Oncology Flashcards
1
Q
What inheritance pattern is seen with Lynch syndrome, Li Fraumeni and Gardners syndrome/ FAP?
A
Autosomal dominant
2
Q
What is the Amsterdam criteria for Lynch syndrome?
A
3
Q
What are the main features of lynch syndrome?
A
MLH1 and MSH2
Autosomal dominant
Sessile like polyps
Endometrial > ovarian > pancreatic
4
Q
What are the features of MEN1?
A
MEN1 affects pituitary, parathyroid and pancreas, + zollinger ellison and gastrinomas
5
Q
What is S100 a tumour marker for?
A
Melanoma, schwannomas
6
Q
Bombesin
A
Small cell lung carcinoma, gastric cancer, neuroblastoma
7
Q
What bones are most affected by metastasis?
A
spine
pelvis
ribs
skull
long bones
special people really should love
7
Q
What are the most common primary sites for bony metastasis?
A
Most common tumour causing bone metastases (in descending order)
prostate
breast
lung
8
Q
What are the most common cancers in the UL?
A
- Breast
- Lung
- Colorectal
- Prostate
- Bladder
- Non-Hodgkin’s lymphoma
- Melanoma
- Stomach
- Oesophagus
- Pancreas
9
Q
T or F, a raised alpha-feto protein level excludes a seminoma
A
T - AFP is abnormal
10
Q
T or F, Cisplatin is associated with hypomagnesaemia
A
T
11
Q
What is AFP a marker of?
A
HCC
Germ cell tumours
Metastatic lung cancer
Neural tube defects
12
Q
What are the features of tumour lysis syndrome?
A
This leads to hyperuricaemia, hyperphosphatemia, hyperkalaemia, and hypocalcaemia.
13
Q
How is tumour lysis syndrome managed?
A
IV fluids
Rasbicurase
Allopurinol
Dialysis
ECG
14
Q
How does rasburicase work?
A
It transforms uric acid into allantoin. Allantoin is more soluble in urine than uric acid, and more easily eliminated by the kidney.
15
Q
What is the 2WW for colorectal cancer?
A
Under 40 = pain and weight loss
Under 50 = PRIC
Pain + rectal bleeding + IDA + change in bowel habits
Under 60 = change in bowel habits and IDA
16
Q
What is the criteria for a 2WW for colorectal cancer under 40?
A
Weight loss and Pain (Winter Princess)
17
Q
What are the criteria for a 2WW for colorectal in under 50?
A
Change in bowel habits
Rectal bleeding
IDA
S
Pain
18
Q
What are the criteria for 2WW for colorectal in under 60?
A
IDA and abnormal bowel movements
19
Q
What is the TMN staging for colorectal cancer?
A
T: Tis (carcinoma in situ/intramucosal cancer), T1 (extends through the mucosa into the submucosa), T2 (extends through the submucosal into the muscularis), T3 (extends through the muscularis into the subserosa), T4 (extends into neighbouring organs or tissues).
N: N0 (no regional lymph node involvement), N1 (metastasis to 1-3 regional lymph nodes), N2 (metastasis to 4 or more regional lymph nodes).
M: M0 (no distant metastasis), M1 (distant metastasis). Staging informs both the prognosis and the treatment plan.
20
Q
What are the criteria for a screening programme?
A
Accurate test
Early phase
Important disease
Ongoing process
Understood treatment
21
Q
What is screening?
A
Screening is a way of identifying apparently healthy people who may have an increased risk of a particular condition. The NHS offers a range of screening tests to different sections of the population.
The aim is to offer screening to the people who are most likely to benefit from it. For example, some screening tests are only offered to newborn babies, while others such as breast screening and abdominal aortic aneurysm screening are only offered to older people.
22
Q
What are the features of basal cell carcinoma?
A
23
Q
Discuss the treatment options for BCC?
A
Imiquimod, 5FU, diclofenac
Cautery, curretage, Mohs surgery
24
What are the stages of bladder cancer?
25
What are the treatments for bladder cancer?
26
What is the most common type of breast cancer?
DCIS Potential to become an invasive breast cancer (around 30%)
27
What are some of pathological markers of breast cancer?
