Term
| how many % of br cancers are due to mutations on BRCA genes? which chromosomes are these on? |
|
Definition
5-10% due to mutations on these genes.
BRCA1 is on Ch 17
BRCA2 is on Ch 13 |
|
|
Term
| describe characteristics of BRCA genes |
|
Definition
they are both tumour suppressors.
BRCA1 on ch17. 65% risk of br ca and 40% risk of ovarian ca.
BRCA2 on ch 13. 45% risk of br ca and 11% risk ovarian ca.
in BRCA1 there wis also 40-60% chance of getting a second breast ca. |
|
|
Term
| mx if you have BRCA genes |
|
Definition
annual MRI age in those age 30-50 carrying genes.
prophylactic mastectomy reduces cancer by 90%.
tamoxifen can reduce contralateral breast ca in carriers but has bad side effects. |
|
|
Term
what % of pts with CRC have FHx of the disease?
a pts RR is related to degree of family history. when should you refer someone for genetic testing? |
|
Definition
20% have FHx.
refer if 2 affected 1st degree relatives < 70 years. (RR X5)
refer if 1 affected 1st degree relative <45 years at diagnosis (RR X 3)
3 close relative affected with average onset < 60 years (RR X 2)
if they have FAP or ?HNPCC |
|
|
Term
FAP: where is the mutation? what gene does it affect? what is the inheritance?
what is the penetrance?
can cancer be prevented and how? |
|
Definition
germ line mutation in APC gene Ch 5.
offspring 50% chance of carrier status
penetrance approches 100% by age 50 years.
total colectomy prevents inevitable development of carcinoma. |
|
|
Term
Peutz Jegher: where is the mutation?
what is the risk of getting cancer from having this? |
|
Definition
Germ line mutation on STK11 (serene threonine kinase)
10-20% lifetime risk of CRC |
|
|
Term
HNPCC1 and HNPCC2: what cancers can you get.
what is the inheritance pattern?
where is the mutation?
lifetime risk for cancers? |
|
Definition
HNPCC1 = CRC
HNPCC2 = uterus, ovary, stomach, renal pelvis, small gut, pancreas
Mutations in 1 of 5 DNA mismatch repair genes.
AD inheritance, incomplete penetrance
CRC risk 60% lifetime
women with mutation have 40% lifetime risk of endometrial ca.
mx; colonoscopic surveillance. |
|
|
Term
| name the 6 alterations in cell physiology that dictate malignant growth. |
|
Definition
1. autonomy from growth signals
2. insensitivity to inhibitory signals
3. evasion of apoptosis
4. unlimited replication potential
5. angiogenesis
6. invasion and metastases. |
|
|
Term
in which gene mutation is is there a gain of fx.
in which is there a loss of fx? |
|
Definition
Gain: ONCOGENE
Loss: TUMOUR SUPPRESSOR |
|
|
Term
| define oncogenes and characteristics |
|
Definition
mutated genes that increase activity in the absence of a relevant signal.
e.g. RAS. mutated in 30% of human cancers. they behave in an AD manner so mutation in only one gene needed.
Mostly somatic events and rarely inherited. |
|
|
Term
| define tumour suppressors |
|
Definition
They act as inhibitors of cellular growth. you need both set of genes to be affected for there to be loss of this function. The first hit is usually inherited and the second hit usually somatic event.
P53 is a tumour suppressor mutated in 50% cancers. |
|
|
Term
name the stepwise cellular mutations leading to CRC.
APC-Kras-DCC-P53 |
|
Definition
There is an APC gene mutation in the normal cell.
This causes hyper proliferation leading to early adenoma.
K-ras mutation of the early adenoma leads to intermediate adenoma.
DCC gene mutation in intermediate adenoma leads to late adenoma.
P53 mutation in late adenoma leads to carcinoma following which other mutations lead to metastasis. |
|
|
Term
oncological emergencies- SCC
causes
s and symptoms
Investigations
management |
|
Definition
causes: extra dural mets
other causes: extension of tumour from vertebral body, direct extension of tumour or crush fracture.
s and s: back pain, weakness, sensory loss, bowel/bladder dysfx
ix: urgent MRI whole spine
mx: dexamethasone 16mg/24hours PO
commonest rx: palliative radiotherapy
decompressive sx in selected pts. |
|
|
Term
discuss SVC obstruction with airway compromise
Causes:
S and S:
Pemberton's test
Ix
mX |
|
Definition
This is not an emergency unless there is tracheal compression with airway compromise
Causes: >90% due to malignancy (3/4 of which are lung ca).rare causes: mediastinal enlargement (germ cell tumour), thymus cancer, mediastinal lymphadenopathy e.g from lymphoma, thrombotic disease (bechets or nephrotic syndrome), thrombus around IV line, harmatoma.
s and s: dyspnoea, orthopnoea, plethora/cyanosis, swollen face/arms, cough, headache, engorged veins
pemberton's test: lifting arms over head for >1mins causes facial plethora/cyanosis, increased JVP (non pulsatile) and inspiratory stridor.
ix: urgent contrast CT
mx: get tissue dx if cause is unknown, PO dexamethasone 8-16mg/24hours, balloon venoplasty and SVC stunting gives rapid relief. This can be done before providing radical or palliative chemo/radio depending on tumour type. |
|
|
Term
malignancy associated hypercalcemia
causes
symptoms
acute mx |
|
Definition
affects 10-20% with ca. affects 40% with myeloma.
very poor prognostic sign.
causes: lytic bone mets, myeloma, osteoclast activating factor or PTH like hormones secreted by the tumour.
symptoms: lethargy, anorexia, nausea, polydipsia, polyuria, constipation, dehydration, confusion, weakness.
mx: IV fluids, IV bisphosphonate
use calcitonin if rx resistant. |
|
|
Term
raised ICP causes
s and s
IX
rx |
|
Definition
due to primary CNS tumour or mets.
s and s: headache (worse am, bending over, coughing), nausea, vomiting, papilloedema, focal neuro signs.
ix: CT/MRI
mx: dexamethosone 8-16mg PO/24H, radio/chemotherapy as appropriate depending on cause.
Mannitol can be tried for symptom relief of cerebral oedema. |
|
|
Term
tumour lysis syndrome occurs in which cancers.
what 3 things is there a rise in?
what does this cause?
how can this be prevented?
what rx if there is renal failure?
what is rasburicase? |
|
Definition
there is rapid cell death when pt starts chemo for rapidly proliferating leukaemia, lymphoma, myeloma and some germ cell tumours.
there is a rise is serum urate, k+ and phosphate. this produces renal failure
prevention: good hydration and allopurinol 24h before chemo.
hemodialysis if there is renal failure
rasburicase is a potent uricolytic agent (stronger than allopurinol) |
|
|
Term
| in SCC and cancer, what situations would the role of urgent radiotherapy become relevant? |
|
Definition
| if the pt had >3 months to live. |
|
|
Term
| what should pts with vertebral involvement from myeloma or breast cancer be given before surgery for SCC? |
|
Definition
| bisphosphonates as it helps with pain and stability. |
|
|
Term
| what are most solid cancers staged using? |
|
Definition
TNM
T- extent of tumour (max T4)
N- spread to nodes (max N3)
M- mets (Max M1) |
|
|
Term
in TNM staging a number of prefixes may be used to specifically describe the exact stage at which the tumour was staged using TNM. what do these pre fixes stand for?
c, p , y, r, a |
|
Definition
c =staged using clinal info before surgery e.g from imaging or biopsy
p = staged after pathological examination
y = staged after neoadjuvant therapy (y comes from thepar-y)
r = if tumour is restaged after disease free interval
a = stage determined at autopsy. |
|
|
Term
TNM staging
what are the different T staging options? |
|
Definition
TX = cannot be assessed
T0 = no evidence of tumour
Tis = in situ
T1-4 = size/extent of primary tumour |
|
|
Term
| TNM staging. what are the options for N staging |
|
Definition
Nx = cannot be assessed
N0 = no involvement
N1-3 = Regional node mets |
|
|
Term
| TNM staging. What stagings of M are available? |
|
Definition
M0 = no distant mets
M1 = distant mets |
|
|
Term
TNM for non small cell lung cancer
T1
T2
T3
T4 |
|
Definition
T1 - size <3 cm. In lobar or distal airway
T2 - size >3cm and >2cm distal to carina. Or it can be any size if there is pleural involvement or obstructive pnemonitis extending to hilum but not all the lung.
