Oncology

Question 1

Describe the T stages in the TNM classification of cancer

Answer 1

Primary tumour (T)

TX Primary tumour cannot be assessed

T0 No evidence of primary tumour

Tis Carcinoma in situ: intraepithelial or invasion of lamina propria

T1 Tumour invades submucosa

T2 Tumour invades muscularis propria

T3 Tumour invades through the muscularis propria into tissues

T4 Tumour invades or is adherent to other organs or structures

Question 2

Describe the N of the TNM classification of cancer

Answer 2

N Nodes
N0 No lymph node metastasis
N1 One regional lymph node metastasis
N2 Multiple, mobile regional lymph node metastases
N3 Fixed regional lymph node metastases
N4 Beyond regional lymph node involvement
NX Lymph nodes, not evaluable

Question 3

Describe the M of the TNM classification of cancer

Answer 3

M Metastasis
M0 No evidence of metastases
M1a  Distant metastases are present and confined to 1 organ or site
M1b Metastases in more than 1 organ 
MX Distant metastases not evaluable

Question 4

In colorectal cancer, what are the referral guideline?

Answer 4

The following patients should be referred urgently (i.e. within 2 weeks) to colorectal services for investigation:
patients >= 40 years with unexplained weight loss AND abdominal pain
patients >= 50 years with unexplained rectal bleeding
patients >= 60 years with iron deficiency anaemia OR change in bowel habit
tests show occult blood in their faeces

An urgent referral (within 2 weeks) should be ‘considered’ if:

• there is a rectal or abdominal mass
• there is an unexplained anal mass or anal ulceration
• patients < 50 years with rectal bleeding AND any of the following unexplained symptoms/findings:
• → abdominal pain
• → change in bowel habit
• → weight loss
• → iron deficiency anaemia

Question 5

In colorectal cancer screening, what is FOBT?

Answer 5

Faecal Occult Blood Testing (FOBT)
The NHS now has a national screening programme offering screening every 2 years to all men and women aged 60 to 74 years. Patients aged over 74 years may request screening.

In addition FOBT should be offered to:
patients >= 50 years with unexplained abdominal pain OR weight loss
patients < 60 years with changes in their bowel habit OR iron deficiency anaemia
patients >= 60 years who have anaemia even in the absence of iron deficiency

Question 6

Which cancers does arsenic increase the risk of?

Answer 6

Angiosarcoma of the liver
Squamous cell skin carcinoma
Lung cancer

Question 7

Which chemicals increase the risk of TCC of bladder?

Answer 7

Aromatic amines:

2-naphthylamine & benzidine

Question 8

What are aflatoxins present in and how are they linked to which cancer?

Answer 8

Aflatoxins are often present in crops such as peanuts and maize. And aspergillus from the aflatoxins increases the risk of hepatocellular carcinoma

Question 9

Does smoked food affect cancer?

Answer 9

Yes - nitrosamines are present in smoked foods and can increase the risk of stomach cancer

Question 10

What is vinyl chloride use in?

Answer 10

Is is used in the production of polymer polyvinyl chloride and increases the risk of angiosarcoma of the liver

Question 11

What are the risk factors for TCC?

Answer 11

• smoking
• exposure to aniline dyes
• rubber manufacture
• cyclophosphamide

Question 12

What are the risk factors for squamous cell carcinoma of the bladder?

Answer 12

• Schistosomiasis
• Calmetter-guerin (BCG) treatment
• smoking

Question 13

What is multiple myeloma?

Answer 13

A bone marrow cancer arising from plasma cells