Oncology Flashcards
Which cancer often causes a rise in parathyroid hormone related peptide (through the ectopic release) ?
Squamous cell lung cancer
What is the first-line therapy for patients with chronic myeloid leukaemia?
Tyrosine Kinase Inhibitor E.g. Imatinib
Which form of lung cancer can cause Cushing’s disease?
Small cell lung cancer
How does small cell lung cancer cause Cushing’s?
The tumour secretes ACTH
What is a significant risk for developing small cell lung cancer?
SMOKING
What chamber of the heart do myxomas most likely originate in?
Left atrium
What is the investigation of choice to diagnose myxomas?
ECHO
What is the treatment for myxomas?
Surgical resection (is usually curative)
A X-ray of a femur shows codman’s triangle and has a sunburnt appearance. What is the most likely diagnosis?
Osteosarcoma
A 65yr old women presents with thoracic back pain - gradually worsening, exacerbated on movement and painful at night. Her blood tests show slight anaemia and hypercalcaemia. What is the most likely diagnosis and pathophysiology of the diagnosis?
Multiple myeloma - causes increased osteoclast activity due to increased cytokine activity released by the myeloma cells.
A patient has advanced prostate cancer with lower back pain. What is the most likely cause of his back pain and what blood network is the cause?
Metastatic bone disease. Due to the spread of the cancer through Batson’s venous plexus.
A patient presents with hypercalcaemia, a palpable mass on neck, family history of thyroid surgery and hypertension. What is the most likely diagnosis?
Men-2a - medullary thyroid cancer, parathyroid hyperplasia and pheochromocytoma.
What are the 4 types of lung cancer and how do they differ? (3 non small cell and 1 small cell) ?
NSC = Adenocarcinoma (most common) - peripheral
- Squamous cell carcinoma - central and common in smokers.
- Large cell carcinoma - peripheral and central and common in smokers.
Small cell carcinoma = central and in older smokers. Metastasis occur early and can spread to the brain.
A 55 yr old man presents to his GP with a 4 week history of a cough. He states it is generally non productive however he has noticed he has coughed up blood a few times. He has also noticed he has been increasingly short of breath and noticed some pleuritic chest pain. He has lost 2 stone in the last few months unintentionally and says he has been feeling a bit tired recently. His dad died of lung cancer when he was 70 and states he is concerned about this. He has 40 pack years and works as a electrician. Based on the most likely diagnosis what would you expect to see O/E and what further investigations would you want to carry out. And based on his history what specific diagnosis would you give?
Lung cancer - small cell carcinoma.
O/E = clubbing, dulla areas on percussion with a slight wheeze. Cervical lymphadenopathy.
Bloods - FBC, U+Es, LFT, Serum calcium
Chest X-ray is first line
CT may be done to confirm the CXR findings.
A PET-CT may also be used for staging and to determine if their are any other mets.
What are possible complications of lung cancer?
Horners syndrome - pancoast tumour
SVC obstruction
Paraneoplastic syndrome - hypercalcaemia, SIADH, Cushing’s syndrome.
What is the main treatment for small cell lung cancer?
Chemoradiation. As normally presents advanced therefore surgery is unable to be carried out.
What chromosome mutations lead to BRCA1/2 and what risk of cancer do these have?
BRCA 1 = chromosome 17 mutation
- increased risk of breast and ovarian cancer
BRCA2 = chromosome 13 mutation
- Increased risk of breast and ovarian cancer as well as endometrial, colorectal, pancreatic, peritoneal, fallopian tube, prostate.
What is the difference between invasive and in situ breast cancer?
Invasive = penetrates the basement membrane whilst in situ means it does not.
What are the 4 types of breast cancer and how do they differ?
Ductal
- in situ (DCIS) - Can become malignant
- Invasive (IDC) - most common invasive. prognosis made on how differentiated the cells are.
Lobular
- In situ (LCIS) - normally a accidental finding but is quite uncommon.
- Invasive (ILC) - Most have oestrogen receptors and there is an increased risk if on HRT.