T3 - this is when cancer involves the chest wall, diaphragm, mediastinal pleura, pericardium or <2cm from but not at the carina. The tumour is >7cm and there are nodules in the same lobe
T4 - heart, mediastinum, great vessels, trachea, oesophagus, vertebral body, carina, malignant effusions or nodules in another lobe. |
|
|
Term
| in non small cell lung ca staging if there is involvement of the tumor at the carina with a malignant effusion what stage would the T be graded at? |
|
Definition
| T4 (involves carina, heart, great vessels, trachea, malignant effusion or nodules in another lobe. |
|
|
Term
| in non small cell lung ca there are nodules present in the same lobe as the cancer tumour. what stage of T would this be given in the TNM staging? |
|
Definition
| T3 is given when there are nodules in the same lobe. if nodules are present in another lobe the stage would be T4 |
|
|
Term
| in non small cell lung ca if the tumour is >3cm in size and > 2cm distal to the carina what T staging would we give? |
|
Definition
| T2 = >3 and >2cm distal to carina. |
|
|
Term
| non small cell lung cancer regional nodes. If peribronchial and/or ipsilateral hilum is involved what N staging would we assign? |
|
Definition
N1 = peribronchial and/or ipsilateral hilum
N2 - ipsilateral mediastinum or subcarinal
N3 - contralateral mediastinum or hilum, scalene, supraclavicular. |
|
|
Term
| in TNM staging for non small cell lung cancer name all the N stages |
|
Definition
NO = no nodes involved
N1 - ipsilateral hilum and/or peribronchial
N2 - ipsilateral mediastinum or subcarinal
N3 - contralateral mediastinum/hilum, scalene or supraclavicular. |
|
|
Term
| in which type of lung cancer is grading not used? |
|
Definition
small cell lung ca.
grading is how similar they look to the normal cells of that tissue. |
|
|
Term
what is small cell lung cancer AKA. what cells do they arise from?
what % of lung cancers do they account for? |
|
Definition
AKA oat cell.
arise from Kulchitsky cells ( part of endocrine system)
account for 15% cases. |
|
|
Term
| small cell lung can AKA oat cell. does it have a good or bad prognosis. What does it respond to? |
|
Definition
It has a bad prognosis. This is because they spread early and are almost always inoperable at presentation.
they respond to chemo.
Summary. small cell AKA oat cell. 15% lung cancers. poor prognosis. early spread. chemo sensitive. |
|
|
Term
| non small cell lung cancer accounts for 85% of lung cancer cases. name the 5 subtypes in this category. |
|
Definition
Squamous
Adenocarcinoma
Large cell
carcinoid tumours
bronchoalveolar cell |
|
|
Term
| define properties of squamous cell carcinoma of the lung. this is a non small cell lung cancer. |
|
Definition
Most common form of non small cell lung ca. (42%)
local spread common
mets late |
|
|
Term
| Adenocarcinoma is the second common non small cell lung ca. name important properties of it |
|
Definition
cancer of mucous cells in bronchial epithelium.
most common in non-smokers
most common associated with asbestos
commonly invades pleura and mediastinum
mets to brain and bone likely. |
|
|
Term
| what are large cell lung cancer? |
|
Definition
less differentiated forms of squamous cell and adenocarcinomas.
they metastasise early. |
|
|
Term
| 2 reasons to refer on 2 week rule for lung cancer |
|
Definition
1. if CXR is suggestive of lung ca
2. aged 40 or > with unexplained hemoptysis. |
|
|
Term
| patients aged 40 or more with 2 of these symptoms or if they smoke they need just one symptom to be referred for an urgent 2 week CXR |
|
Definition
cough
fatigue
SOB
chest pain
weight loss
apetite loss |
|
|
Term
if to is > 40 and has the following what would you consider?
finger clubbing
supraclavicular lymph nodes or persistant clavicular ones
thrombocytosis
chest signs suggestive of lung ca
persistant/ recurrent chest infection. |
|
Definition
|
|
Term
| describe the groupings on lung cancer staging |
|
Definition
IA - T1 N0 M0.
IB - T2 N0 M0.
IIA - T1 N1 M0.
IIB - T2 N1 M0 or T3 N0 M0.
IIIA - T1-3 N2 M0 or T3 N1 M0.
IIIB - any T4 or any N3 M0.
IV - any M1. |
|
|
Term
| rx for stage I or II lung cancer |
|
Definition
| Lobar resection. Those who cannot tolerate surgery due to cormorbidities can undergo radical radiotherapy. |
|
|
Term
| stages I-III NSCLC not suitable for surgery should be offered? |
|
Definition
|
|
Term
| which type of lung cancer is strongly associated with PTHr protein secretion and hypercalcemia? |
|
Definition
squamous cell ca. typically a central cancer.
strongly associated with finger clubbing and hypertrophic pulmonary osteoarthropathy. |
|
|
Term
| which peripherally located lung cancer is common in non smokers? |
|
Definition
|
|
Term
| what type of lung cancer may secrete B-HCG> |
|
Definition
|
|
Term
| which peripherally located lung cancer is common in non smokers? |
|
Definition
|
|
Term
| what type of lung cancer may secrete B-HCG> |
|
Definition
|
|
Term
what is Li-Fraeumeni syndrome
inheritance pattern?
when is it diagnosed? |
|
Definition
germ line mutation of P53.
AD
high incidence of sarcomas and leukemias
diagnosed when pt gets sarcoma < 45 years or
1st degree with cancer <45 and another family member with cancer < 45 years or sarcoma at any age. |
|
|
Term
| which syndrome can the Amsterdam criteria identify? |
|
Definition
Lynch syndrome. AKA HNPCC
AD condition
80% chance of colon or endometrial cancer in affected people. |
|
|
Term
| what is the Amsterdam criteria? |
|
Definition
3 or more family members with diagnosis of CRC. one must be 1st degree relative of the other 2.
must affect 2 successive generations.
one or > colon cancers diagnosed < 50 years
FAP has been excluded. |
|
|
Term
what syndrome is considered a variant of FAP?
what gene on which chromosome is affected? |
|
Definition
Gardners syndrome
AD condition
APC gene on chromosome 5.
