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3B Specialties > Oncology > Flashcards

Oncology Flashcards

1
Q

types of thyroid cancer

A 
Papillary 
Follicular 
Medullary 
Lymphoma 
Anaplastic
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2
Q

Papillary thyroid cancer

A

young patients
spread - lymph nodes and lung (jugulo-diagastric node metastasis - lateral aberrant thyroid)
Rx - total thyroidectomy +/- node excision +/- radioiodine

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3
Q

Follicular thyroid cancer

A

middle ages
spreads early via blood –> bone and lungs
well differentiated
Rx - total thyroidectomy + T4 suppression + radioiodine ablation

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4
Q

Medullary thyroid cancer

A

sporadic or part of MEN syndrome
may produce calcitonin –> used as a tumour marker
do not concentrate iodine
Phaeochromocytoma screen pre-op
Rx –> thyroidectomy + node excision. Consider external beam radiotherapy.

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5
Q

Thyroid Lymphoma

A

may present with stridor or dysphagia
Do full staging before treatment (chemoradiotherapy)
Assess histology for mucosa-associated lymphoid tissue (MALT –> good prognosis)

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6
Q

Anaplastic thyroid cancer

A

elderly
poor response to treatment
try excision and radiotherapy

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7
Q

Oropharyngeal carcinoma

A

Advanced at presentation –> 20% node +ve at presentation
men more than women
- smoker with sore throat and sensation of a lump

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8
Q

Oropharyngeal carcinoma

risk factors

A

Pipe smoking
Chewing tabacco
High Risk HPV type 16

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9
Q

Oropharyngeal carcinoma

Rx

A

Surgery and radiotherapy

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10
Q

Signs and symptoms of

Head & neck squamous cell carcinomas

A
  • neck pain/ lump
  • hoarse voice >6 weeks
  • sore throat > 6 weeks
  • mouth bleeding
  • mouth numbness
  • sore tongue
  • painless ulcers
  • patches in the mouth
  • ear ache/ effusion
  • lumps (lip/ mouth/ gum)
  • speech change
  • dysphagia
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11
Q

leukoplakia

A

white vulval patches due to skin thickening and hypertrophy
- itchy
- biospy
Rx –> topical corticosteroids, psoralens + UV phototherapy, methotrexate, ciclosporin

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12
Q

Malignant bone disease

A

Rare primary, common secondary (prostate, thyroid, lung, kidney, breast)

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13
Q

Bone sarcoma presentation

A

non-mechanical bone or joint pain
bone pain at night
bony swellings
pathological fractures

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14
Q

Osteoscarcoma

A
  • typically adolescents
  • metaphyses of long bones - esp around the knee
  • secondaries in bone affected by Pagets Disease or after irradiation
  • -> present with pain before mass
  • post amputation recurrence –> micrometastises
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15
Q

Osteosarcoma imaging

A 
bone destruction and new bone formation --> sun-ray spiculation 
periosteal elevation (Codman's triangle)
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16
Q

Ewings Sarcoma

A

malignant round cell tumour of long bones (diaphysis) and limb girdles
presents in adolescence

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17
Q

Ewings Sarcoma Imaging

A

Bone destruction
New bone formation in concentric layers –> onion ring sign
periosteal elevation

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18
Q

Ewings sarcoma treatment

A

chemo
radiotherapy
surgery

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19
Q

Chrondrosarcoma

A 
associated with pain or lump 
axial skeleton in middle age 
de novo 
pop-corn calcification on X-ray
Excision is best management
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20
Q

Osteochondroma

A

BENIGN
- proximal femur, knee or proximal humerus
- painful mass associated with trauma
- seen on X-Ray as a bony spur arising from the cortex, ointing away from the joint
Remove if causing problems

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21
Q

Osteiod Osteoma

A 
BENIGN 
- painful benign bone lesion 
- long bones and spine of males 10-25
-local cortical sclerois on x-r with central radiolucent nidus
relieved by ibuprofen 
CT biopsy and radio frequency ablation
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22
Q

Chondroma

A

BENIGN

  • cartilaginous tumours
  • bone surfaces or within the medulla
  • causes local swelling or fracture
  • exclude malignancy
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23
Q

Define sarcoma

A

malignant neoplasm arising from mesenchymal cells

  1. Soft tissue cancers
  2. Primary bone cancers
  3. GI stomal cell tumours
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24
Q

Define carcinoma

A

epithelial cells and frequently cause breast, bowel and lung cancers

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25
Q

Soft tissue sarcomas

A

originate from fat, muscle, –> painless enlarging mass
RF –> neurofibromatosis type 1 and previous radiotherapy
Rx–> excision with wide margins and radiotherapy

