Solid Cancers Flashcards by ian rowley

Bowel cancer screening program?

Faecal occult blood every 2 years from 60-74

One off flexible sig at 55

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What is used to grade cancer patient fitness? Categories?

WHO performance status
0 - fine
1 - restricted to light work
2 - up and about >50%, unable to work, self caring
3 - bed/chair bound >50%, needs care
4 - bed/chair bound all the time, needs care
5 - dead

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How are differing ways of determining TNM scores prefixed?

What do the ‘y’ and ‘r’ prefixes mean?

C - by clinical exam
P - by pathological exam
A - at autopsy
U - by USS

Y - post chemotherapY or radiotherapY
R - recurrent/relapse

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Reasons for staging cancer

Determine treatment aims
Determine treatment type
Prognostic 
Monitor treatment efficacy 
Assist in trials

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5 year survival of dukes A vs dukes D

93% vs 6.6%

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Dukes staging of colorectal cancer

A - mucosa or submucosa
B - through muscularis mucosa
C - into regional lymph nodes
D - distant mets

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5 symptoms from local effect of colorectal cancer?

Pr bleeding
Mass
Abdo pain
Change in bowel habits 
Tenesmus

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Lifetime risk of ca breast in women?

1:8

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Proportion of ca breast occuring in men

0.7%

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Risk factors for ca breast?

Increasing age
Female
Oestrogen (hrt, cocp, early menarche, late menopause, nulliparous, never breastfed)
FHx
Alcohol

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Impact of benign breast disease on future breast cancer

Harder to detect threrefore worse prognosis but not increased incidence

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Screening program for breast cancer

Mammogram every 3 years from 47 to 73

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Signs and symptoms of breast cancer

Lump
Thickening
Dimpling/puckering
Discharge/bleeding
Change in size/contour
Nipple inversion/crusting
Peau de orange

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2ww criteria for breast cancer

Over 30 with lump in breast or axilla
Over 50 with unilateral nipple discharge, retraction or concerning feature
Any age with concerning skin changes

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What is the triple diagnosis in breast cancer

Exam
Radiology
Biopsy

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When is uss useful in breast cancer? Why?

Under 35s as breast too dense for mammogram

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How can a breast cancer be biopsied

Fine needle cytology
Core biopsy
Excision biopsy

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How can the perceived severity of a breast lump be recoded in the notes?

Graded 1-5 (most likely malignant) on:
Physical exam - P
Core biopsy - B
Cytology - C
Mammogram - M 
USS - U

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What calculator can be used in working out breast cancer prognosis. What does it importantly include and not include?

Nottingham prognostic index
Includes tumour size, grade and node involvement
Misses receptor status

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What types of non invasive breast carcinoma are there. How do they usually present?

DCIS
LCIS
present at screening with calcificaiton

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Invasive breast cancers and presentation of top two

Invasive ductal carinoma (lump)
Invasive lobular carcinoma (thickening)
Medullary
Tubular 
Inflammatory

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Imaging for a invasive lobular carcinoma

Needs an mri post biopsy as doesnt show on mammogram

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Breast cancer receptor status and treatments

Oestrogen/progesterone (ER/PR)

tamoxifen - a selective estrogen receptor antagonist used prior to menopause
aromatase inhibitor - blocks adrenal oestrogen syntheis used after menopause

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Surgical options in breast cancer

Breast - local excision with wide margins, masectomy

Axilla - sentinal node biopsy, axillary clearence

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Reasons to perform masectomy

Patient choice Multiple tumours in one breast Large tumour in comparison to breast Tumour behind nipple Previous local excision (cant have two doses of radio to one place) Prophylactic in familial if patient desires Male breast cancer

Reasons for chemo in breast cancer

Neoadjuvant to shrink allowing local rather than massectomy | Inflammatory type

Breast reconstruction types

Implant - inflate over weeks | Muscle flap - e.g lat dorsi

Disadvantage of breast reconstruction surgery

Increases healing time Longer surgery Increased infection risk Can delay adjuvant treatment

When taking a breast cancer fhx what should be asked about as well as breast cancer?