You get multiple colonic polyps |
|
|
Term
| what extra colonic disease manifest in Gardners syndrome? |
|
Definition
skull osteoma
thyroid cancer
epidermoid cysts. |
|
|
Term
| name most common causes of cancer in UK |
|
Definition
breast
lung
crc
prostate
bladder
non hodgkins
melanoma |
|
|
Term
| name most common causes of death from cancer |
|
Definition
|
|
Term
| what does the carcinogen aflatoxin increase risk of? |
|
Definition
|
|
Term
| Anilline dyes are a carcinogen. which cancer do they cause? |
|
Definition
| bladder cancer - transitional cell ca |
|
|
Term
| which cancer does asbestos exposure increase risk to? |
|
Definition
| mesothelioma and bronchial ca. |
|
|
Term
| Nitrosamines increase risk to which 2 cancers? |
|
Definition
| oesophageal and gastric ca |
|
|
Term
| hepatic angiosarcoma can be caused by which carcinogen? |
|
Definition
|
|
Term
| Cyclophosphamide is an aklalyting agent used in cancer. It works by cross linking DNA. name an adverse affect of this drug. |
|
Definition
Hemorrhagic cystitis. this can be reduced by hydration and using MESNA which binds to the toxic metabolite that causes hemorrhagic cystitis.
it can also cause myelosuppression and transitional cell carcinoma. |
|
|
Term
| what cases account for majority of cases of SCC due to cancer? |
|
Definition
|
|
Term
| what morphine regime should people with palliative pain be started on |
|
Definition
| MR or immediate PO prep with immediate release break through cover |
|
|
Term
true or false
PO MR preps are suggested over transdermal patches |
|
Definition
|
|
Term
| what dose is the break through dose of morphine normally? |
|
Definition
|
|
Term
| in chronic kidney pts which opiates are preferred for safer prescribing? |
|
Definition
| Alfentanil, buprenorphine and fentanyl are preferred |
|
|
Term
where would you use the DUKES criteria?
where would you use FIGO criteria? |
|
Definition
Dukes in CRC
FIGO in gynae cancers |
|
|
Term
| in which cancer do you use the Gleason score? |
|
Definition
| In prostate cancer. it is histological grading of the cancer |
|
|
Term
| chemo: give examples and MOA of alkylating agents |
|
Definition
Cyclophosphamide, Chlorambucil and Busilfan
They are anti proliferative drugs that bind DNA via alky groups. |
|
|
Term
| chemo: give examples and MOA of antimetabolites |
|
Definition
MTX and 5-flurouracil.
they interfere with normal cellular metabolism of nucleic acids |
|
|
Term
| chemo: give examples and MOA of vinca alkaloids. |
|
Definition
Vincristine and Vinblastine.
They are spindle poisons that target mechanisms of cell division. |
|
|
Term
| name some anti tumour Abx |
|
Definition
Dactinomycin
doxorubicin
mitomycin |
|
|
Term
| when does neutropenia occur? |
|
Definition
| 10-14 days after chemo but can occur within 7 days for taxanes.(e.g. Paclitaxel) |
|
|
Term
breast cancer TNM staging.
Name all the T stagings |
|
Definition
Tx - tumour can't be evaluated
T0 - no evidence of cancer in breast
Tis - in situ. this can be ductal, lobar or pager's disease
T1 - tumour is <2cm (20mm). this stage has 3 parts
T1a- >1mm <5mm
T1b - >5mm <10mm
T1c - >10mm and <20mm
T2 - > 20mm <50mm
T3 - >50mm
T4a - grown into chest wall
T4b - grown into skin
T4c - grown into chest wall and skin
T4d - inflammatory breast cancer. |
|
|
Term
| In TNM breast cancer staging N describes whether your cancer has spread to lymph nodes. what are the different stagings for N? |
|
Definition
Nx - can't be assessed e.g. previously removed
N0 - no cancer cells in near by nodes
N1 - nodes in admit but they are not stuck to surrounding tissues
N1a - 1-3 lymph nodes and one is larger than 2mm
N1b - cancer in internal mammary nodes
N1c - 1-3 in armpit and internal mammary nodes but they are too small to feel.
N2a - lymph nodes in armpit that are stuck to each other or other structures
N2b - internal mammary nodes but no evidence of nodes in armpits.
N3a - nodes below collarbone
N3b - node sin armpit and breastbone
N3c - nodes above collarbone |
|
|
Term
| TNM staging for breast cancer. what are the different stages for M? |
|
Definition
M0 - no sign that cancer has spread.
M1 - distant mets |
|
|
Term
| principles of radiotherapy |
|
Definition
used in >50% of cancer pts
IR produces free radicals which damage DNA. normal cells better at repairing this damage than cancer cells so can recover before the next dose. |
|
|
Term
| how long can it take for radiotherapy to produce a therapeutic effect? |
|
Definition
|
|
Term
| list some early side effects/reactions to radiotherapy. They occur within 8 weeks of treatment. |
|
Definition
tiredness -
skin reactions - use moisturisers
mucositis - avoid smoking, alcohol and spicy foods. as porin gargles may help. rx oral thrush with nystatin +/- fluconazole.
Nausea and vomiting - esp with stomach, liver and brain rx
diarrhoea - keep hydrated, try loperamide
dysphagia - in thoracic rx
cystitis - after pelvic rx, use NSAIDs
bone marrow suppression - more likely after chemo unless large areas are being irradiated. |
|
|
Term
|
Definition
|
|
Term
when do late reactions to radiotherapy occur?
name some of these |
|
Definition
They occur months or years after rx.
CNS - somnolence. rx with steroids
Lung - Pneumonitis, rx with prednisolone
GI - xerostomia, rx with pilocarpine or artificial saliva with meals
GU -urinary frequency
hypothyroid with neck radiotherapy
panhypopituitary following radical rx on pituitary fossa. |
|
|
Term
| list 4 ways of delivery radiotherapy |
|
Definition
external beam
stereotactic - focuses on small lesions with accurate precision
Bracytherapy - radiation source place in or close to tumour
radioisotope therapy - e.g radioiodine |
|
|
Term
how quickly should you refer if a smoker presents with persistent heamoptysis?
what if they were a non smoker aged 45 presenting with persistent heamptysis? |
|
Definition
refer urgently within 2 weeks for both.
smoker and persistant heamoptysis = 2w referal
non smoker over 40 years with persistant heamoptysis = also 2 week referal |
|
|
Term
| what sort of symptoms would warrant urgent referral for GI malignancy? |
|
Definition
dyspepsia plus any one of the following:
chronic GI bleeding
dysphagia
progressive unintentional weight loss
persistant vomiting
iron deficiency anemia
epigastric mass or suspicious barium meal result |
|
|
Term
| if a pt presents with persistent recent onset dyspepsia, what age do they need to be over to be referred for endoscopy? |
|
Definition
|
|
Term
| what ix should be done in all people presenting with s and s of lower GI malignancy? |
|
Definition
PR exam and FBC.
refer if >40 with PR bleeding AND bowel habit change (loose stools >6 weeks)
refer any age with right abdominal mass that is likely to be bowel
palpable rectal mass
men or non menstruating women with unexplained iron deficiency anemia
high risk groups such as those with UC |
|
|
Term
| what types of lumps would warrant referral for breast ca pathway? |
|
Definition
discrete hard lump with fixation
if they are > 30 with discrete hard lump that remains after period
if a lump presents post menopausal (discrete, hard lump)
under age 30 with enlarging hard lump or FHx
if they have had previous br ca presenting with new lump
unilateral eczematous skin/nipple change unresponsive to topical rx
recent nipple distortion
unilateral bloody discharge
men > 50 with unilateral firm mass |
|
|
Term
when would you refer for gynea cancer pathway?
what ix should you do in any abdo or pelvic mass? |
|
Definition
post menopausal bleeding in non HRT women.
vulval lumb or bleeding
if they have stopped HRT > 6 weeks ago and have post menopausal bleeding
you should USS any abdo or pelvic mass |
|
|
Term
| when to refer under urology 2wk rule |
|
Definition
hard irregular prostate (use PSA result)
normal prostate but raised PSA and urinary symptoms
painless macro heamaturia at any age
age > 40 with recurrent or persistent UTI or hematuria
age > 50 with unexplained micro hematuria
swelling in body of testes or any abdominal mass arising from urinary tract
ulceration or mass in penis |
|
|
Term
| when to refer for CNS cancer pathway |
|
Definition
new onset CN palsy of unilateral sensorineural deafness
recent onset headache with features of raised ICP
new or unexplained headache with progressive severity
recent onset seizures. |
|
|
Term
25% of large benign prostates give a PSA reading up to how much?
