Oncology Flashcards

Question

bronchoscopy for lung cancer

Answer 1

flexible versus rigid - flexible - >conscious sedation - >can visualise tertiary bronchi - >diagnostic and therapeutic options - rigid - >larger - >can only access proximal airways - >requires general anaesthesia - >used for interventions not available with flexible flexible, conventional white light - endobronchial brushing, washing or lavage - >cytology - >obvious lesions in airway - transbronchial biopsy with forceps - >peripheral, parenchyma lesions - >not directly visualised - >typically image guided (fluoscopy or ultrasound) - >histology - transbronchial needle aspirate - >lesions and lymph nodes close to airways - >guided by CT images in conventional endobronchial ultrasound - flexible bronchoscopy with hybrid scope - >ultrasound probe attached - real time ultrasound guidance - >visualise anatomy - >localise lymph nodes and peripheral lesions - endobronchial needle aspirate or biopsy - >cytology with aspirate complications - common - >hypotension and hypoxia from sedation - >bleeding - >pneumothorax - >nasal/throat pain - >haemoptysis - rarer but serious - >broncho/laryngospasm - >infection - >cardiac arrthymias

Answer 2

``` FBC -anaemia -leuko/thrombocytosis EUC -hyponatraemia -hypokalaemia (cushing/ACTH) CMP -hypercalcaemia LFTs -al phos Coags ``` CXR -nodules, effusion, atelectasis, mediastinal mass CT chest, neck, upper abdo with contrast -tumour spread -poor sensitivity for mediastinal staging PET CT -adjunct to CT (combination improves staging accuracy) -more accurate evaluation of mediastinum and extrathoracic disease -sometimes detects occult mets -can guide biopsy -not required if mets is already confirmed Confirm diagnosis - sputum cytology - >high specificity, low sensitivity - bronchoscopy - >transbronchial needle aspirate most common - >conventional or EBUS - transthoracic needle aspiration - >peripheral lesions unaccessible by bronchoscopy - other lymph nodes - >supraclavicular or neck - thoracocentesis - >if pleural effusion - >presence of malignant cells Pretreatment - ECG - pulmonary function tests - staging scan (eg. MRI brain) - genes (primary or metastatic lesion) - >EGFR - >ALK - >ROS1

Answer 3

epidermal growth factor receptor (EGFR) - encoded by tyrosine kinase gene - mainly adenocarcinoma - never smokers - detected by PCR - benefit from EGFR kinase inhibitor therapy over chemo anaplastic lymphoma kinase (ALK) - rearrangements in gene - adenocarcinoma in young non smokers - detected by FISH - benefit from ALK inhibitor therapy over chemo ROS1 - receptor tyrosine kinase - driver oncogene - young, never smokers or light smokers - adenocarcinoma

Answer 4

division between surgical resection and inoperable (chemo/radiation) - anatomic staging - physiologic staging - >patient's ability to withstand treatment - principally for NSCLC - >small cell assumed to be systemic at time of diagnosis anatomic staging - inoperable - >any criteria of stage 3 or 4 - >malignant pleural effusion - >tamponade - >within 2cm carina - >phrenic and laryngeal nerve involvement physiologic staging - screen for comorbidities - >basic bloods, ECG etc - pulmonary function tests (COPD common) - >FEV1 >2L or 80% predicted = pneumonectomy - >FEV1 >1.5L = lobectomy - cardiopulmonary exercise testing - >for borderline lung function - >maximal O2 consumption <15mL/kg = high post op complication risk - secondary surgical options - >wedge or anatomic segmental resection - >higher rate of recurrence - MI - >within past 3 months = contraindication to thoracic surgery - other major contraindications - >uncontrolled arrhythmias - >FEV1 <1L - >PCO2 >45 - >DLco<40% - >severe PHTN

Answer 5

NSCLC - Stage 1A - >surgery alone - Stage 1B - >surgery + adjuvant chemo - Stage II or III with hilar or mediastinum nodes only - >surgery + adjuvant chemo - supraclavicular or contralateral nodes - >no surgery - >chemoradiation - Stage 4 - >systemic therapy (chemo, immunotherapy) - >pain management - >radiotherapy SCLC - limited - >surgically resection not usually recommended - >can be performed with adjuvant chemo - extensive - >combined chemo + radiation preferable - >alternate chemo/radiation if intolerable

Answer 6

