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Phase 4 > Oncology > Flashcards

Oncology Flashcards

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1
Q

what type of cancer is most commonly associated with superior vena cava obstruction?

A

lung cancer - most common

also lymphoma

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2
Q

what are 6 causes of superior vena cava obstruction?

A

malignancy - non-small cell lung cancer, lymphoma, metastatic seminoma, Kaposi’s sarcoma, breast cancer

Aortic aneurysm
Mediastinal fibrosis
goitre
SVC thrombosis

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3
Q

what are 4 complications of superior vena cava syndrome?

A

laryngeal oedema and airway obstruction
cerebral oedema - neuro signs
Low cardiac output and hypotension
PE - if due to thrombus

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4
Q

what are 8 symptoms of superior vena cava syndrome?

A

SOB - may be exacerbated lying down
Swelling of face, neck and arms , may have conjunctival/periorbital oedema
Chest pain
Headache - worse in morning
Visual disturbance
Pulseless jugular vein distension
collateral vein development - late sign
compressive symptoms - stridor, dysphagia, hoarse voice

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5
Q

what investigations can be done for superior vena cava syndrome?

A

CXR - mass or widened mediastinum
CT thorax with contrast
MRI chest
US doppler of upper extremities
Venography
Biopsy

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6
Q

what is the management of superior vena cava syndrome?

A

PCI stenting if emergency
Radio/chemotherapy and corticosteroids if malignant
Tumor removal
Thrombolysis if due to thrombus

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7
Q

how common is lung cancer?

A

3rd most common in UK

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8
Q

what is.the most common type of lung cancer?

A

non-small cell adenocarcinoma

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9
Q

what are 3 types of non-small cell lung cancer?

A

adenocarcinoma
squamous cell carcinoma
large cell carcinoma

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10
Q

what is mesothelioma?

A

lung malignancy affecting meothelial cells of pleura linked to asbestos inhalation. Poor prognosis

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11
Q

what are 9 presentations of lung cancer?

A

SOB
cough
Haemoptysis
finger clubbing
recurrent pneumonia
weight loss
lymphadenopathy
Hoarse voice - especially pancoast tumoour
SVC syndrome

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12
Q

what is dysplasia?

A

the presence of abnormal cells in a tissue

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13
Q

what is special about small cell lung cancers?

A

have neuroendocrine differentiation and release neuroendocrine hormones with a wide range of paraneoplastic associations

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14
Q

what is a pancoast tumour?

A

a type of lung cancer located at the lung apex that can lead to shoulder pain and Horner’s syndrome (ptosis, miosis, anhydrosis)

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15
Q

what are 5 paraneoplastic syndromes that can be caused by lung cancer?

A

Hypercalcaemia due to production of PTH peptide

Cushings - due to ectopic ACTH production

SIADH leading to hyponatraemia

Lamber-eaton myasthenic syndrome - caused by antibodies against small cell lung cancer

Clubbing

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16
Q

how can small cell lung cancer cause Lamber-eaton myasthenic syndrome ?

A

due to antibodies against small cell lung cancer which target and damage voltage gated calcium chennels on presynaptic terminals of motor neurones leading to weakness in proximal muscles. Can also affect intraocular, levator and pharyngeal muscles causing diplopia, ptosis, slurred speech and dysphagia

may also have dry mouth, blurred vision, impotence, dizziness due to autonomic dysfunction

17
Q

what sign can be used to assess for superior vena cava syndrome?

A

Pemberton’s sign

raising hands over head causes facial congestion and cyanosis

18
Q

what are 5 investigations for lung cancer?

A

CXR - hilar enlargement, peripheral opacity, u/l pleural effusion, collapse

Staging contrast CT
PET-CT
Brochoscopy
Histological diagnosis - brochoscopy biopsy or percutaneous biopsy

19
Q

what is the management of non-small cell lung cancer?

A

Radiotherapy
Surgery - mediastinoscopy prior as CT does not always show mediastinal lymph node involvement - often lobectomy.

Poor response to chemo

20
Q

what are 8 contrindications to surgery in non-small cell lung cancer?

A

general health
Stage IIIb or IV
FEV1<1.5L
malignant pleural effusion
tumour near hilum
vocal cord paralysis
SVC obstruction

21
Q

what is the management of small cell lung cancer?

A

limited spread - 4-6 cycles of cisplatin based chemo +/- radiotherapy

Extensive mets - platinum based combo chemo + radiotherapy

22
Q

where is lung cancer likely to metastasise to?

A

Brain
bone
liver

23
Q

what are 4 risk factors for AAA?

A

smoking
HTN
Syphilis - rare
connective tissue disorders- EDH type 1 and marfans - rare

24
Q

what is the normal size of the abdominal aorta?

A

<1.5cm women
<1.7cm men

> 50 years

25
Q

when does screening for AAA take place?

A

males aged 65

26
Q

what happens to AAAs 3-4.4cm?

A

small aneurysm - rescan every 12 months

26
Q

what happens to AAA <3cm?

A

normal no action needed

27
Q

what happens to AAAs 4.5-5.4cm?

A

medium aneurysm - rescan every 3 months

28
Q

what happens to AAAs >5.5cm?

A

large aneurysm - refer 2ww to vascular for probable intervention

29
Q

what puts an AAA at high rupture risk?

A

symptomatic
diameter >5.5cm
Rapidly enlarging >1cm a year

30
Q

what is the management of AAA?

A

elective endovascular repair (EVAR) or open repair

EVAR - stent placed in abdominal aorta via femoral artery to prevent blood collecting in aneurysm

31
Q

what are 4 presentations of AAA rupture?

A

Pain in back or loin - abdo pain radiating through to back

Cardiovascular failure - tachy, hypotensive (shock), poorly responsive to fluids

Distal ischaemia - if haematoma in aneurysmal cavity can embolise and cause distal artery occlusion

Death

32
Q

what investigations should be done for ruptured AAA?

A

USS - quick diagnostic test to rule out AAA

CT angio - gold standard

Bloods
- FBC
- U+E - due to contrast needed for endovascular procedure
- coag screen
- group, save and cross match for surgery

33
Q

what are the 2 types of repair for rupture AAA?

A

open surgical repair - using midline laparotomy for direct visualisation

Endovascular aneurysm repair (EVAR)

34
Q

what are 7 complications of ruptured AAA?

A

renal failure
MI
bowel ischaemia
limb ischaemia
graft infection
abdominal compartment syndrome - more common in open surgery
endo leak of blood around aneurysm graft causing enlargement of aneurysm - only with EVAR

35
Q

what is the usual size for the thoracic aorta?

A

ascending <4.5cm
descending <3.5cm

36
Q

what is a false aneurysm?

A

usually de to trauma such as RTC, when intima and media rupture and there is dilation of vessel with blood only being contained within adventitia whereas true aneurysm has dilation of all layers of vessel

37
Q

what are 6 presentations of throacic abdominal aneurysm?

A

chest/back pain
trachea or L bronchus compression - cough, SOB, stridor
Phrenic nerve compression - hiccups
Oesophageal compression - dysphagea
Recurrent laryngeal nerve compression - hoarse voice

38
Q
A

Phase 4 (20 decks)

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