what is the association between BMI and PSA? |
|
Definition
10ng/mL
if BMI goes down PSA goes up thus men with BMI <25 may have raised PSA. |
|
|
Term
| other causes than prostrate cancer than can result in increased PSA |
|
Definition
BPH
BMI <25
tall men
african men
recent ejaculation
recent PR exam
prostitis
UTI - PSA levels may taken months to return to baseline after UTI |
|
|
Term
| ages 50-59 what is the PSA cut off value? |
|
Definition
|
|
Term
| what is the PSA cut off value in ages 60-69? |
|
Definition
|
|
Term
| if a male is 70 or > what is their normal PSA cut off value |
|
Definition
|
|
Term
| in prostrate carcinoma what percentage have PSA > 10 ng/ml? |
|
Definition
|
|
Term
| 6 months after starting 5 alpha reductase inhibitors what would we expect to see in the PSA level? |
|
Definition
| will be ~50% lower after 6 months. |
|
|
Term
| a pt has had a radical prostatectomy. what should happen to his PSA levels. she should you refer to a urologist? |
|
Definition
it should be undetectable
refer if levels are > 0.04ng/ml |
|
|
Term
| an odd eyelid rash is diagnosed as dermatomyostis. this is deemed part of a paraneoplastic and an underlying search for malignancy is started. what cancer is this associated with> |
|
Definition
|
|
Term
raised AFP found in HCC and germ cell tumours.
what other conditions can it be raised in? |
|
Definition
cirrhosis
pregnancy
neural tube defects |
|
|
Term
| a woman is suspected of having medullary thyroid cancer. which tumour marker could we look for to be raised? |
|
Definition
|
|
Term
what tumour marker is linked to ovarian cancer?
what other conditions can it be raised in? |
|
Definition
ca 125
raised in liver disease, CF, pancreatitis,urinary retention, HF, dm, pregnancy, IBS |
|
|
Term
| which cancers do the markers 19-9 and 15-3 pertain to? |
|
Definition
19-9 pancreatic
15-3 breast |
|
|
Term
| CEA used in CRC what other conditions can it be raised in? |
|
Definition
smoking
CKD
jaundice
diverticulitis |
|
|
Term
| B-HCG associated with the gestational trophoblast. It is raised in germ cell and testicular tumours. which other cancer is it associated with? |
|
Definition
|
|
Term
| causes of nausea and vomiting in cancer |
|
Definition
chemo
constipation
gi obstruction
drugs
severe pain
cough
oral thrush
infection and uraemia |
|
|
Term
| mode of action for cyclizine. what is the typical dose? |
|
Definition
its an anti H1 and anticholinergic. it has central actions.
50mg/8h |
|
|
Term
domperidone 10-20mg/8h
what is its mode of action.
can it cause anti pyramidal SE? |
|
Definition
it is a peripheral antidopaminergic.
it doesn't cross the BBB so doesn't cause anti pyramidal SE |
|
|
Term
which anti emetic crosses the BBB, blocks CTZ and has peripheral pro kinetic effects?
what is the usual dose? |
|
Definition
|
|
Term
which typical antipsychotic is good for treating drug or metabolically induced nausea?
what is the usual dose? |
|
Definition
haloperidol
0.5 - 1.5mg/12hour |
|
|
Term
which anti emetic is good for chemo/radiotherapy induced nausea?
what is the MOA
what is the usual dose? |
|
Definition
Ondansetron
serotonin antagonist 5HT3
4-8mg/8h |
|
|
Term
name a broadspectrum anti emetic that has sedative properties?
what is the usual dose? |
|
Definition
Levomepromazine
3 - 12.5mg/12 hours |
|
|
Term
| give 3 reasons for constipation in cancer |
|
Definition
opiates
hypercalcemia
dehydration |
|
|
Term
| list the different syringe driver drugs and doses in palliative care |
|
Definition
diamorphine for pain start 10-20mg/24hours
midazolam for agitation 20-100mg/24h
cyclizine 150mg/24h or haloperidol 1.5-10mg/24h for N+V
glycopirronium for resp secretions 0.6-1.2mg/24h
hyoscine hydrobromide for resp secretion 0.6-2.4mg/24huse hyoscine butyl bromide for bowel colic 2-120mg/24h
bowel colic |
|
|
Term
| what are the dosing differences between hyoscine hydrobromide and butyl bromide? |
|
Definition
Hyoscine hydrobromide 0.6-2.4mg/24h
hyoscine butylbromide 20-120mg/24 hours
do not forget the massive dosage differences between hydro and butyl bromide |
|
|
Term
describe the 4 types of biopsies available in breast cancer ix
look at once notes for explaining the procedure. |
|
Definition
there are 4 ways
Needle
Punch
Wire guided
vacuum assited |
|
|
Term
| which biopsy might be used to diagnose inflammatory breast disease or pagets? |
|
Definition
|
|
Term
| describe the different biopsy procedures for lung cancer. |
|
Definition
percutaneous
surgical biopsy
neck lymph node US and biopsy |
|
|
Term
| outline possible SE of percutaneous lung biopsy |
|
Definition
bleeding
chest infection
SOB - needing more o2
pnemothorax |
|
|
Term
| when might you have a surgical lung biopsy |
|
Definition
if the area is difficult to sample percutaneously.
this can be done keyhole (VATS)
or open surgery through a thoracotomy. |
|
|
Term
| what is the name of the keyhole surgery to surgically obtain a lung biopsy? |
|
Definition
| video assisted thorascopic surgery (VATS) |
|
|
Term
| name the 2 biopsy methods available for prostrate cancer biopsy |
|
Definition
Transrectal US guided biopsy (TRUS)
Transperineal (template/perineal biopsy) |
|
|
Term
| what is a trasnrectal biopsy? |
|
Definition
used in prostrate biopsy.
its a type of needle biopsy that is taken through the rectum using a transrectal us scanner. |
|
|
Term
| when might you do a transperineal template/targeted biopsy? |
|
Definition
| if your biopsy is negative but doctor thinks cancer is present but the biopsy has missed it. |
|
|
Term
| what are the 2 types of transperineal biopsies? |
|
Definition
targeted (regular) biopsy - small no of samples taken
saturated biopsy - done under GA and many biopsies are taken. the perineal approach is done through the skin beneath your testicles. |
|
|
Term
| what disease is diagnosed in children by taking a rectal biopsy? |
|
Definition
| Hirsprungs disease. This is the only way to diagnose this disease. |
|
|
Term
| name the 3 types of biopsies used in cervical biopsies |
|
Definition
Punch biopsy - stain cervix with dye to show abnormal areas
cone biopsy - done under GA. cone shapes pieces are removed for examination.
endocervical curretage -cells removed from endocervical canal using a curette. |
|
|
Term
| what is the name of the test used in cervical examination where the cervix is swabbed with iodine. what is the significance? |
|
Definition
it is called the Schiller test
It is used to ID abnormal tissues. |
|
|
Term
| how would you biopsy the ovaries. what else might you biopsy in suspected ovarian cancer? |
|
Definition
image guided biopsy either US or CT
you may also biopsy the omen tun as cancer may spread there |
|
|
Term
| in breast staging TNM T1 means the tumour is 2cm across or less. T1 is further split into 4 stages what are these and what do they mean? |
|
Definition
T1mi - micro tumour that is 0.1cm across or less
T1a - tumour >0.1com but less than 0.5cm
T1b - >0.5cm but less than 1cm
T1c - >1cm but less than 2cm. |
|
|
Term
| in breast cancer what does T2 mean? |
|
Definition
T2 - >2cm but less than 5cm
T3 - >5cm |
|
|
Term
| in breast cancer staging T4 is further split into 4 stages. What are these and what do they mean? |
|
Definition
T4A - tumour spread to chest wall
T4B - spread into skin. breast might be swollen
T4C - both chest wall and skin spread
T4D - inflammatory carcinoma |
|
|
Term
what are isolated tumour cells? ITC
what is their significance? |
|
Definition
Isolated tumour cells (ITCs) are small clusters of cancer cells in one area of a lymph node.
