Oncology, Haematology and Palliative Flashcards
sclerosis radiological appearance
increased density
Renal cancer Paraneoplastic syndromes
Polycythaemia (RCC secretes unregulated erythropoietin)
Renin - raised BP
Hypercalcaemia (RCC secretes a hormone that mimics the action of PTH)
Stauffer Syndrome (abnormal liver function tests demonstrating an obstructive jaundice – without any localised liver or biliary metastasis!)
Refer people using a suspected cancer pathway referral for renal cancer if they are aged 45 and over and have:
Unexplained visible haematuria without urinary tract infection or
Visible haematuria that persists or recurs after successful treatment of urinary tract infection.
Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for bladder cancer if they are aged 60 and over and have
unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test.
Courvoisier’s law
Painless jaundice plus a non-tender palpable gallbladder is pancreatic cancer until proven otherwise
pancreatic cancer tumour marker
CA19-9
CA19-9 is also tumour marker for cholangiocarcinoma, a bile duct cancer.
Whipple’s procedure
removal of the head of the pancreas, the antrum of the stomach, the 1st and 2nd parts of the duodenum, the common bile duct, and the gallbladder.
oesophageal squamous cell risk factors
smoking, XS alcohol, Plummer vinson syndrome ,Deficiencies in zinc and selenium,Achalasia
Oesophageal adenocarcinoma risk factors
GORD ,Barrett’s oesophagus adenocarcinoma, obesity, Hiatus hernia , Achalasia ,medications that relax the lower oesophageal sphincter
most common cancers to metastasize to bone are
breast, bronchus, thyroid, kidney and prostate.
commonly metastasise to the brain.
Breast cancer, lung cancer and melanoma
2WW breast cancer
Aged 30 or older who have an unexplained breast lump with or without pain, or
Aged 50 years and over with any of the following symptoms in one nipple only:
Discharge.
Retraction.
Other changes of concern.
2WW lung cancer
have chest X‑ray findings that suggest lung cancer or
are aged 40 and over with unexplained haemoptysis.
2WW colorectal cancer
≥60 years with iron deficiency anaemia or change in bowel habit
Positive occult test
≥50yrs with unexplained rectal bleeding and another symptom
≥40yrs with unexplained weight loss and abdominal pain
Features of breast cancer
hard irregular, typically painless, fixed lesions, skin dimpling, nipple retraction, discharge
Breast screening
All women aged 50-70 years
invited every 3 years
Cervical screening
Every three years aged 25 – 49
Every five years aged 50 – 64
Tumour lysis syndrome electrolyte abnormalities
hyperuricaemia
hyperkalaemia
hyperphosphatemia
hypocalcaemia
increased blood urea nitrogen
precipitating renal failure.
2WW oesophageal cancer
Offer urgent direct access upper gastrointestinal endoscopy to assess for oesophageal cancer in people:
With dysphagia, or
Aged 55 years and over with weight loss and any of the following:
Upper abdominal pain.
Reflux.
Dyspepsia.
2WW pancreatic cancer
if they are aged 40 years and over and have jaundice.
2ww suspected malignant melanoma of the skin
suspicious pigmented skin lesion with a weighted 7-point checklist score of 3 or more.
checklist:
Major features of the lesions (scoring 2 points each):
Change in size.
Irregular shape.
Irregular colour.
Minor features of the lesions (scoring 1 point each):
Largest diameter 7 mm or more.
Inflammation.
Oozing.
Change in sensation
or if dermoscopy suggests melanoma of the skin.
or in people with a pigmented
Antiemetics
persistent nausea–>
motion related/food –>
multifactorial/unknown cause –>
persistent nausea–> metaclopramide
motion related/food –>cyclizine
multifactorial/unknown cause –> levomepromazine
A Krukenberg tumour refers to
a metastasis in the ovary, usually from a gastrointestinal tract cancer, particularly the stomach. Krukenberg tumours have characteristic “signet-ring” cells on histology,
Hereditary non-polyposis colorectal cancer (HNPCC) or Lynch Syndrome
genetic mutation in the DNA mismatch repair genes (MSH1/MSH2) and predisposes individuals to colorectal, endometrial and ovarian cancers. It is inherited in an autosomal dominant fashion, and genetic testing is indicated in all suspected individuals (those with 3+ family members known carriers, or affected by these cancers).
HNPCC confers a 60% lifetime risk of colorectal cancer, and a 40% risk of endometrial cancer in carriers of the gene mutation.