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26
Q

Lymphadenopathy

reactive causes

A

infective

  - bacterial (pyogenic, TB, brucella, syphilis)
  - Viral (EBV, HIV, CMV, infectious hepatitis)
  - toxoplasmosis, trypanosoiasis

Non-infective
- sarcoidosis, amyloidosis, berylliosis, connective tissue disease, dermatological or drugs (phenytoin)

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27
Q

Lymphadenopathy

Infiltrative causes

A

Benign histiocytosis
Malignant –>
haematological –> lymphoma, leukamia: ALL, CLL, AML
metastatic carcinoma from breast, lung bowel, prostate, kidney or head & neck cancers

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28
Q

Causes of mediastinal masses

A
  • mediastinal fat
  • retrosternal thyroid
  • unfolded aorta or aortic aneurysm
  • lymph node enlargement (sarcoidosis, lymphoma, mets, TB)
  • tumour –> thyoma, teratoma
  • cysts –> bronchogenic, pericardial
  • paravertebral mass (TB)
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29
Q

Normal aortic lumps on the L border

A
  1. Aortic knuckle
  2. Pulmonary outflow tract
  3. Left ventricle

Mediastinum moves towards collapsed lung and away from processes that add volume (effusion)

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30
Q

glandular epithelieum

A

benign - adenoma

malignant - adenocarcinoma

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31
Q

Squamous epithelium

A

benign - squamous papilloma

malignant - squamous cell carcinoma

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32
Q

transitional epithelium

A

benign - transitional papilloma

malignant - transitional cell carcinoma

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33
Q

melatocytes

A

benign= naevus

malignant - malignant melanoma

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34
Q

striated muscle

A

benign - rhabdomyoma

malignant - rhabdomyosarcoma

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35
Q

Smooth muscle

A

benign - leiomyoma

malignant - leiomyosarcoma

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36
Q

fat

A

lipoma

liposarcoma

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37
Q

nerve sheath

A

neurofibroma

neurofibrosarcoma

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38
Q

Lymphocytes

A

lymphoma

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39
Q

Glial cells

A

glioma

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40
Q

metaplasia

A

change in a cell type from one fully differentiated pattern to another fully differentiated pattern
e.g barretts oesophagus

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41
Q

dysplasia

A

epithelial cells with a disorder of maturation most common on the cervix

  • division of cells above normally proliferative basal cell layer
  • loss of polarity of the nucleus
  • lack of differentiation
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42
Q

carcinoma in situ

A

severe degree of dysplasia with no discernible differentiation in cells between base and top of epithelium
no evidence of stromal invasion

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43
Q

microinvasive carcinoma

A

tumours that have invaded through the basal membrane but only into surrounding stroma

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44
Q

invasive carcinoma

A

any tumour that has invaded substantially through the basement membrane - able to gain access to lymphovascular channels and metastasize to distant sites

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45
Q

metastasis

A

spread and growth of tumour to site distant from origin
- tumour cells travel in the blood or lymphatic systems, or across a body cavity such as the pleura, peritoneum or meninges

46
Q

process of metastasis

A
  1. detachment
  2. invasion through basement membrane
  3. invasion through connective tissues
  4. invasion into blood vessels/ lymphatics
  5. survival in blood vessel/ lymphatic channel - opportunity for host immune recognition
  6. extravasion
  7. Growth at the distant site
47
Q

proto-oncogenes

A

overactivity of these genes leads to development of cancer

e.g Ras genes

48
Q

tumour suppressor genes

A

underactivity of these genes lead to the development of cancer
e.g. retinoblastoma

49
Q

mutator phenotype

A

cells with early loss of DNA damage detection and repair mechanisms
e.g. hereditary non-polyposis colorectal cancer

50
Q

P53

A

present in over 50% of human cancers
mutations acquired during lifetime
controls transcription of other genes that control transcription, mediate apoptosis and arrest the cell cycle

non-functional p53 proteins lead to progressive accumulation of DNA damage in successive generations of cells

51
Q

APC

Adenomatous polyposis coli gene

A

lost in 80% of sporadic colorectal cancers

individuals with 1 deleted APC develop hundreds of adenomas in by 20yo inevitably develop Colorectal Ca

52
Q

DNA binding chemotherapy

alkylating agents

A

direct alteration of DNA by alkylating agents or platinum complexes

antiproliferative drugs that bind via alkyl groups to DNA

e.g. cyclophosphamide

53
Q

anti-metabolite chemotherapy

A

block synthesis of purines and pyrimidines, essential for DNA synthesis

interfere with normal cellular metabolism of nucleic acids
e.g. methotrexate, 5-fluorouracil