They are less than 0.2 mm across, a single tumour cell, or a cluster
of fewer than 200 cells.
Lymph nodes containing only ITCs are not counted as positive lymph nodes. |
|
|
Term
| what can stage 1A breast cancer be denoted by? what rx are available for this type of br cancer? |
|
Definition
T1 N1
T0 N1
rx: surgery: WLE or lumpectomy plus several weeks of radiotherapy to rest of the breast
rx: mastectomy +/- radiotherapy (usually not needed)
sentinel lymph node biopsy +/- removal of affected nodes. |
|
|
Term
| stage 1A breast cancer: if it has hormone receptors for oestrogen or progesterone how can this be treated? |
|
Definition
| you can give hormone therapy for at least 5 years. |
|
|
Term
| stage 1A: if your breast cancer is >1cm or high grade (cells look very abnormal) what rx might you have? |
|
Definition
|
|
Term
| stage 1A: cancer has HER2 receptors. what can be offered to this pt and for what duration? |
|
Definition
Herceptin AKA trastuzumab
usually for a year |
|
|
Term
| what does stage 1 breast cancer mean? |
|
Definition
| The cancer is small and only in the breast tissue or in lymph nodes close to the breast. |
|
|
Term
| what does stage 2 breast cancer mean? |
|
Definition
Cancer is either in the breast, nearby lymph nodes or both.
its an early stage cancer |
|
|
Term
| There are 2A and 2B stages. what do these mean?? |
|
Definition
2A
there is no tumour or there is a tumour but <2cm and cancer in 1-3 nearby lymph nodes OR
tumour >2cm but <5cm with no lymph node involvement
2B
> 2cm and <5cm with small lymph node involvement OR
> 2cm and <5cm across with 1-3 lymph node involvement OR
>5cm with no lymph node involved |
|
|
Term
| treatment for stage 2 breast cancer |
|
Definition
WLE or lumpectomy + radiotherapy
SLNB
mastectomy + reconstruction. if you need radiotherapy then you are advised to wait after radiotherapy to get breast reconstruction. |
|
|
Term
| in stage 2 cancer what is a benefit of having pre op chemo or hormone therapy? |
|
Definition
| allows the cancer to be shrunk down. this might allow women to have lumpectomy instead of mastectomy. |
|
|
Term
| reasons why you may have chemo after surgery in br ca |
|
Definition
large cancer
high grade
spread into several lymph nodes
doesn't have hormone receptors |
|
|
Term
| what does stage 3 breast cancer mean? |
|
Definition
spread to lymph nodes close to breast, to the skin of the breast or to the chest wall.
AKA locally advanced breast cancer. |
|
|
Term
| stage 3 is split into 3 stages. Name the characteristics of stage 3A |
|
Definition
3A
-no tumour or tumour of any size + 4-9 lymph nodes underarm pit or breast bone involved
-tumour >5cm with small clusters of cancer cells in lymph nodes
- >5cm and spread into up to 3 nodes of armpit or near breast bone. |
|
|
Term
| stage 3 is split into 3 stages. Name the characteristics of stage 3B |
|
Definition
spread to skin of breast or chest wall. it causes ulcers or swelling.
cancer in up to 9 lymph nodes in armpit or nodes near breast bone.
inflammatory breast cancer. |
|
|
Term
stage 3 is split into 3 stages. Name the characteristics of stage 3C
how is stage 3C divided by doctors? |
|
Definition
the tumour can be any size, there doesn't have to be a tumour.
cancer in breast skin causing swelling/ulcer and in chest wall
spread to 10 or > lymph nodes in armpit, lymph nodes above/below collar bone
doctors split stage 3C into operable and inoperable cancers. |
|
|
Term
In the TNM staging system what stage are all these?
T0 N2 M0
T1 N2 M0
T2 N2 M0
T3 N1 M0
T3 N2 M0 |
|
Definition
|
|
Term
In the TNM staging system what stage are all these?
T4 N0 M0
T4 N1 M0
T4 N2 M0 |
|
Definition
|
|
Term
What stage in breast cancer staging does thi denote?
Any T N3 M0 |
|
Definition
|
|
Term
| discuss rx for stage 3 breast cancer |
|
Definition
chemo and biological therapy may be first line followed by surgery or vice versa.
biological therapy and chemo to shrink down tumour allowing a lump rather than the whole breast removal.
also removal of armpit ymph nodes.
stage 3 is when you have radiotherapy after surgery.
you may have chemo after for a few months.
If ca is HER receptor positive you might have Herceptin. |
|
|
Term
what does stage 4 br ca mean?
characteristics of Stage 4 breast cancer. |
|
Definition
it has spread to other parts of the body.
AKA advanced, metastatic or secondary breast cancer.
tumour of any size
lymph nodes may or may not be involved
cancer has mets to other parts of the body. |
|
|
Term
what stage does this denote of breast cancer?
Any T Any N M1 |
|
Definition
|
|
Term
| treatment for stage 4 /secondary breast cancer depends on many factors. list these |
|
Definition
the part of the body which the cancer has spread to
rx you have already had
general health
if you have had your menopause
whether it is fast/slow growing
whether cancer cells have receptors. |
|
|
Term
| if cancer has hormone receptors in stage 4 can we use hormone therapy? what if the cancer doesn't have receptors but there are spread to the liver and lungs? |
|
Definition
hormone therapy can be used in stage 4/secondary breast cancer if receptors are evident
if there are not receptors but mets to lungs and liver then doctor may offer you chemotherapy. |
|
|
Term
| what is the main rx for limited disease in small cell lung cancer? |
|
Definition
Chemotherapy
you then have radiotherapy to your chest.
if you are fit enough you might have both together. |
|
|
Term
| after rx for small cell lung cancer, the pt may get radiotherapy to their head. what is known as and what is it for? |
|
Definition
Prophylactic cranial radiotherapy (PCR)
aims to kills any cacer cells that may have spread to brain but too small to see on scans. |
|
|
Term
| stage 1 NSCLC rx options: |
|
Definition
stage 1 means cancer is small and is contained inside the lung. It hasn’t spread to lymph nodes.
surgery plus chemo if pt fit
if unfit, radiotherapy |
|
|
Term
what is stage 2 lung cancer?
what is the mx options here? |
|
Definition
stage 2 split into 2A and 2B
2A: 4-5cm and no lymph node spread
2B
up to 5cm and spread to nodes OR
5-7cm and no lymph node spread OR
more than one area of cancer in one lobe of lung
cancer spread to structures close to lung |
|
|
Term
| rx for stage 2 lung cancer |
|
Definition
surgery + chemo.
if not fit for surgery: radio therapy or radio chemotherapy |
|
|
Term
| what does stage 4 lung ca mean? |
|
Definition
cancer has spread to your other lung or to a distant part of your body such as the liver or bones.
RX: chemotherapy
biological therapy
radiotherapy
symptom control treatment, such as treatment to help you breathe more easily |
|
|
Term
| how often do you have chemotherapy? |
|
Definition
| every 3-4 weeks this is known as a cycle. you usually have 4-6 cycles of chemo |
|
|
Term
| common side effects to chemo |
|
Definition
feeling sick
loss of appetite
losing weight
feeling very tired
a lower resistance to infections
bleeding and bruising easily |
|
|
Term
| what is Cisplatin. give some properties including SE of this drug |
|
Definition
damages DNA so cells can't divide. it ties strands of DNA together.
taken via drip
SE: immunosupression, dyspnoea, bruising, bleeding gums or epistaxis, lethargy, nausea, kidney damage, changes to hearing. |
|
|
Term
Carboplatin
characteristics of the drug
SE |
|
Definition
interferes with development of genetic material a call, stops it from dividing into 2 and kills it.
given by a drip into arm.