DCIS: - presumably malignant lesion with no evidence of invasion - comedo - >large necrotic core - >lots of calcification - >degree of comedo necrosis correlates with prognosis - cribiform - >back to back glands without stroma in between - micropapillary - >tufts of cells without fibrovascular core - papillarly - >intraluminal projections - >contains fibrovascular core - solid - >fill and distend involved spaces - >no papillation or necrosis INFILTRATING: - macro - >grey - >gritty - >invade in haphazard manner, creating stellate appearance - micro - >cords/nests of tumour cells - >varying amounts of gland formation - >induce fibrous change in parenchyma

Answer 7

divided into three grades (architecture and cytology) -grade 1 ->well differentiated ->infiltrate stroma as solid nests of glands ->uniform nuclei -grade 2 ->moderately differentiated ->infiltrate as solid nests with some glandular formation ->nuclear pleomorphism ->moderate mitotic rate grade 3 ->poorly differentiated ->solid nests of neoplastic cells with not gland formation ->marked nucelar atypia ->high mitotic rate

Answer 8

OVERALL arises from complex interactions of susceptibility genes and driver mutations resulting in uncontrolled expression of endogenous growth factors and signalling pathways GENES Familial/germline - approx 10% are due to identifiable genes - notable genes - >BRCA1/2 (tumour suppressor/ DNA repair) - >p53 (Li Fraumini syndrome) - >PTEN (Cowen syndrome) - BRCA1 - >approx 3/4 develop breast cancer - >approx 1/3 develop ovarian cancer - >almost always triple negative - BRCA2 - >more likely to be ER positive Sporardic - thought to be due to risk factors - >eg. estrogen exposure - p53 - >occurs in 40% of breast cancer - acquired mutations in PTEN - >in 10% HORMONES Genetic/epigenetic changes (driver mutations) - over express ER - >gene is ESR1 - >80% of all breast cancer - amplification of erbB2 - >codes for HER2 - >25% of breast cancer OUTCOMES final common pathway - DCIS -> invasive cancer - incompletely understood - >majority of genetic/hormonal alterations already in place - >may relate to similar remodelling events as occurs in pregnancy pathways - BRCA2 (luminal) - >ER, HER2 positive - >flat epithelial atypia -> atypical ductal hyperplasia -> DCIS - HER2 positive (HER2 enriched) - >either ER positive/negative - >atypical apocrine adenosis -> DCIS - BRCA1 (Basal) - >triple negative - >precursor lesion to DCIS not yet described - >usually have p53 mutation

Answer 9

availability - funded by medicare if >10% chance of finding mutation - strong hx - >multiple relatives with breast/ovarian - >younger age at diagnosis - >bilateral breast - >ashkenazi jew options - mutation search - >in affected individual - >determine if BRCA1/2 is present - predictive test - >in family member of affect individual - >determine whether they have family mutation - founder mutation testing - >offered to populations with high rates outcome - surgery almost completely reduces risk - >risk reducing salpingo-oopherectomy - >risk reducing mastectomy - increased life expectancy - >chance of being alive by 70 goes from 50% to 80% - alternative - >surveillance - >tamoxifen/raloxifen

Answer 10

mammography - high sensitivity and specificity - >detects cancer years before it becomes clinically evident - suspicious findings - >spiculated focal mass - >dense mass - >clustered or linear branching microcalcifications ultrasound - utility - >combined increased sensitivity and specificity - >better sensitivity than mam in younger patients - >differentiate cystic (benign), solid and complex masses - >characterise lesion found on exam but not mammography - >involvement of axilla and breast nodes MRI - highest sensitivity but poor specificity - >hasnt been shown to improve outcomes

Answer 11

core needle biopsy - prefered - >still minimally invasive - >differentiates pre-invasive and invasive - >inadequate sampling less likely - >assessment of receptor status - image guided - >ultrasound - >stereotactic (xray) - >tomosynthesis (3-D xray reconstruction) - >MRI ``` fine needle aspirate -sensitivity >98% -specificity ->97% -utility ->rapid diagnosis of malignancy -negatives ->cannot distinguish between invasive/non-invasive ->higher false neg ->higher inadequate sampling ->often can't be used for receptor status ``` surgical biopsy - not first line - >performed when FNA or CNB impossible - can be excisional/incisional punch biopsy -rarely used

