Solid Tumors

Question 1

Prostate cancer
- Risk Factors

Answer 1

Prostate cancer RFs

1. Old age
2. Black ethnicity
3. Obesity
4. BRACA 2
5. Family history

Question 2

Prostate cancer
- Histology

Answer 2

Prostate cancer

1. Adenocarcinoma
2. Peripheral zone

Question 3

Prostate cancer
- S&S

Answer 3

Prostate cancer

1. Frequency/OAB
2. Nocturia
3. Visible haematuria
4. Dribble
5. Systemic symptoms
6. Back pain

Question 4

PSA Requisites

Answer 4

PSA

1. No sex or anal sex
2. No prostate interventions
3. Range changes with age
4. No UTI
5. No vigorous exercise

Question 5

Prostate cancer screening

Answer 5

Prostate cancer screening

NHS does not recommend
opportunistic screening if patient counselled

Question 6

Prostate cancer grading and staging

Answer 6

Prostate cancer grading and staging

1. Gleason grade
   - first and second most common
2. TNM staging

Question 7

Prostate cancer
- metastasis

Answer 7

Prostate metastasis
1. Bones
2. Lymph nodes

Question 8

Prostate Cancer
DRE findings

Answer 8

Prostate DRE

1. Firm
2. Hard
3. Asymmetrical
4. Irregular

Question 9

Prostate Referral

Answer 9

Prostate Referral

1. Abnormal DRE
2. PSA

Question 10

Prostate cancer diagnosis
- Process

Answer 10

Prostate diagnosis

1. DRE/PSA
2. mpMRI (multi parametric)- Likert 5 point scoring
3. Biopsy - transperineal

Question 11

Prostate cancer
- Management

Answer 11

Prostate cancer

• Supportive
  1. Active surveillance (PSA, DRE, MRI)
• Medical
  2. GnRH Agonist (Goserelin)
  3. Androgen receptor blockers (Bicalutimide)

4. Surgical (Radical prostatectomy)
   - NB Side effects
5. Radical radiotherapy
   - External beam or Brachy therapy
6. Bilateral orchidectomy
7. Chemotherapy
   - Docetaxel

Question 12

Breast Cancer
- Grading and staging

Answer 12

Breast Cancer

1. Stage 1-4
2. Grade 1-3

Question 13

breast cancer
screening

Answer 13

mammography every 3 years aged 50-70

under 50 if:
- previous cancer
- first degree relative with cancer <50
- known BRCA1/2

Question 14

Breast cancer classification

Answer 14

most are adenocarcinomas:
- in situ / invasive
- ductal / lobular

Question 15

breast cancer risk factors

Answer 15

• female
• increasing age
• FH
• BRCA 1/2
• exposure to unopposed oestrogens:
  -> early menarche, late menopause, nulliparity etc.
• chest radiation
• obesity

Question 16

breast cancer presentation

Answer 16

• asymptomatic
• lump - usually firm, mostly painless
• nipple retraction
• skin changes - tethering or dimpling
• nipple discharge
• ulceration

Question 17

breast cancer assessment

Answer 17

triple assessment:

1. examination
2. imaging (USS or mamography)
3. biopsy

Question 18

breast cancer
Mx

Answer 18

surgery

• WLE
• mastectomy
• sentinal node biopsy

radiotherapy

• after WLE

chemo

• neoadjuvant, adjuvant or palliative

hormonal

• pre menopause - SERM - Tamoxifen
• post menopause - aromatase inhibitors - anastrozole

biological

• herceptin (trastuzumab) - if HER2 +ve

Question 19

bowel cancer
histology - most common

Answer 19

adenocarcinoma

Question 20

bowel cancer - 2 genetic mutations

Answer 20

• adenomatous polyposis (ANP)
• hereditary nonpolyposis colorectal cancer (HNPCC)

Question 21

bowel cancer
- risk factors

Answer 21

• increasing age
• male
• FH
• IBD
• low fibre diet
• high processed meat intake
• smoking, alcohol

Question 22

bowel cancer
- Ix

Answer 22

• gold standard: colonoscopy with biopsy
• staging: CT, MRI rectum, endo-anal ultrasound

Question 23

Bowel Cancer
- Grading

Answer 23

Bowel Cancer
- Grade 1-3

Question 24

Bowel cancer
- Staging

Answer 24

Bowel cancer staging

1. TNM
2. Stage 1-4
3. Dukes A-D
   TNM 1-4 equivalent

Question 25

lung cancer - epidaemiology

Answer 25

3rd most common cancer commonest cancer death

Question 26

lung cancer - risk factor

Answer 26

- smoking - silica - asbestos - family history - radiation to chest - air polution - COPD, fibrosis, TB, HIV

Question 27

lung cancer - histology

Answer 27

- small-cell lung cancer (20%) - release neuroendocrine hormones - can cause paraneoplastic syndromes - non-small cell lung cancer (80%) - adenocarcinoma (40%) - squamous cell carcinoma (20%) - large-cell carcinoma (10%) - other types (10%) - mesothelioma - affects mesothelial cells of the pleura - liked to asbestos inhalation - poor prognosis - latent period between exposure and development of cancer

Question 28

lung cancer - presentation/red flags

Answer 28

- SOB - cough - unexplained cough lasting more than 3 weeks - haemoptysis - finger clubbing - recurrent pneumonia - weight loss - lymphadenopathy - lethargy - weakness - hoarseness - dysphagia - chest pain - wheeze - fever

Question 29

name 4 extrapulmonary manifestations of lung cancer

Answer 29

- recurrent laryngeal nerve palsy - SVCO - horner's syndrome - SIADH

Question 30

lung cancer - Ix

Answer 30

- CXR first line - staging CT - PET CT biopsy: - ultrasound guided endobronchial biopsy - CT guided transthoracic

Question 31

lung cancer - general management

Answer 31

non-small cell - surgery - first line for non-small cell - if disease isolated - radiotherapy can also be used for non-small cell if inoperable - adjuvant/palliative chemo small-cell - chemo and radiation - prognosis worse