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Solid Cancers Flashcards

1
Q

What are some inherited causes of colon cancer?

A

Familial Adenomatous Polyposis (FAP)
Hereditary Nonpolyposis Colorectal cancer
Familial Colorectal cancer

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2
Q

What are some lifestyle factors that increase the risk of colon cancer?

A

Low fibre high fat diet with red/processed meat
Obesity
Cigarette smoking
Alcohol

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3
Q

What can be protective against developing Colon cancer?

A

Exercise

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4
Q

What are some symptoms of a Rt sided Colon cancer?

A

Weight loss
Weakness
Obstruction
Iron Deficiency

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5
Q

What are some symptoms of a Lt sided Colon cancer?

A 
Constipation
Abdominal pain
Reduced stool calibre
Alternating bowel habit
Rectal bleeding
Large Bowel Obstruction
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6
Q

What are some symptoms of a Colon cancer in the rectum?

A

Obstruction
Tenesmus
Bleeding
Palpable PR Mass

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7
Q

When are patients invited for Bowel Cancer screening?

A

60-74y they are invited every 2y

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8
Q

What does Bowel Cancer screening detect?

A

Presence of Fecal Occult Blood via FIT test

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9
Q

If initial Bowel Cancer screening is positive, what is the next step?

A

Patient is referred for Colonoscopy

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10
Q

What are some appropriate investigations for suspected Bowel Cancer?

A

Baseline Bloods
Colonoscopy/Flexible Sigmoidoscopy
CT Colon
Biopsy

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11
Q

Which tumour marker is specific for bowel cancer?

A

Carcinoembryonic antigen (CEA)

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12
Q

Which staging system is used to stage colon cancer?

A

Dukes Staging

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13
Q

What is Dukes stage 0?

A

Cancer cells are only within the mucosa of the colon/rectum

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14
Q

What is Dukes stage A?

A

Cancer has invaded the muscular layer, with no further spread

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15
Q

What is Dukes stage B?

A

The cancer has invaded the muscular layer with localised spread

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16
Q

What is Dukes stage C?

A

The cancer has spread to regional lymph nodes, with no distant metastases

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17
Q

What is Dukes stage D?

A

Cancer has spread to distant metastases

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18
Q

What are some potential surgical procedures performed in Colon cancer?

A

Rt or Lt Hemicolectomy

Anterior resection

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19
Q

Which Chemotherapeutic agents can be used for Colon Cancer?

A

5-Fluororacil

Capecitabine

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20
Q

Which immunotherapy agent is often used in Colon cancer?

A

Cetuximab

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21
Q

What are some risk factors for development of Lung Cancer?

A 
Large number of Pack Years
TB
COPD
Previous Radiotherapy
Pulmonary Fibrosis
HIV
Airflow obstruction
Increasing age
FHx
Carcinogen exposure - Asbestos
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22
Q

What are some symptoms of Lung Cancer?

A 
Cough
Haemoptysis
Dyspnoea
Chest Pain
Recurrent Chest Infections
Weight loss
Anorexia
Fatigue
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23
Q

What are some clinical signs that may be present with Lung Cancer?

A 
Cachexia
Clubbing
Anaemia
Lymphadenopathy
SVCO
Horners
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24
Q

Which investigations are appropriate with suspected Lung Cancer?

A

Bloods - FBC, U&E, Calcium, LFTs, INR
CXR and Staging CT
PET
Histology + Biopsy

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25
Q

Which tumour markers may be present with a lung cancer?

A 
CEA
Ca19.9
Ca125
PSA
Alpha-Fetoprotein
Beta-hCG
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26
Q

When should a patient be referred for investigations via 2WW for suspected lung cancer?

A

CXR Findings suggestive of Lung Ca

or

Age >40 with Haemoptysis

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27
Q

How is Lung Cancer staged?

A

TNM

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28
Q

Grossly, how is lung cancer classified?

