Surgical Oncology Flashcards
What are the hallmarks of cancer development?
List tumour markers and the tumours they are associated with.
CEA - CRC, (can also be elevated in breast, pancreatic, ovary, lung, gastric, thyroid and in smokers)
Ca 19-9 - pancreatic
Ca125 - ovarian
AFP - hepatic (+ yolk sac ov ca).
HCG - testicular
Chromogranin A - NETs/carcinoid
Calcitonin - thyroid (medullary)
PSA - prostate
LDH - melanoma
List the most common metastasis site for each of the following:
- breast
- colorectal
- pancreatic
- melanoma
- sarcoma
- breast > lung
- colorectal > liver + lung
- pancreatic > liver + lung
- melanoma > lung
- sarcoma > lung
List the most common primary cancer for the following metastasis site for each of the following:
- small intestine
- skin
- bone
- ovary
- adrenal
- small intestine >melanoma
- skin > breast or melanoma
- bone > breast
- ovary - GIT/ gastric (krukenberg)
- adrenal - lung + breast
What cancer is most likely to give a ‘st marys joseph node’
Pancreatic cancer
What is tumour lysis syndrome?
AS a tumour lyses (breaksdown) with chemotherapy or radiation treatment the spillage of cell contents including purines and pyrimidines leads to electrolyte abnormalities.
Treated with IVF, Allopurinol and Rasburicase if required and sometimes dialysis.
How does radiation therapy work?
- Damages DNA
- Cells most vulnerable in the M phase and therefore cells rapdily cycling as in cancer are relatively more vulnerable than native tissue.
- Creates oxygen radicals that induce apoptosis
- effect best in higher oxygen levels so best preop and in smaller tumours that haven’t outstripped their blood supply.
What are the potential side effects of radiation therapy?
Early:
- dermatitis (graded 1,2,3 on severity (dry, wet, full thickness necrosis)
- fatigue
Late:
- radiation induced angiosarcoma (RIAS)
- location dependent e.g. pulmonary fibrosis in chest/breast radiotherapy
What are the delivery options for radiotherapy?
External beam radiation
Internal delivery via radioactive implant e.g. brachytherapy or seed or ingested radioactive liquid e.g. radioisotope Iodine 131 for thyroid ca.
What could pathology be in enlarged lymph nodes?
Depends.. but broadly speaking:
Benign or malignant (primary or metastatic)
Benign:
- infective bacterial or viral/reactive
e.g. TB, cat scratch fever, mononucleosis, cellulitis, toxoplasmosis, HPV, Hepatitis, HIV, CMV
- medication induced e.g. phenytoin, cephalosporins
- reactive to recent vaccine
- recent transplant or blood transfusion
Malignant:
Primary:
- Nonhodkgins lymphoma
- Hodgkins lymphoma
Secondary:
Mets from a number of different primary options:
Neck - H&N cancers, skin
Axilla - Breast, skin
Supraclav - gastric, skin, breast
Paraaortic - testicular, CRC
Portal - cholangio, panc, hepatic, CRC
Iliac - anal, CRC, skin
Inguinal - skin, anal
https://www.aafp.org/pubs/afp/issues/1998/1015/p1313.html
When sending off a lymph node to the lab why must it be sent fresh?
A fresh sample (unlike a formalin preserved one) can undergo the following testing:
- flow cytometry
- imprinting
- DNA and RNA testing more accurate
- Next generation sequencing
- Chromosomal analysis
What is the pathophysiology of malignant ascites formation?
Multifactorial. May be due to lymphatic or venous obstruction, oncotic shifts or enhanced vascular permeability due to diffuse cytokine release.
How is malignant ascites managed?
Management of symptoms (largely due to pressure effect on organs):
- diuretics
-> drainage
- therapeutic peritonitic taps (paracentesis)
- peritonitic drain
- peritonitic vascular shunt
Management of cancer:
- HIPEC
- treatment of primary
Management of complications:
- antibiotics in SBP
What are the malignancies that most commonly cause a malignant ascites?
- ovarian
- peritoneal mets e.g. from mucinous adenocarcinoma or goblet cell adenocarcinoma as examples
- CRC
- HPB
- oesophagogastric
