Oncology Flashcards
1
Q
two broad types of lung cancer
A
small cell + non-small cell
2
Q
small cell + non-small cell lung cancer differentiated by
A
histology
3
Q
sub classes of non-small cell lung cancer
A
squamous cell, adenocarcinoma, large cell carcinoma
4
Q
small cell + non-small cell lung cancer worst prognosis?
A
small cell
5
Q
squamous cell lung carcinoma
A
centrally located, associated with parathyroid hormone related protein secretion (hypercalcaemia), clubbing, hypertrophic pulmonary osteoarthropathy, ectopic TSH secretion (hyperthyroidism)
6
Q
centrally located, associated with parathyroid hormone related protein secretion, clubbing, hypertrophic pulmonary osteoarthropathy, ectopic TSH secretion
A
squamous cell carcinoma
7
Q
hypertrophic pulmonary osteoarthropathy is
A
disorder associated with severe clubbing: subperiosteal new bone formation at the distal ends of long bones, metatarsals, metacarpals, proximal phalanges, symmetrical arthropathy of adjacent joints, clubbing, gynaecomastia
8
Q
disorder associated with severe clubbing: subperiosteal new bone formation at the distal ends of long bones, metatarsals, metacarpals, proximal phalanges, symmetrical arthropathy of adjacent joints, clubbing, gynaecomastia
A
hypertrophic pulmonary osteoarthropathy
9
Q
lung adenocarcinoma
A
peripherally located, gynaecomastia, hypertrophic pulmonary osteoarthropathy, most common lung cancer in non-smokers (still predominantly smokers affected)
10
Q
peripherally located, gynaecomastia, hypertrophic pulmonary osteoarthropathy, most common lung cancer in non-smokers
A
adenocarcinoma
11
Q
large cell lung carcinoma
A
peripherally located, anaplastic, poorly differentiated, poor prognosis, may secrete b-HCG
12
Q
anaplastic
A
poorly differentiated
13
Q
peripherally located, anaplastic, poorly differentiated, poor prognosis, may secrete b-HCG
A
large cell lung carcinoma
14
Q
poorly differentiated cells
A
anaplastic
15
Q
small cell lung cancer
A
neuroendocrine tumour, centrally located, arise from APUD cells, ectopic ADH (hyponatraemia), ACTH (hypertension, hyperglycaemia, Cushings, bilateral adrenal hyperplasia, hypokalaemic alkalosis) secretion, Lambert-Eaton syndrome, causes majority of paraneoplastic syndrome in lung cancer
16
Q
APUD cells
A
small cell lung cancer arises from them: amine (high amine content) precursor uptake (high uptake of amine precursors) decarboxylase (high content of the enzyme decarboxylase)
17
Q
neuroendocrine tumour, centrally located, arise from APUD cells, ectopic ADH, ACTH secretion, Lambert-Eaton syndrome
A
small cell lung cancer
18
Q
why poor prognosis with small cell lung cancer
A
usually metastatic by time of diagnosis
19
Q
types of staging for lung cancer
A
TNM and Stage I-IV
20
Q
TNM staging
A
Tx, T0, Tis, T1 <3cm, T2 3-5cm, T3 5-7cm, T4 >7cm
Nx, N0, N1 hilum, N2 ipsilateral mediastinum, N3
M0, M1a bilateral lung, M1b single area outside of chest, M1c
21
Q
Lambert Eaton syndrome/Lambert Eaton myasthenic syndrome (LEMS)
A
rare autoimmune disorder (voltage-gated calcium channels) characterised by muscle weakness, paraneoplastic syndrome
Differential diagnosis: myasthenia gravis
22
Q
rare autoimmune disorder (voltage-gated calcium channels) characterised by muscle weakness, paraneoplastic syndrome
A
Lambert Eaton syndrome/Lambert Eaton myasthenic syndrome (LEMS)
23
Q
small cell lung cancer management
A
limited disease can be cured with chemotherapy + radiotherapy, advanced disease is managed palliatively
24
Q
limited lung disease can be cured with chemotherapy + radiotherapy, advanced disease is managed palliatively
A
small cell lung cancer
25
lung cancer risk factors
smoking (x10 risk), asbestos (x5 risk), arsenic, radon, nickel, chromate, aromatic hydrocarbon, cryptogenic fibrosing alveolitis
26
cryptogenic fibrosing alveolitis aka
idiopathic pulmonary fibrosis
27
idiopathic pulmonary fibrosis aka
cryptogenic fibrosing alveolitis
28
cryptogenic fibrosing alveolitis/idiopathic pulmonary fibrosis is
fibrosis of the alveolar walls imparing gas exchange
29
fibrosis of the alveolar walls imparing gas exchange
cryptogenic fibrosing alveolitis/idiopathic pulmonary fibrosis
30
three investigations for suspected lung cancer
chest radiograph, CT scan, broncoscopy + biopsy
31
additional investigation for non small cell
PET scan - establish eligibility for curative treatment
32
PET scan is an additional investigation for which lung cancer
non-small cell
33
PET scan uses
18-fluorodeoxygenase which is taken up by neoplastic tissue
34
2 week lung referral if
suspicious chest radiograph or >40 years + unexplained haemoptysis
35
suspicious chest radiograph or >40 years + unexplained haemoptysis
2 week lung referral
36
urgent 2 week chest radiograph if >40 years + 2 of the following or smoker + 1 of the following
cough, fatigue, shortness of breath, chest pain, weight loss, apetite loss
37
cough, fatigue, shortness of breath, chest pain, weight loss, apetite loss should prompt
urgent 2 week chest radiograph if >40 years + 2 of the following or smoker + 1 of the following
38
"consider" urgent 2 week chest radiograph if >40 years and...
