Peer Share Flashcards
1
Q
ca125
A
ovarian
2
Q
ca19-9
A
pancreatic
3
Q
ca15-3
A
breast
4
Q
PSA
A
prostate
5
Q
CEA
A
bowel
6
Q
AFP
A
NSGCT (yolk sac/teratocarcinoma)
hepatocellular
7
Q
HCG
A
germ celltumours (seminomas, NSGCT)
8
Q
calcitonin
A
medullary thyroid cancer
9
Q
tumour markers
A
CA125 = ovarian
CA19-9 = pancreatic
CA15-3 = breast
PSA = prostate
CEA = bowel
AFP = NSCGT (yolk-sac/teratocarcinoma) and hepatocellular
HCG = germ cell tumours (seminomas?NSCGT)
calcitonin = medullary thyroid cancer
10
Q
def: radical
A
curative
11
Q
def: neoadjuvant
A
before primary treatment to shrink tumour
12
Q
def: adjuvant
A
after treatment to destroy remaining cells and reduce liklihood of recurrence
13
Q
def: palliative
A
aims to extend life and control pain but will not cure
14
Q
ECOG performance scoring
A
0 = fully active, able to carry on all pre-disease performance without restriction
1 = restricted in physcially strenuous activity but ambulatory and able to carry out work of light or sedentary nature (e.g light house work/office work)
2 = ambulatory and capable of all selfcare but anuable to carry out any work activities; up and about more than 50% of waking hours
3 = capable of only limited selfcare; confined to bed or chair more than 50% of waking hours
4 = completely disabled; cannot carry on any selfcare; totally confined to bef or chair
5 = dead
15
Q
def: radiotherapy
A
- ionising radiation daages DNA
- cancer cells have poorer repair mechanisms than healthy cells
- results in increased cancer cell death
16
Q
uses: radiotherapy
A
radical
neo-adjuvant
adjuvant
palliative
17
Q
types: radiotherapy
A
extrenal beam = traditional rtx
brachytherapy = radioactive beads placed into tumour e/g prostate cancer
SABR = stereotactic ablative rtx (CT guided) giving higher doses in fewer fractions
18
Q
def: Gy rtx
A
gray = the dose
19
Q
def: Fr rtx
A
fraction = number of sessions dose is delivered over
20
Q
advantages and disadvantages compared to surgery: rtx
A
adv:
1. no GA
2. less painful
3. treat tumour margin
dis:
1. less staging information
2. greater risk secondary mallignancy
3. less psychological benefit
21
Q
short term SEs: rtx
A
SHORT TERM INFALMMATION
* fatigue
* nausea
* heair loss
* hoarseness
* pain/discomfort
* skin reactions: dry desquamation (skin not boken) and wet (skin broken - infection risk)
* mucositis: dysphagia/weight loss/altered bowel habit/urinary symptoms
22
Q
late/long-term SEs rtx
A
LONG TERM FIBROSIS/SCARRING
* fatigue
* pain
* altered bowel habit
* urinary discomfort/cystitis
* dry mouth
* dry cough (pneumonitis)
* infertility
* seconday cancers
* cardiac toxicity
* skin reactions: pigmentation/talangectasia/atrophy/ulceration/permanent hair loss)
23
Q
def: SACT
A
systemic anti-cancer therapy
1. chemotherapy
2. hormonal
3. targeted
4. biologic
24
Q
def: chemotheraoy (cytotoxic)
A
targets DNA of cells
25
def: hormonal therapy
exploits oestrogen/androgen involvement
26
def: targeted therapy
inibits molecular pathways needed for tumour growth e.g herceptin (breast cancer)
27
def: biologic therapy
stimulates host response to aid tumour cell destruction
28
hormonal therapy: examples
tamoxifen (breast cancer)
LHRHs e.g goserelin (prostate cancer)
29
SEs: targeted therapy
menstrual distrubance, hot flushes, VTE and endometrial cancer
30
NB: lines for chemo treatment
PICC lines cannot be inserted on same side as mastectomy with lymph node clearance
if bilateral mastectomy must have centrally inserted CVC
31
def: chemotherapy
targets rapidly dividing cells DNA
32
reducing toxicity: chemotherapy
using different chemos with different MOAs reduces toxicity
33
SEs: chemotherapy
targets other rapidly diving cells: hair follicles/GIT cells causing change in bowel habit/ bone marrow cells (anaemia/thrombocytopenia/pancytopenia
* general fatigue