SE: same as Cisplatin plus infertility and periods stopping |
|
|
Term
| how does radiotherapy work? |
|
Definition
| uses high energy X-ray to kill cancer cells. |
|
|
Term
| you can have radiotherapy on its own if you are unfit for surgery and have stage 1,2 or 3 lung cancer. what are the 2 protocols? |
|
Definition
you can have daily radiotherapy for 4 to 7 weeks with breaks at weekends OR
3 times a day for 12 days with no weekend break. This is called CHART – continuous hyperfractionated accelerated radio therapy |
|
|
Term
| side effects when having radiotherapy for lung cancer |
|
Definition
tired and weak
feel sick
have a sore mouth or throat
have difficulty or soreness on swallowing
cough
lose your neck or chest hair
have chest pain |
|
|
Term
SE of chemoradiotherapy.
Do they get better or worse
how long do they last? |
|
Definition
SE gradually get worse during rx and can cx to get worse after rx ends,
most effects begin to improve after 1-2 weeks
SE: tiredness, weakness
immunosupression
breathlessness,
bleeding, bruising, looking pale
feeling or being sick,
kidney damage
numbness or tingling in fingers or toes. |
|
|
Term
| what are biological therapies in cancer? |
|
Definition
The are tx that act on processes in cells. they may:-
Stop cancer cells from dividing and growing
Seek out cancer cells and kill them
Encourage the immune system to attack cancer cells |
|
|
Term
| Long Term SE of radiotherapy: |
|
Definition
cough and breathlessness
narrowing of food pipe
inflammation to lining of heart
spinal cord damage |
|
|
Term
|
Definition
tired, weak
nausea,
reddening/darkening of skin
sore mouth and throat
difficulty swallowing
cough
loss of neck and chest hair
chest pain |
|
|
Term
| types of biological treatments available for cancer |
|
Definition
monoclonal antibodies
vaccines
blood cell growth factors
cancer cell blockers
antiangiogenic drugs
interferon and interleukin 2
gene therapy |
|
|
Term
Monoclonal antibody treatment
how is it administered
SE |
|
Definition
administered via a drip
SE: allergic reaction to infusion. |
|
|
Term
| what drug is used in breast cancer hormone therapy if the pt is suitable? |
|
Definition
| Tamoxifen this is to with hormone therapy. if the question asks about biological therapy we would be thinking about monoclonal antibodies like Herceptin. |
|
|
Term
| is there a liquid version of tamoxifen? |
|
Definition
Yes it is called Saltamox.
you take Tamoxifen for 5 years it is usually in tablet form. |
|
|
Term
| side effects of tamoxifen |
|
Definition
light headed,
hot flushes
nausea
tiredness and weakness
vaginal changes
eye problems
leg cramps
hair thinning
fluid build up |
|
|
Term
| what is the gleason score? |
|
Definition
histological grading of prostate cancer.
2 is well differentiated
10 is poorly differentiated. the higher the score the worse the cancer. |
|
|
Term
| how is a gleason scored assigned? |
|
Definition
| the two most common glandular growth patterns are graded and scores added together to get a total score. e.g. the most common growth is graded as 3, the second most common growth pattern graded as 4 thus total gleason score is 7. |
|
|
Term
| The Gleason score has been used as the best prognostic indicator for prostate cancer. How many grades are there? |
|
Definition
|
|
Term
| what are the categorisations of gleason score in relation to local progression? |
|
Definition
Gleason score of 4 or less: well differentiated; ten-year risk of local progression 25%.
Gleason score 5-7: moderately differentiated; ten-year risk of local progression 50%.
Gleason score over 7: poorly differentiated; ten-year risk of local progression 75%. |
|
|
Term
|
Definition
surgery: radical prostatectomy
radiotherapy : alternative to surgery. external beam or brachtherapy
cryotherapy: for locally advanced cancer
chemotherapy - for metastatic disease
anti androgen therapy |
|
|
Term
| what is the main side effect of concern with anti LHRH therapy? |
|
Definition
The flare phenomenon.
It is associated with bone pain, acute bladder outlet obstruction, obstructive acute kidney injury, spinal cord compression, and fatal cardiovascular events due to hypercoagulation status. |
|
|
Term
| how would you treat the flare phenomenon? |
|
Definition
| Anti-androgens (eg, cyproterone acetate or flutamide) should be started before the LHRH analogue and should be continued for a two-week period. |
|
|
Term
| what image modality is used to stage CRC? |
|
Definition
| Contrast-enhanced CT... of the chest, abdomen and pelvis should be used to estimate the stage of disease for patients with colon cancer. |
|
|
Term
| which imaging modality can be used to asses risk of local reoccurrence in CRC? |
|
Definition
|
|
Term
| what are the different stages of CRC? |
|
Definition
0 - carcinoma in situ
1 -restricted to inner lining or muscle wall. no nodal involvement
2 -further local spread but no nodes and no mets
3 - nodal involvement
4 - mets |
|
|
Term
|
Definition
| surgery followed by radiotherapy or chemotherapy. |
|
|
Term
| which lymphoma is associated with Reed-Sternberg cells? |
|
Definition
|
|
Term
| Hodgkins lymphoma is classified into 2 entities what are they and which one accounts for majority of the cases? |
|
Definition
Classic Hodgkins 95% cases:
Nodular
Mixed
Lymphocyte rich
lymphocyte depleted
5% cases are nodular lymphocyte predominant hodgkins (NLPHL) |
|
|
Term
| which classical Hodgkins lymphoma is commonly seen in immunosuppressed pts and which virus is it associated with? |
|
Definition
Lymphocyte depleted hodgkins lymphoma.
Associated with EBV, |
|
|
Term
| what is different about nodular lymphocyte predominant hodgkins lymphoma (NLPHL) that accounts for 5% of cases? |
|
Definition
histologically distinct
no reed-sternberg cells
risk of transformation to high grade non-hodgkins
it is managed differently from classical hodgkins. |
|
|
Term
|
Definition
night sweats
unexplained fever >38
weight loss >10% over 6 months |
|
|
Term
| pts with Hodgkins can present with painless lymphadenopathy. what might make the glands hurt? |
|
Definition
|
|
Term
| what examination findings would you find in someone with Hodgkins? |
|
Definition
| lymphadenopathy, hepatosplenomegaly, SVC syndrome |
|
|
Term
| what scan is needed to stage Hodgkins? |
|
Definition
| CT scan of thorax and abdomen |
|
|
Term
| rxs used in Hodgkins lymphoma |
|
Definition
radiation therapy
chemotherapy
combined therapy |
|
|
Term
| what does radio and chemotherapy increase the risk of? |
|
Definition
| secondary solid tumours e.g. ca of lung, breast, stomach |
|
|
Term
| which vaccines should be given to Hodgkins pts? |
|
Definition
pneumococcal and influenza
recommended also are men c and HIb |
|
|
Term
| which consequence of chemotherapy is typically seen 5 years after rx? |
|
Definition
leukaemia.