persistent/recurrent chest infections, clubbing, supraclavicular lymphadenopathy/persistent cervical lymphadenopathy, chest signs, thrombocytosis
39
persistent/recurrent chest infections, clubbing, supraclavicular lymphadenopathy/persistent cervical lymphadenopathy, chest signs, thrombocytosis should prompt
"consideration" of urgent 2 week chest radiograph in >40 years
40
non-small cell lung cancer management
20% eligible for surgery, curative palliative radiotherapy, poor response to chemotherapy
41
20% eligible for surgery, curative palliative radiotherapy describes management of which lung cancer
non-small cell
42
surgical contraindications for lung cancer resection
general health, metastatic disease, FEV1 <1.5L, malignant pleural effusion, tumour near hilum, vocal cord paralysis, superior vena cava obstruction
43
general health, metastatic disease, FEV1 <1.5L, malignant pleural effusion, tumour near hilum, vocal cord paralysis, superior vena cava obstruction are contraindications for
lung cancer surgical resection
44
recurent laryngeal nerve supplies
vocal cords
45
vocal cords supplied by
recurrent laryngeal nerve
46
recurrent laryngeal nerve damage leads to
hoarse voice, difficulty breathing
47
hoarse voice/difficulty breathing can be caused by
recurrent laryngeal nerve/vocal cords damage
48
superior laryngeal nerve supplies
cricothyroid
49
cricothyroid responsible for
voice pitch
50
voice pitch controlled by
cricothyroid
51
cricothyroid supplied by
superior laryngeal nerve
52
complications of lung cancer
superior vena cava obstruction, Horner's, rib errosion, pericarditis, atrial fibrillation, metastases, ectopic hormone producion
53
lung metastasises to
bone, brain, liver, adrenals
54
superior vena cava obstruction, Horner's, rib errosion, pericarditis, atrial fibrillation, metastases, ectopic hormone producion are complications of
lung cancer
55
bone, brain, liver, adrenals sites of metastases for
lung cancer
56
2 week ENT referral for
persistent unexplained hoarseness of voice, unexplained neck lump
57
persistent unexplained hoarseness of voice, unexplained neck lump warrants
2 week ENT referral
58
acanthosis nigricans
symmetrical brown velvety plaques often found on neck, axilla, groid
59
symmetrical brown velvety plaques often found on neck, axilla, groid
acanthosis nigricans
60
acanthosis nigricals is associated with
gastrointestinal adenocarcinomas, diabetes mellitus, obesity, polycystic ovary syndrome, acromegaly, Cushing's, hypothyroidism, familial, Prader-Willi syndrome, oral contraceptive pill, nicotinic acid
61
gastrointestinal adenocarcinomas, diabetes mellitus, obesity, polycystic ovary syndrome, acromegaly, Cushing's, hypothyroidism, familial, Prader-Willi syndrome, oral contraceptive pill, nicotinic acid
associated with acanthosis nigricans
62
type of pleural effusion asociated with neoplasm
exudative, >30g/L protein (lung cancer, mesothelioma, metastases)
63
malignancies causing syndrome of innapropriate ADH
small cell lung, pancreas, prostate
64
small cell lung, pancreas, prostate can all cause
syndrome of innapropriate ADH production
65
SIADH biochemistry
hyponatraemia, low plasma osmolality, high urine osmololity (retained H2O leads to dilution of blood and concentration of urine)
66
hyponatraemia, low plasma osmolality, high urine osmololity
SIADH
67
myeloma mneumonic
CRAB: hypercalcaemia, renal failure, anaemia (pancytopaenia), bone pain
68
rouleaux formation
stacking of RBC on blood film = myleoma
69
stacking of RBC on blood film
rouleaux formation
70
multiple myeloma
plasma cell neoplasm in bone marrow, 60-70 year olds, bone disease (bone pain, osteoporosis, pathological fractures (vertebral), osteolytic lesions), lethargy, infection, hypercalcaemia, renal failure
71
plasma cell neoplasm in bone marrow, 60-70 year olds, bone disease, lethargy, infection, hypercalcaemia, renal failure
multiple myeloma
72
investigations for multiple myeloma
monoclonal serum proteins (IgG or IgA), urine Bence Jones protein, bone marrow, whole body MRI (bone lesions)
73
monoclonal serum proteins, urine Bence Jones protein, bone marrow, whole body MRI are investigations for