Ductal Carcinoma In Situ (DCIS
Lobular Carcinoma In Situ (LCIS)
Invasive Ductal Carcinoma – NST
Invasive Lobular Carcinomas (ILC)
Inflammatory Breast Cancer
28
What are the treatments for breast cancer?
Wide local excision
Adjuvant therapies
Traztuzumab
Endocrine therapies
Radiotherapy
29
Where do most breast cancers metastasise to?
Metastasis (2 Ls 2 Bs)
You can remember the notable locations that breast cancer metastasis occur using 2 Ls and 2 Bs:
L – Lungs
L – Liver
B – Bones
B – Brain
30
What is the referral criteria for women with breast cancer?
An unexplained breast lump in patients aged 30 or above
Unilateral nipple changes in patients aged 50 or above (discharge, retraction or other changes)
An unexplained lump in the axilla in patients aged 30 or above
Skin changes suggestive of breast cancer
NON-URGENT for under 30
The NICE guidelines suggest considering non-urgent referral for unexplained breast lumps in patients under 30 years.
31
What is triple assessment?
Clinical assessment (history and examination)
Imaging (ultrasound or mammography)
Biopsy (fine needle aspiration or core biopsy)
32
Define neo-adjuvant, adjuvant and definitive?
Neoadjuvant therapy – intended to shrink the tumour before surgery
Adjuvant chemotherapy – given after surgery to reduce recurrence
Treatment of metastatic or recurrent breast cancer
33
What are some drawbacks of radiotherapy?
General fatigue from the radiation
Local skin and tissue irritation and swelling
Fibrosis of breast tissue
Shrinking of breast tissue
Long term skin colour changes (usually darker)
34
What are the three methods of breast reconstruction?
Immediate or delayed
Latissmus dorsi
Transversus rectus abdominis flap
DIEP flap
35
What are latissimus dorsi flaps?
Latissimus Dorsi Flap
The breast can be reconstructed using a portion of the latissimus dorsi and the associated skin and fat tissue. The tissue is tunnelled under the skin to the breast area.
“Pedicled” refers to keeping the original blood supply and moving the tissue under the skin to a new location.
“Free flap” refers to cutting the tissue away completely and transplanting it to a new location.
36
What is a TRAM flap?
The breast can be reconstructed using a portion of the rectus abdominis, blood supply and skin. This can be either as a pedicled flap (tunnelled under the skin) or a free flap (transplanted). It poses a risk of developing an abdominal hernia due to the weakened abdominal wall.
37
What is a DIEP flap?
Deep Inferior Epigastric Perforator Flap (DIEP Flap)
The breast can be reconstructed using skin and subcutaneous fat from the abdomen (no muscle) as a free flap. The deep inferior epigastric artery, with the associated fat, skin and veins, is transplanted from the abdomen to the breast. The vessels are attached to branches of the internal mammary artery and vein. This is a complex procedure involving microsurgery. There is less risk of an abdominal wall hernia than with a TRAM flap, as the abdominal wall muscles are left intact.
38
What are some treatments for oestrogen receptor positive breast cancer?
Fulvestrant (selective oestrogen receptor downregulator)
GnRH agonists (e.g., goserelin or leuprorelin)
Ovarian surgery
39
How is chronic lymphoedema managed?
Massage techniques to manually drain the lymphatic system (manual lymphatic drainage)
Compression bandages
Specific lymphoedema exercises to improve lymph drainage
Weight loss if overweight
Good skin care
40
When are women offered a sentinel node biopsy?
A sentinel lymph node biopsy may be used during breast cancer surgery where the initial ultrasound does not show any abnormal nodes.
41
How is a sentinel node biopsy carried out?
An isotope contrast and a blue dye are injected into the tumour area. The contrast and dye travel through the lymphatics to the first lymph node (the sentinel node). The first node in the drainage of the tumour area shows up blue and on the isotope scanner. A biopsy can be performed on this node, and if cancer cells are found, the lymph nodes can be removed.
42
What are some changes seen in the breast in cancer patients?
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
43
What does the screening programme entail?
The NHS breast cancer screening program offers a mammogram every 3 years to women aged 50 – 70 years.
Screening aims to detect breast cancer early, which improves outcomes. Roughly 1 in 100 women are diagnosed with breast cancer after going for a mammogram.
44
What are some cons to screening?
