Pass med onc Flashcards
Most common tumours causing bone mets
prostate (most)
breast
lung
most common sites of mets
spine (most)
pelvis
ribs
skull
long bones
clinical fx of bone mets
bone pain
pathological fracturesb
blood tests of bone mets
raised ALP
hypercalcaemia
most common causes of cancer in UK
- Breast
- Lung
- Colorectal
- Prostate
- Bladder
- Non-Hodgkin’s lymphoma
- Melanoma
- Stomach
- Oesophagus
- Pancreas
most common causes of deaths from cancer in uk
- Lung
- Colorectal
- Breast
- Prostate
- Pancreas
- Oesophagus
- Stomach
- Bladder
- Non-Hodgkin’s lymphoma
- Ovarian
hepatocellular carcinoma carcinogen
aflatoxin (produced by aspergillus)
transitional cell carcinoma carcinogen
aniline dyes
mesothelioma and bronchial carcinoma carcinogen
asbestos
oesophageal and gastric cancer carcinogen
nitrosamines
hepatic angiosarcoma carcinogen
vinyl chloride
cervical cancer most important risk fx
Human papilloma virus
subtypes carcinogenic cervical cancer
16, 18, 33
subtypes non cancerous cervical cancer
6 and 11
non cancerous condition associated for cervical cancer
genital warts
histological fx of cervical cancer
endocervical cells undergo changes resulting in koilocytes, which appear like:
- enlarged nucleus
- irregular nuclear membrane contour
- nucleus stained darker
- perinuclear halo
common s/e of chemo
N+V
risk factors for development of N+V from chemo
anxiety
age less than 50 years old
concurrent use of opioids
the type of chemotherapy used
N+V from chemo tx
low risk of sx - metoclopramide
high risk - ondansetron (esp if combined with dexamethasone)
cyclophosphamide indication
mx of cancer and autoimmune condition
cyclophosphamide s/e
haemorrhagic cystitis
myelosuppression
transitional cell carcinoma
cyclophosphamide mechanism
alkylating agent works by cross linking DNA
how reduce incidence of haemorrhagic cystitis in use of cyclophosphamide
Mesna:
2-mercaptoethane sulfonate Na binds to a metabolite of cyclophosphamide called acrolein which is toxic to urothelium…inactivating metabolite
bleomycin mechanism
degrades preformed DNA
bleomycin s/e
lung fibrosis
athracyclines (doxorubicin) mechanism
Stabilizes DNA-topoisomerase II complex inhibits DNA & RNA synthesis
doxorubicin s/e
cardiomyopathy
methotrexate mechanism
Inhibits dihydrofolate reductase and thymidylate synthesis
methotrexate s/e
Myelosuppression, mucositis, liver fibrosis, lung fibrosis
flurouracil mechanism
Pyrimidine analogue inducing cell cycle arrest and apoptosis by blocking thymidylate synthase (works during S phase)
fluorouracil s/e
Myelosuppression, mucositis, dermatitis
6-mercaptopurine mechanism
Purine analogue that is activated by HGPRTase, decreasing purine synthesis
6-mercaptopurine s/e
myelosuppression
cytarabine mechanism
Pyrimidine antagonist. Interferes with DNA synthesis specifically at the S-phase of the cell cycle and inhibits DNA polymerase
cytarabine s/e
myelosuppression, ataxia
vincristine mechanisms
inhibits formation of microtubules
vicristibine s/e
Vincristine: Peripheral neuropathy (reversible) , paralytic ileus
Vinblastine: myelosuppression
docetaxel mechanism
Prevents microtubule depolymerisation & disassembly, decreasing free tubulin
docetaxel s/e
neutropenia
irinotecan mechanism
inhibits topoisomerase I which prevents relaxation of supercoiled DNA
irinotecan s/e
myelosuppression
cisplatin mechanism
crosslinking of dna
cisplatin s/e
Ototoxicity, peripheral neuropathy, hypomagnesaemia
hydroxyrurea (hydroxycarbamide) mechanism
Inhibits ribonucleotide reductase, decreasing DNA synthesis
hydroxyurea s/e
myelosuppresion
li fraumeni syndrome genetics
aut dom
germline mutations to p53 tumour supressor gene
li fraumeni syndrome high incidence
sarcomas and leukaemias
brca 1 and 2 gene which chromosome
brca 1 - chromosome 17
brca 2 - 13
brca 1 and 2 associated risk
breast cancer
ovarian cancer
just brca 2 - prostate cancer
lynch syndrome inheritance
aut dom
lynch syndrome associated risk
colon cancer and endometrial cancer at young age
lynch syndrome risk criteria
high risk individuals identified using amsterdam criteria
amsterdam criteriab
Three or more family members with a confirmed diagnosis of colorectal cancer, one of whom is a first degree (parent, child, sibling) relative of the other two.