54
Q

anti-microtubule chemotherapy

A

interferes with mitosis

55
Q

topoisomerase chemotherapy

A

inhibition leads to DNA damage

56
Q

Bone marrow side effects of chemotherapy

A

neutropenia
infection
thrombocytopenia
anaemia

57
Q

GI side effects of chemotherapy

A

nausea
vomiting
diarrhoea
mouth ulcers

58
Q

skin side effects of chemotherapy

A

hair loss

59
Q

gonad side effects of chemotherapy

A

infertility

60
Q

anti-microtubule side effects of chemotherapy

A

peripheraly nerve damage

61
Q

Anthracycline side effects of chemotherapy

A

cardiomyopathy

62
Q

Side effects of radiotherapy

GI tract

A

mucosal ulceration

–> sore mouth, diarrhoea

63
Q

Side effects of radiotherapy

Skin

A

erythema and desquamation (similar to sun burn)

64
Q

Side effects of radiotherapy

bone marrow

A

myelosuppression

  • WCC –> platelets –> RBC
65
Q

Side effects of radiotherapy

Gonads

A

fall in sperm count

ovarian failure

66
Q

Late effects of radiotherapy

A
  • lung fibrosis

- spinal cord damage - myelitis

67
Q

oxygen effect of radiotherapy

A

hypoxia causes resistance to radiation and abnormal vasculature of cancer can produce hypoxic areas within the cancer- potential to cause failure to eradicate cancer with radiotherapy

68
Q

Principles of combination chemotherapy

A

each drug should

  • single agent activity in that tumour type
  • different mechanism of activity
  • non-overlapping toxicity
  • action on a different part of the cell cycle
  • different mechanisms of resitance
69
Q

Causes of Spinal Cord Compression

A
  • extradural metastatases
  • extension of tumour from a vertebral body
  • direct extension of the tumour
  • crush fracture
70
Q

Signs and symptoms of spinal cord compression

A

back pain
weakness or sensory loss with a root distribution or sensory level
bowel and bladder dysfunction

low threshold for patients with known cancer and new onset back pain

71
Q

Investigation of spinal cord compression

A

urgent MRI

72
Q

Management of Spinal Cord Compression

A
  • Dexamethasone 16mg/ 24hrs PO

- >3/12 to live - urgent radiotherapy, significantly longer - spinal reconstruction may be appropriate

73
Q

SVCO

A
  • not an emergency unless there is tracheal obstruction with airway compromise
74
Q

Causes of SVCO

A
  • maligancy (90% of cases, 3/4 from lung cancer)
  • mediastinal enlargement (germ cell tumour)
  • thymus maligancy
  • mediastinal lymphadenopathy (lymphoma)
  • thrombotic disorders - Behcets or nephrotic syndromes
  • thrombus around IV central line
  • hamartoma
75
Q

Signs and symptoms of SVCO

A 
dyspnoea 
orthopnoea
plethora/ cyanosis 
swollen face and arm
cough
headache 
engorged veins
76
Q

SVCO - Pemberton’s test

A

Lifting the arms above the head >1 min

  • facial plethora/ cyanosis
  • non-pulsatile increase in JVP
  • inspiratory stridor
77
Q

SVCO

investigation

A

urgent contrast enhanced CT

78
Q

Management of SVCO

A

tissue diagnosis of cause
oral dexamethasone (8-16mg)
consider ballon venoplasty and SVC stenting

79
Q

Malignancy associated hypercalcaemia

A

poor prognostic sign

80
Q

Causes of Malignancy associated hypercalcaemia

A

lytic bone metastases
production of osteoclast activating factor
production of PTH- like hormones

81
Q

Symptomsof Malignancy associated hypercalcaemia

A

lethargy, anorexia, naeusea, polydipsia, polyuria, constipation, dehydration, confusion, weakness

82
Q

Acute management of malignancy associated hypercalaemia

A
  • rehydration

- IV bisphosphonates (or calcitonin if resistant)

83
Q

Tumour lysis syndrome

A

rapid cell death on starting chemotherapy for rapidly proliferating leukaemia, lymphoma, myeloma and some germ cell tumours

  • ->
  • rise in serum urate, potassium and phosphate

–> precipitating renal failure

84
Q

Preventing tumour lysis syndrome

A
  • hydration and allopurinol started before chemotherapy

- haemodialysis may be needed in renal failure

85
Q

Neutropenic Sepsis

A

neutrophils <0.5 x109/L

  • full barrier nursing
  • avoid IM injections
  • look for infection - mouth, axilla, perinuem, IVI site
  • check FBC, platelets, INR, LFTs, LDH, CRP, blood/urine/sputum/stool cultures
86
Q

Testitcular tumours

A

commonest malignancy in men aged 15-44

  • seminoma
  • non-seminomatous germ cell tumour
  • mixed germ cell tumour
  • lymphoma
87
Q

Signs of testicular tumour

A

typically painless testis lump found after trauma/infection+/- haematospermia

  • secondary hydrocele
  • pain
  • dyspnoea (lung mets)
  • abdominal mass
  • effects of secreted hormones
88
Q

