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Solid malignancy Flashcards

1
Q

What are the RF of prostate cancer?

A
  • Increasing age
  • FH
  • African heritage
  • BRCA2 gene mutation
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2
Q

What are the CF of prostate cancer?

A

LUTS
Asymptomatic - raised PSA
Bone pain - mets
Ejaculatory sx eg. blood in semen - rare

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3
Q

What are the ix into prostate cancer?

A

DRE
PSA - poor ix, mets unlikely if <10
MRI prostate/pelvis - often pre biopsy to decide technique, also if no suspicious areas don’t need biopsy
Biopsy - transperineal most commonly, for Gleason grading

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4
Q

What are some common causes of raised PSA?

A

Prostate cancer
UTI - dip
Prostatitis
Enlarged rpostate eg. BPH
Acute urinary retention

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5
Q

What factors influence treatment of prostate cancer?

A

Age
DRE - staging - localised, locally adv or advanced
PSA
Biopsies - Gleason grade
MRI - nodes or mets ? and bone scan

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6
Q

What is the treatment of metastatic prostate cancer?

A

Hormones - enzalutamide = androgen R antagonist, GnRH agonist or bilat orchidectomy
Palliation - single dose RT for bone pain, bisphosphonates

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7
Q

What is the treatment for locally advanced prostate cancer?

A

Radical radiotherapy w adjuvant hormones
External beam RT? Procitis is complication
Brachytherapy - seeds inside ?

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8
Q

What is the treatment for localised prostate cancer?

A

Active surveillance
Curative - radical prostatectomy, RT, incontinence or erectile dysfunc r the complications
Palliative - deferred hormones, watchful waiting

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9
Q

What are the differential diagnosis for haematuria?

A

Cancer - RCC, TCC bladder, prostate cancer
Stones
Infection and inflam
BPH
Glomerular eg. nephritic syndrome

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10
Q

What are the ix into haematuria?

A

Flexible cystoscopy
USS of kidney
Urine cytology

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11
Q

What is the presentation of testicular cancer?

A

Painless lump in the body of the testis - 2WW. Most are germ cell tumours - hx of undescended testis

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12
Q

What are the ix into testicular cancer? How do you treat?

A

Urgent USS of scrotum
Tumour markers - aFP, hCG, LDH
Treat - inguinal orchidectomy

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13
Q

What are the RF of bladder cancer? TCC

A

Smoking
Occupational exposure - rubber or plastics manufacture, handling crude oil, carbon, painting, mechanics, hairdressers
Male more than women

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14
Q

What are the ix into bladder cancer? How is it treated?

A

Cystoscopy - treat w TURBT
Can sometimes give single intravesical dose of chemo eg. mitomycin
High risk - intravesical BCG to create immune response
Mets - cisplatin based chemo
Biologicals

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15
Q

What is the treatment of upper tract TCC?

A

Nephro ureterectomy

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16
Q

What are the RF of RCC

A

Male and white
Smoking
Obesity
Dialysis

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17
Q

What is the presentation of RCC?

A

Haematuria
Incidental finding on imaging
Palpable mass - vv rare

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18
Q

What is the treatment of RCC?

A

Surveillance
Excision - partial or radical nephrectomy
Mets - palliative, biologicals and targeted therapies

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19
Q

What are sx of lung cancer?

A

Unexplained cough >3w
Haemoptysis
SOB
Hoarse, dysphagia
Chest pain, wheeze
B sx

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20
Q

What are some signs of lung cancer?

A

SVC obstruction
DVT
Clubbing
Horner’s syndrome

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21
Q

Where does lung cancer met to most commonly?

A

Other lung or other lung lobe
Liver, brain, bone, adrenal glands

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22
Q

What are the ix into lung cancer?

A

Biopsy + histology
Bloods - FBC (infection, anaemia), U+E (contrast CT), Ca (bone profile, paraneoplastic syndrome), LFTs (tests and mets), INR (tests)
CXR - hilar enlargement, pleural effusion, collapse, opacity
Staging - CT thorax, abdo, pelvis w contrast

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23
Q

What are the options for biopsy in lung cancer?

A

US guided neck node core for cytology - least invasive
Nothing in the neck - bronchoscopy = EBUS
CT biopsy if peripheral mass
Sputum sample for cytology
Pleural effusion - thoracoscopy

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24
Q

What are the ix into malignant pleural effusion?

A

Bloods - FBC, U+E, CRP, INR, LFT
US guided diagnostic aspirate - protein, LDH, cytology, microbiology
-ve cytology - medical thoracoscopy
If you have pleural effusion in lung cancer normally have non curative treatment.