risk is higher in pts who undergo splenectomy or have advanced disease. |
|
|
Term
| what should any pt with neutropenia be given with chemo? |
|
Definition
Abx prophylactic
Chemo regimens in Hodgkins
ABVD (preferred over BEACOPP in pregnancy)
BEACOPP |
|
|
Term
| rx regime for Hodgkins in early stage 'favourable outcome' and 'unfavourable outcome' |
|
Definition
favourable:
chemo ABVD with radiotherapy (increase cycles of chemo for worse disease)
unfavourable early stage:
BEACOPP and then ABVD plus radiotherapy. |
|
|
Term
| advanced Hodgkins age 16-60 rx |
|
Definition
| 6-8 cycles of ABVD or 6 cycles of BEACOPP |
|
|
Term
| how long after radiotherapy to head and neck can hypothyroidism manifest in a rx Hodgkins pt? |
|
Definition
|
|
Term
| what special rx must the blood undergo if we were to be transfusing a pt who has been treated for Hodgkins lymphoma in the past? |
|
Definition
| it needs to be irradiated blood. |
|
|
Term
| which type of leukimea may occur in those rx with chemo, radio or combo therapy? |
|
Definition
|
|
Term
| complications of Hodgkins rx |
|
Definition
infertility
breast cancer if receiving supradiagphramatic radiotherapy
increased risk of other cancers
hypothyroid
cardiovascular disease |
|
|
Term
| which lymphoma (hodgkins or non Hodgkins) has a predilection to disseminate to extra nodal sites? |
|
Definition
| Non Hodgkins spreads more. |
|
|
Term
| NHL can be prognostic all divided into low grade and high grade. explain |
|
Definition
Low grade - relatively good prognosis but disease not curable in advanced stages
High grade - shorter natural history but significant number can be cured with intensive combo chemotherapy regimes |
|
|
Term
| briefly describe the broad classifications of NHL |
|
Definition
precursor B
mature B
precursor T
mature T
low grade
high grade |
|
|
Term
| is HL or NHL more common? |
|
Definition
| NHL more common, >5 as common as HL. |
|
|
Term
| what are the 2 most common types of NHL? |
|
Definition
Diffuse large B cell lymphoma (DLBCL) - high grade
follicular lymphoma - low grade |
|
|
Term
|
Definition
watch full waiting
single/multi agent chemo
radiotherapy
vaccines
Abx prophylaxis with chemo if pt is neutropenic |
|
|
Term
| which monoclonal antibody is recommended to be used with CHOP chemo combo in diffuse large b cell NHL. |
|
Definition
|
|
Term
| mantle cell lymphomas: do they affect men or women more? what are they responsive to? what happens after rx stops? |
|
Definition
more common in men over 50's
responsive to chemo
relapse after rx stopped. |
|
|
Term
| whats the main rx in early stage follicular lymphoma? what about in advanced disease? |
|
Definition
Radiotherapy in early stages
Chemo is stages III-IV |
|
|
Term
| whats the rx for primary CNS lymphoma? |
|
Definition
Chemotherapy with high dose MTZ
dexamethosone for 2nd line palliation
whole brain radiotherapy |
|
|
Term
| risk factors for men to get breast cancer |
|
Definition
clinical disorders from hormonal imbalances esp gynaecomastia and cirrhosis
radiation exposure
postive FHx
genetic predisposition |
|
|
Term
| risk factors for breast cancer |
|
Definition
age
genes
FHx
nulliparity, having children late e.g. 1st child after 30 years
early menarche, late menopause
not breast feeding (breast feeding is protective)
chest radiation
HRT
COC |
|
|
Term
| which type of carcinoma may present as a bloody discharge from the nipple? |
|
Definition
|
|
Term
| should you refer a woman aged 31 with unexplained breast lump with or without pain using the 2w pathway? |
|
Definition
yes you should.
The criteria is age 30 or > with unexplained breast lump. whether it is not/painful does not matter.
consider referral if they have a lump in their armpit |
|
|
Term
| when would you refer a women over 50 for breast cancer 2 week wait? |
|
Definition
if they have the following in one nipple only
discharge
retraction
any other causes for concern |
|
|
Term
| US is more effective in scanning younger women for breast cancer. why is this? |
|
Definition
| when they are young, their breast tissue is more dense and this is good for US. |
|
|
Term
| when would you recommend mastectomy over WLE? |
|
Definition
| if tumour size is >4cm or the tumour is multi focal |
|
|
Term
| why are women who have undergone a mastectomy and will be getting radiotherapy advised to get a reconstruction after they have had their radiotherapy? |
|
Definition
| because radiotherapy may delay wound healing. |
|
|
Term
| Tamoxiefen has a pro- estrogenic effect on the uterus. what does this do to the risk of getting endometrial cancer? |
|
Definition
|
|
Term
| around what % of breast cancers are oestrogen receptor positive? |
|
Definition
~80%. use tamoxifen for 5 years if women are pre menopausal.
if they are post menopausal use aromatase inhibitors. |
|
|
Term
| Anastrazole and Letrozole are aromatase inhibitors. what is their MOA? |
|
Definition
| they work by stopping the conversion of androgens into oestrogen in the peripheral tissues. |
|
|
Term
| give examples of antracycline cytotoxic chemo agents |
|
Definition
|
|
Term
| how often is Herceptin given and for how long. What is the other name for Herceptin? |
|
Definition
given every 3 weeks for 1 year
Trastuzumab is the fancy name |
|
|
Term
| most prostate cancers are adenocarcinomas arising from which zone of the gland? |
|
Definition
|
|
Term
| what are the 3 well established risk factors for prostate cancer? |
|
Definition
AGE
race - AFRO CARIBBEAN GOT IT BAD
FHx |
|
|
Term
| signs of possible prostate cancer on DRE include |
|
Definition
hard craggy prostate
assymetry
nodule in a lobe
induration of a part or whole of prostate
lack of mobility
palpable seminal vesicles |
|
|
Term
| when is Docetaxel chemotherapy suggested? |
|
Definition
| in metastatic castrate-resistant prostate cancer |
|
|
Term
| gynaecomastia is a SE of starting which long term anti androgen therapy. what can be offered to reduce this? |
|
Definition
bicalutamide can cause man boobs.
Men who will be on this for >6m should receive prophylactic radiotherapy to both breast buds within the first month of treatment. |
|
|
Term
if a pt has CXR suggestive or lung cancer OR
are aged 40 or > with unexplained heamoptysis what action should you do? |
|
Definition
| urgent referral under 2 week rule |
|
|
Term
| what signs and symptoms would make you refer for an urgent CXR? |
|
Definition
if the pt is over 40 years and has 2 or > of the following or if they have ever smoked and have 1 of the following
cough
fatigue
SOB
weight loss
apetite loss |
|
|
Term
| how do you stage lung cancer? |
|
Definition
| contrast enhanced CT. this should include the liver and adrenals |
|
|
Term
| stage groupings of lung cancer |
|
Definition
IA - T1 N0 M0.
IB - T2 N0 M0.
IIA - T1 N1 M0.
IIB - T2 N1 M0 or T3 N0 M0.
IIIA - T1-3 N2 M0 or T3 N1 M0.
IIIB - any T4 or any N3 M0.
IV - any M1. |
|
|
Term
|
Definition
surgery or radiotherapy if they are unsuitable for surgery.
small cell cancer is sensitive to chemotherapy |
|
|
Term
| what is included in the staging process for small cell lung cancer? |
|
Definition
LDH, LFT, sodium.
contrast enhanced chets CT including liver and adrenal glands.
it is divided into limited disease and extensive disease. |
|
|
Term
| supportive and palliative care in lung cancer: what to give in breathlessness? |
|
Definition
strong opiates
breathing exercises |
|
|
Term
| supportive and palliative care in lung cancer: what to give in bronchial obstruction? |
|
Definition
external beam radiotherapy
debulking bronchosscopinc procedures
extrinsic compression may be rx with stents |
|
|
Term
| supportive and palliative care in lung cancer: how to rx pleural effusions? |
|
Definition
aspiration and drainage.
in those who benefit from this rx consider talc pleurodesis (this is a form of chemical pleurodesis where the pleural space is artificially obliterated) |
|
|
Term
supportive and palliative care in lung cancer: distressing heamptysis
for cough
for chest pain |
|
Definition
radiotherapy and debunking brochoscopy for heamoptysis
for cough: opiates and radiotherapy
for chest pain: radiotherapy |
|
|
Term
| supportive and palliative care in lung cancer: for troublesome horsiness |
|
Definition
|
|
Term
| supportive and palliative care in lung cancer: SVC obstruction |
|
Definition
chemo or radiotherapy depending on stage of disease
stent insertion |
|
|
Term
supportive and palliative care in lung cancer:
bone pain
cerebral mets |
|
Definition
bone pain: single dose radiotherapy
cerebral mets: radiotherapy and corticosteroids |
|
|
Term
| supportive and palliative care in lung cancer: SCC |
|
Definition
| medical emergency, rx in 24 hours of radiotherapy, steroids and surgical rx. |
|
|
Term
| what is the most common presenting symptom of bladder canceR? |
|
Definition
| painless haematuria. it should be treated as bladder cancer until proven otherwise. |
|
|
Term
| what are the referral guidelines for bladder cancer? |
|
Definition
45 or > with unexplained painless gross hematuria without UTI
45 or > with persisting painless hematuria after successfully treating UTI
aged 60 or > with microscopic hematuria and either dysuria or raised WCC on blood test. |
|
|
Term
| mx of localised bladder cancer |
|
Definition
TURBT (transurethral resection of bladder tumour) + single dose of mitocycin C intravesical.
