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Year 4 - 4. Cancer Care > Prostate / urological cancer and Head & Neck cancer > Flashcards

Prostate / urological cancer and Head & Neck cancer Flashcards

1
Q

State the ages and frequency for cervical cancer screening

A

25 - 65

25-50 = every 3 years
50-65 = every 5 years

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2
Q

State some risk factors for prostate cancer

A
  • Age (rare under 50)
  • Close family history
  • Ethnicity (African heritage)
  • Genetic conditions (BRCA1 / BRCA2)
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3
Q

State some signs or symptoms for prostate cancer

A

Can be asymptomatic = had PSA

Lower urinary tract symptoms
OBSTRUCTIVE SYMPTOMS
- Hesitancy
- Poor and/or intermittent stream
- Straining
- Prolonged micturition
- Feeling of incomplete bladder emptying
- Dribbling
STORAGE SYMPTOMS
- Frequency
- Urgency
- Urge incontinence
- Nocturia

Bone pain, often back pain (metastatic)

Ejaculatory problems (rare)

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4
Q

State investigations in the prostate cancer diagnosis

A
  • PSA blood test
  • DRE
  • Biopsy (transperineal with local anaesthetic)
  • MRI prostate prior to biopsy (only if radical approach)
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5
Q

State some common causes of raised PSA

A
  • Prostate cancer
  • Urinary infection
  • Prostatic inflammation (prostatitis)
  • Large / enlarged prostate (benign prostatic hyperplasia)
  • Acute urinary retention
  • Vigorous exercise especially cycling
  • Sexual activity
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6
Q

State % of patients with normal PSA can have prostate cancer

A

15% of patients with normal PSA can have prostate cancer

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7
Q

What % of men will have a raised PSA

A

10%

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8
Q

State some factors influencing treatment decisions for prostate cancer

A
  • Age
  • PSA
  • MRI staging e.g. T stage and N stage
  • Gleason Grade (score - low magnification grading)
  • Bone scan (metastasis)
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9
Q

State what the Gleason’s score is and how the scoring system works

A

Score is based on how much the cancer looks like healthy tissue when viewed under a microscope

Biopsy area where the cancer is most obvious and another area of growth
- Each area a score from 3 to 5
- The scores are added together
- Overall score between 6 and 10 (higher the numbers, worse it is)

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10
Q

State the medicine used most often for hormone castration

A

LHRH agonist (acts on leydig cells in the testes, which then) - prevents pulsatile release of GNRH
Given for life

Initial surge in testosterone, from initial stimulation of GNRH
This is a flare - need to give an anti-androgen e.g. bicalutamide

If PS < 2 and hormone sensitive - can have chemotherapy

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11
Q

State some established curative intent treatments for localised (non-metastatic) prostate cancer

A

+ active surveillance if low risk

  • Prostatectomy (robotic)
  • Conformal radiotherapy (+ GnRH agonists for 3-6 months e.g. Gosarelin)
  • Brachytherapy
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12
Q

State the treatment options for the following risk levels for non-metastatic prostate cancer:

Low risk (Gleason’s score = 6)
Intermediate risk (Gleason’s score = 7)
High risk (Gleason’s score = 9-10)

A

Low risk (Gleason’s score = 6):
- Active surveillance

Intermediate risk (Gleason’s score = 7):
- Active surveillance
- Radical radiotherapy (+ GnRH agonists for 3-6 months e.g. Gosarelin)
- Robotic prostatectomy

High risk (Gleason’s score = 9-10):
- Radical radiotherapy (+ GnRH agonists for 3-6 months e.g. Gosarelin)
- Robotic prostatectomy

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13
Q

State the follow up for prostate cancer treated radically

A

Check PSA levels:
– at least 6 weeks after treatment
– at least every 6 months for the first 2 years
– at least once a year after the first 2 years

After 2 years, can be discharged to primary care if PSA stable and no complications from treatment

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14
Q

Which patients benefit most from robotic prostatectomy

A
  • Younger men < 70
  • BMI < 35
  • Localised high-risk non-metastatic prostate cancer
  • Locally advanced non-metastatic
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15
Q

State some side effects for radical radiotherapy (prostate)

A
  • Erectile dysfunction (up to 1/3)
  • Urinary symptoms (LUTS)
  • Urinary incontinence (1%)
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16
Q

List the potential benefits and harms of PSA screening

A

Benefits:
- Low cost
- More sensitive and specific that DRE alone
- Early detection of prostate cancer

Harms:
- False positives = unnecessary biopsy
- False negatives = missed cases
- Overdiagnosis = unnecessary interventions for clinically insignificant disease
- Potential complications from interventions e.g. erectile dysfunction

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17
Q

List some ways in which locally advanced or metastatic prostate cancer can present