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25
What is Light's criteria?
Transudate = protein <0.5, LDH <0.6 Causes - congestive HF, hypoalbuminaemia - cirrhosis, nephrotic syndrome Exudate = protein >0.5, LDH >0.6 Causes - malignancy, PE, infection, autoimmune
26
What is done w incidental lung nodules?
5mm + = follow up 8mm + = active intervention 20mm + = cancer clinic
27
What are the different types of lung cancer?
80% Non small cell lung cancer - SCC, large cell, adenocarcinoma 40% 20% small cell lung cancer - linked with smoking
28
What is the treatment of hypercalcaemia?
>3 = treat IV fluids - see if reduces Ca Pamidronate one off reduces Ca
29
What is WHO performance status?
0 - fully active w/o restriction 1 - restricted in physically strenuous activity, able to carry out light work 2 - capable of self care but can't work 3 - limited self care, seated/bed >50% time 4 - completely bed bound 5 - dead
30
Where does prostate cancer most affect?
Peripheral zone
31
What are some risks of prostate biopsy?
Pain False -ve - miss cancerous area Bleeding in stools, urine and semen Infection Urinary retention Erectile dysfunc
32
What are the RF of lung cancer?
Smoking and second hand smoke Prev lung disease Asbesto or radon exposure FH
33
What is the management of NSCLC?
1st line = surgery = lobectomy, segmentectomy or wedge resection if isolated disease, curative RT can be curative if early disease Adjuvant chemo after surgery or palliative
34
What is the management of SCLC?
Chemo (cisplatin based) and RT - much worse prognosis than NSCLC
35
What are the ix prior to surgery for NSCLC?
LFT - determine the type of surgery and can predict post op lung func
36
What are the extrapulm manifestations of lung cancer?
RLN palsy Phrenic nerve palsy = SOB SVCO Paraneoplastic syndrome - SIADH and Cushing's syndrome = SCLC, hypercalcaemia = SCC Limbic encephalitis Lambert Easton syndrome Horner's = pancoast tumour
37
What is referral guidance for lung cancer?
2WW referral: - Suggestive CXR and unexplained haemoptysis >40 - Recurrent chest infection or clubbing or supraclav LA >40 - >40 and have smoked w sx of lung cancer
38
What staging is used for lung cancer?
TMN
39
What is the prognosis for lung cancer?
Biggest cause of cancer related death in UK 1 year survival ~40%, 5 year survival ~16%
40
What are some differentials for breast lumps?
- Breast cancer - Fibroadenoma - Fibrocystic breast changes - Breast cysts - Fat necrosis - Lipoma - Galactocele - Phyllodes tumour
41
What are the RF of breast cancer?
- Female - Increase O exposure eg. COCP, HRT, long time w periods - Glandular breast tissue - Obesity and smoking - FH
42
What hereditary syndromes predispose someone to breast cancer?
BRCA 1 - 60-80% risk breast cancer BRCA 2 - 45-70% risk breast cancer Also increase risk of breast cancer in men
43
What are the types of breast cancer?
Ductal or lobular carcinoma in situ - pre cancerous or cancerous cells not breached the BM, can spread Invasive ductal (most common) or lobular carcinoma Inflam breast cancer Paget's disease of the nipple
44
What is inflam breast cancer?
~1-3% of breast cancers Looks like breast abscess or mastitis - swollen, warm, ternder breast w pitting skin = peau d'orange Doesn't respond to abx Worst prognosis
45
What is Paget's disease of the nipple?
Erythematous scaly rash - looks like eczema of the nipple Indicates breast cancer involving the nipple
46
What screening is there for breast cancer?
50-71 years old women, transmen and transwomen on HRT have a mammogram Satisfactory - no evidence of breast cancer Abnormal - need further ix Unclear - need further ix
47
What are the CF of breast cancer?
Asymptomatic Lump - irregular, hard/firm, fixed Breast pain Change to skin appearance, pitting, tethering Nipple inversion or discharge Features of mets
48
What is triple assessment in breast cancer?
1. Hx and exam 2. Imaging - mammogram and US 3. Biopsy - FNA or core biopsy
49
What are the other ix into breast cancer?
CXR MRI breast CT chest abdo pelvis w contrast ±CT brain ±Liver USS ±Bone scan ±PET/CT
50
What is the tumour marker for breast cancer?
Ca 15-3
51
What receptors are there in breast cancer?
Oestrogen Progesterone HER2 - can have herceptin, ab that blocks HER2 pathway
52
What is the screening for breast cancer?
Normal pt - mammogram every 3 years for women aged 50-70 High risk pt - annual mammogram for high risk pt Can have chemoprevention, genetic counselling and pre test counselling, bilat mastectomy or oophorectomy also
53
What pt are at high risk of breast cancer?
1st degree relative w breast cancer <40 years 1st degree male relative w breast cancer 1st degree relative w bilat breast cancer <50 years x2 1st degree relatives w breast cancer
54
What chemoprevention is offered for high risk women?
Tamoxifen - pre menopausal Anastrozole - post menopausal