Answer 12

SLNB versus ALND - SLNB - >when clinically negative nodes - ALND - >palpable nodes - >suspicious nodes on US - >advanced disease SLNB technique - hypothesis - >metastatic tumour spreads to one or a few lymph nodes before involving others - >potentially avoid morbidity of ALND - surgical levels - >level 1 below pec minor - >level 2 behind pec minor - >level 3 medial and above pec minor - inject tracer near tumour or into areolar plexus - >blue dye - >radioactive colloid - identify sentinel nodes - >after approx 5 mins - >incision in axilla - >identify bluest nodes or gamma probe - >excise sentinel nodes MORBIDITY ALND - infection - haematoma - seroma - arm lymphoedema - >radical mastectomy - >radiation therapy - >ALND - nerve injury - >eg long thoracic = winging - >rare

Answer 13

imaging -detected by screening mam = better than clinical path - advanced stage = poor - higher grade = poor - lymphovascular invasion = poor morphology ->ILC initially less recurrence than IDC, then more after 6 years tissue marker - ER/PR positive = good - HER2 positive = bad genomic profile - luminal - >luminal A = best prognosis of all - 21 gene recurrence score - >RT PCR - >evaluates expression of 21 genes within tumour - >provides risk score - >useful in determining benefit of adjuvant chemo

Answer 14

early disease and locally advanced - breast conserving lumpectomy + radiation - mastectomy - lymph nodes - >SLNB if clinically negative - >ALND if mets present or positive exam - consider - >chemo - >biology therapy - >endocrine therapy - neoadjuvant chemo for locally advanced mets - symptomatic relief is priority - anti-oestrogen - >tamoxifen - radiotherapy - >bone pain - >prevent fractures - surgery - >focal control

Answer 15

non modifiable - age >40 - male - black - family history - vocal cord dysplasia modifiable - smoking - alcohol - acid - >GORD - >achlohydria in gastrectomy - radiation - HPV

Answer 16

neck CT with contrast ->useful for evaluating lymph node mets chest CT with contrast - >lymphadenopathy - >nodules not detected by xray FNA neck mass - >histology may reveal squamous cell - >negative does not rule out diagnosis flexible laryngoscopy - >visualise lesion - >assess airway patency consider: - rigid videostroboscopy - >evaluate vocal cord movement - >submucosal lesion - rigid bronchoscopy - >biopsy - whole body CT PET

Answer 17

nodes of head and neck common - waldeyes ring - level 1 - >submandibular - level 2-4 - >from angle of jaw to neck - >understernoclidomastoid - level 5 - >posterior triangle - level 6 - >paramedia (tracheal and thyroid) area haematogenous - bone - liver - lung

Answer 18

Neoplasia benign - pituitary adenoma + CMP - craniopharyngioma - meningioma - pituicytoma ``` malignant (primary = Good Luck Curing) -germ cell -lymphoma -chordoma (metastatic) -breast -lung ``` Hyperplasia -eg. gonadotroph in congential hypogonadism Cysts (RAD) - rathke's cleft - arachnoid - dermoid Abscess AV fistula

Answer 19

- cryptorchidism - personal history - family history - cannabis - infection (mumps and HIV)/trauma

Answer 20

Stage 1 - no evidence of metastatic spread on chest/abdo/pelvis imaging - if pre-orchiectomy hCG levels elevated, decline post surgery - can be locally invasive through albuginea, with or without lymphovascular invasion Stage 2 - abdo node involvement - stratified further by size Stage 3 -distant (non-retroperitoneal) mets

Answer 21

Lymphatic - initial route - retroperitoneal nodes - left sided --> left para-aortic nodes inferior to left renal vessel - right sided --> aortocaval nodes inferior to right renal vessels - inguinal if scrotal violation has occured - later = retrocrural, mediastinal and suprclavicular Haematogenous - lung most common - liver, brain and bone

Answer 22

Germ cell (TESTY) = 95% - teratoma/carcinoma - embryonal carcinoma - seminoma - trophoblastic (choriocarcinoma) - yolk sac Sex chord stromal - leydig - sertoli - granulosa Gonadoblastoma (mixed seminoma with sertoli) Paratesticular - mesothelial - epithelial Non-hodgkins lymphoma

Answer 23

