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FPE > Solid Cancers > Flashcards

Solid Cancers Flashcards

1
Q

Bowel cancer screening program?

A

Faecal occult blood every 2 years from 60-74

One off flexible sig at 55

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2
Q

What is used to grade cancer patient fitness? Categories?

A

WHO performance status
0 - fine
1 - restricted to light work
2 - up and about >50%, unable to work, self caring
3 - bed/chair bound >50%, needs care
4 - bed/chair bound all the time, needs care
5 - dead

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3
Q

How are differing ways of determining TNM scores prefixed?

What do the ‘y’ and ‘r’ prefixes mean?

A

C - by clinical exam
P - by pathological exam
A - at autopsy
U - by USS

Y - post chemotherapY or radiotherapY
R - recurrent/relapse

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4
Q

Reasons for staging cancer

A 
Determine treatment aims
Determine treatment type
Prognostic 
Monitor treatment efficacy 
Assist in trials
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5
Q

5 year survival of dukes A vs dukes D

A

93% vs 6.6%

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6
Q

Dukes staging of colorectal cancer

A

A - mucosa or submucosa
B - through muscularis mucosa
C - into regional lymph nodes
D - distant mets

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7
Q

5 symptoms from local effect of colorectal cancer?

A 
Pr bleeding
Mass
Abdo pain
Change in bowel habits 
Tenesmus
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8
Q

Lifetime risk of ca breast in women?

A

1:8

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9
Q

Proportion of ca breast occuring in men

A

0.7%

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10
Q

Risk factors for ca breast?

A 
Increasing age
Female
Oestrogen (hrt, cocp, early menarche, late menopause, nulliparous, never breastfed)
FHx
Alcohol
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11
Q

Impact of benign breast disease on future breast cancer

A

Harder to detect threrefore worse prognosis but not increased incidence

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12
Q

Screening program for breast cancer

A

Mammogram every 3 years from 47 to 73

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13
Q

Signs and symptoms of breast cancer

A 
Lump
Thickening
Dimpling/puckering
Discharge/bleeding
Change in size/contour
Nipple inversion/crusting
Peau de orange
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14
Q

2ww criteria for breast cancer

A

Over 30 with lump in breast or axilla
Over 50 with unilateral nipple discharge, retraction or concerning feature
Any age with concerning skin changes

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15
Q

What is the triple diagnosis in breast cancer

A

Exam
Radiology
Biopsy

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16
Q

When is uss useful in breast cancer? Why?

A

Under 35s as breast too dense for mammogram

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17
Q

How can a breast cancer be biopsied

A

Fine needle cytology
Core biopsy
Excision biopsy

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18
Q

How can the perceived severity of a breast lump be recoded in the notes?

A 
Graded 1-5 (most likely malignant) on:
Physical exam - P
Core biopsy - B
Cytology - C
Mammogram - M 
USS - U
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19
Q

What calculator can be used in working out breast cancer prognosis. What does it importantly include and not include?

A

Nottingham prognostic index
Includes tumour size, grade and node involvement
Misses receptor status

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20
Q

What types of non invasive breast carcinoma are there. How do they usually present?

A

DCIS
LCIS
present at screening with calcificaiton

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21
Q

Invasive breast cancers and presentation of top two

A 
Invasive ductal carinoma (lump)
Invasive lobular carcinoma (thickening)
Medullary
Tubular 
Inflammatory
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22
Q

Imaging for a invasive lobular carcinoma

A

Needs an mri post biopsy as doesnt show on mammogram

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23
Q

Breast cancer receptor status and treatments

A

Oestrogen/progesterone (ER/PR)

  • tamoxifen - a selective estrogen receptor antagonist used prior to menopause
  • aromatase inhibitor - blocks adrenal oestrogen syntheis used after menopause
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24
Q

Surgical options in breast cancer

A

Breast - local excision with wide margins, masectomy

Axilla - sentinal node biopsy, axillary clearence

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25
Q

Reasons to perform masectomy

A

Patient choice
Multiple tumours in one breast
Large tumour in comparison to breast
Tumour behind nipple
Previous local excision (cant have two doses of radio to one place)
Prophylactic in familial if patient desires
Male breast cancer

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26
Q

Reasons for chemo in breast cancer

A

Neoadjuvant to shrink allowing local rather than massectomy

Inflammatory type

27
Q

Breast reconstruction types

A

Implant - inflate over weeks

Muscle flap - e.g lat dorsi

28
Q

Disadvantage of breast reconstruction surgery

A

Increases healing time
Longer surgery
Increased infection risk
Can delay adjuvant treatment

29
Q

When taking a breast cancer fhx what should be asked about as well as breast cancer?