Anxiety and stress
Exposure to radiation, with a very small risk of causing breast cancer
Missing cancer, leading to false reassurance
Unnecessary further tests or treatment where findings would not have otherwise caused harm
45
What is cervical cancer?
46
What is HPV?
Causes pre-cancerous changes that eventually lead to Cervical Cancer
Low risk HPV 6,11 – Genital warts
High risk - HPV 16,18 - Can lead to CIN
HPV vaccination Programme started in 2008 – initially girls (12-13 yrs. – in yr8) , from 2019 boys and girls in yr 8
Vaccine Types :
Gardasil ® - HPV Type 6,11,16 and 18
47
How is cervical screening delivered?
48
What is CIN?
49
What is anticipated from CIN changes?
CIN 1 – Spontaneously regress in 50-60% of cases within 2 years. 10 x greater risk of cervical ca than normal cytology. Repeat colposcopy every 6m , LLETZ if persistent
CIn 2 – 3-5 % risk of ca in 10 yrs , less likely to spontaneously regress. LLETZ recommended
Cin 3 – 20-30 % chance of cervical cancer in 10 ys . LLETZ recommended
50
How is CIN managed?
CIN 2 and CIN 3 --> LLETZ --> 6 month FU
51
What is a complication of LLETZ?
Pre-term labour
52
How is colposcopy delivered?
53
What is the staging for cervical cancer?
54
What is the treatment for stage 1 cervical cancer?
Cone biopsy
55
What is the treatment for stage 1 cervical cancer in a woman that wants to have a family?
56
What is screening and what is the criteria for screening?
Screening is a method of identifying a seemingly healthy population group that are at risk from a particular disease. The screening test needs to be accurate, accessible, easy to perform, important, understood disease progression and can be continously used.
57
What is sorafenib used for?
Sorafenib is used to treat late-stage kidney cancer (advanced renal cell carcinoma), liver cancer (hepatocellular carcinoma)
58
What is the WHO performance status?
59
What are the causes of endometrial cancer?
60
What are some differentials for PMB?
Vulva /Vagina- Atrophic Vaginitis , Cancer
Cervix – Cervical polyps , Cervical cancer ( <1%)
Uterus – Atrophy, Endometrial cancer, Endometrial Hyperplasia, Endometrial polyps
Ovaries – Ovarian cancer
61
What are the investigations for endometrial cancer?
62
What are the risk factors for endometrial cancer?
63
What is the staging for endometrial cancer?
64
What is the treatment for stage 1 endometrial cancer?
65
What is endometrial hyperplasia?
66
How is endometrial hyperplasia managed?
LNG - US
67
Which cancers most commonly metastasise to the brain?
lung, breast, colon, kidney, thyroid gland , skin (melanoma),
Let's be creative k the student
68
What is the most common cancers to metastasise to bone?
Breast
Lung
Prostate
69
What are the symptoms of multiple myeloma?
bone pain - often in your back, hips, shoulders or ribs
broken bones (fractures)
tiredness (fatigue), shortness of breath and weakness - these are symptoms of low red blood cells (anaemia)
pain, changes in sensation or weakness - these are symptoms of spinal cord compression
lots of infections or infections that don't go away
feeling thirsty, passing urine more frequently, confusion and drowsiness - these are all symptoms of high calcium levels in the blood
70
Outline the tests for multiple myeloma
71
List the targeted medications for multiple myeloma.
thalidomide
lenalidomide
bortezomib
daratumumab
Chemotherapies are less targeted
72
How else is multiple myeloma managed?
radiotherapy Open a glossary item to an area of myeloma that is causing pain
surgery to a broken bone, or to stop a weakened bone from breaking
bisphosphonates Open a glossary item to reduce bone pain or lower calcium levels
plasma exchange (plasmapheresis) to lower protein levels in the blood
a blood transfusion to treat tiredness (caused by low red blood cell levels)
antibiotics to treat infections
fluids to help your kidneys work
73
List side effects of chemotherapy medications.
Hypomagensiumia and cisplatin
74
Outline the 5 acute oncological presentations.
Hypercalcemia of malignancy
Tumour lysis syndrome
Superior vena cava obstruction
MSCC
Neutropenic sepsis
75
Discuss how Hodgkins lymphoma is managed?