multiple myeloma
74
multiple myeloma diagnostic requirements
1 major + 1 minor or 3 minor with signs/symptoms
75
1 major + 1 minor or 3 minor with signs/symptoms are dfiagnostic criteria for
multiple myeloma
76
major diagnostic criteria for multiple myeloma
plasmacytoma, 30% plasma proteins in bone marrow, high M protein in blood/urine
77
plasmacytoma, 30% plasma proteins in bone marrow, high M protein in blood/urine
major diagnostic criteria for multiple myeloma
78
minor diagnostic criteria for multiple myeloma
10-30% plasma cells on bone marrow, minor increase in M protein in blood/urine, osteolytic lesions, low antibody
79
plasmacytoma
discrete solitary mass of neoplastic monoclonal plasma cells in bone or soft tissue
80
discrete solitary mass of neoplastic monoclonal plasma cells in bone or soft tissue
plasmacytoma
81
10-30% plasma cells on bone marrow, minor increase in M protein in blood/urine, osteolytic lesions, low antibody
minor diagnostic criteria for multiple myeloma
82
CA125
monoclonal antibody for ovarian cancer (+? elevated in cholangiocarcinoma)
83
monoclonal antibody for ovarian cancer
CA125
84
CA19-9
monoclonal antibody for pancreatic cancer (+ 80% of cholangiocarcinomas)
85
monoclonal antibody for pancreatic cancer
CA19-9
86
CA15-3
monoclonal antibody for breast cancer
87
monoclonal antibody for breast cancer
CA15-3
88
PSA
tumour antigen for prostate cancer
89
tumour antigen for prostate cancer
PSA (prostate specific antigen)
90
AFP (alpha-fetoprotein)
tumour antigen for hepatocellular cancer + teratomas/germ cell tumours e.g. testicular
91
tumour antigen for hepatocellular cancer + teratomas
AFP (alpha-fetoprotein)
92
CEA (carcinoembryonic antigen)
tumour antigen for colorectal cancer (+ ?elevated in cholangiocarcinoma)
93
tumour antigen for colorectal cancer
CEA (carcinoembryonic antigen)
94
S-100
tumour antigen for melanoma + schwannomas
95
tumour antigen for melanoma + schwannomas
S-100
96
bombesin
tumour antigen for small cell lung cancer, gastric cancer + neuroblastoma
97
tumour antigen for small cell lung cancer, gastric cancer + neuroblastoma
bombesin
98
commonest causes of hepatocellular carcinoma
hepatitis B and C infection
99
hepatitis B and C infection are the commonest cause of what cancer
hepatocellular
100
risk factors for hepatocellular carcinoma
cirrhosis (secondary to hepatitis B/C, alcohol, haemachromatosis, primary billiary cholangitis), alpha-1-antitrypsin deficiency, hereditary tyrosinosis, glycogen storage disorder, aflatoxin, oral contraceptive pill, anabolic steroids, porphyria cutanea tarda, male sex, diabetes mellitus, metabolic syndrome
101
primary biliary cholangitis aka
primary biliary cirrhosis
102
cirrhosis, alpha-1-antitrypsin deficiency, hereditary tyrosinosis, glycogen storage disorder, aflatoxin, oral contraceptive pill, anabolic steroids, porphyria cutanea tarda, male sex, diabetes mellitus, metabolic syndrome are risk factors for what cancer
hepatocellular
103
primary biliary cirrhosis aka
primary biliary cholangitis
104
primary biliary cholangitis/cirrhosis
autoimmune destrucion of small bile ducts leading to cholestasis, leading to fatigue, pruitis and jaundice
105
autoimmune destrucion of small bile ducts leading to cholestasis, leading to fatigue, pruitis and jaundice
primary biliary cholangitis/cirrhosis
106
aflatoxin
poisonous carcinogen produced by certain moulds (causes HCC)
107
poisonous carcinogen produced by certain moulds
aflatoxin (causes HCC)
108
polyphoria cutanea tarda
blistering of sun exposed skin
109
blistering of sun exposed skin
polyphoria cutanea tarda
110
hepatocellular carcinoma presentation
often late, jaundice, ascites, RUQ pain, hepatomegaly, splenomegaly, pruitis
111
jaundice, ascites, RUQ pain, hepatomegaly, splenomegaly, pruitis are presentations of
hepatocellular carcinoma
112
screening for hepatocellular carcinoma is offerend to
people with liver cirrhosis secondary to hepatitis B/C or haemachromatosis or alcohol (males)
113
people with liver cirrhosis secondary to hepatitis B/C or haemachromatosis or alcohol (males) are entitles to
screening for hepatocellular carcinoma
114
management of hepatocellular carcinoma