Risk factors for testicular tumours

A

undescended testis
infant hernia
infertility

89
Q

Staging testicular tumours

A
  1. No evidence of metastasis
  2. Infradiaphragmatic node involvement (spread by para-aortic not inguinal nodes)
  3. Supradiaphragmatic node involvement
  4. Lung involvement (haematogenous)
90
Q

histology of lung tumours

A 
35% squamous cell 
27% adenocarcinoma 
20% small (oat) cell 
10% large cell 
rare- alveolar cell carcinoma

Clinically most important difference between Small Cell (SCLC) and non-small cell (NSCLC)

91
Q

Symptoms of Lung Ca

A 
Cough
Haemoptysis 
Dyspnoea
Chest pain
Recurrent/ slow resolving pneumonia 
lethargy
anorexia 
weight loss
92
Q

Signs of Lung Ca

A 
Cachexia 
anaemia
clubbing 
HPOA (hypertrophic osteoarthopathy) - causes wrist pain
supraclavicular nodes 
axillary nodes

Chest signs:

  • none
  • consolidation
  • collapse
  • pleural effusion

Mets
-bony tenderness
hepatomegaly
confusion/ fits /focal CNS signs

93
Q

Complications of Lung Ca

local

A 
recurrent laryngeal nerve palsy
phrenic nerve palsy 
SVC obstruction
Horners syndrome (Pancoast's tumour)
rib erosion 
pericarditis 
AF
94
Q

Complication of Lung Ca

Metastasis

A 
brain
bone - bone pain, anaemia, Ca2+ increases
liver
adrenals - Addisons
Endocrine - ectopic hormone excretion
95
Q

Complications of Lung CA

  • non metastatic neurology
A 
confusion 
fits
cerebellar syndrome 
proximal myopathy 
neuropathy
polymyositis
96
Q

Non-small cell lung cancers

Treatments

A

excision
curative radiotherapy
Chemoradiotherapy for more advanced disease
platinum based mono-clonal antibodies targetting epidermal growth factor receptors

97
Q

Small cell lung cancers

A

nearly always disseminated at presentation

- may respond to chemotherapy but invariably relapse

98
Q

Palliative treatment in lung Ca

A

radiotherapy for bronchial obstruction, SVCO, haemoptysis, bone pain and cerebral mets

SVC setents
Endobronchial therapy - tracheal stenting, cryotherapy, laser, brachytherapy
pleural drainage/ pleurodesis

99
Q

Liver tumours

A

most commonly secondaries from breast, bronchus or GI tract

100
Q

Symptoms of liver tumours

A 
fever 
malaise
anorexia
weight loss 
RUQ pain --> liver capsule stretch 
jaundice (late)
rupture --> intraperitoneal haemorrhage
101
Q

Signs of liver tumours

A

hepatomegaly
signs of chronic liver disease (Leuconychia (white nails), Clubbing, Palmar erythema, Hyperdynamic circulation, Duypetren’s contracture, Spider naevi, Xanthelasma, Gynaecomastia, Atrophic testes, Loss of body hair, Parotid enlargement, Hepatomegaly)
evidence of decompensation - jaundice, ascites

102
Q

Liver metastasis

A

signify advanced disease
treatment and prognosis depend on primary
chemo may be effective (lymphomas)
excision of small, solitary tumors

103
Q

hepatocellular carcinoma

A

primary hepatocyte neoplasia

104
Q

Signs and symptoms of HCC

A

fatigue, reduced appetite, RUQ pain, weight loss, jaundice, ascites, haemobilia

105
Q

Causes of HCC

A 
HBV
HCV
AIH (autoimmune hepatitis)
cirrhosis 
NAFLD
aflatoxin 
Clonorchis sinesis 
anabolic steroids
106
Q

Treatment of HCC

A

resect solitary tumours
liver transplant
percutaneous ablation
tumour embolisation

107
Q

Prevention of HCC

A

HBV vaccination

No needle sharing

108
Q

Choloangiocarcinoma

A

10% of liver primaries

109
Q

Causes of Choloangiocarcinoma

A 
flukes
biliary cysts
Caroli's disease
HBV
HVC
DM
biliary enteric surgery
110
Q

Symtoms of Choloangiocarcinoma

A 
Fever
Abdominal pain +/- ascites
Malaise
Increasing bilirubin 
very high alkaline phosphate
111
Q

Management of Choloangiocarcinoma

A

70% unsuited to surgery
76% recur
post op complications - liver failures, bile leak & GI bleed

112
Q

MEN Syndrome

A

functioning hormone producing tumours in multiple organs
inherited AD
- MEN 1 & 2 –> Neurofibromatosis, Von Hippel-Lindau and Peutz-Jeghers

3B Specialties (7 decks)

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