosamines (in smoked food)
32
What are the risk factors for gastric cancer?
1) Smoking
2) Pernicious anaemia
3) H. pylori infection
4) High alcohol intake > 6 units/day
5) Dietary nitrosamines (in smoked food)
6) Atrophic gastritis
7) Blood group A
8) Adenomatous polyps
9) Achlorhydria (as seen in Menetrier's disease)
33
GORD is a risk factor for which type of cancer?
Oesophageal adenocarcinoma via Barrett's oesophagus (NOT gastric cancer)
34
Which country as a higher incidence of gastric cancer and why?
Japan - more smoker foods, dietary nitrosamines risk factor
35
How does gastric cancer present?
1) Anaemia (iron deficient)
2) Weight loss
3) Early satiety (anorexia)
4) Recent onset/progression of symptoms
5) Malaena/haematemesis
6) Dysphagia (swallowing difficulty)
7) Epigastric pain
8) Palpable non-tender mass in LUQ (+ palpable left supraclavicular Virchow's node) - both suggest advanced disease
36
What are indications for 2ww urgent referral for OGD?
1) Dysphagia (at any age)
2) ≥ 55 years + weight loss AND
- Upper abdo pain OR reflux OR dyspepsia
- Upper abdo mass consistent with gastric cancer
37
What are indications for 6ww non-urgent referral for OGD?
1) Haematemesis (at any age)
2) ≥ 55 years with:
- Treatment-resistant dyspepsia
- Upper abdo pain AND low Hb
- Raised platelet count AND nausea OR vomiting OR reflux OR weight loss OR dyspepsia OR epigastric pain
- N&V AND weight loss OR reflux OR dyspepsia OR epigastric pain
38
How is gastric cancer diagnosed?
OGD (endoscopy) + biopsy
39
What needs to be done after gastric cancer is diagnosed?
Tumour staging to assess whether it is resectable (not resectable if extensive local spread or any distant metastases)
40
What investigations can be done for gastric cancer post-endoscopy to stage the tumour and see if it is resectable?
1) CT CAP (first line) - to assess size, local spread and lymph node spread, visceral metastases to liver or lungs
2) MRI - for metastatic spread to liver and advanced local disease (less accurate for early localised spread so CT preferred)
3) Endoscopic US - to check for invasion to surrounding structures e.g. heart or lungs, most accurate for local staging of oesophageal cancer (T and N), due to limited penetration of US waves will not inform about metastatic spread
41
What is a T0-T3 stage tumour?
Only locally invaded (includes operative tumours that can be cured)
42
What is a T4 stage tumour?
Tumour has invaded local structures - operative intervention needed?
43
Can nodal spread of a tumour be treated surgically?
Depends on the site of spread
44
Is metastatic cancer inoperable?
Usually yes
45
How is locally invasive disease managed in gastric cancer?
Partial or total gastrectomy + neoadjuvant chemotherapy
46
What is a potential curative treatment in a gastric cancer non-surgical candidate?
Radiotherapy + chemotherapy (fluorouracil)
47
How can palliation be managed in advanced cases of gastric cancer?
1) Surgery - to relieve obstruction or haemorrhage
2) Chemotherapy - improves QoL
48
What investigation is indicated for patients with suspected colorectal cancer?
Urgent colonoscopy
49
Which is the leading cause of gynaecological related cancer in the UK?
Ovarian cancer
50
Why does ovarian cancer have high mortality?
Symptoms are often vague until relatively advanced
51
What are the three types of ovarian cancer?
1) Epithelial ovarian tumours
2) Germ cell tumours
3) Sex cord stromal tumours
52
What is the most common type of ovarian cancer (90%)?
Epithelial ovarian tumours
53
What is the most common type subtype of epithelial ovarian cancer?
Serous cystadenocarcinoma
54
What are Psammoma bodies?
Round collections of microscopic calcification
55
Which cancers are associated with the presence of Psammoma bodies on histology?
1) Serous cystadenocarcinoma - epithelial ovarian tumour
2) Papillary thyroid cancer
3) Meningioma
4) Mesothelioma
56
What are the features of epithelial ovarian tumours?
1) Originate from the epithelium which lines the fimbria of the fallopian tubes or ovaries
2) They are partially cystic and the cysts can contain fluid
3) The initial metastatic spread typically involves the peritoneal cavity, with seeing particularly affecting the bladder, paracolic gutters and the diaphragm
57
What type of tumour do tumour markers alpha fetoprotein and somethings beta hCG indicate?
Germ cell ovarian tumours
58
What are the features of germ cell ovarian tumours?