surgery, transplantation, radiofrequency ablation, transarterial chemoembolisation, sorafenib (multikinase inhibitor)
DON'T BIOPSY! risk of seeding
115
surgery, transplantation, radiofrequency ablation, transarterial chemoembolisation, sorafenib is the management of
hepatocellular carcinoma
116
liver primaries make up what percentage of liver malignancies
5%
117
cholangiocarcinoma
bile duct neoplasm, jaundiuce
118
you shouldn't biopsy
suspected hepatocellular carcinoma for risk of seeding
119
bile duct neoplasm, jaundiuce
cholangiocarcinoma
120
risk factors fo cholangioncarcinoma
primary sclerosing cholangitis/sclerosis, typhiod, liver flukes
121
primary sclerosing cholangitis/sclerosis, typhiod, liver flukes are risk factors for
cholangiocarcinoma
122
Pemberton sign
PT to raises arms until they touch side of face, cyanosis/worsening SOB = +ve test
123
PT to raises arms until they touch side of face, cyanosis/worsening SOB = +ve test
Pemberton's sign
124
PSA can be falsely elevated by
BPH, prostatitis, UTI, ejaculation, vigorous exercise, urinary retention, instrumentation of the urinary tract, prostate biopsy, DRE
125
BPH, prostatitis, UTI, ejaculation, vigorous exercise, urinary retention, instrumentation of the urinary tract can cause, prostate biopsy, DRE
false elevation of PSA
126
causes of a superior vena cava obstruciton
non-small cell lung cancer, lymphoma, metastatic seminoma, Kaposi's sarcoma, breast cancer, aortic aneurysm, mediastinal fibrosis, goitre, SVC thrombosis
127
non-small cell lung cancer, lymphoma, metastatic seminoma, Kaposi's sarcoma, breast cancer, aortic aneurysm, mediastinal fibrosis, goitre, SVC thrombosis are all potential causes of
SVCO
128
SVCO management
dexamethasone, balloon venoplasty, stenting, chemotherapy, radiotherapy
129
dexamethasone, balloon venoplasty, stenting, chemotherapy, radiotherapy to manage
SVCO
130
aniline dyes
carcinogen, causes transitional cell carcinoma of the bladder
131
carcinogen, causes transitional cell carcinoma of the bladder
aniline dye
132
asbestos
causes mesothesioma and bronchial carcinoma
133
causes mesothesioma and bronchial carcinoma
asbestos
134
nitrosamines
carcinogen used in the manufacture of cosmetics, pesticides + rubber produciton causing oesophageal and gastric cancer
135
carcinogen causing oesophageal and gastric cancer
nitrosamine
136
vinyl chloride
carcinogen used in the manufacture of PVC causing hepatic angiosarcoma
137
carcinogen causing hepatic angiosarcoma
vinyl chloride
138
normal range for PSA
<4
139
<4
normal range for PSA
140
PSA can be falsely elevated by
BPH, prostatitis, UTI, ejaculation, vigorous exercise, urinary retention, instrumentation of the urinary tract
141
BPH, prostatitis, UTI, ejaculation, vigorous exercise, urinary retention, instrumentation of the urinary tract can cause
false elevation of PSA
142
wait how long after UTI/prostatitis treatment to measure PSA
1 month
143
wait 1 month to measure PSA after
UTI/prostatitis treatment
144
wait how long after ejaculation/vigorous exercise to measure PSA
48 hours
145
wait 48 hours to measure PSA after
ejaculation/vigorous exercise
146
Gleasdon score
used to grade prostate cancer, graded 3-5 based on the characteristics of the two most prevelent cell type e.g. 3+3 is lowest grade
147
score used to grade prostate cancer
Gleasdon score
148
prostate cancer is usually an
adenocarcinoma
149
rish factors for developing prostate cancer
age, obesity, Afro-Caribean origin, family history
150
age, obesity, Afro-Caribean origin, family history are risk factors for developing
prostate cancer
151
prostate cancer tends to originate in what part of the prostate
periphery > centrally therefore can be asymptomatic as obstruction symptoms don't develop until the tumour size is advanced
152
symptoms of prostate cancer
asymptomatic, obstruciton, haematuria, haematospermia, pain
153
asymptomatic, obstruciton, haematuria, haematospermia, pain could be symptoms of
prostate cancer
154
hormone therapy for prostate cancer includes
synthetic GNRH agonist (goserelin/Zoladex), antiandrogen (cyproterone acetate)
155
locally advanced prostate cancer is T...