A
  • LUTS
  • Back pain / pelvic pain
  • Haematuria
  • Haematochezia
  • Haematospermia
  • Spontaneous hip fracture
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18
Q

State some differentials for haematuria

A
  • Cancer e.g. renal, bladder, advanced prostate
  • Renal stones
  • Infection
  • Inflammation
  • BPH / enlarged prostate
  • Schistosomiasis (parasite)
  • Nephritic syndrome e.g. IgA nephropathy
  • Haemolytic uraemic syndrome
  • Henoch-Schönlein Purpura
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19
Q

State some investgations for haematuria

A
  • Urine cytology
  • Flexible cystoscopy
  • USS KUB or CT urogram
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20
Q

State 3 tumour markers for testicular cancer

A
  • Alpha fetoprotein
  • hCG
  • LDH
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21
Q

State some risk factors for bladder cancer

A
  • Smoking (45%)
  • Occupational exposure (6%)
  • Ionising radiation
22
Q

State some management steps for bladder cancer based on the following severities
- Non-muscle invasive
- Muscle invasive
- Systemic

A

Non-muscle invasive:
- Surveillance cystoscopy (if low risk)
- Intra-vesicular chemotherapy (medium and high risk)
- Intra-vesicular BCG (high risk)
- Radical cystectomy if high risk

Muscle invasive
- Radical cystectomy
- Radiotherapy

Systemic - palliative approach:
- Chemotherapy
- Immunotherapy

23
Q

State some presenting symptoms for renal cell carcinoma

A
  • May be incidental finding
  • Haematuria
  • Palpable mass (adult polycystic kidney disease)
24
Q

State some risk factors for penile cancer

A
  • Increased age (over 50)
  • Phimosis
  • Hygeine / smegma
  • HPV 16 & 18
  • Psoriasis treatment (PUVA)
25
Q

State the first line treatment for testicular cancer

A

Inguinal orchidectomy

26
Q

Outline common sites of metastasis for prostate cancer

A

LLB

Lung
Liver
Bone
+ lymph nodes

27
Q

Outline common sites of metastasis for head and neck cancers

A

LLB

Lung
Liver
Bone

28
Q

List the main types of thyroid cancer

A
  1. Papillary
  2. Follicular
  3. Medullary thyroid carcinoma
  4. Anaplastic (poor prognosis)
29
Q

List some risk factors for thyroid cancer

A
  • Existing thyroid disease (Hashimoto’s, goitre)
  • Radiation exposure
  • Family history (certain genetic disorders such as multiple endocrine neoplasia)
  • Female
  • Obesity
  • SLE
30
Q

List some presenting symptoms for thyroid cancer

A
  • Neck lump / goitre
  • Hoarse voice
  • Dysphagia
  • Odynophagia
  • Dyspnoea
  • Stridor
  • Weight loss / anorexia
  • Lethargy / fatigue
  • Bone pain (metastatic disease)
31
Q

State some differentials for neck lumps (thyroid cancer)

A
  • Benign thyroid disease
  • Thyroglossal cyst
  • Lymphadenopathy
  • Laryngitis (hoarse voice)
  • Laryngeal cancer (hoarse voice)
32
Q

List some investigations for suspected thyroid cancer

A
  • ECG (can cause arrhythmias)
  • Urinalysis (phaeochromocytoma)
  • Thyroid function tests
  • Thyroid autoantibodies
  • Plasma calcitonin and carcinoembryonic antigen (if suspicious for MEN)
  • USS
  • CT / MRI
  • Fine needle aspiration
33
Q

Outline how thyroid cancer is generally managed

A
  • Surgery
  • Radioactive remnant ablation
  • Lifelong Levothyroxine replacement
    +/- adjuvant therapy in some cases e.g. anaplastic

Serum thyroglobulin is a marker used to monitor for signs of disease recurrence

34
Q

State some differentials for a detectable prostate mass / enlargement on DRE

A
  • Prostate cancer
  • BPH
  • Normal (benign) asymmetry
  • Prostatitis
  • Cyst
  • Prior TURP/biopsy scar
35
Q

State 2 GnRH agonists and describe how they work for managing prostate cancer

A

Goserelin (Zoladex)
Leuprorelin (Prostap)

Stimulate GnRH receptors on the anterior pituitary, leading to large release of LH/FSH leading to increased testerone initially.

