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My MRCP > Types of cancer > Flashcards

Types of cancer Flashcards

1
Q

What are carcinoma

A

Cancer that begins in epithelial tissue

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2
Q

What are examples of adenocarcinoma [2]

A

Glandular epithelium

  • Stomach
  • Intestine
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3
Q

What are SCC [5]

A

Affects squamous epithelium

  • Cervix
  • Anus
  • Head and neck
  • Skin
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4
Q

What are TCC [4]

A

Uroepithelium

  • Renal pelvis
  • Ureter
  • Bladder
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5
Q

What is a sarcoma [6]

A

Begins in mesenchyme

  • Bone
  • Cartilage
  • Fat
  • Muscle
  • Blood vessels
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6
Q

What is leukaemia / lymphoma

A

Leukaemia - starts in blood forming tissue e.g. marrow

Lymphoma - begin in cells of immune system

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7
Q

What are germ cell tumour

Classification

A

Originate from germ cells in testis or ovaries

  • Seminoma
  • Non seminoma
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8
Q

How does cancer spread [4]

A

Direct
Lymphatic to regional LN - follow vascular
Haematenous
Trans-coleomic ( across body cavity e.g. pleura -> peritoneum -> pericardium)

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9
Q

What modalities of treatment are available in cancer [3]

A

Local
Regional
Systemic

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10
Q

What is BRCA 1 and 2 linked with

A

BRCA 1 - breast and ovarian
BRCA 2 - prostate, breast and ovarian

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11
Q

Aflatoxin produced by Aspergillus

A

Liver HCC

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12
Q

Aniline dyes

A

Bladder TCC

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13
Q

Asbestos

A

Mesthelioma

Bronchial

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14
Q

Nitrosamine

A

Oesophageal

Gastric

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15
Q

Vinyl chloride

A

Hepatic angiosarcoma

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16
Q

Monoclonal AB
Ca125
Ca 19-9
Ca 15-3

A

Ovarian
Pancreatic
Breast

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17
Q 
Tumour antigen 
PSA
AFP
CEA
S-100
Bombesin
A 
PSA = prostatic
AFP = HCC or teratoma
CEA = colorectal
S-100 = melanoma / schwanomma
Bombesin = SCLC / gastric / neuroblastoma
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18
Q

Calcitonin

ADH

A

Calcitonin: Medullary thyroid

ADH > SIADH - lung cancer

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19
Q

Lymphatic drainage in cancer
Superficial inguinal LN [6]
Deep inguinal

A
  • Superficial inguinal: anal canal below pectinate line, perineum, thigh skin, penis, scrotum, vagina
  • Deep inguinal: glans penis
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20
Q

Para-aortic
Axillary
Coeliac

A
  • Para-aortic: testes, ovaries, kidney, adrenal gland
  • Axillary: lateral breast, upper limb
  • Coeliac: stomach
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21
Q

What are the three histological subtypes of testicular cancer?

A

choriocarcinoma, yolk sac tumour, and teratoma.

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22
Q

What are the two sex cord stromal tumours?

A

The two sex cord stromal tumours are Leydig cell tumour and Sertoli cell tumour.

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23
Q

What are the features of choriocarcinoma?

Biochemical and prognosis

A

Choriocarcinoma is the most aggressive testicular cancer subtype, with widespread metastases via blood, very high βHCG, and does not produce αFP.

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24
Q

What are the features of yolk sac tumour?

definition, biochemical

A

yolk sac tumour produces αFP and is a tumour with tissue or organ components resembling normal derivatives of more than one germ layer.

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25
Q

What are the features of teratoma?

median age of diagnosis, prominent features

A

Teratoma is diagnosed at a median age of 40-50 years and can be virilising or feminising, with precocious puberty.

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26
Q

What are the features of Leydig cell tumour?

A

Leydig cell tumour is virilising, with associated precocious puberty.

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27
Q

What are the features of Sertoli cell tumour?

associated with what genetic syndrome, main clinical feature

A

Sertoli cell tumour is feminising, more commonly associated with Peutz-Jeger syndrome.

28
Q

What are the three histological subtypes of ovarian cancer?

A

The three histological subtypes of ovarian cancer are high grade serous, endometrioid, and clear cell.

29
Q

What are the features of high grade serous ovarian cancer?

Genetic mutation associated with this cancer

A

High grade serous ovarian cancer is the most common subtype, accounting for up to 80% of ovarian cancers.
BRCA1 or 2 mutations are present in up to 10% of patients.

It is usually diagnosed at an advanced stage and has a poor prognosis.

30
Q

What are the features of endometrioid ovarian cancer?

associations, stage at diagnosis, prognosis

A
  • diagnosed at an early stage with a good prognosis
  • is associated with MSI, Lynch syndrome, and endometrial cancer.