T3/T4
156
flutamide should be used as pretreatment for
goserelin in hormone therapy for prostate cancer
157
active monitoring, watchful waiting, radical prostatectomy, external beam radiotherapy, brachytherapy are management options for
T1/T2 prostate cancer
158
management options for T3/T4 prostate cancer
hormone therapy, radical prostatectomy, external bean radiotherapy, brachytherapy
159
hormone therapy, radical prostatectomy, external bean radiotherapy, brachytherapy are management options for
T3/T4 prostate cancer
160
management options for metastatic prostate cancer
medical/surgical castration
161
medical/surgical castration is the management of
metastatic prostate cancer
162
watchful waiting in prostate cancer is suitable for
elderly patients, multiple comorbidities, low Gleason score
163
elderly patients, multiple comorbidities, low Gleason score are suitable for
watchful waiting
164
active surveillance in prostate cancer is suitable for
stage T1c, 3+3, PSA density <0.15, cancer in <50% of 10 biopsies (+ at least 1 rebiopsy) with <10mm of any core involved
165
stage T1c, 3+3, PSA density <0.15, cancer in <50% of 10 biopsies (+ at least 1 rebiopsy) with <10mm of any core involved patients are suitable for
active surveillance
166
radiotherapy side effects in prostate cancer
radioation proctitis, rectal malignancy
167
radioation proctitis, rectal malignancy are side effects of
radiotherapy in prostate cancer
168
side effects of a radical prostatectomy
erectile dysfunction
169
erectile dysfunction is a side effect of
a radical prostatectomy
170
hormone therapy for prostate cancer includes
synthetic GNRH agonist (goserelin/Zoladex), antiandrogen (cyproterone acetate)
171
when commencing goserelin treatment pretreat with
flutamide (antiandrogen) to prevent initial flair of prostate cancer symptoms when commencing on a GNRH agonist
172
flutamide should be used as pretreatment for
goserelin in hormone therapy for prostate cancer
173
wait how long after prostate biopsy to do a PSA
6 weeks
174
wait 6 weeks to measure PSA after
prostate biopsy
175
wait how long after DRE to do PSA
1 week
176
wait 1 week to measure PSA after
DRE
177
3 weeks concurrent treatment with goserelin
cyproterone acetate (antiandrogen) to prevent tumour flare
178
cyproterone acetate is prescribed for how long in hormonal management of prostate cancer
3 weeks concurrently with goserelin, start 3 days before
179
thrombocytosis
high platelets
180
high platelets
thrombocytosis
181
two main origin cell types of breast cancer
ductal and lobar
182
ductal and lobar describe the
cell type origin of the two most common breast cancers
183
ductal and lobar can then be further divided into
in situ and invasive disease
184
tumours compatible with wide local excision
solitary lesions, peripheral tumours, small lesion in large breasts, DCIS <4cm, PT choice
185
solitary lesions, peripheral tumours, small lesion in large breasts, DCIS <4cm, PT choice are indications for
wide local excision
186
tumours compatible with a mastectomy
multifocal tumours, central tumours, large lesion in small breast, DCIS >4cm, PT choice
187
multifocal tumours, central tumours, large lesion in small breast, DCIS >4cm, PT choice are indications for
mastectomy
188
breast cancer risk factors
BRCA (40% lifetime risk of breast/ovarian), 1st degree premenopausal relative, nuliparity, 1st pregnancy >30, early menarche, late menopause, HRT, COCP, previous breast cancer, not breastfeeding, ionising radiation, p53 gene mutation, obesity, previous surgery for benign breast lesion
189
BRCA (40% lifetime risk of breast/ovarian), 1st degree premenopausal relative, nuliparity, 1st pregnancy >30, early menarche, late menopause, HRT, COCP, previous breast cancer, not breastfeeding, ionising radiation, p53 gene mutation, obesity, previous surgery for benign breast lesion
breast cancer risk factors
190
Nottingham prognostic index
indication of survival using tumour size, LN, grade
191
indication of survival (breast cancer) using tumour size, LN, grade
Nottingham prognostic index
192
two types of breast reconstruction
latissimus dorsi, subpectoralis implants
193
latissimus dorsi, subpectoralis implants
types of breast reconstructive surgery
194
breast cancer screening programme
women 47-73, 3 yearly mammogram
195
hormone therapies
```
tamoxifen (pre and perimenopausal women), increase risk of endometrial cancer, VTE, menopausal symptoms
aromatase inhibitors (postmenopausal women)
```
196
tamoxifen and aromatase inhibitors
hormone therapies for breast cancer
197
biological therapy
herceptin for HER2 positive breast cancers
198
herceptin
biological breast cancer treatment for HER2 positive tumours
199
most common type of breast cancer
invasive ductal carcinoma aka NST no special type
200
NST
no special type = invasive ductal carcinoma
201
Modified Bloom + Richardson
grading system for breast cancer
202
grading system for breast cancer
Modified Bloom + Richardson
203
anastrozole
aromatase inhibitor
204
aromatase inhibitor
anastrozole
205
ovarian cancer risk factors
family history, BRCA, early menarche, late menopause, nuliparity
COCP is protective
206
family history, BRCA, early menarche, late menopause, nuliparity
COCP is protective