Ovarian cancer

Risk factors for ca prostate

Age Fhx Black ethnicity

Presentation of ca prostate

Nocturia Frequency of urination Advanced disease - haematuria Metastatic disease - bone pain

Causes of raised PSA

``` Cancer BPH Ejeculation (no sex for 3 days before test) UTI Urinary retention Catheterisation Prostatitis ```

What to consider with a patient on finasteride who needs a psa

First few months psa uninterpretable. After that must double psa

What two factors should be considered when considering to refer an individual with a smooth soft prostate and a raised PSA

Size of PSA vs size of prostate (PSA density) | Speed of rise of PSA (PSA velocity)

How is prostate cancer graded?

Gleason grade Looks at degree of gland formation Grade of the most common region + grade of the next most common region (1-5 + 1-5)

Treatment options for localised prostate cancer

Watchful waiting/active surveillance Prostatectomy Radiotherapy

Complication rate of prostatectomy

1/3 rd erectile dysfunction | 1/3rd urinary incontinance

Main treatment of metastasised prostate ca | How is this done? What needs to be given with it

Castration (with initial chemotherapy) LHRH agonist Androgen antagonist for 2/52 to stop initial flare

Problem with chemical castration in metastatic prostate cancer long term. Solution?

Tumours become castrate resistant. | Give chemo

Difference between watchful waiting and active surveillance

Watchful waiting - pt not suitable for active Tx - wait for symptoms Active surveillance - suitable for active Tx - follow up regularly

Risk factors for bladder cancer

``` Shistosomiasis Occupational (dyes, tar, rubber) Smokers FHx Age Male Drugs (cyclophosphamide, pioglitasone) ```

Presentation of bladder cancer

Painless frank haematuria Hydronephrosis Mass Recurrent UTI

Investigations in suspected bladder cancer

USS CT urogram Cystoscopy Urine cytology

Non muscle invasive types of bladder cancer

CIS - flat lesion - high grade TPa - peduculated lesion - low grade TP1 - invading lamina propria

Treatment of non muscle invasive bladder cancer

Diathermy / TURBT | Adjuvant intravesicular chemo or BCG

Treatment of muscle invasive bladder cancer

Fit - radical cystectomy Unfit - radical radiotherapy Metastasised - chemotherapy

What is the screening program for bowel cancer?

Faecal occult blood with colonoscopy if +ve every 2 years from 60-69 Flexi sig at 55

Symptoms of rectal cancer?

Tenesmus Frank bleeding Prolapse

Symptoms of right sided bowel cancer

``` Weight loss Anaemia Mass Appendicitis Obstruction Fistula ```

Symptoms of left sided bowel cancer

Change in bowel habits | Mixed in blood

Who should be referred under 2ww with PR bleeding

Anyone over 50 | Anyone under 50 with pain, weight loss, change in bowel habits, iron deficiency

Who should be referred under 2ww for change of bowel habits?

Anyone over 60 | Anyone under 60 with positive faecal occult blood

Someone presents with abdo pain and weight loss. Over what age should they be referred on 2ww

When should someone with anaemia be referred on 2ww for colon cancer?

60 (iron deficient) | +ve faecal occult blood (offered in iron deficient 60)

Options if a patient isnt fit for colonsocopy but is suspected of having bowel cancer?

``` Sigmoidoscopy (good for distal lesions) Contrast CT (good for large lesions) CT colonogram (good if can tolerate some prep) ```

What staging investigations should be performed in rectal cancer?

CT CAP | MRI pelvis

What are the dukes stages of colorectal cancer

A - limited to muscularis propria B - through muscularis propria C - nodes involved D - distant met

Risk factors for bowel cancer

Hereditory - fap hnpcc Dietry - low fibre, high red meat Pmh - previous cancer, ibd, cholecystectomy

What med lowers bowel cancer risk

Aspirin

When is neoadjuvant therapy used in bowel cancer?

Rectal cancers

Novel therapy that is used in bowel cancer?

Anti vegf monoclonal antibody

Surgery options for rectal cancer

Trans anal endoscopic microsurgery (tem) | Total mesorectal excision

Palliative surgical proceedures in bowel cancer

Stent Bypass Debulking resection Stoma - defunctioning