BCG injection
chemo then radical cystectomy |
|
|
Term
| in thyroid cancer name 2 tumour types that are well differentiated and 2 that are not. what is the prognosis between the 2 groups? |
|
Definition
well differentiated: papillary or follicular. usually curable.
not well differentiated: medullary or anaplastic. worse prognosis. |
|
|
Term
| papillary thyroid cancer is the most common type of thyroid cancer accounting for 70%. name some of its characteristics. |
|
Definition
usually presents 35 and 40 years
3 x > common in women
often presents as micro tumour <1cm with excellent long term prognosis
spreads locally in neck with mets to lung and bone |
|
|
Term
| what is the most common subtype of thyroid cancer? what % does it account for? |
|
Definition
| papillary is the most common subset of thyroid cancer accounting for 70% of cases. |
|
|
Term
| which type of thyroid cancer occurs in areas with low iodine? |
|
Definition
Follicular thyroid carcinoma,
second most common cancer
3 x more common in women
presents between 30-60 years
greater propensity to metastasise than papillary tumours |
|
|
Term
| which thyroid cancer is associated with raised calcitonin? |
|
Definition
| Medullary thyroid carcinoma. |
|
|
Term
| if women have pre-existing chronic thyroiditis with subclinical or overt hypothyroidism which type of thyroid cancer are they at increased risk to? |
|
Definition
|
|
Term
| where is Hurthle cell carcinoma located? |
|
Definition
thyroid
hurtle cell carcinoma considered a variant of follicular cell carcinoma. |
|
|
Term
| which thyroid cancer is the most aggressive ? describe its characteristics |
|
Definition
anaplastic thyroid cancer
arises from follicular cells but is very poorly differentiated
60-70 years peak incidence
usually arises from a well define tumour that has undergone further mutations
clinical diagnosis: hard mass pressing on structures
mets are usually present on presentation
mean survival <6m whatever the rx. |
|
|
Term
| MEN 2 is associated with which type of thyroid carcinoma? what is the inheritance pattern? |
|
Definition
MTC medullary thyroid carcinoma
AD inheritence |
|
|
Term
the following are risk factors for which cancer?
1. Cowden's syndrome (macrocephaly, mild learning difficulties, carpet-pile tongue, with benign or malignant breast disease).
2. Familial adenomatous polyposis.
3. Obesity. |
|
Definition
|
|
Term
| what scan is used in the diagnosis of thyroid lymphoma? |
|
Definition
|
|
Term
| what is recommend for thyroid tumours >4cm or mutifocal disease? |
|
Definition
|
|
Term
| what is the most common type of ovarian cancer? |
|
Definition
epithelial tumour.
they account for 90% of ovarian tumours
occur most commonly in woman over 50 |
|
|
Term
| which type of ovarian tumour occurs in younger women less than 35 and has excellent prognosis? |
|
Definition
germ cell tumour.
usually presents as rapidly enlarging abdominal mass that causes considerable pain. |
|
|
Term
| risk factors for ovarian cancer |
|
Definition
age
smoking
lifestyle - obesity, lack of exercise
occupational exposure to asbestos
HRT
early menarche, late menopause, nulliparity
FHx of ovarian ca, Br1 Br2 genes
history of endometriosis |
|
|
Term
| protective factors against ovarian cancer |
|
Definition
breast feeding
child bearing
early menopause
oral contraceptive pill |
|
|
Term
| where do ovarian cancers met to? |
|
Definition
| pelvic and peri-aortic lymph nodes |
|
|
Term
| when should you refer and when should you consider tests for ovarian ca? |
|
Definition
refer: ascites or pelvic mass that isn't fibroids
consider for testing: if woman > 50 presents frequently (>12 times in year) with the following symptoms
bloating
early satiety
pelvic/abdo pain
urinary urgency/frequency |
|
|
Term
| when performing a CA 125 test, what result is considered raised? what should you do next? |
|
Definition
35 IU/ml or >
you should arrange pelvic and abdo USS. if scan suggestive of ovarian ca refer pt urgently. |
|
|
Term
| name other causes for a raised CA 125 |
|
Definition
endometriosis
pelvic inflammatory disease
pregnancy
torsion, rupture of a cyst
other ca
other peritoneal pathology
HF |
|
|
Term
| which index is used in ovarian ca to estimate risk of malignancy? |
|
Definition
Risk Malignancy Index.(RMI)
NICE = if more than 250 refer to MDT
SIGN = if > 200 refer |
|
|
Term
how is RMI calculated?
menopause status
1 = premenopausal
3 = postenopausal
USS score
0 - no abnormalities
1 - 1 abnormality
3 - 2 or > |
|
Definition
| US score x menopausal status score x CA 125 in U/ml |
|
|
Term
| in women <40 with suspected ovarian ca what other tumours should you exclude? |
|
Definition
endodermal sinus tumours - test AFP
dysgerminomas - check bHCG |
|
|
Term
| what staging is used in ovarian cancer? |
|
Definition
|
|
Term
| if ovarian dance rid limited to ovaries what FIGO stage is it? |
|
Definition
|
|
Term
| if the ovarian tumour involves one or both ovaries but there is pelvic extension what stage is it using the FIGO criteria? |
|
Definition
|
|
Term
| If there are microscopically confirmed implants of ovarian cancer outside the ovaries what FIGO stage is the cancer? |
|
Definition
|
|
Term
| if there are distant mets then which stage is this according to FIGO? |
|
Definition
|
|
Term
| how do you confirm ovarian cancer histologically? |
|
Definition
|
|
Term
|
Definition
exploratory laparotomy for histology, staging and de bulking
TAH BSO
chemotherapy may be done after |
|
|
Term
| what are the survival rates according to FIGO staging? |
|
Definition
Stage I: 97.3%
Stage II: 93.5%
Stage III: 71%
Stage IV: 51.4% |
|
|
Term
| List the 10 Wilson and Jungner criteria for screening. |
|
Definition
important condition
recognisable laten stage of disease
history of disease must be known and understood
suitable test available
acceptable to the population
case finding should be continuous and not on a one off basis
agreed policy on who to treat
facility available to rx
rx acceptable to recognised population
cost of case finding, rx etc should be economically balanced. |
|
|
Term
| what is the bowel cancer occult blood test and how often is it done. what ages? |
|
Definition
It is a screening program
for men and women aged 60-74
it is done every 2 years |
|
|
Term
breast cancer screening program
age range
how often |
|
Definition
|
|
Term
|
Definition
| Screening is the process of identifying individuals who appear healthy but may be at increased risk of a disease or condition. |
|
|
Term
|
Definition
25-49 every 3 years
50-64 every 5 years |
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|