A

Ovarian cancer

30
Q

Risk factors for ca prostate

A

Age
Fhx
Black ethnicity

31
Q

Presentation of ca prostate

A

Nocturia
Frequency of urination
Advanced disease - haematuria
Metastatic disease - bone pain

32
Q

Causes of raised PSA

A 
Cancer
BPH
Ejeculation (no sex for 3 days before test)
UTI
Urinary retention
Catheterisation
Prostatitis
33
Q

What to consider with a patient on finasteride who needs a psa

A

First few months psa uninterpretable. After that must double psa

34
Q

What two factors should be considered when considering to refer an individual with a smooth soft prostate and a raised PSA

A

Size of PSA vs size of prostate (PSA density)

Speed of rise of PSA (PSA velocity)

35
Q

How is prostate cancer graded?

A

Gleason grade
Looks at degree of gland formation
Grade of the most common region + grade of the next most common region (1-5 + 1-5)

36
Q

Treatment options for localised prostate cancer

A

Watchful waiting/active surveillance
Prostatectomy
Radiotherapy

37
Q

Complication rate of prostatectomy

A

1/3 rd erectile dysfunction

1/3rd urinary incontinance

38
Q

Main treatment of metastasised prostate ca

How is this done? What needs to be given with it

A

Castration (with initial chemotherapy)
LHRH agonist
Androgen antagonist for 2/52 to stop initial flare

39
Q

Problem with chemical castration in metastatic prostate cancer long term. Solution?

A

Tumours become castrate resistant.

Give chemo

40
Q

Difference between watchful waiting and active surveillance

A

Watchful waiting - pt not suitable for active Tx - wait for symptoms
Active surveillance - suitable for active Tx - follow up regularly

41
Q

Risk factors for bladder cancer

A 
Shistosomiasis
Occupational (dyes, tar, rubber)
Smokers
FHx
Age
Male
Drugs (cyclophosphamide, pioglitasone)
42
Q

Presentation of bladder cancer

A

Painless frank haematuria
Hydronephrosis
Mass
Recurrent UTI

43
Q

Investigations in suspected bladder cancer

A

USS
CT urogram
Cystoscopy
Urine cytology

44
Q

Non muscle invasive types of bladder cancer

A

CIS - flat lesion - high grade
TPa - peduculated lesion - low grade
TP1 - invading lamina propria

45
Q

Treatment of non muscle invasive bladder cancer

A

Diathermy / TURBT

Adjuvant intravesicular chemo or BCG

46
Q

Treatment of muscle invasive bladder cancer

A

Fit - radical cystectomy
Unfit - radical radiotherapy
Metastasised - chemotherapy

47
Q

What is the screening program for bowel cancer?

A

Faecal occult blood with colonoscopy if +ve every 2 years from 60-69
Flexi sig at 55

48
Q

Symptoms of rectal cancer?

A

Tenesmus
Frank bleeding
Prolapse

49
Q

Symptoms of right sided bowel cancer

A 
Weight loss
Anaemia
Mass
Appendicitis
Obstruction 
Fistula
50
Q

Symptoms of left sided bowel cancer

A

Change in bowel habits

Mixed in blood

51
Q

Who should be referred under 2ww with PR bleeding

A

Anyone over 50

Anyone under 50 with pain, weight loss, change in bowel habits, iron deficiency

52
Q

Who should be referred under 2ww for change of bowel habits?

A

Anyone over 60

Anyone under 60 with positive faecal occult blood

53
Q

Someone presents with abdo pain and weight loss. Over what age should they be referred on 2ww

A

40

54
Q

When should someone with anaemia be referred on 2ww for colon cancer?

A

60 (iron deficient)

+ve faecal occult blood (offered in iron deficient 60)

55
Q

Options if a patient isnt fit for colonsocopy but is suspected of having bowel cancer?

A 
Sigmoidoscopy (good for distal lesions) 
Contrast CT (good for large lesions) 
CT colonogram (good if can tolerate some prep)
56
Q

What staging investigations should be performed in rectal cancer?

A

CT CAP

MRI pelvis

57
Q

What are the dukes stages of colorectal cancer

A

A - limited to muscularis propria
B - through muscularis propria
C - nodes involved
D - distant met

58
Q

Risk factors for bowel cancer

A

Hereditory - fap hnpcc
Dietry - low fibre, high red meat
Pmh - previous cancer, ibd, cholecystectomy

59
Q

What med lowers bowel cancer risk

A

Aspirin

60
Q

When is neoadjuvant therapy used in bowel cancer?

A

Rectal cancers

61
Q

Novel therapy that is used in bowel cancer?

A

Anti vegf monoclonal antibody

62
Q

Surgery options for rectal cancer

A

Trans anal endoscopic microsurgery (tem)

Total mesorectal excision

63
Q

Palliative surgical proceedures in bowel cancer

A

Stent
Bypass
Debulking resection
Stoma - defunctioning

FPE (11 decks)

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