The Big 4

Question 1

Risk factors for breast cancer?

Answer 1

Prolonged oestrogen exposure:

• early menarche, late menopause
• nulliparity/ late first child
• use of HRT
• prolonged use of OCP

BRCA 1/2 (defect in tumour suppressor gene)
Alcohol excess, smoking, obesity

Question 2

What is the breast cancer screening service?

Answer 2

Women aged 50 - 70yrs
Every 3 years, invited for a mammogram
^^risk - can go before 50
After age of 70, can request their own appointments

Question 3

What constitutes a triple assessment?

Answer 3

1) breast examination
2) core needle biopsy + histopathology
3) Imaging –> mammogram/USS/CT/MRI

Question 4

Markers of breast cancer?

Answer 4

ER - oestrogen
PR - progesterone
HER2 - cell surface receptor controlling cell growth and division

Ca 15.3
CEA - carcinoembryonic antigen

Question 5

Sites of oestrogen synthesis

Answer 5

Pre-menopausal –> ovaries

Post-menopausal –> adipose tissues - extra-ovarian

Question 6

What options are their to combat oestrogen driven cancers?

Answer 6

Tamoxifen - block oestrogen
Oophorectomy - remove source
Aromatase inhibitors - block extra-ovarian synthesis (anastrozole, letrozole)

Question 7

Negatives of Tamoxifen therapy?

Answer 7

Moos changes, vaginal discharge, low libido
^ risk of endometrial cancer
^ risk DVT/Stroke

Question 8

Negatives of aromatase inhibitors?

Answer 8

Mood changes, vaginal dryness, low libido
lowers bone density
arthralgia/myalgia

Question 9

What is lynch syndrome?

Answer 9

Hereditary nonpolyposis colorectal cancer
Autosomal dominant inheritance

50-70% lifetime risk of colorectal cancer
80% lifetime risk of endometrial cancer

Question 10

Describe the bowel screening programme

Answer 10

Every 2 years for men/women aged 60 - 74

3 separate samples sent for fecal occult blood (FOB)

Question 11

Describe dukes staging of colon cancer

Answer 11

A - confined to bowel wall
B - through bowel wall, but no nodes involved
C - involves local nodes
D - distant mets

Question 12

Management of colon cancer

Answer 12

Surgical resection of tumour - hemicolectomy, anterior resection
+ chemo/radio if needed

6 monthly CEA
CT scan at 18 months, 3 and 5 years
colonoscopy within 12 months and 3 years after that

Question 13

Types of lung cancer?

Answer 13

Adenocarcinoma (50%) - of alveoli
Small cell carcinoma - neuroendocrine cells
Squamous cell carcinoma (bronchi)
Large cell carcinoma (large neuroendocrine cells)

Question 14

How can Lung cancer cause Cushing’s syndrome

Answer 14

Small cell lung cancer —> Ectopic ACTH production –> Cushing’s syndrome

Question 15

What is Pancoast’s tumour

Answer 15

Apical lung tumour
–> sympathetic chain compression –> Horner’s syndrome

Miosis, ptosis, anhidrosis

Question 16

Investigations in prostate cancer

Answer 16

PSA - prostate specific antigen - raised by many things
TRUS - trans-rectal US guided biopsy
- can cause rectal discomfort, blood in urine/semen, infection and sepsis

Question 17

Describe the Gleason grading system

Answer 17

Grades minor and major tissue architecture from 2 - 5, then added together

E.g. Gleason 3 + 3 (6) = low grade
Gleason 3 + 4 (7) = intermediate grade
Gleason 4 + 4 (8), or 5 + 5 (10) = high grade

Question 18

Management options for prostate cancer, and +ves / -ves

Answer 18

Surgical resection - good if <70yrs, not comorbid. -ves - long term risk of incontinence/impotence

Brachytherapy - fit men, not comorbid. -ves - avoid if large prostate, urinary symptoms

Radiotherapy - non-invasive, good if comorbid. -ves - risk of long term bowel problems, not curative

Question 19

Indication and side effects of Androgen Deprivation Therapy (ADT)

Answer 19

For sclerotic bone mets in prostate cancer
SEs
Hot flushes, sexual dysfunction - shrinkage of penis/testicles
loss of muscle bulk and strength
memory effects and mood disturbance
weight gain, risk of DM
osteoporosis and fractures
CVD