ABVD
doxorubicin hydrochloride (Adriamycin), bleomycin sulfate, vinblastine sulfate, and dacarbazine.
76
Discuss how non-Hodgkins lymphoma is managed,
R-CHOP regimen
77
What is the Ann Arbour scoring system?
78
What are the risk factors for oesophageal cancer?
79
How is oesophageal cancer managed?
Stage 1 -mucosal resection
Stage 2 - surgery / chemotherapy/ radiotherapy
Stage 3 - surgery / chemotherapy/ radiotherapy
Stage 4 - palliative
Consider immunotherapy
80
What are some immunotherapies for oesophageal cancer?
81
What are the symptoms of ovarian cancer?
1. Non specific
2. Mass
3. Early satiety
4. Loss of appetite
5. Abdominal distension
6. Diarrhoea
7. Urgency
82
What is ovarian cancer?
83
What are some risk factors for ovarian cancer?
Early menarche
Late menopause
Nulliparity
BRCA1/2 (50-80%) risk
HNPCC/ Lynch Syndrome (endometrial and bowel cancer)
84
What is the classification of ovarian cancers?
85
What are the investigations for ovarian cancer?
86
Compare BCC and SCC.
87
What is the link between AK, SCC and ISCC
88
What is another name for SCC in situ>
Bowen's disease
89
What are the treatments for Bowens disease?
cryotherapy – liquid nitrogen is sprayed on to the affected skin to freeze it. The procedure may be painful and the skin may remain a bit uncomfortable for a few days. The affected skin will scab over and fall off within a few weeks.
imiquimod cream or chemotherapy cream (such as 5-fluorouracil) – this is applied to the affected skin regularly for a few weeks. It may cause your skin to become red and inflamed before it gets better.
curettage and cautery – the affected area of skin is scraped away under local anaesthetic, where the skin is numbed, and heat or electricity is used to stop any bleeding, leaving the area to scab over and heal after a few weeks
photodynamic therapy (PDT) – a light-sensitive cream is applied to the affected skin and a laser is directed on to the skin a few hours later to destroy the abnormal cells. The treatment session usually lasts between 8 to 45 minutes. You may need more than 1 session
surgery – the abnormal skin is cut out under local anaesthetic and stitches may be needed afterwards.
90
What are the different types of melanoma?
91
What are the 2 WW criteria for melanoma?
92
Who is referred for lung cancer?
Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for lung cancer if they:
Have chest X-ray findings that suggest lung cancer, or
Are aged 40 years and over with unexplained haemoptysis.
Offer an urgent chest X-ray (to be performed within 2 weeks) to assess for lung cancer in people aged 40 years and over if they have two or more of the following unexplained symptoms,
93
What is considered in the 2WW for stomach and oesophageal cancers?
Age >55
Loss of weight
Anaemia
Reflux
Melaena
Emesis
Dysphagia
94
What is the most common type of prostate cancer?
Prostate cancer is a malignant tumour of the prostate. Almost all cancers of the prostate (95%) are adenocarcinomas.
95
What are the risk factors for prostate cancer?
Increasing age.
Black ethnicity.
Family history of prostate cancer.
96
What are the symptoms of prostate cancer?
Lower back or bone pain.
Lethargy.
Erectile dysfunction.
Haematuria.
Anorexia/weight loss.
Lower urinary tract symptoms (LUTS), such as frequency, urgency, hesitancy, terminal dribbling, and/or overactive bladder.
97
How should suspected prostate cancer be managed in primary care?
A digital rectal examination (DRE).
A prostate-specific antigen (PSA) test.
98
What is the threshold for PSA in those aged between 60-69?
more than 4.5 in a person aged 60–69 years
99
What are the treatment options for a patient with prostate cancer?
Watchful waiting.
Active surveillance.
Chemotherapy
Tamofixen
Hormonal treatment
Acetate
Radiotherapy
Surgery
100
What is given with Goserelin in prostate cancer?
Cyproptyerone acetate
101
What disease should be considered in an older woman with IBS symptoms?
Ovarian cancer should also be suspected and tests carried out in any woman over 50 years of age if she has had symptoms suggestive of irritable bowel syndrome within the last 12 months.
102
What are the markers for testicular cancer?
103
