What is the epidemiology of sarcoma?
- 1% of all adult tumours
- Soft tissue sarcoma is more common than bone sarcoma (80% are soft tissue)
What are the two types of sarcoma?
Soft tissue sarcoma or bone sarcoma
What are the clinical features of soft tissue sarcoma?
- Lump that is painless at first
- Pain as lump grows and presses against nerves and muscles
- A leiomyosarcoma in the womb may cause bleeding outside period
- Most sarcoma metastasis to lung initially
How is soft tissue sarcoma diagnosed?
- MRI and core needle biopsy
- CT thorax for lung metastasis
How is soft tissue sarcoma treated?
- Surgical resection (if possible) + chemotherapy
+/- radiotherapy
How is bone sarcoma diagnosed?
- X ray, CT or MRI
- Bone scans and biopsy
How is bone sarcoma treated?
- Wide surgical resection/ reconstruction
- Chemotherapy +/- radiotherapy
What are the clinical features of bone sarcoma?
- Non mechanical bone pain that is still present when still
- Swelling
- Feeling tired
- Pyrexia
- Weight loss
What is lymphoedema?
- Chronic non-pitting oedema causing by lymphatic insufficiency
- Most commonly affects the legs and tends to progress with age
How is lymphoedema treated?
- Compression stockings
- Physical massage
- For filariasis infection, give oral diethylcarbamazine
- If recurrent cellulitis, long term cellulitis
What are the causes of primary lymphoedema?
- Inherited deficiency of lymphatic vessels
What are the causes of secondary lymphoedema?
- Obstruction of lymphatic vessels e.g. filarial infection (parasitic worms)
- Malignant disease
- Trauma
- Radiotherapy
- Surgery
Briefly explain the pathophysiology of paracetamol poisoning
Paracetamol is predominantly metabolised via a phase II reaction and conjugated with glucuronic acid and sulphate. If glucuronic acid and sulphate stores are low, paracetamol will undergo a phase I metabolism via oxidation to produce a toxic compound NAPQI that is immediately conjugated. An excess of paracetamol leads to a toxic build up of NAPQI.
How is paracetamol overdose treated?
- Gastric decontamination= activated charcoal
- Give IV Acetycysteine
Give 3 types of amyloidosis
- AL amyloid (primary)
- AA amyloid (Secondary)
- ATTR familial amyloidosis
How is amyloidosis diagnosed?
- Biopsy of rectum/ subcut fat= congo red staining with red-green birefringent under polarised light microscopy
What is amyloidosis?
A group of disorders of protein metabolism in which there’s extracellular deposition of an insoluble fibrillar protein called amyloid.
What is the most common cancer in women?
Breast (Infiltrating duct carcinoma)
What is the epidemiology of breast cancer?
- Affects 1 in 8 women
What are the clinical features of breast cancer?
- Painless, increasing mass
- Nipple discharge
- Skin tethering
- Ulceration
- Oedema and erythma
What are the risk factors for breast cancer?
- Increasing age
- Family history of breast cancer
- BRCA1 or BRCA2 mutation
- Never having a child
- Not having breast-fed
- Late menopause
- HRT
- COCP
How is breast cancer diagnosed?
- Clinical examination
- Radiology (USS for under 35s, Mammography and USS for over 35s)
- Histology and cytology
How is stage 1 and 2 breast cancer treated?
- Surgery
- Radiotherapy
- Chemotherapy
- Endocrine therapy if oestrogen or progesterone receptor +Ve disease
How is stage 3 and 4 breast cancer treated?
- Radiotherapy to bony lesions
- Oral tamoxifen in ER +ve
- Trastuzumab for HER2 +Ve
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