Oncology Flashcards
Give the two signs indicating immediate admission is required in suspected lung cancer.
Signs of superior vena cava obstruction
Stridor
What symptom requires an urgent two week wait in suspected lung cancer in smokers or non-smokers over the age of 40?
Persistent haemoptysis
Outside of persistent haemoptysis, what are some other factors that indicate an urgent two week wait referral is required in suspected lung cancer?
(1) Suggestive chest X-ray (pleural effusion or slowly resolving consolidation)
(2) Normal chest X-ray but high level of clinical suspicion
(3) History of asbestos the exposure and recurrent chest pain and dyspnoea.
(4) Unexplained systemic symptoms with suspicious CXR.
High risk groups include ex and current smokers, COPD, asbestos exposure and history of previous cancer.
Urgent referral should be required if an upper GI cancer is suspected regardless of H. Pylori status if there is dyspepsia and any one of the following seven symptoms. Name some.
(1) Chronic GI bleeding
(2) Dysphagia
(3) Progressive unintentional weight loss
(4) Persistent vomiting
(5) Iron deficiency anaemia
(6) Epigastric mass
(7) Suspicious barium meal result
Name some symptoms that would require urgent two week wait referral in a suspected lower GI cancer. (Remember to do PR examination and FBC in all patients with suspected lower GI cancer.)
(1) Over the age of 40 with PR bleeding and bowel habit change (more loose or frequent for greater than six weeks).
(2) Any age with a right lower abdominal mass likely to be bowel.
(3) Palpable rectal mass
(4) Men or non-menstruating women with unexplained iron deficiency anaemia and a Hb level less than 11 or 10 respectively.
High risk groups: Ulcerative colitis, family Hx
Name some of the nine signs and symptoms that would require an urgent two week wait referral for a suspected breast cancer.
(1) Discrete hard lump with fixation
(2) Over 30 with a discrete lump persisting after a period or presenting post-menopause.
(3) Under 30 with an enlarging fixed and hard lump or (4) family history
(5) Previous breast cancer with a new lump or suspicious symptoms
(6) Unilateral eczematous skin or nipple change unresponsive to topical treatment.
(7) Recent nipple distortion
(8) Spontaneous bloody unilateral nipple discharge
(9) Men over 50 with a unilateral firm subareolar mass
Consider referral if under 30 with a lump or persistent breast pain.
What are the three things that indicate an urgent two week wait referral is required in a suspected gynaecological malignancy?
(1) Examination suggestive of cervical malignancy (do NOT wait for smear test result)
(2) Post menopausal bleeding in non-HRT patients or HRT patients after 6 weeks since cessation.
(3) Vulval lump or bleeding.
Also consider in persistent intermenstrual bleeding
Ultrasound any abdominal or pelvic mass not urological or GI in origin. Do pelvic and abdominal examinations, with speculum as appropriate.
What are some of the 8 indications for two week wait urgent referral when considering a suspected urological malignancy?
(1) Hard irregular prostate (refer with PSA result)
(2) Normal prostate but raised PSA with urinary symptoms
(3) Painless visible haematuria (macroscopic) at any age
(4) Over 40 with persistent or recurrent UTI and haematuria
(5) Over 50 with Unexplained non-visible (microscopic) haematuria
(6) Any abdominal mass arising from the urinary tract
(7) Swelling or mass in the body of the testis
(8) Ulceration or mass in the penis
Name some of the findings that would result in consideration of an urgent two week wait referral if a there was a suspected central nervous system malignancy.
New onset cranial nerve palsy or unilateral sensorineural deafness
Recent onset headaches with features of raised intracranial pressure (e.g. vomiting, drowsiness, posture-related headache, pulse-synchronous tinnitus) or other CNS symptoms
A new and different unexplained headache of progressive severity
Recent onset seizures
Consider in rapid progression of subacute focal deficit, Unexplained cognitive impairment, or personality changes with features indicative of a tumour.
What are the three Major factors (scoring two points each) on the Glasgow scale for malignant melanoma?
Change in size
Change in shape
Change in colour
What are the three minor features (scoring one point each) on the Glasgow scale for malignant melanoma?
Inflammation, crustier or bleeding
Sensory change
Diameter >7mm (unless growth in the vertical plane - beware)
Less helpful features include asymmetry, irregular colour, elevation, irregular border.
Short periods of intense UV Exposure is a major cause, especially in the early years. If the lesion is well demarcated, smooth and regular it is unlikely to be a melanoma, but diagnosis can be tricky so if in doubt, refer.
How would a squamous cell skin carcinoma usually present?
Usually presents as an ulcerated lesion with hard, raised edges in sun-exposed sites.
A-E Criteria
Asymmetrical Border - irregular Colour - non uniform Diameter - >7mm Elevated
May begin as a solar keratosis or be found on the lips of smokers or in long standing ulcers. Metastasis to local lymph nodes is rare but local destruction may be extensive.
What would be the standard treatment of a squamous cell skin carcinoma?
Excision and radiotherapy to treat recurrence or any affected nodes.
Note: the condition may be confused with a keratocanthoma (a fast growing, benign, self-limiting papule plugged with keratin).
How would a basal cell skin carcinoma usually present?
Aka a rodent ulcer
(1)Nodular. Typically a pearly nodule with a rolled telangiectasic edge on the face or a sun-exposed site. May have a central ulcer.
Metastasis are very rare but it slowly causes local destruction if left untreated.
(2) Superficial. Lesions appear as red scaly plaques with a raised, smooth edge, often in the trunk or shoulders. Cause most frequently UV exposure.
Treatment is excision, cryotherapy or for superficial BCCs, topical fluorouracil or imiquimod.