A

Small Cell

Non-Small Cell

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29
Q

What are some subtypes of Non-Small Cell lung cancer?

A

Adenocarcinoma
Squamous cell
Large Cell +/- neuroendocrine features
Adenosquamous

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30
Q

Which Lung Cancer is particularly chemosensitive?

A

Small Cell

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31
Q

Which Chemotherapeutic agents are often used with Lugn Cancers?

A

Cisplatin
Gemcitabine
Docetaxel

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32
Q

Which Biological agent can be used with Lung Cancer?

A

Pembrolizumab

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33
Q

Which performance scale can be used to quantify patient function with lung cancer?

A

WHO Performance Scale

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34
Q

How would a patient present if they are WHO Performance Scale 0?

A

Normal, fully active without any restriction of activities

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35
Q

How would a patient present if they are WHO Performance Scale 1?

A

Restricted in physically strenuous activity, but ambulatory and able to carry out light work

36
Q

How would a patient present if they are WHO Performance Scale 2?

A

Ambulatory and Capable of self-care, unable to carry out any work. Up and about for more than 50% of the day

37
Q

How would a patient present if they are WHO Performance Scale 3?

A

Capable of limited self-care, confined to bed/chair more than 50% of the time.

38
Q

How would a patient present if they are WHO Performance Scale 4?

A

Completely disabled, cannot self-care

39
Q

How would a patient present if they are WHO Performance Scale 5?

40
Q

When are men commonly affected by Prostate Cancer?

41
Q

Which cell type are the majority of Prostate cancers?

A

Adenocarcinoma

42
Q

Where in the Prostate do Prostate Cancers originate?

A 
Peripheral Zone (75%)
Transitional Zone (20%)
Central Zone (5%)
43
Q

Histologically, how can Prostate Cancer be defined?

A

Acinar Adenocarcinoma

Ductal Adenocarcinoma

44
Q

In Prostate Cancer, where do Acinar Adenocarcinomas originate?

A

Glandular cells within the Prostate gland

45
Q

In Prostate Cancer, where do Ductal Adenocarcinomas originate?

A

Cells lining the duct of the Prostate

46
Q

What are some risk factors for development of Prostate Cancer?

A 
Age
Ethnicity - Black African/Carribean
FHx
BRCA1/2 Mutations
Obesity
DM
Smoking
47
Q

What are some clinical features suggestive of Prostate Cancer?

A

LUTS - Weak Stream, Increased Frequency, Urgency

48
Q

What are some clinical features suggestive of advanced Prostate Cancer?

A 
Haematuria
Dysuria
Incontinence
Haematospermia
Suprapubic Pain
Loin Pain
Rectal Tenderness
49
Q

What are some clinical features suggestive of metastatic Prostate Cancer?

A

Bone Pain
Lethargy
Anorexia
Unexplained weight loss

50
Q

Which blood marker can be used to monitor Prostate Cancer?

51
Q

Other than cancer, which other conditions can lead to elevations of PSA?

A 
BPH
Prostatitis
Vigorous Exercise
Ejaculation
Recent DRE
52
Q

Which Biopsies can be performed for suspected Prostate Cancer?

A

Transperineal Biopsy - Under GA, low infection risk

Transrectal US Biopsy (TRUS) - Under local

53
Q

How is Prostate Cancer graded?

A

Gleason Grading

54
Q

How does Gleason Grading for Prostate Cancer work?

A

Macroscopic examination of differentiation of cells from 2 different samples are then assigned a score

55
Q

Which Gleason Score is associated with the best outcome?

A

Gleason 3+3 = Gleason 6

56
Q

How can Low-Risk Prostate Cancer (Gleason 6) be managed?

A

Active Surveillance

57
Q

How can intermediate/high-risk Prostate Cancer (Gleason 7 or higher) be managed?

A

Radical Treatment

58
Q

How should metastatic Prostate Cancer be managed?

A

Chemotherapy +/- Hormonal Agents

59
Q

What surgical options are available for Prostate Cancer management?