55
What surgery options are there in breast cancer?
- Tumour removal - breast conserving surgery or mastectomy w breast recon - Axillary clearance
56
What are the hormone treatments used in breast cancer?
1. Tamoxifen - pre menopausal 2. Aromatase inhib - post menopausal eg. letrozole Both block O production, given for 5-10 years in women w O R +ve breast cancer
57
What targeted treatments are used in breast cancer?
HER2 R targetters - herceptin, perjeta
58
What are the RF of colorectal cancer?
FH FAP and HNPCC/Lynch syndrome IBD Increased age Diet w lots of red meat, processed meat and not much fibre Obesity and sedentary lifestyle Smoke and alcohol
59
What are the red flags for bowel cancer?
Change in bowel habit Unexplained weight loss Rectal bleeding Unexplained abdo pain Fe def anaemia Mass
60
What is the 2WW criteria for cancer referral?
>40 years w abdo pain and unexplained weight loss >50 years unexplained rectal bleed >60 years w change in bowel habit or Fe def anaemia
61
What is bowel cancer screening?
FIT - faecal immunochemical test in 60-74 years every 2 years Tests for human Hb in stool, +ve - colonoscopy
62
What are the ix into bowel cancer?
Colonoscopy - gold standard, can biopsy Sigmoidoscopy - when only rectal bleeding CT colonography CT AP thorax w contrast - staging CEA = tumour marker
63
What is the management of bowel cancer?
Surgical resection - w stoma or anastomosis formation Chemo RT Palliative care
64
What are the different surgeries in bowel cancer?
R hemicolectomy - caecum, ascending and proximal transverse colon L hemicolectomy - distal transverse and descending colon High ant resection - remove simoid colon Low ant resection - remove sigmoid colon and upper rectum APR - removes rectum and anus Hartmann's - emergency, remove recto sigmoid colon and colostomy formation
65
What are the complications of bowel cancer surgery?
Bleed, infection, pain, VTE Damage to neighbouring structures Post op ileus Anaesthetic risks Failure of anastomosis, need stoma Failure to remove tumour Adhesions Incisional hernias
66
What is low ant resection syndrome?
Urgency and freq of bowel movements Faecal incontinence Difficulty controlling flatulence
67
What are some tumour markers?
CEA - bowel cancer Ca 125 - ovarian cancer Ca 19-9 - pancreatic cancer Ca 15-3 - breast cancer AFP - hepatocellular and testicular PSA - prostate
68
What is the most common type of head and neck cancer and where is it?
SCC Nasal cavity Paranasal sinuses Mouth Salivary glands Pharynx Larynx
69
What are the RF of head and neck cancer?
Smoke Chewing tobacco or betel leaves Alcohol HPV EBV
70
What are the red flags of head and neck cancer?
Lump in mouth or lip Unexplained ulceration of mouth >3 weeks Erythroplakia Erythroleukoplakia Persistent neck lump Unexplained hoarse voice Unexplained thyroid lump
71
What is the treatment of head and neck cancer?
Chemo, RT, surgery, palliation Cetuximab
72
What are the RF of BCC?
Long term UV exposure Prev BCC UVA therapy for psoriasis Skin type 1 Immunosuppression Genetic syndromes - xeroderma pigmentosa
73
What are the CF of BCC?
In areas of the body that get lots of sunlight - head, neck, hands, ears Small slow growing lesions Raised pearly edges Telangiectasia ASymptomatic
74
What are the ix into SCC and BCC?
Dermatoscope examination Excision biopsy
75
What is the management of BCC?
Imiquimod cream 5 flurouracil cream Cryotherapy, curettage Excision - margins 3-5 mm ±skin graft Can do Mohs' micrographic surgery
76
What prevention advice is given for skin cancer?
Avoid sunbeds Use SPF50 all year Protective clothing - hats etc, sit in shade
77
What are the RF of SCC?
Prolonged UV exposure Chronic wounds and inflam Immunosuppression Pre malignant conditions eg. AK, Bowen's disease Smoking
78
What are the CF of SCC?
Nodular, indurate, keratinised Ulcerated Bleeding/itchy Growing quickly Sun exposed sites
79
What is Bowen's disease?
Growth of cancerous cells confined to outer layer of skin - SCC in situ Small red scaly lesion, normally flat and treated w topicals
80
What is the management of SCC?
Excision Low risk - 4mm margin High risk - 6mm v high risk - 10mm
81
Which areas are most commonly affected by melanoma and where does it met to?
Trunk and legs Mets - every tissue and organ in body ! can met to anywhere
82
What are the RF of melanoma?
UV exposure Genetic mutations Premalignant lesions Prev melanoma Age Caucasian >50 naevi Sunbeds Type 1 and 2 skin
83
What are the CF of melanoma?
New naevus or change to existing mole Bleed/ulcer Asymmetrical Irreg border Uneven colour Diameter >6mm Evolving lesion LN involvement
84
What are the ix into melanoma?
Excision biopsy to diagnose Staging CT CAP - TNM
85
What can help to determine met risk in melanoma?
Breslow thickness

Cancer care (6 decks)

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