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MSRA > Oncology > Flashcards

Oncology Flashcards

1
Q

What is the 2WW criteria for lung cancer?

A

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

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2
Q

What is the 2WW criteria for oesophageal cancer?

A

Refer for 2WW OGD if:
1. Dysphagia
2. Aged 55 or over with weight loss and upper abdo pain/reflux/dyspesia

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3
Q

What is the 2WW criteria for pancreatic cancer?

A

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

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4
Q

What is the 2WW criteria for stomach cancer?

A

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

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5
Q

What is the 2WW criteria for gallbladder cancer?

A

Consider 2WW USS in patients with an upper abdominal mass consistent with an enlarged gall bladder

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6
Q

What is the 2WW criteria for liver cancer?

A

Consider 2WW USS in patients with an upper abdominal mass consistent with an enlarged liver

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7
Q

What is the 2WW criteria for colorectal cancer?

A

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

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8
Q

What is the 2WW criteria for anal cancer?

A

Consider referral to specialist if unexplained anal mass/ulceration

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9
Q

What is the 2WW criteria for breast cancer?

A

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

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10
Q

What is the 2WW criteria for ovarian cancer?

A

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

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11
Q

What is the 2WW criteria for endometrial cancer?

A

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

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12
Q

What is the 2WW criteria for cervical cancer?

A

Consider referral to spcialist if abnormal cervix seen

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13
Q

What is the 2WW criteria for vulval cancer?

A

Consider referral to specialist if unexplained vulval lump, ulceration or bleeding

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14
Q

What is the 2WW criteria for vaginal cancer?

A

Consider referral to specialist if unexplained palpable mass

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15
Q

What is the 2WW criteria for prostate cancer?

A

Refer to specialist if malignant feeling prostate on DRE

Consider PSA +DRE if:
- persistent LUTS
- ED
- Visible haematuria

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16
Q

What are the normal thresholds for PSA based on age?

A

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

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17
Q

What is the 2WW criteria for bladder cancer?

A

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

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18
Q

What is the 2WW criteria for renal cancer?

A

Refer to specailist if >45 and:
- unexplained visible haematuria (after treatment of UTI)

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19
Q

What is the 2WW criteria for testicular cancer?

A

Cosnider referral/USS if testicular symptoms/changes

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20
Q

What is the 2WW criteria for penile cancer?

A

Consider referral if ulcerated lesion on penis (without STD or after treatment for STD)

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21
Q

What is the 2WW criteria for skin cancer?

A

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!

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22
Q

What is the 2WW criteria for laryngeal/thyroid cancer?

A

Consider referral if aged 45 with:
- persistent unexplained hoarseness
- unexplained neck lump

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23
Q

What is the 2WW criteria for oral cancer?

A

Consider referral if:
- unexplained ulceration for >3 weeks
- persistent lump in neck
- lump on lip or oral cavity
- leukoplakia/erythroplakia

24
Q

What is the 2WW criteria for brain/CNS cancer?

A

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

25
Q

What is the 2WW criteria for leukemia?

A

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)

26
Q

What is the 2WW criteria for myeloma?

A

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

27
Q

What is the 2WW criteria for Hodgkins lymphoma?

A

ADULTS: Consider referral to specialist if unexplained lymphadenopathy

Children as above but within 48h

27
Q

What is the 2WW criteria for sarcoma?

A

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

28
Q

What is the 2WW critera for childhood cancers?

A

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

29
Q

What is the 2WW criteria for CUP?

A

Offer referral if unexplained weight loss, appetite loss or DVT

30
Q

What are the 3 most common cancers in the UK?

A
  1. Breast
  2. Lung
  3. Colorectal
31
Q

What cancer is most associated with CA125?

A

Ovarian cancer

32
Q

What cancer is most associated with CA199?

A

Pancreatic cancer

33
Q

What cancer is most associated with CA153?

A

Breast cancer

34
Q

What cancer is most associated with AFP?

A

Hepatocellular cancer
Teratoma

35
Q

What cancer is most associated with CEA?

A

Colorectal cancer

36
Q

What cancer is most associated with S-100?

A

Melanoma
Schwannoma

37
Q

What cancer is most associated with bombesin?

A

SCLC
Gastric cancer
Neuroblastoma

38
Q

How does cyclophosphamide work and what are the adverse effects?

A

MOA: Alkylating agent which causes crss linking in DNA

AE: haemorrhagic cystitis, myelosuppression, transitional cell carcinoma

39
Q

How does bleomycin work and what are the adverse effects?

A

MOA: degrades preformed DNA
AE: Lung fibrosis - dose related

40
Q

How do anthracyclines work and what are the adverse effects?

A

MOA: Stabilizes DNA-topoisomerase II complex to inhibt DNA and RNA syntehsis

AE: Cardiomyopathy

41
Q

What are the antimetabolite chemotherapy drugs and the adverse effects?

A

Methotrexate, fluorouracil, 6-mercaptopurine, cytarabine

Tend to cause myelosuppresion and mucositis

42
Q

Which chemotherapy agents act on microtubules to inhibit formation?

A

Vincristine (causes peripheral neuropathy), vinblastine, docetazel

43
Q

How does cisplatin work and what arae the adverse effects?

A

MOA: Causes cross linking in DNA

AE: Ototoxicity, peripheral neuropathy, hypomagnesaemia

44
Q

How does hydroxycarbamide work and what are the adverse effects?

A

MOA: Inhibitrs ribonucleotide reductase decreasing DNA synthesis

AE: Myelosuppression

45
Q

What is a seminoma?

A

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

46
Q

What is Le Fraumeni Syndrome?

A

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

47
Q

What are the features of BRCA 1 and 2?

A

BRCA 1 - chromosome 17
BRCA 2 - chromosome 13

BRCA 1 - breast cancer and ovarian cancer
BRCA 2 - breast cancer and prostate cancer in men

48
Q

What are aromatase inhibitors?

A

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

49
Q

What are hormone therapies?

A

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

50
Q

What are HER2 inhibitor targeted therapies?

A

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

51
Q

What is Lynch syndrome?

A

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

52
Q

What is familial adenomatous polyposis?

A

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

53
Q

What is Gardners syndrome?

A

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

54
Q

Which cancer will cause a rise in calcitonin levels?

A

Medullary thyroid cancer (as it originates from the parafollicular cells which produce calcitonin)

MSRA (24 decks)

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