Oncology Flashcards
What is the 2WW criteria for lung cancer?
Refer to specialist if:
- CXR findings suggestive of lung cancer
- Aged 40 or over with unexplained haemoptysis
Urgent CXR if 40 and over if 2 or more of below or 1 if have ever smoked/been exposed to asbestos:
- Cough
- Fatigue
- SOB
- Chest pain
- Weight loss
- Appetite loss
Consider if persistent chest infection, finger clubbing, lymphadenopathy, chest signs, thrombocytosis
What is the 2WW criteria for oesophageal cancer?
Refer for 2WW OGD if:
1. Dysphagia
2. Aged 55 or over with weight loss and upper abdo pain/reflux/dyspesia
What is the 2WW criteria for pancreatic cancer?
Refer to specialist if aged 40 or over with jaundice
Consider urgent 2WW CT scan if aged 60 or over with weight loss + any of the following:
- diarrhoea
- back pain
- abdominal pain
- nausea
- vomiting
- constipation
- new onset diabetes
What is the 2WW criteria for stomach cancer?
Refer to specialist if upper abdominal mass consistent with stomach cancer
Refer for 2WW OGD if:
- dysphagia OR
- aged 55 with weight loss + upper abdo pain, reflux or dyspepsia
What is the 2WW criteria for gallbladder cancer?
Consider 2WW USS in patients with an upper abdominal mass consistent with an enlarged gall bladder
What is the 2WW criteria for liver cancer?
Consider 2WW USS in patients with an upper abdominal mass consistent with an enlarged liver
What is the 2WW criteria for colorectal cancer?
FIT testing for patients with any of the following:
- upper abdominal mass
- change in bowel habit
- iron deficiency anamiea
- aged 40 + with unexplained weight loss/abdo pain
- aged <50 with rectal bleeding + abdo pain or weight loss
- aged 50+ with rectal bleeding OR abdo pain OR weight loss
- aged 60+ with any anaemia
Refer to specialist if FIT 10micrograms or over
Refer to specialist if rectal mass at any age
What is the 2WW criteria for anal cancer?
Consider referral to specialist if unexplained anal mass/ulceration
What is the 2WW criteria for breast cancer?
Refer to specialist if:
- Aged 30 or over with unexplained breast lump
- Aged 50 or over with unilateral discharge, retraction or any other change of concern
Consider 2WW referral in those with skin changes or unexplained axillary lump
What is the 2WW criteria for ovarian cancer?
Refer to spcialist if:
- ascites
- pelvic/abdominal mass
Check Ca125 in primary care if persistent:
- abdominal distension
- early satiety or loss of appetite
- pelvic/abdominal pain
- increased urinary frequency/urgency
If Ca125 is 35 or over, arrange USS of abdo/pelvis and:
- refer to specialist if abnormal
- assess for other causes of symptoms
What is the 2WW criteria for endometrial cancer?
Refer to specialist if aged 55 or over with post menopausal bleeding
Consider USS/referral if under 55 with PMB or over 55 with unexplained discharge/haematuria
What is the 2WW criteria for cervical cancer?
Consider referral to spcialist if abnormal cervix seen
What is the 2WW criteria for vulval cancer?
Consider referral to specialist if unexplained vulval lump, ulceration or bleeding
What is the 2WW criteria for vaginal cancer?
Consider referral to specialist if unexplained palpable mass
What is the 2WW criteria for prostate cancer?
Refer to specialist if malignant feeling prostate on DRE
Consider PSA +DRE if:
- persistent LUTS
- ED
- Visible haematuria
What are the normal thresholds for PSA based on age?
Below 40 - clinical judgement
40 to 49 - >2.5
50 to 59 - >3.5
60 to 69 - >4.5
70 to 79 - >6.5
Above 79 - clinical judgement
What is the 2WW criteria for bladder cancer?
Refer to specialist if >45 with:
- unexplained visible haematuria (that persists post UTI treatment)
Refer to specialist if >60 with:
- unexplained non visible haematuria + dysuria or raised WCC
What is the 2WW criteria for renal cancer?
Refer to specailist if >45 and:
- unexplained visible haematuria (after treatment of UTI)
What is the 2WW criteria for testicular cancer?
Cosnider referral/USS if testicular symptoms/changes
What is the 2WW criteria for penile cancer?
Consider referral if ulcerated lesion on penis (without STD or after treatment for STD)
What is the 2WW criteria for skin cancer?
Refer to specailist for suspected MM if 3 or more points of:
- change in size (2)
- irregular shape (2)
- irregular colour (2)
- largest diameter 7mm or more (1)
- inflammation (1)
- oozing (1)
- change in sensation (1)
Consider referral for SCC/BCC if appearances are suggestive!
What is the 2WW criteria for laryngeal/thyroid cancer?
Consider referral if aged 45 with:
- persistent unexplained hoarseness
- unexplained neck lump
What is the 2WW criteria for oral cancer?
Consider referral if:
- unexplained ulceration for >3 weeks
- persistent lump in neck
- lump on lip or oral cavity
- leukoplakia/erythroplakia
What is the 2WW criteria for brain/CNS cancer?
ADULTS: consider 2WW MRI in progressive, sub acute loss of CNS function
CHILDREN: Consider referral to specialist in 48h if newly abmormal cerebeller or other central neurological function
What is the 2WW criteria for leukemia?