* N+V
* thrombosis
* peripheral neuropathy
* infertility
* hypersensitivity reactions
* organ toxicity
* palmar-plantar erythema (emollients rx)
34
extravasation: chemotherapy
leakage of fluids/medication from vein can causer tissure damage and necrosis
PICC line reduces risk
35
breast: screening
3 yearly mammogram from 50-70
36
RFs: breast
lifestyle - sedentary, high fat diet, smoking, BMI
genetic - BRCA1/2, fhx breast/ovarian ca
hormonal - nulliparity/ early menarche/ late menopause/ HRT (increased unopposed oestrogen)
ionising radiation
37
red flag 2 week referral criteria: breast
>=30 with unexplained breast lump
>=50 unilateral nipple discharge or retraction
38
consider red flag: breast
skin changes suggesting breast cancer
>=30 unexplained axillary lump
39
non-urgent referral: breast
<30 uneplained breast lump
40
triple assessment: breast
1. examination
2. imaging (mammogram +/- USS)
3. biopsy (FNA/core)
41
mammograms in younger patients
not as useful in younger women due to increased fibrous tissue and less fat
42
TNM staging: breast
T:
T1 - <2cm
T2 - 3-5cm
T3 - >5cm
T4a - chest wall
T4b - skin
T4c - both chest wall and skin
T4d - inflammatory
N:
N0 = no nodes
N1 = 1-3 nodes
N2 = 4-9 nodes
N3 = >10 nodes
M:
M0 = no mets
M1 - mets
43
staging scans: breast
isotope bone scan and CT abdo/thorax
44
primary surgical management: breast
1st line in breast cancer
CI'd - M1, T4 and unfit for surgery pts
WLE: solitary, peripheral, small lesion
mastectomy: multifocal, central, large lesion
axillary node clearance: palpable/USS +ve, SLNB indicated
if >1 node +ve on SLNB or N1-3 clinically
45
indication for WLE v mastectomy: breast
WLE - solitary, peripheral, small lesion
mastectomy - multifocal, large, central lesion
46
SE axillary node clearance: breast
* lymphadenopathy
* functional arm impairment
47
adjuvant radiotherapy: breast
* almost always indicated
* whole breat RT after WLE
* tumur bed boost: >=50, triple -ve, high grade, close margins
* chest wall RT after mastectomy and T>=3 or N>=2
* supraclavicular fossa >=N2
48
indications chest wall RT: breast
after mastectomy and T>=3 or N>=2
49
chemotherapy: breast
* neoadjuvant to shrink tumour
* adjuvant -ve, 2-5% risk: oncotype DX analysis
* node -ve, >5% risk = FEC chemo
* node +ve = FEC-docetaxel chemo
50
adjuvant SACT: breast
hormonal in ER or PR +ve for 5-10 years
pre-menopausal/perimenopausal = tamoxifen
postmenopausal = anastrazole (risk of OP)
targeted in HER2 +ve for 1 year
node -ve = trastuzumab (herceptin)
node +ve trastuzumad and pertuzumab
51
ER or PR +ve breast:
hormonal SACT pre/perimenopausal = tamoxifen
postmenopausal = anastrazole
for 5-10 years
52
HER 2 +ve: breast
targeted SACT
node -ve = trastuzumab (herceptin)
node +ve = trastuzumab (herceptin) and pertuzumab
for 1 year
53
primary SACT: breast
only if surgery CI'd
hormonal/targeted/chemotherapy
54
RFs: colorectal cancer
* age
* genetics/fhx - lynch syndrome (HPCC), FAP
* lifestyle - obesity, diet/smoking/alcohol/sedentary
* large polyp
* pelvic RT
55
red flag 2 week wait referral criteria: colorectal
>= 40 with weight loss + abdo pain
>= 50 with rectal bleeding
>=60 with iron deficiency anaemia or altered bowel habit
>positive FOB/qFIT
56
consider red flag criteria: colorectal
rectal or abdominal mass
<50 with rectal bleeding AND
* abdo pain
* altered bowel habit
* weight loss
* iron-deficiency anaemia
57
offer QFIT: colorectal cancer
>=50 abdominal pain or weight loss
<60 changes to bowel habit or iron deficiency anaemia
>>=60+ no iron deficiency
58
investigations: colorectal
1st line = colonoscopy (CT colonogram if frail/intolerant/co-morbidities)
CEA: NOT for screening - only used after diagnosis
59
ix mets: colorectal
CT
CT PET
if rectal: MRI rectum and endoanal USS
60
TNM: colorectal
T:
T1 - through mucosa into submucosa