ovarian cancer risk factors
207
CA125 can be falsely elevated due to
endometriosis, benign ovarian cyst
208
CA125 should be performed if
abdominal distension, bloating, early satiety, loss of appetite, pelvic/abdominal pain, increased urinary urgency +/ frequency
209
abdominal distension, bloating, early satiety, loss of appetite, pelvic/abdominal pain, increased urinary urgency +/ frequency
do a CA125
210
ovarian cancer staging
stage 1 = tumour confined to ovary
stage 2 = tumour outside ovary, but within pelvis
stage 3 = tumour outside pelvis but within abdomen
stage 4= distant metastasis
211
bladder cancer risk factors
smoking (even up to 20 years after quitting), hydrocarbons, aniline dye, rubber production, cyclophosphamide
212
smoking (even up to 20 years after quitting), hydrocarbons, aniline dye, rubber production, cyclophosphamide are risk factors for
bladder cancer
213
bladder cancer TNM staging
```
T1 = subepithelial connective tissue, T2 = muscularis propria, T3 = perivesicular fat, T4 = further invasion
N1 = single regional LN in true pelvis, N2 = multiple regional LN in true pelvis, N3 = common iliac LN
M1 = metastasis
```
214
true pelvis
space between pelvic inlet and pelvic outlet
215
space between pelvic inlet and pelvic outlet
true pelvis
216
inflammatory breast cancer
progressive erythema, odema, in the absence of infection
217
breast: progressive erythema, odema, in the absence of infection
inflammatory breast cancer
218
T1/T2 prostate cancer is
local disease
219
T3/T4 prostate cancer is
locally advanced
220
CML symptoms
young PT, fatigue, weight loss, early satiety, splenomegaly, leucocytosos (basophils, eosinophils), night sweats, LUQ pan (splenic infarction), hepatomegaly, easy bruising, lymphadenopathy
221
young PT, fatigue, weight loss, early satiety, splenomegaly, leucocytosos (basophils, eosinophils), night sweats, LUQ pan (splenic infarction), hepatomegaly, easy bruising, lymphadenopathy are symptoms of
CML
222
CML is
a myeloproliferative DZ, of pluripotent haemopoietic stem cells, >90% of cases caused by Philadelphia ch
223
a myeloproliferative DZ, of pluripotent haemopoietic stem cells, >90% of cases caused by Philadelphia ch
CML
224
AML is
BM malignancy where blood cell precursors are arrested in an early stage of development, continue to proliferate w/i BM leading to pancytopaenia
225
PTs who have received an organ transplant are at risk of what type of ca
skin, particularly SCC, due to long term immunosuppression, therefore should avoid sun exposure
226
cyclophasphamide SE
haemorrhagic cystitis, myelosuppression, TCC
227
bleomycin SE
L fibrosis
228
doxorubicin SE
cardiomyopathy
229
methotrexate SE
myelosuppression, mucositis, liver fibrosis, L fibrosis
230
fluorouracil (5-FU) SE
myelosuppression, mucositis, dermatitis
231
6-mercaptopurine SE
myelosuppression
232
cytarabine SE
myelosuppression, ataxia
233
vincristine SE
peripheral neuropathy (reversible), paralytic ileus
234
vinblastine SE
myelosppression
235
docetaxal SE
neutropaenia
236
cisplatin SE
ototoxicity, peripheral neuropathy, hypomagnesaemia
237
hydroxyurea/hydroxycarbamide SE
myelosuppression
238
common tumours that cause bone mets
prostate > breast > L
239
common sites for bone mets
spine > pelvis > ribs > skull > long bones
240
schistosomiasis is associated with
SCC of the bladder
241
SCC of the bladder is associated with
schistosomiasis
242
nasopharyngeal ca is associated with
EBV infection
243
EBV infection is associated with
nasopharyngeal ca
244
reduce the incidence of haemorrhagic cystitis in cyclophosphamide use
hydration + mesna
245
ABL is associated with
CML
246
c-MYC is associated with
Burkitt's lymphoma
247
n-MYC is associated with
neuroblastoma
248
BCL-2 is associated with
follicular lymphoma
249
RET is associated with
MEN types II + III
250
RAS is associated with
many ca, esp pancreatic
251
erb-B2/HER2/neu is associated with
breast, ovarian ca
252
CML gene mutation
ABL
253
Burkitt's lymphoma gene mutation
c-MYC
254
neuroblastoma gene mutation
n-MYC
255
follicular lymphoma gene mutation
BCL-2
256
MEN types II + III gene mutation
RET
257
breast/ovarian ca gene mutation
erb-B2/HER2/neu
258
ALL is the most common malignancy among
children
259
peak incudence of ALL
2-5 y.o.
260
features of ALL
anaemia (lethargy, pallor), neutropaenia (f/severe infections), thrombocytopaenia (easy bruising, petechiae), bone pain (2' to BM infiltration), hepatosplenomegaly, testicular swelling
261
Wilms' tumour is
most common renal tumour in children
262
features of Wilms' tumour
abdo mass, painless haematuria, flank pain, anorexia, fever, ux
263
Wilms' tumour management
nephrectomy, chemotherapy, radiotherapy
264
prognosis in Wilms' tumour
good
265
common sites of CRC
rectal > signmoid > descending colon > transverse colon > ascending colol + caecum
266
CRC screening program
2 yearly FOBT for men + women 60-74, via post, abnormal results have colonoscopy
267
types of CRC
sporadic (95%), HNPCC, FAP
268
HNPCC is
an autosomal dominant condition, poorly differentiated, highly aggressive CRC, also at risk of endometrial ca
269
criteria used to indicate HNPCC
Amsterdam criteria
270
Amsterdam criteria consists of
3 family members with CRC, over 2 generations, 1 of which <50 y.o.