``` Smoking Occupational -paints, metals, hair dyes, leather work, cement Water -low intake -chlorine -arsenic Chronic cystitis HPV infection Upper UT urothelial cancer Iatrogenic -radiation Drugs -cyclophosphamide -phenacitin -thiazelidediones Family Hx ```

Answer 24

Varies by risk category Observation -monitoring course of disease with aim to provide palliative treatment when signs or symptoms arise Active surveillance - PSA 6-12 monthly - DRE 6/12 monthly - biopsy >12 monthly - treat with curative intent when detected External beam radiotherapy - focused radiation - every day for 2 months - 20% risk bowel dysfunction - 70% risk erectile dysfuntion Brachytherapy -transperineal implantation of radioactive sources into prostate without incision Radical prostatectomy - when localised to prostate - lymph nodes can be resected - reduces recurrence but does not improve mortality - 70% risk erectile dysfunction ADT - LHRH agonist or antagonist plus NSAID initially - bilateral orchiectomy - mainly for metastatic disease - 70% erectile dysfunction

Answer 25

AEEIoU -adenosis (columnar surrounding fibromuscular) -ectropian -endometriosis -infection (herpes, syphilis, STI) other -ulcerative (nabothian, leiomyoma, polyp) Abnormal uterine bleeding FIGO (POLICEMAN) - polyps (uterine/cervical) - ovulatory dysfunction - leiomyoma - iatrogenic (drugs, contraceptive device) - coagulopathy (vWD) - endometrial dysfunction - malignancy (cervical, leiomyosarcoma, endometrial carcinoma - adenomyosis - not otherwise classified Vaginal/Vulva bleeding BAIT - benign (polyp) - atrophy - infection - trauma (sex, foreign body, pelvic)

Answer 26

Urinalysis Urine cytology FBC EUC LFTs -alphos ``` CT contrast/non con -locally invasive -nodes MRI with gadolinium -same or more sensitive as CT IVP -largely replaced by CT ``` Flexible cystoscopy - narrow band imaging - fluroscene staining Consider - urinary markers - CXR/ chest CT - Pelvis CT

Answer 27

T - Ta = papillary (restricted to urothelium) - Tis = carcinoma in situ (usually flat, restricted by basement membrane) - T1 = through BM, not into MP - T2 = into MP - T3 = through MP (adventitia/perivesicle fat) - T4 = invasion into prostate, vagina, uterus or bowel; invasion into pelvic/abdo wall N - N1 = single lymph node in pelvis - N2 = multiple lymph nodes in pelvis - N3 = involvement of common iliac nodes M - Nodes beyond common iliac - distant mets ``` Stage 1 -T1 Stage 2 -T2 Stage 3 -T3/4 -Any T with any N Stage 4 -any M -T4b with any N ```