T2 - through submucosa into muscularis proproa
T3 - through muscularis propria to subserosa
T4 - through intestinal wall and into adjacent organs
N:
N0 - no nodes
N1 - 1-3 nodes
N2 - 4+ nodes
M:
M0 - no mets
M1 - mets
61
staging: colorectal
stage 1 - <=T2 + N0 + M0
stage 2 - T3 or T4 + N0 + M0
stage 3 - any T + N1 or N2 + M0
stage 4 - M1
62
management: colorectal
stage 1 - surery alone
stage 2 - surgery + clinical trial
stage 3 - surgery + chemo
stage 4 - palliative surgery/chemo
63
referral criteria: prostate
* raised PSA >4
* abnormal prostate on DRE
64
ix: prostate cancer
1. multiparametric MRI - results using 5-point LIKERT scale influence decision to biopsy
2. biopsy (for Gleason) if LIKERT 3+ TRUS or transperineal biopsy if LIKERT 1 or 2 (low risk)
3. isotope bone scan
65
Gleason score: prostate
1 = undifferentiated cells (not cancerous)
3 = cells turn cancerous
5 = undifferntiated cells
2 numbers used and most dominant cell comes first
6 = benign, 10 = highly malignant
group 1 <=6
group 2 3+4 = 7
group 3 4+3 = 7
group 4 = 8
group 5 9+
| https://www.youtube.com/watch?v=T19xd3AalPs
66
T stage: prostate
T1 - invisible
T2 - confined to prostate (a - <1/2 lobe, b >1/2 lobe, c both)
T3 - extends through capsule
T4 - extends to other structures (excluding seminal vesicles)
67
prognosis and management: prostate
see table
68
prognosis and management: prostate
see table
69
adv and dis: prostate management
surgery:
ad = psych benefit and histology
dis = GA, incontinence, ED, bowel perforation
brachytherapy:
ad = fast recovery, further rx, less ED
dis = urinary obstruction and GA
external RT
ad = no GA, less ED/urinary SE
dis = proctitis and secondary malignancy
70
metastatic management: prostate
hormonal therapy:
LHRH (GnRH agonists) - gosereline and deslorelin
anti-androgens - abiraterone and bicalutamide
chemo - docetaxel
bone targeted therapy - zolendronic acid/radium
RT/SABR for mets
71
signs: spinal cord compression
LOCAL BACK PAIN AND TENDERNESS
* exacerbated by coughing/sneezing/straining/lying flat
* uncontrolled by analgesia
NEUROLOGICAL PROBLEMS (ADVANCING)
* bladder dysfunction (retention/dribbling/incontinence)
* bowel dysfx (incontinence/constipation)
* weakness i arms/legs
* hypothesia (numbness)
CAUDA EQUINA (below L1/2)
* sciatic pain (usulally bilateral)
* impotence
* baldder dysfx
* sacral aesthesia
* loss of sphincter tone
* weakness/wasting of gluteal muscles
BILATERAL MOTOR NEURONE SIGNS
GIBBUS - swelling sue to spinal angulation caused by vertebral collapse
72
bony mets: SCC
breast
lung
prostate
multiple myeloma
73
ix: SCC
neurological exam
MRI whole spine gold standard
can do XR spine
74
rx: SCC
* medical emergency
* IMMEDIATE DEXAMETHASONE 8m PO/IV BD
* PPI and aanalgesia
definitive management:
1. surgical decompression - gold standard (CI: unfit or complete paraplegia for >24hrs + pain well controlled)
2. radiotherapy in radiosensitive tumours - can make worse before better so give prophylactic dexamethasone
3. bisphosphonates if breast, prostate or myeloma
75
outcomes: SCC
strongly dependent on level of neruological dysfunction
approx 30% survive for 1 year
may have irreversible paraplegia/quadriplegia or loss of bladder/bowel fx if late diagnosis
76
symptoms: SVCO
gradual onset with symptoms worsening with bending over or lying down
* dyspnoea
* swelling of face/neck/arms
* cough
* headache
* visual disturbance
* dizziness
* syncope
* chest pain
* hoarseness
* nasal congestion
* epistacis
* haemoptysis
77
pembertons test: SVCO
raising arms over head for 1 minute will cause
facial plethora and cyanosis
78
signs: SVCO
* dyspnoea
* orthopnoea
* facial plethora
* dilated/engorged veins
Pemberton's test- where lifting the arms over the head for more than 1 minute will precipitate facial plethora and cyanosis.