What are the 4 molecular subtypes of breast cancer?
Luminal A
Luminal B
Her2
Basal
At what age are women offered a mammogram?
50-71 years old.
How can breast cancer present?
Breast or axillary lump - irregular, hard and fixed
Skin - change, tethering, oedema, peu d’orange
Nipple - inverted, discharge (+/- blood), dilated veins
If breast cancer is suspected what are the next steps that are taken?
2WW - triple assessment
History, examination and imaging.
Mammogram is 1st choice - if cancer is present may have a soft tissue mass or microcalcifications
Ultrasound scan - used normally for under 40’s or the elderly
Fine needle aspiration may be used to obrain a biopsy.
What investigations would be used to stage and plan a breast cancer diagnosis?
FBC,Renal, LFT, Bone profile Chest x-ray Breast MRI CT-cap if mets are likely Receptor testing - ER, PR, Her2 If under 50 = BRCA test.
What are the differential diagnoses for a breast lump/change?
Fibroadenoma - lump will be mobile
Cyst - can diagnose with a ultrasound
Fat necrosis - usually happens post trauma
Abscess - infection usually staph aureus. Increased risk whilst breastfeeding.
Lipoma - biopsy may be required to distinguish
What treatment would be used for a HER2 receptor positive breast cancer? Are there any cautions?
Trastuzumab (Herceptin)
Check and monitor cardiac function and shouldn’t be used during pregnancy or 7 months post partum
There are 2 drugs that can be used for ER/PR positive breast cancers. How long would you use them , what are they and whats the difference?
5 yr course
Tamoxifen - 1st line for men and premenopausal women. It is a SERM
S/E = blood clots, endometrial cancer, osteoporosis.
Anastrozole (aromatase inhibitor)
- inhibits peripheral androgens –> oestrogen
Ist line for post menopausal women
S/E = menopause symptoms, osteoporosis and MSK pain.
What treatments would be used for local or early breast cancer?
Surgery - WLE and radiotherapy or a mastectomy with breast reconstruction
Lymph nodes may be removed - want to do a sentinel lymph node biopsy before though.
Chemotherapy may be used prior to surgery to reduce the tumour and make it easier. (FEC routine)
What treatment is recommended for metastatic breast cancer?
Endocrine + target therapy + chemotherapy
What are the risk factors for bladder cancer?
Male SMoking Work in dye or rubber industry increased age radiation schistosomiasis - SCC type
What are the 4 types of bladder cancer?
Transitional cell carcinoma - most common
Squamous cell carcinoma
Adenocarcinoma/Sarcoma - rare
A patient presents with haematuria what are the differential diagnosis?
Bladder, renal or prostate cancer
Renal calculi
UTI
What are the first line imaging for hematuria - suspected bladder cancer?
Flexible cystoscopy and CT Kub
How would you manage non muscle invasive bladder cancer?
TURBT resection is 1st line. If a high risk patient then may give intravesical therapy - BCG or mitomycin C.
Surveillance as 70% 3yr recurrence rate
How would you manage muscle invasive bladder cancer?
Radical cystectomy = 1st line. Alongside chemo (cisplatin regimen). Post cystectomy - ileal conduit formation (urostomy) or bladder reconstruction using small bowel. Regular CTs.
How would you manage locally advanced or metastatic bladder cancer?
Chemotherapy - cisplatin or carboplatin and gemcitabine regimen.
Where is a renal cell carcinoma most likely to occur in the kidney?
Proximal convoluted tubule
What is multiple myeloma?
Disease of plasma cells (antibody producing B lymphocytes). Causing 1 type of plasma cell to be over produced which then blocks up the bone marrow and hinders the production of cells. They also produce paraproteins which damage the kidneys and increase the amount of osteoclasts.
What are the immunoglobulins most produced in myeloma?
IgG
IgA
What are the main features of myeloma?
CRAB
Hypercalcaemia Renal failure Anaemia (+thrombocytopenia) Bone lesions \+ respiratory and urinary infections more likely.
What is the main treatment for a patient with myeloma under 65?
Stem cell transplant