Endometrioid ovarian cancer accounts for 10% of ovarian cancers

31
Q

What are the features of clear cell ovarian cancer?

Ethnicity, genetic mutations associated with

A

Clear cell ovarian cancer accounts for 5-10% of ovarian cancers, is more common in East Asia, and is associated with MSI and Lynch syndrome. It is less sensitive to platinum chemotherapy.

32
Q

What is HER2 assay commonly used for in oncology

A

Breast cancer and gastroesophageal cancer; predicts response to anti-HER2 therapy (e.g. trastuzumab).

33
Q

What cancer is associated with KRAS or NRAS mutation?
What cancer is associated with BRAF mutation?
What cancer is associated with EGFR mutation?

A
  • KRAS or NRAS - colorectal cancer
  • Lung adenocarcinoma - EGFR mutation
  • BRAF mutation - BRAF mutation
34
Q

What are the three main histological subtypes of lung cancer?

A

Squamous NSCLC
Adenocarcinoma NSCLC
SCLC

35
Q

What are the characteristics of squamous NSCLC?

A

Central location
Cavitating
Associated with hypercalcaemia

36
Q

What are the characteristics of adenocarcinoma NSCLC?
What does large cell carcinoma secrete?

genetic associations

A

NSCLC Adenocarcinoma
* Peripheral location
* More common in non-smokers
* Associated with EGFR mutation, ALK, ROS and RET translocations

Large cell carcinoma
* typically peripheral, may secrete beta-HCG

37
Q

What are the characteristics of SCLC?

A

Rapidly proliferating
Frequent brain metastases

38
Q

What are the four main histological subtypes of renal cancer?

A

Clear cell (proximal tubule)
Papillary (proximal tubule)
Chromophobe (collecting ducts)
Oncocytoma (collecting ducts)

39
Q

Lung cancer: non-small cell management

what % suitable for surgery, modes of treatment [3]

A
  • only 20% suitable for surgery
  • mediastinoscopy performed prior to surgery as CT does not always show mediastinal lymph node involvement
  • curative or palliative radiotherapy
  • poor response to chemotherapy
40
Q

SCLC: features

Name 3 secretions that can happen and their consequences. Lambert eaton?

A
  • usually central
  • arise from APUD cells
  • associated with ectopic ADH, ACTH secretion
  • ADH → hyponatraemia
  • ACTH → Cushing’s syndrome
  • ACTH secretion can cause bilateral adrenal hyperplasia, the high levels of cortisol can lead to hypokalaemic alkalosis
  • Lambert-Eaton syndrome: antibodies to voltage gated calcium channels causing myasthenic like syndrome
41
Q

APUD cells

A

an acronym for
Amine - high amine content
Precursor Uptake - high uptake of amine precursors
Decarboxylase - high content of the enzyme decarboxylase

42
Q

SCLC Management

A

Management
* usually metastatic disease by time of diagnosis
* patients with very early stage disease (T1-2a, N0, M0) are now considered for surgery. NICE support this approach in their 2011 guidelines
* however, most patients with limited disease receive a combination of chemotherapy and radiotherapy
* patients with more extensive disease are offered palliative chemotherapy

43
Q

What are the characteristics of clear cell renal cancer?

also known as hypernephroma

A
  • accounts for 85% of primary renal neoplasms.
  • Frequent loss of chromosome 3p
  • Associated with von Hippel-Lindau gene alterations, tuberous sclerosis, ADPKD.
44
Q

Renal cell cancer

name the classical triad, name 3 endocrine effects

A

classical triad:
* haematuria
* loin pain
* abdominal mass
pyrexia of unknown origin
endocrine effects
* may secrete erythropoietin (polycythaemia)
* parathyroid hormone-related protein (hypercalcaemia), renin
* ACTH

45
Q

Associated syndromes with RCC

[3]

A

paraneoplastic hepatic dysfunction syndrome
varicocele
* majority are left-sided
* caused by the tumour compressing veins
Stauffer syndrome
* a paraneoplastic disorder associated with renal cell cancer
* typically presents as cholestasis/hepatosplenomegaly
* it is thought to be secondary to increased levels of IL-6

46
Q

RCC - T1 vs T2 staging

A

T1 Tumour ≤ 7 cm and confined to the kidney
T2 Tumour > 7 cm and confined to the kidney

47
Q

RCC - T3 vs T4 staging

A

T3 Tumour extends into major veins or perinephric tissues, but not into the ipsilateral adrenal gland and not beyond Gerota’s fascia
T4 Tumor invades beyond Gerota’s fascia (including contiguous extension into the ipsilateral adrenal gland)

48
Q

RCC Management

A
  • for confined disease a partial or total nephrectomy depending on the tumour size
  • patients with a T1 tumour (i.e. < 7cm in size) are typically offered a partial nephrectomy
  • alpha-interferon and interleukin-2 have been used to reduce tumour size and also treat patients with metatases
  • receptor tyrosine kinase inhibitors (e.g. sorafenib, sunitinib) have been shown to have superior efficacy compared to interferon-alpha
49
Q

What are the characteristics of papillary renal cancer?