79
causes: SVCO
usually lung cancers
ymphoma 2nd most common
80
ix: SVCO
* CXR - right para-tracheal mass, mediastinal lymphadenopathy
**CT chest gold standard diagnosis** (contrast enhanced)
defines level and degree of venous blockage
identifies cause and staging
81
rx: SVCO
* ABCDE, high flow oxygen
* **dexamethasone 8mg PO/IV BD** with PPI
* tissue diagnosis
* stenting - indicated for thrombua and is bridge to chemo/radiotherapy while awaiting histo
* chemotherapy (small cell/lymphoma/germ cell)
* radiotherapy - poor performance status, previous chemo or relapse)
82
oucome: SVCO
prognosis dependent on underlying condition and extent of obstruction
* if untreated survival time = 30 days
* XRT tx - at least 30 months in 45% lymphoma and 10% lung
83
causes: raised ICP
SOL - primary brain tumour/brain mets/abscess/haematoma
hydrocephalus - CSF obstruction
benign IC hypertension
84
ix: raised ICP
* full clinical examination
* FBC, U+E, LFT and tumour markers
* contrast enhanced CT
* MRI if CT still ?
85
common tumours that met to brain: raised ICP
* lung cancer most common
* breast cancer
* melanoma
86
symptoms and signs: brain mets
PAPILLOEDEMA
* headache (early symptoms - worse in AM and when coughing/sneezing)
* nausea and vomiting (AM)
* cognitive impairment
* drowsiness
* seizures
* behavioural changes
* focal neurological changes
* altered gait
87
rx: brain mets
DEXAMETHASONE 8mg PO/IV BD with PPI
further - surgery or whole brain RT
PATIENTS CANNOT DRIVE AND MUST INFORM DVLA
88
outcomes: brain mets
* high morbidity
* dependent on primary tumour
* median survival without treatment is 1 month
89
most common cancers: hypercalcaemia
* breast
* lung
* head and neck
* renal
* lymphoma
* multiple myeloma
90
symptoms: hypercalcaemia
dehydration is most common finding
usually when >3.0mmol/L
bones, stones, thrones, abdominal groans and psychaitric moans
* bone pain
* stones
* polyuria and polydipsia
* N+V
* fatigue, malaise and weakness
* confusion
above 3.5mmol/Lconfusion, drowsiness and death
91
causes: hypercalcaemia
* bone metastases
* increased PTH protein - occurs in SCC, breast, porstate, renal, kmelanoma and neuroendocrine cancers (80%)
* calcitriol secretion from tumour
92
ix: hypercalcaemia
bloods - FBC, U+E, LFT, CRP, glucose, PTH, alk phos
12 lead ECG - shortened qT, severe hypercalcaemia = widerend T waves
CXR if underlying cause unknown
93
rx: hypercalcaemia
* immediate rehydration (IV 0.9% NaCL) - 4 to 6L in 24 hours
* IV bisphosphonate - zolendronic acid 4mg IV given after 24 hrs (moves calcium back into bones)
* discontinue thiazide diuretics/Ca/vit D supplements
94
outcomes: hypercalcaemia
poor prognosis if severe
95
def: thrombocytopenia
when chemo suppresses bone marrow
spontaneous bleeding likely when platelets <20x10^9L-1
96
symtpoms: thrombocytopenia
* malaise
* fatigue
* general weakness
* unexplained bleeding - epistaxis, gum bleeding
97
signs: thrombocytopenia
bruising
purpura
petechial rash
98
ix: thrombocytopenia
FBC (low plt, ?anaemia)
LFT, U+E (high urea ?upper GI bleed), coag screen
vit B12 and folic acid
99
rx: thrombocytopenia
* group and crossmatch
* arrange platelet Plt <10x10^9 or Plt <20x10^9 if active sepsis/bleeding
100
clinical triad: PE
SOB, pleuritic chest pain and haemoptysis
101
symptoms: PE
* triad - SOB, pleuritic chest pain and haemoptysis
* tachycardia - most common
* cough
* raised JVP
* cyanosis
* check for DVT
102
ix: PE
* 2-level wells score
* rotuine bloods, D-dmier, ABG, troponin, BNP
* **CTPA**
* CXR, ECG
103
rx: PE
A-E
anticoagulation - DOAC or LMWH if on chemo
thrombolysis if SBP <90mmHg
104
complications: PE
development of chronic thromboembolic HTN can lead to RSHF
105
def: TLS
caused by destruction of lage number of cancer cells
results in electrolyte abnormalities and renal failure
most common in leukaemia and lymphoma
hyperkalaemia
hyperphosphataemia
hypocalcaemia
high uric acid
106
symptoms: TLS
* fatigue
* N+V
* SOB
* myalgia
* syncope
* tetany
* seizures
* dark urine
* arrhythmias
* HF
107
ix: TLS
* hyperphosphataemia
* hyperkalaemia
* hyperuricaemia
* hypocalcaemia
* lactic acidosis
* raised serum LDH
108
rx: TLS
* A-E assesssment
* IV fluids
* rasburicase - clears uric acid from blood
* hyperkalaemia kit
* haemodialysis if required
109
prophylaxis: TLS
allopurinol
adequate hydration