Two successive affected generations.
One or more colon cancers diagnosed under age 50 years.
Familial adenomatous polyposis (FAP) has been excluded
gardners syndrome genetics
aut dom familial colorectal polyposis
Mutation of APC gene located on chromosome 5
considered a variant of familial adenomatous polyposis coli
clinical fx gardners syndrome
Multiple colonic polyps
Extra colonic diseases include: skull osteoma, thyroid cancer and epidermoid cysts
Desmoid tumours are seen in 15%
gardeners syndrome mx
most undergo colectomy as risk of colorectal cancer
all pts investigations mets disease of unknown primary
FBC, U&E, LFT, calcium, urinalysis, LDH
Chest X-ray
CT of chest, abdomen and pelvis
AFP and hCG
lytic bone lesions extra Inv
myeloma screen
men extra inv mets
PSA
testicular US in men with germ cell tumour
GI sx mets extra inv
endoscopy
breast cancer mets extra inv
mammography
3 main subtypes of non small cell lung cancer
squamous cell
adenocarcinoma
large cell
squamous cell lung cancer fx
typically central
hypercalcaemia (PTHrP secretion)
finger clubbing
cavitating lesions
hypertrophic pulmonary osteoarthropathy
adenocarcinoma lung cancer fx
typically peripheral
most common type of lung cancer in non-smokers, although the majority of patients who develop lung adenocarcinoma are smokers
large cell lung cancer fx
typically peripheral
anaplastic, poorly differentiated tumours with a poor prognosis
may secrete β-hCG
spinal cord compression neoplastic how bad
oncological emergency
majority cause of spinal cord compression
extradural compression from vertebral body mets
most common primary cancer spinal cord compression
lung
breast
prostate
clinical fx neoplastic spinal cord compression
back pain
the earliest and most common symptom
may be worse on lying down and coughing
lower limb weakness
sensory changes: sensory loss and numbness
neurological signs depend on the level of the lesion. Lesions above L1 usually result in upper motor neuron signs in the legs and a sensory level. Lesions below L1 usually cause lower motor neuron signs in the legs and perianal numbness. Tendon reflexes tend to be increased below the level of the lesion and absent at the level of the lesion
investigations neoplastic spinal cord compression
urgent whole MRI scan within 24 hours
neoplastic spinal cord compression mx
high dose oral dexamethasone
urgent oncological assesment for consideration f radiotherapy or sugrery
PET scan how work
a form of nuclear imaging which uses fluorodeoxyglucose (FDG) as the radiotracer. This allows a 3D image of metabolic activity to be generated using glucose uptake as a proxy marker. The images obtained are then combined with a conventional imaging technique such as CT to decide whether lesions are metabolically active.