271
FAP is
a rare autosomal dominant condition which leads to the formation of hundereds of polyps by 30-40 y.o., ineviatably develop carcinoma
272
guidelines for 2/52 referral to colorectal services
>40 y.o. + unexplained weight loss + abdo pain
>50 y.o. + unexplained PR bleeding
>60 y.o. + Fe deficiency anaemia or change in bowel habits
+ve FOBT
273
consider 2/52 referral to colorectal services if
PR/abdo mass, unexplained anal mass/ulceration, <50 y.o. + PR bleeding + abdo pain/change in bowel habits/weight loss/Fe deficiency anaemia
274
FOBT should be offered to
>50 y.o. + unexplained abdo pain or weight loss
<60 y.o. + change in bowel habit or Fe deficiency anaemia
>60 y.o. + anaemia
275
how to stage for CRC
CT CAP, colonoscopy/CT colonography, ?MRI rectum
276
CRC management
Sx, chemotherapy, neoadjuvent RT (rectal ca), palliation (stents, bypass, diversion stomas)
277
Sx for caecal, ascending, proximal transverse CRC
R hemicollectomy
278
Sx for distal transverse, desceding CRC
L hemicollectomy
279
Sx for sigmoid CRC
high ant resection
280
Sx for rectal CRC
ant resection
281
Sx for anal verge CRC
abdo-perineal excesion of rectum
282
an autosomal dominant condition, poorly differentiated, highly aggressive CRC, also at risk of endometrial ca describes
HNPCC
283
Amsterdam criteria is used to indicate
HNPCC
284
3 family members with CRC, over 2 generations, 1 of which <50 y.o. are the criteria for
Amsterdam criteria
285
a rare autosomal dominant condition which leads to the formation of hundereds of polyps by 30-40 y.o., ineviatably develop carcinoma describes
FAP
286
>40 y.o. + unexplained weight loss + abdo pain
>50 y.o. + unexplained PR bleeding
>60 y.o. + Fe deficiency anaemia or change in bowel habits
+ve FOBT
require 2/52 referral to colorectal services
287
PR/abdo mass, unexplained anal mass/ulceration, <50 y.o. + PR bleeding + abdo pain/change in bowel habits/weight loss/Fe deficiency anaemia
consider 2/52 colorectal services referral
288
>50 y.o. + unexplained abdo pain or weight loss
<60 y.o. + change in bowel habit or Fe deficiency anaemia
>60 y.o. + anaemia
offer FOBT
289
R hemicollectomy is used to resect
caecal, ascending, proximal transverses CRC
290
L hemicollectomy is used to resect
distal transverse, descending CRC
291
high ant resection is used to resect
sigmoid CRC
292
ant resection os used to resect
rectal CRC
293
abdo-perineal excision of rectum is used to resect
anal verge CRC
294
gastric ca peak age
60-70 y.o.
295
gastric ca most common in which countries
Japan, China, Finland, Colombia
296
gastric ca on histology
signet ring cells
297
gastric ca associations
H. pylori infection, blood group A, gastric adenomatous polyps, pernicious anaemia, smoking, salty, spicy, nitrate-rich diet
298
gastric ca features
dyspepsia, N, V, anorexia, weight loss, dysphagia
299
gastric ca investigations
endoscopy + biopsy, CT/endoscopic US, laparoscopy, PET CT
300
gastric ca management
Sx, lymphadenectomy, chemo
301
signet ring cells seen on histology indicate
gastric ca
302
H. pylori infection, blood group A, gastric adenomatous polyps, pernicious anaemia, smoking, salty, spicy, nitrate-rich diet are associated with
gastric ca
303
dyspepsia, N, V, anorexia, weight loss, dysphagia are features of
gastric ca
304
types of oesophageal ca
adenocarcinoma, squamous cell carcinoma
305
risk factors for oesophageal ca
smoking, EtOH, GORD, Barrett's oesophagus, achalasia, Plummer-Vinson S
306
features of oesophageal ca
dysphagia, anorexia, weight loss, V, odynophagia, hoarseness, melaena, cough
307
odynophagia
pain on swallowing food
308
oesophageal ca investigations
endoscopy, CT CAP, laproscopy, PET CT
309
oesophageal ca management
Sx, chemo, palliation
310
smoking, EtOH, GORD, Barrett's oesophagus, achalasia, Plummer-Vinson S are risk factors for
oesophageal ca
311
dysphagia, anorexia, weight loss, V, odynophagia, hoarseness, melaena, cough are features of
oesophageal ca
312
pain on swallowing food
odynophagia
313
AML features
anaemia, pallor, lethagy, neutropenia (ECC may be high, functioning neutrophils low), f infections, thrombocytopenia, bleeding, splenomegaly, bone pain
314
poor prognostic features for AML