1) Originate from the germ cells in the embryonic gonad
2) Typically grow rapidly and spread predominantly via the lymphatic route
3) Most commonly arise in young women, which is atypical for most cases of ovarian cancer
59
What is the most common type of germ cell ovarian tumour?
Dysgerminoma
60
Which type of cancer has a histological appearance similar to 'fried eggs'?
Ovarian germ cell tumour - dysgerminoma
61
Which type of ovarian cancer typically arises in young women?
Germ cell tumours
62
What are the features of sex cord stromal ovarian tumours?
1) Originate from connective tissue
2) Rare - making up < 5% of all ovarian tumours
3) Malignant but much less aggressive than epithelial tumours
63
What is an example of an ovarian cancer that is secondary to another cancer elsewhere, which has metastasised to the ovary from its primary site?
Krukenberg tumour (ovarian malignancy) - "signet ring" sub-type of tumour, typically gastrointestinal in origin (most common source = stomach), which has metastasised to the ovary
64
What are risk factors for ovarian cancer?
1) Older age
2) Smoking
3) Greater number of ovulations (early menarche, late menopause)
4) Obesity
5) HRT
6) BRCA1 and BRCA2 genes
65
What are protective factors for ovarian cancer?
1) Parity
2) Breastfeeding
3) Early menopause
4) COCP use
66
What are the clinical features of ovarian cancer?
Symptoms often develop late in the course of the cancer
1) Non-specific e.g. abdominal discomfort, bloating, early satiety, urinary frequency or change in bowel habits
2) Ascites in late disease - due to cancer producing vascular growth factors which increase vessel permeability
3) Pelvic, back and abdo pain in late disease
4) May be palpable mass where the cancer is growing
67
What are differentials for ovarian cancer?
1) Other causes of abdominal discomfort - GI conditions e.g. IBS
2) Other causes of masses e.g. fibroids, ovarian cysts and other cancers e.g. bladder, endometrial
68
When do you urgently refer women for suspected ovarian cancer (2ww)?
Any woman with ascites and/or an unexplained pelvic/abdominal mass
69
In which patients should you consider tests for ovarian cancer?
Patients > 50 with:
1) Abdominal distension
2) Early satiety
3) Pelvic/abdominal pain
4) Urinary frequency/urgency
70
What are the two initial tests for ovarian cancer?
1) CA-125
2) Pelvic and abdominal ultrasound
71
What score can be used to stratify the likelihood of ovarian cancer?
Risk of Malignancy Index (RMI)
72
How do you calculate the RMI for ovarian cancer?
Ultrasound score x menopausal score x Ca-125 level
1) Ultrasound score - 0-3 depending on the number of abnormalities identified
2) Menopausal score - 1 for premenopausal, 3 for postmenopausal
73
What further tests can be done for ovarian cancer?
1) CT scans for staging
2) AFP and beta-hCG for younger women who may have germ cell cancers
3) Laparotomy for tissue biopsy
74
What is Stage I ovarian cancer?
Limited to the ovaries (more detail on substages on Quesmed)
75
What is Stage II ovarian cancer?
Involving one or both ovaries with pelvic extension and/or implants (more detail on substages on Quesmed)
76
What is Stage III ovarian cancer?
Involving one or both ovaries with microscopically confirmed peritoneal implants outside the pelvis (more detail on substages on Quesmed)
77
What is Stage IV ovarian cancer?
Tumour involving one or both ovaries with distant metastases
78
What does ovarian cancer management depend on?
The stage of the cancer and the patient's fitness for treatment
79
What are surgical options for ovarian cancer management?
1) Early disease - surgery can include removal of the uterus, ovaries, fallopian tubes and infracolic omentectomy
2) Advanced disease - debulking surgery can be performed
80
What are chemotherapy options for ovarian cancer management?
1) Adjuvant chemotherapy in combination with surgery
2) Intraperitoneal chemotherapy may be performed at the time of operation
3) Biological therapies are being trialled
81
What is a dermoid cyst?
1) Mature ovarian teratoma - contain cells of many different cell lineages and a lesion can consist of hair, skin, cartilage, teeth and thyroid tissue
2) Nearly always benign
82
What would be the histology of a Krukenberg tumour?
Mucin secreting signet cells
83
What is a type of epithelial ovarian cancer NOT associated with Psammoma bodies on histology?
Mucinous cystadenocarcinoma
84
What is a complication of mucinous cystadenocarcinoma rupture?
Pseudomyxoma peritonei - the progressive accumulation of mucin-producing cells within the abdomen and pelvis
85
What would be found on histology of a serous cystadenocarcinoma?
Complex papillary architecture, nuclear atypia, presence of Psammoma bodies
