solid organ malignancy Flashcards
what tests can be be done on ascitic fluid in a patient suspected of cancer?
albumin cytology glucose LDH microscopy, culture, sensitivity pH
how can you tell that a distended abdomen is due to ascites?
everted umbilicus in a normally inverted one
in a patient that presents with confusion, what serum investigation do you want to do?
calcium BM LFTs U&Es FBC
difference between corrected calcium and ionised calcium and total calcium?
calcium binds to albumin in the blood. depending on albumin levels, measured calcium can be interpreted wrongly. always interprete corrected calcium as that accounts for albumin levels
what should be done for hypercalcaemia?
hydration IV saline
bisphoshonates
haloperidol can be used as an anti-emetic, t or f
t
how to find out normal range of ESR based on age?
(age + (10 if female))/2
what type of cancers would raised AFP and Beta HCG suggest?
germ cell cancer
what would MCV be in iron deficiency anaemia?
microcytic
what kind of MCV anaemia would u get in chronic gi bleed
microcytic anaemia
what types of screening programs are there in UK, and the ages
cervical - 25
breast - 50
colon - 60
what causes transudates
organ failure - heart, liver, kidney
what causes exudates
infection, inflammation, cancer
what is a carcinoma of unknown primary?
when cancer presents with symptoms from mets, before primary site is found
difference between carcinoma of unknown primary and primary tumours
early dissemination
more aggressive
unpredictable metastatic pattern
absence of symptoms from primary tumour
4 classifications of carcinoma of unknown primary by cytology
adenocarcinoma - well differentiated
adenocarcinoma - poor/undifferentiated
squamous cell carcioma
undifferentiated carcinoma
most common cytology of carcinoma of unknown primary
well-moderately differentiated adenocarcinoma
approach to carcinoma of unknown primary?
find primary
exclude curable cancers
characterise specific aetiology of symptoms
decide treatment aim - curative or palliative
where do carcinoma of unknown primary present commonly?
screening, of if over 75 years old, 40% present at A&E
symptoms of carcinoma of unknown primary
symptoms localised to mets, lumps, mass, obstruction, ulceration,
systemic symps - weight loss, fatigue, fever, paraneoplastic effects
common endocrine paraneoplastic effects of carcinoma of unknown primary
cushings due to ACTH
SIADH due to vasopressin
hypercalcaemia due to PTHrP
how to investigate carcinoma of unknown primary (standard)
full exam incld breast, rectal, pelvic, head/neck
FBC, biochem, LFTs, calcium, urinalysis, FOB
CXR, other Xrays
CT thorax, abdomen, pelvis
specialised tests in investigating carcinoma of unknown primary
endoscopes
biopsies
cancer markers
whole body PET-CT
what can immunohistochemistry identify in investigating carcinoma of unknown primary
neuroendocrine tumours lymphomas germ cell tumours melanomas sarcomas embryonal malignancies