Oncology Flashcards
What cancers is HPV associated with?
Cervical
Anal
Head and neck
What subtypes of HPV are cancerous?
HPV16 and HPV18
HPV16 produces E6 protein, which binds to and inactivates p53 protein leading to dysregulation of cell cycle and apoptotic pathways
What cancer is Epstein Barr Virus associated with?
non-Hodgkin’s lymphomas
What cancer is HTLV1 infection associated with?
T-cell lymphomas
What cancer is H. Pylori associated with?
MALT (mucosal associated lymphoid tissue) tumours
What is the 2nd commonest cancer?
Lung cancer
What are the different types of lung carcinoma?
- Small cell lung carcinoma
- Non-small cell lung carcinoma
a) Squamous cell
b) Adenocarcinoma
c) Large cell carcinoma
d) Adenocarcinoma in situ - Mesothelioma
- Sarcoma
- Lymphoma
What is the most common lung carcinoma?
Adenocarcinoma is now the most common lung cancer (40%) - it used to be squamous cell lung carcinoma until the 80s
What does small cell lung cancer arise from?
Endocrine cells called Kulchitsky cells
What type of lung cancer is more aggressive?
Small cell lung cancer
Grows rapidly and is highly malignant
70% are disseminated at presentation
Metastasise earlier in their course so often cannot be treated by surgery
What gene mutations are commonly found in adenocarcinomas?
EGFR - 19 & 21 mutations
ALK - translocation
ROS1 - mutation
Which patients is the EGFR mutation more common in?
East Asians
Females
Non-smokers
Young patients
What are the main causes of lung cancer?
Smoking - 90%
Occupation - asbestos exposure, uranium mining, ship building, petroleum refining
How does lung cancer usually present in order of most common symptoms?
Cough - 80%
Haemoptysis - 70%
Dyspnoea - 60%
Chest pain - 40%
Weight loss, anorexia, lethargy
Recurrent pneumonia
How does an apical Pancoast tumour present?
Horner’s syndrome
Ptosis, miosis, anhidrosis
Hoarseness of voice
How can a mediastinal tumour present?
Hoarseness of voice due to recurrent laryngral nerve palsy
SVC obstruction
What types of lung cancer can cause paraneoplastic syndromes?
Small cell lung cancer
Squamous cell lung cancer - hypercalcaemia
Large cell cancer - gynaecomastia
Give examples of paraneoplastic syndromes and their relevant hormone
Excess ACTH - Cushing’s
Excess PTH - hypercalcaemia
Excess HCG - gynaecomastia
Excess ADH - SIADH
What are some skin manifestations of lung cancer?
Dermatomyositis
Herpes zoster
Acanthosis nigricans
What signs might be seen on inspection of the hands in lung cancer?
Clubbing
Anaemia - pale palmar creases
Pain in the wrist - hypertrophic pulmonary osteoarthropathy
On auscultation of the chest, what sounds would be heard in lung cancer?
Monophonic wheeze due to partial airway obstruction
What factors of the history, examination and investigations would indicate squamous cell carcinoma?
Cigarette smoking
Hypercalcaemia - they secrete PTH-related peptide
Bronchial obstruction - often found centrally, close to bronchi
What factors of the history, examination and investigations would indicate adenocarcinoma?
History:
- Woman
- Non-smoker
- Asbestos exposure
Investigations:
- EGFR, ALK, ROS1 mutations
- Peripheral tumour
What might be seen on a chest x-ray in lung cancer?
Nodule Hilar enlargement Consolidation Pleural effusion Lung collapse Bony mets