A

Radical Prostatectomy

Brachytherapy

60
Q

What is Brachytherapy?

A

Transperineal implantation of radioactive seeds into the prostate

61
Q

What is Watchful Waiting in relation to Prostate Cancer?

A

A symptom-guided approach to Prostate Ca management - Focus on symptom control and QoL. Reserved for older patients with lower life expectancy

62
Q

What is Active Surveillance for Prostate cancer?

A

Monitoring of disease offered to select patients with low/intermediate risk disease

63
Q

Which monitoring is appropriate for active surveillance of Prostate Cancer?

A

3/12 PSA
6-12/12 DRE
Frequent Biopsy

64
Q

How can invasive carcinomas of Breast be classified?

A

Invasive Ductal Carcinoma - Most common
Invasive Lobular Carcinoma - More common in older women
Others

65
Q

What are some risk factors for development of Breast Cancer?

A 
Female Sex
Age
BRCA1/2 Mutations
FHx in first degree relative
Previous Benign Disease
Obesity 
Alcohol consumption
Exposure to Unopposed Oestrogen
66
Q

How may Breast Cancer present?

A 
Asymptomatic - Detected via screening
Symptomatic:
Breast Lumps
Asymmetry
Swelling
Abnormal Nipple Discharge
Nipple Retraction
Skin Changes - Peau d'orange
Mastalgia
Palpable Axillary Lump
67
Q

With suspected Breast Cancer, what assessments does a Triple Assessment involve?

A

Examination
Imaging
Histology or Cytology

68
Q

How is prognosis predicted with confirmed Breast Cancer?

A

Nottingham Prognostic Index

69
Q

When are women offered screening for Breast Cancer?

A

Every 3y between ages of 50-70

70
Q

What is Pagets disease of the Nipple?

A

Roughening, reddening and ulceration of the nipple usually secondary to Neoplasm

71
Q

What are some clinical features of Pagets disease of the Nipple?

A

Itching/Redness of Areola +/- Nipple
Flaking and Thickened Skin on/around Nipple
Pain
Sensitivity

72
Q

How can Pagets disease of the Nipple be managed?

A

Surgical removal of nipple and areola

Radiotherapy if underlying malignancy

73
Q

What is Breast Carcinoma in Situ?

A

A malignancy that is contained within the basement membrane, and is a pre-malignant condition

74
Q

What is a Ductal Carcinoma in Situ?

A

Malignancy of ductal tissue that is contained within the basement membrane of the breast

75
Q

How should DCIS be managed?

A

Wide-local excision

Mastectomy if widespread

76
Q

What is Lobular Carcinoma in Situ?

A

Malignancy of secretory lobules of the breast, usually a pre-menopausal diagnosis

77
Q

What are some surgical options for treatment of breast malignancy?

A

Wide-Local excision for breast conservation with localised disease
Mastectomy - Indicated in multifocal disease
Axillary Surgery - To assess for nodal involvement

78
Q

What happens in a Sentinal Node Biopsy?

A

Removal of the first lymph node a tumour drains into

79
Q

What happens in Axillary Node Clearance?

A

Removal of all the nodes within the Axilla

80
Q

How does Tamoxifen work?

A

Blockade of Oestrogen receptors within the tumour

81
Q

What are some example Aromatase Inhibitors?

A

Anastrazole

Letrozole

82
Q

How do Aromatase inhibitors work?

A

Bind to oestrogen receptors inhibiting further growth. Advised for adjuvant therapy in Post-Menopausal patients

83
Q

When is immunotherapy used for Breast Cancer?

A

When cancers express specific growth factors

84
Q

What is a common growth factor expressed by Breast Cancer, and which immunotherapy is used to treat it?

A

HER2 - Herceptin

85
Q

What is one of the major side-effects of Herceptin?

A

Risk of Cardiac Toxicity

Cancer Care (5 decks)

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