uses PET scan
evaluating primary and possible metastatic disease
cardiac PET: not used mainstream currently
sx of spinal mets (before compression)
Unrelenting lumbar back pain
Any thoracic or cervical back pain
Worse with sneezing, coughing or straining
Nocturnal
Associated with tenderness
SVC obstruction how urgent
oncological emergency
most common associated SVC obstruction
lung cancerc
clinical fx SVC obstruction
dyspnoea is the most common symptom
swelling of the face, neck and arms - conjunctival and periorbital oedema may be seen
headache: often worse in the mornings
visual disturbance
pulseless jugular venous distension
causes SVC obstruction
common malignancies: small cell lung cancer, lymphoma
other malignancies: metastatic seminoma, Kaposi’s sarcoma, breast cancer
aortic aneurysm
mediastinal fibrosis
goitre
SVC thrombosis
options for tx of SVC obstruction
endovascular stenting is often the treatment of choice to provide symptom relief
certain malignancies such as lymphoma, small cell lung cancer may benefit from radical chemotherapy or chemo-radiotherapy rather than stenting
the evidence base supporting the use of glucocorticoids is weak but they are often given
tumour markers specificity
low generally
CA-125
ovarian cancer
CA 19-9
pancreatic cancer
CA 15-3
breast cancer
PSA
prostatic carcinoma
AFP
hepatocellular carcinoma, teratoma
CEA
colorectal cancer
S-100
melanoma, schwannomas
bombesin
small cell lung carcinoma, gastric cancer, neuroblastoma
breast cancer ddx
fibrocystic, lipoma, fibroadenoma
poor prog breast cancer
size
grade
BRCA 1/2 positive and er negaticvebr
brca 1/2 genetic testing
<50 yrs and close relative, two or more close relatives with breast cancer
colorectal genetics
sporadic (95%)
hereditary non-polyposis colorectal carcinoma (HNPCC, 5%)
familial adenomatous polyposis
colorectal genetic referral meets crieteria
The Amsterdam criteria are sometimes used to aid diagnosis:
at least 3 family members with colon cancer
the cases span at least two generations
at least one case diagnosed before the age of 50 years
colorectal screening
the NHS now has a national screening programme offering screening every 2 years to all men and women aged 60 to 74 years in England, 50 to 74 years in Scotland. Patients aged over 74 years may request screening
pancreatic cancer associations
increasing age
smoking
diabetes
chronic pancreatitis (alcohol does not appear an independent risk factor though)
hereditary non-polyposis colorectal carcinoma
multiple endocrine neoplasia
BRCA2 gene
KRAS gene mutation
pancreatic cancer ix
high-resolution CT scanning is the investigation of choice if the diagnosis is suspected
imaging may demonstrate the ‘double duct’ sign - the presence of simultaneous dilatation of the common bile and pancreatic ducts
pancreatic cancer mx
a Whipple’s resection - rare (pancreaticoduodenectomy) is performed for resectable lesions in the head of pancreas. Side-effects of a Whipple’s include dumping syndrome and peptic ulcer disease
adjuvant chemotherapy is usually given following surgery
ERCP with stenting is often used for palliation
renal cell carcinoma associations
more common in middle-aged men
smoking
von Hippel-Lindau syndrome
tuberous sclerosis
incidence of renal cell cancer is only slightly increased in patients with autosomal dominant polycystic kidney disease
renal cell carcinoma mx
for confined disease a partial or total nephrectomy depending on the tumour size
patients with a T1 tumour (i.e. < 7cm in size) are typically offered a partial nephrectomy
alpha-interferon and interleukin-2 have been used to reduce tumour size and also treat patients with metatases
receptor tyrosine kinase inhibitors (e.g. sorafenib, sunitinib)
prostate cancer mx
radical prostatectomy (erectile dysfunction)
radiotherapy: external beam and brachytherapy (patients may develop proctitis and are also at increased risk of bladder, colon, and rectal cancer following radiotherapy for prostate cancer)
GnRH agonists: e.g. Goserelin (Zoladex)
b/l orchidectomy
bicalutamide
non-steroidal anti-androgen
blocks the androgen receptor
cyproterone acetate
steroidal anti-androgen
risk fx of testicular cancer
infertility (increases risk by a factor of 3)
cryptorchidism
family history
Klinefelter’s syndrome
mumps orchitis
testicular cancer presentation
a painless lump is the most common presenting symptom
pain may also be present in a minority of men
hydrocele
gynaecomastia
this occurs due to an increased oestrogen:androgen ratio
germ-cell tumours → hCG → Leydig cell dysfunction → increases in both oestradiol and testosterone production, but rise in oestradiol is relatively greater than testosterone
leydig cell tumours → directly secrete more oestradiol and convert additional androgen precursors to oestrogens
testicular cancer mx
orchidectomy
radio or chemo
hepatocellular carcinoma risk fx
hepatitis B & C, alcohol, haemochromatosis and primary biliary cirrhosis. Other risk factors include:
alpha-1 antitrypsin deficiency
hereditary tyrosinosis
glycogen storage disease
aflatoxin
drugs: oral contraceptive pill, anabolic steroids
porphyria cutanea tarda
male sex
diabetes mellitus, metabolic syndrome
hepatocellular carcinoma xi
ultrasound (+/- alpha-fetoprotein)
hepatocellular carcinoma mx
early disease: surgical resection
liver transplantation
radiofrequency ablation
transarterial chemoembolisation
sorafenib: a multikinase inhibitor