ADULT: Consider FBC in 48h in pts with:
- pallor
- persistent fatigue
- unexplained fever
- unexplained infection
- generalised lymphadenopathy
- unexplained bruising/bleeding/petechia
- hepatosplenomegaly
CHILDREN: Refer for immediate assessment if unexplained petechiae/hepatosplenomegaly (otherwise as above)
What is the 2WW criteria for myeloma?
FBC/bone profile/ESR in people aged 60 or over with persistent bone pain or unexplained fracture
Protein electrophoresis + bence jones urine in 48h in those with hypercalcaemia or leukopenia + above symptoms
Refer to specialist if above suggestive of myeloma
What is the 2WW criteria for Hodgkins lymphoma?
ADULTS: Consider referral to specialist if unexplained lymphadenopathy
Children as above but within 48h
What is the 2WW criteria for sarcoma?
Bone:
Adults - consider referral if XR suggestive of sarcoma
Children - consider 48h referral if XR suggestive of sarcoma
Soft tissue:
Adults - consider 2WW USS if unexplained lump increasing in size
Children - consider 48h USS if unexplained lump increasing in size
What is the 2WW critera for childhood cancers?
Neuroblastoma - consider 48h referral in children with palpable abdominal mass or unexplained enlarged abdominal organ
Retinoblastoma - consider referral if absent red reflex
Wilms - consider 48h referral if palpable abdominal mass, unexplained abdominal organ or visible haematuria
What is the 2WW criteria for CUP?
Offer referral if unexplained weight loss, appetite loss or DVT
What are the 3 most common cancers in the UK?
- Breast
- Lung
- Colorectal
What cancer is most associated with CA125?
Ovarian cancer
What cancer is most associated with CA199?
Pancreatic cancer
What cancer is most associated with CA153?
Breast cancer
What cancer is most associated with AFP?
Hepatocellular cancer
Teratoma
What cancer is most associated with CEA?
Colorectal cancer
What cancer is most associated with S-100?
Melanoma
Schwannoma
What cancer is most associated with bombesin?
SCLC
Gastric cancer
Neuroblastoma
How does cyclophosphamide work and what are the adverse effects?
MOA: Alkylating agent which causes crss linking in DNA
AE: haemorrhagic cystitis, myelosuppression, transitional cell carcinoma
How does bleomycin work and what are the adverse effects?
MOA: degrades preformed DNA
AE: Lung fibrosis - dose related
How do anthracyclines work and what are the adverse effects?
MOA: Stabilizes DNA-topoisomerase II complex to inhibt DNA and RNA syntehsis
AE: Cardiomyopathy
What are the antimetabolite chemotherapy drugs and the adverse effects?
Methotrexate, fluorouracil, 6-mercaptopurine, cytarabine
Tend to cause myelosuppresion and mucositis
Which chemotherapy agents act on microtubules to inhibit formation?
Vincristine (causes peripheral neuropathy), vinblastine, docetazel
How does cisplatin work and what arae the adverse effects?
MOA: Causes cross linking in DNA
AE: Ototoxicity, peripheral neuropathy, hypomagnesaemia
How does hydroxycarbamide work and what are the adverse effects?
MOA: Inhibitrs ribonucleotide reductase decreasing DNA synthesis
AE: Myelosuppression
What is a seminoma?
A malignant germ cell tumour that involves the testicle or mediastinum, retroperitoneum. It is treatable and curable if discovered in the early stages.
Tumour marker - raised bHCG, normal AFP
What is Le Fraumeni Syndrome?
AD condition consisting of germline mutations to the p53 tumour suppressor gene > sarcoma and leukemia
Tends to be diagnosed with an individual develops sarcoma <45yo or has a 1st degree relative
What are the features of BRCA 1 and 2?
BRCA 1 - chromosome 17
BRCA 2 - chromosome 13
BRCA 1 - breast cancer and ovarian cancer
BRCA 2 - breast cancer and prostate cancer in men
What are aromatase inhibitors?
eg. letrozole, anastrozole, exemestane
Drugs that lower estrogen levels by stopping aromatase from changing other hormones into oestrogen
Used in ER+ breast cancers
More effective in posst menopausal women
What are hormone therapies?
eg. tamoxifen
Tamoxifen is a selective oestrogen receptor modulator (has both positive and antagonistic effectrs)
Used in hormone receptor positive breast cancer
Used in pre and post menopausal women
What are HER2 inhibitor targeted therapies?
eg. herceptin (trastuzumab)
Attached to HER2 receptor on cancer cells to block them receiving growth signals. This is an example of an immune targetted therapy.
Used in HER2 positive breast cancer
What is Lynch syndrome?
AD condition causing development of colonic cancer and endometrial cancer at a young age
Use Amsterdam criteria to identify high risk individuals (3 or more family members with colorectal cancer, or 1 or more under age of 50) - ensure to exclude FAP
What is familial adenomatous polyposis?
A genetic condition causing development of colon polyps. If untrated this can develop into colorectal cancer and other cancers
Some pts have APG mutations although 1 in 3 will develop a de novo mutation
Other symptoms may include (although more likely to occur in Gardnders):
- Osteomas
- Abnormal teeth
- Congenital hypertrophy of retinal pigment epithelium
- Non cancerous skin changes
- Adrenal masses
What is Gardners syndrome?
AD condition causing multiple colonic polyps, osetoma, thryoid cancer and epidermoid cysts - considered a variant of FAP
Caused by a mutation of the APC gene on chromosome 5
Most patients will undergo colectomy to reduce risk of colorectal cancer
Which cancer will cause a rise in calcitonin levels?
Medullary thyroid cancer (as it originates from the parafollicular cells which produce calcitonin)