>60 y.o., >20% blast cells after 1st course of chemo, ch 5 or 7 dels
315
Burkitt's lymphoma is
a high grade B-cell neoplasm
316
two forms of Burkitt's lymphoma
sproadic = abdo, endemic (African) = maxilla + mandible
317
sporadic Burkitt's lymphoma is > common in PTs with
HIV
318
endemic/African form of Burkitt's lymphona is associated with
EBV infection
319
Burkitt's lymphoma on microscopy
'stary sky' apearance
320
management of Burkitt's lymphoma
chemo
321
risk associated with treating Burkitt's lymphoma
tumour lysis S
322
complications of tumour lysis S
hyperkalaemia, hyperphosphataemia, hypocalcaemia, hyperuricaemia, acute renal failure
323
CLL is caused by
monoclonal proliferation of well differentiated lymphocytes which are almost always B-cells
324
features of CLL
asymptomatics, anorexia, weight loss, bleeding, infection, lymphadenopathy
325
complications of CLL
hypogammaglobulinaemia leading to recurrent infections, warm AI haemolytic anaemia, transformation to high grade lymphoma
326
CLL investigations
blood film, immunophenotyping
327
CLL on blood film
smudge cells
328
CLL transformation to high grade lymphoma aka
Richter's transformaiton
329
indications that Richter's transformaiton has happened
LN swelling, fever w/o infeciton, weight loss, night sweats, N, abdo pain
330
Hodgkin's lymphoma is characterised by the presence of
Reed-Sternberg cells
331
features of HL
lymphadenopathy (painless, non-tender, asymetrical), weight loss, pruitis, night sweats, fever, alcohol pain, normocytic anaemia, eosinophillia, raised LDH
332
HL staging
CT CAP
333
management of HL
chemo, radiotherapy
334
HL is linked to
EBV infeciton
335
myelodysplasia is
acquired neoplastic disorder of haematopoietic SC, pre-leukaemia, may progress to AML
336
myelodysplasia presentation
anaemia, neutropaenia, thrombocytopenia
337
anaemia, pallor, lethagy, neutropenia (ECC may be high, functioning neutrophils low), f infections, thrombocytopenia, bleeding, splenomegaly, bone pain are features of
AML
338
a high grade B-cell neoplasm describes
Burkitt's lymphoma
339
'stary sky' apearance on microscopy
Burkitt;s lymphoma
340
monoclonal proliferation of well differentiated lymphocytes which are almost always B-cells
CLL
341
asymptomatics, anorexia, weight loss, bleeding, infection, lymphadenopathy are features of
CLL
342
hypogammaglobulinaemia leading to recurrent infections, warm AI haemolytic anaemia, transformation to high grade lymphoma are complications of
CLL
343
smudge cells on blood film
CLL
344
Richter's transformaiton is when
CLL transforms to a high grade lymphoma
345
LN swelling, fever w/o infeciton, weight loss, night sweats, N, abdo pain are features of
Richter's transformation
346
Reed-Sternberg cells are characteristic of
HL
347
lymphadenopathy (painless, non-tender, asymetrical), weight loss, pruitis, night sweats, fever, alcohol pain, normocytic anaemia, eosinophillia, raised LDH are features of
HL
348
acquired neoplastic disorder of haematopoietic SC, pre-leukaemia, may progress to AML describes
myelodysplasia
349
anaemia, neutropaenia, thrombocytopenia describes the presentaiton of
myelodysplasia
350
Waldenstrom's macroglobulinaemia is
uncommon, lymphoplasmacytoid malignancy, characterised by the secretion of IgM
351
features of Waldenstrom's macroglobulinaemia
monoclonal IgM paraproteinaemia, weight loss, lethargy, visual disturbances, hepatosplenomegaly, lymphadenopathy, Raynaud's
352
uncommon, lymphoplasmacytoid malignancy, characterised by the secretion of IgM
Waldenstrom's macroglobulinaemia
353
monoclonal IgM paraproteinaemia, weight loss, lethargy, visual disturbances, hepatosplenomegaly, lymphadenopathy, Raynaud's are features of
Waldenstrom's macroglobulinaemia
354
NHL presentation
55-60 y.o., painless widespread lymphadenopathy, raised LDH, paraprotein, AIHA
355
most common form of NHL
diffuse large b cell lymphoma
356
55-60 y.o., painless widespread lymphadenopathy, raised LDH, paraprotein, AIHA describes the presentation of
NHL
357
Reed-Sternberg cells look like
large multinucleated cells with prominent eosinophilic nucleoli
358
poor prognosis is HL associated with
weight loss (>10% in 6/12), fever (>30'c), night sweats