A

15% of renal cancer
Exists as type I (good prognosis, MET mutation) and Type II (poor prognosis)

50
Q

What are the characteristics of oncocytoma renal cancer?

associations

A
  • Multiple/bilateral in tuberous sclerosis and Birt-Hogg-Dube/Hornstein-Knickenberg syndrome
  • Autosomal dominant genetic disorder with susceptibility to renal cancer, renal and pulmonary cysts, and noncancerous fibrofolliculomas
51
Q

What are the two main histological subtypes of breast cancer?

Which is more common?

A

Infiltrating ductal carcinoma
Infiltrating lobular carcinoma

52
Q

What are the characteristics of infiltrating ductal carcinoma?

A

Most common (>70%)
Fibrous tissue response leads to palpable mass

53
Q

What are the characteristics of infiltrating lobular carcinoma?

A
  • 5-10% of breast cancer
  • Infiltrates as single cells
  • May have no mass lesion
  • More often multicentric/bilateral
  • Spreads to peritoneum/meninges
54
Q

What are the characteristics of medullary carcinoma and tubular carcinoma of the breast?

A
  • Medullary carcinoma: High-grade syncytial growth with lymphoplasmacytic infiltrate; increased in BRCA1 mutation carriers; improved survival
  • Tubular carcinoma: More common in screened population; low grade; metastases infrequent; favourable prognosis
55
Q

Fluorescence in-situ hybridisation vs Immunohistochemistry

A

Immunohistochemistry tests identify antigens (typically proteins) in a cell using complementary antibody binding. The tumour is then viewed under a light or fluorescent microscope.
FISH - uses fluorescent probes, which bind to complementary DNA sequences to identify changes (amplification, deletions, translocations) at the DNA level in cells.

56
Q

What is HER2 amplification used to diagnosis and its clinical application?

A

Breast cancer and gastroesophageal cancer; predicts response to anti-HER2 therapy (e.g. trastuzumab).

57
Q

What is the FISH assay ALK translocation used to diagnosis and its clinical application?

A

NSCLC; predicts response to crizotinib therapy.

58
Q

What is the FISH asay used to diagnose:
* Burkitt’s lymphoma
* Follicular lymphoma

A
  • Burkitt’s lymphoma - MYC t(8:14)
  • Follicular lymphoma - Bcl2 t(14:18)
59
Q

TNM cancer staging system

Describe the T category

4 parts

A

T category reflects assessment of the primary tumour
* TX: the primary tumour is not evaluable.
* T0: no evidence of a primary tumour.
* Tis: carcinoma in situ.
* T1–T4: description of size and/or extent of a primary tumour which is evaluable.

60
Q

N category reflects involvement of nearby lymph nodes. Describe it in 3 parts.

A
  • NX: regional lymph nodes are not evaluable.
  • N0: no regional lymph node involvement with cancer.
  • N1–N3: involvement of regional lymph nodes (number dependent on cancer subtype).
61
Q

What are the 2 parts of the M category?

A

M category is descriptive of the presence or absence of distant metastases:
* M0: no distant metastasis.
* M: presence of distant metastases.

62
Q

Performance status scale (ECOG) - describe category 0, 1 and 2

A
  • CAT 0: Fully active, able to carry on all pre-disease performance without restriction.
  • CAT 1: Restricted in physically strenuous activity, but ambulatory and able to carry out work of a light or sedentary nature, e.g. light housework, office work.
  • CAT 2: Ambulatory and capable of all self-care, but unable to carry out any work activities; up and about more than 50% of waking hours.
63
Q

Performance status scale (ECOG) - describe category 3, 4, & 5.

A
  • CAT 3: Capable of only limited self-care; confined to bed or chair more than 50% of waking hours.
  • CAT 4:Completely disabled; cannot carry on any self-care; totally confined to bed or chair.
  • CAT 5: Dead.
64
Q

Insulinoma

Define
Association
Features

A

An insulinoma is a neuroendocrine tumour deriving mainly from pancreatic Islets of Langerhans cells
Association: 50% have MEN-1
Features
* HYPOGLYCAEMIA causing diplopia, weakness, early morning, before meal
* Rapid weight gain
* High insulin, high C-peptide

65
Q

Insulinomaa

Diagnosis
Management

A

Diagnosis
* supervised, prolonged fasting (up to 72 hours)
* CT pancreas

Management
* surgery
* diazoxide and somatostatin if patients are not candidates for surgery

My MRCP (43 decks)

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