However over few days/weeks and continuous stimulation, GnRH receptors become desensitised and less production of LH/FSH leading to a reduction of testosterone production (hypogonadotropic hypogonadism)

36
Q

State 2 cancers associated with Epstein Barr viral infection

A

Burkitt’s lymphoma
Nasopharyngeal cancers

37
Q

List the most common cellular type of cancer of head and neck

A

Squamous cell carcinoma

38
Q

List some risk factors for head and neck cancer

A

Non-modifiable:
- Male

Modifiable:
- Alcohol
- Tobacco
- Betel quid (oral cancer)
- HPV (mainly type 16, most significantly linked to oropharyngeal cancer)
- EBV infection (nasopharyngeal cancer)
- Occupational wood dust / asbestos exposure (sinonasal cancer)
- Immunodeficiency
- Prior radiation to area

39
Q

List some premalignant conditions for head and neck cancers (esp. oral)

A
  • Leukoplakia (white patches)
  • Erythroplakia (red patches)
  • Erythroleukoplakia (mixed red and white patches)
  • Oral lichen planus
  • Actinic cheilitis

Lifetime risk of transformation ranging from 0-20%

40
Q

List some potential presenting features for oral cavity cancers

A
  • Oral mass (typically painless) e.g. inner lip / tongue / floor of the mouth / hard palate
  • Cervical lymphadenopathy

+ Constitutional symptoms e.g. fever, weight loss, night sweats

(Less commonly = non-specific e.g. oral cavity bleeding / localised pain / neck lump / jaw swelling)

41
Q

List some potential presenting features for oropharyngeal cancers

A
  • Painful swallow (odynophagia)
  • Dysphagia (problems swallowing)
  • Tonsillar lump / asymmetrical tonsil
  • Neck lump / cervical lymphadenopathy
  • Feeling of “something in the throat

+ Constitutional symptoms e.g. fever, weight loss, night sweats

42
Q

List some potential presenting features for nasopharyngeal cancers

A
  • Neck lump
  • Unilateral conductive hearing loss

+ Constitutional symptoms e.g. fever, weight loss, night sweats

43
Q

List some potential presenting features for laryngeal cancers

A
  • Hoarse voice
  • Dysphagia
  • Persistent cough
  • Referred ear pain
  • Stridor (if advanced)

+ Constitutional symptoms e.g. fever, weight loss, night sweats

44
Q

List some investigations to consider for suspected head and neck cancers

A
  • Flexible nasendoscopy
  • Biopsy of lesion (method depends on location)
    If solely lymphadenopathy = ultrasound-guided fine needle aspiration (FNA)

Imaging:
- MRI imaging of the head and neck
- If strong suspicion, CT neck and chest
(may use PET-CT if cancer of unknown origin)

45
Q

What should a patient be assessed for, before radiotherapy specifically for head and neck cancers

A

Assessment of dental health prior to radiotherapy

46
Q

Suggest some additional considerations for the management of patients with head and neck cancers

A
  • Smoking / alcohol cessation
  • Nutrition with route of feeding
  • Assessment of dental health prior to radiotherapy
47
Q

Generally, outline how head and neck cancers are managed

A
  1. Surgical resection +/- adjuvant radiotherapy (may need flap reconstruction for oral cavity lesions)
  2. Primary radiotherapy +/- adjuvant chemotherapy
  3. Chemotherapy
48
Q

Outline how oral cavity cancers are generally managed

A

Small tumours:
- Wide local excision +/- neck dissection

Advanced tumours:
- Surgical resection +/- flap reconstruction
- Neck dissection (adjuvant radiotherapy or chemotherapy)

49
Q

Outline how tonsillar + tongue cancers are generally managed

A

Small tumours:
- Surgical resection +/- neck dissection or radiotherapy

Advanced tumours:
- Primary radiotherapy +/- adjuvant chemotherapy

50
Q

Outline how laryngeal cancers are generally managed

A

Small tumours:
- Surgical resection +/- bilateral neck dissection
- Primary radiotherapy +/- adjuvant chemotherapy

Advanced tumours:
- Laryngectomy with post-operative radiotherapy +/- adjuvant chemotherapy
- Primary radiotherapy +/- adjuvant chemotherapy

51
Q

State some potential complications of head and neck cancer treatments
- Radiotherapy
- Surgical
- Chemoradiotherapy

A

Radiotherapy:
- Local skin reaction
- Mucositis
- Hair loss
- Xerostomia (salivary glands)
- Difficulty swallowing
- Osteonecrosis (rare long term)
- Secondary cancers (rare long term)

Surgical:
- Damage to local nerves (accessory, vagus, hypoglossal, or mandibular
- Damage to lymphatic system (chyle leak)
- Pharyngocutaneous fistula (following laryngectomy)
- Dysphagia (pharyngeal/oesophageal strictures)

Chemoradiotherapy:
- Chronic pain
- Persistent hoarse voice
- Hearing loss

52
Q

State some hormonal therapies that can be used in the management of prostate cancer

A

LH blockers e.g. Goserelin = stops production of LH, reduces production of testosterone by the testes

Anti androgens = blocks testosterone receptors on the cancer cells

GnRH blocker = blocking GnRH stops the testicles producing testosterone (at the level of the ant. pituitary)

Year 4 - 4. Cancer Care (9 decks)

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