Solid organ malignancy

Question 1

treatment

Answer 1

micrometastase will be the fatal component of cancer
present at diagnosis
therefore cancer will need extra therapy - chemo/radio
eg lumpectomy are used rather than radical mastectomy as no improvement in prognosis

Question 2

platinum

Answer 2

toxic to cells as they divide

still used now to prevent proliferation

Question 3

diagnosis

Answer 3

40% of cancer diagnoses in >75yo are made via emergency department
for most patients they notice a change in normal function

Question 4

transcoelomic spread

Answer 4

cancer cells in the abdomen spread via the ascitic fluid present in everyone
will travel upwards via paracolic gutter, and cascade over the omentum and downwards, spreading the cancer

Question 5

lymph nodes

Answer 5

always check for local lymph node involvement in a cancer diagnosis/suspicion

NB testicular cancer involves para-aortic lymph nodes, not inguinal

Question 6

paraneoplastic effects

Answer 6

humoral: tumour secreting a substance (eg ACTH) which causes the effect. will improve after the tumour is removed
immunological: tumour presents an antigen to which the immune system produces an antibody which then reacts with self. can cause problems after the cancer has been treated

Question 7

targets

Answer 7

2 week wait
Tx must start within 31 days of agreeing with patient
Tx must start within 62 days of initial GP referral

trust fined £37k per breach of targets pro rata depending on where delay occurs

Question 8

carcinoma of unknown primary

Answer 8

patient presents because of mets, but primary site cannot be identified

due to:
early dissemination
clinical absence of primary
etc

tends to be unpredictable and aggressive, and the primary does not cause symptoms

2.3-4.5% of all cancers
half of patients have multiple sites of involvement

even after autopsy, 70% of primaries remain unknown. therefore investigations are not always as useful as just starting Tx

classified based on light microscopy:
well-moderately differentiated adenocarcinoma
poorly/undifferentiated adenocarcinoma (better prognosis)
squamous cell carcinoma
neuroendocrine carcinoma

limited life expectancy, median survival 6-9 months

1. search for primary site
2. rule out potentially curable/treatable cancers
3. characterise pathological entity and then treat the patient. may be curative or palliative