Answer 28

Local spread - irritative voiding symptoms (urgency, frequency etc) - obstructive voiding symptoms (straining, incomplete voiding) - retention (clot formation or outlet obstruction) - hydronephrosis (tumour of the trigone and ureteral orifice) Lymphatic spread -iliace nodes --> para-aortic Haematogenous -bone, brain, liver, lung Prostatic urothelial carcinoma -up to 25% Upper UT urothelial carcinoma (ureter/pelvis) - up to 25% - high mortality

Answer 29

``` Stage 1 -T1 (not palpable)/T2 (confined to prostate) -and PSA <10 -and GG 1 Stage 2 -combinations of T1/2 with PSA >10<20 and GG 1-4 Stage 3 -T3/4 -PSA >20 -GG 5 Stage 4 -N1 -M1 ```

Answer 30

Gynecomastia -production of hCG by foci of choriocarcinoma or trophoblastic cells Hyperthyroidism -alpha and beta subunit homology between TSH and hCG Paraneoplastic limbic encephalitis -mood/behavioural changes -short term memory problems and cognitive difficulty -focal seizures (impaired awareness) -hypothalamic = hyperthermia, somnolence, endocrine -anti-Ma2 antibodies (selectively expressed in neuronal nucleoli and tumour cells)

Answer 31

CATFACES - cachexia - anaemia (chronic disease) - thrombocytosis - fever (night sweats, weight loss) - amyloidosis (secondary, inflammation) - calcium (hypercalcaemia: lytic mets, bone turnover prostaglandins, PTHrP) - erythrocytosis (EPO) - Stauffer syndrome (IL-6, GM-CSF)

Answer 32

T1 - limited to kidney - <7cm T2 - limited to kidney - >7cm T3 - into perinephric tissue - limited by Gerota's fascia - a = renal vein - b= vena cava below diaphragm - c = vena cava above diaphragm Nodes -N1 or N0 Mets - M1 or M0 - multiple lymph nodes, adjacent organs, distant ``` Stage 1 -T1, N0, M0 Stage 2 -T2, N0, M0 Stage 3 -T3, N0/1, M0 -T1/2, N1, M0 Stage 4 -M1 ```

Answer 33

Urinalysis Urine culture/PCR? ``` FBC beta HCG -20% seminomas -all choriocarcinoma AFP -no pure seminomas or choriocarcinoma -elevated in rest LDH -prognostic/staging Placental al phos -advanced disease LFTs -mets -GGT raised in seminoma ``` Ultrasound - extrinsic vs intrinsic - pure seminoma = non cystic/fluid filled (NSGCT's may be hetergeneous and cystic) - microcalcification (common but non-specific) - cannot determine spread through albuginea CT abdo/pelvis - retroperitoneal node involvment - high false negative CXR -lung mets CT chest -if CXR shows lesion or nodes on abdo CT PET CT -controversial utility Radical inguinal orchiectomy -histologic evaluation and local control Consider - retroperitoneal lymph node dissection for subset of NSGCT identified after orchiectomy - contralateral biopsy (controversial) due to rate of testicular germ cell tumour in situ

Answer 34

- based solely on architectural features - correlates closely with clinical behaviour - based on growth pattern and degree of differentiation, scored 1-5 with worse being 5 - 2 most common scores are reported and summed (tertiary score for group 3 when <5% are higher grade) gleason group (risk of recurrence and mortality increases) - Group 1 = 6 or less - Group 2 = 7 (3+4) - Group 3 = 7 (4+3) - Group 4 = 8 - Group 5 = 9 or 10

Answer 35

``` urinalysis -haematuria -leuks/nitrites -WCC urine culture ``` ``` FBC -anaemai/erythrocytosis -thrombocytosis (Stauffer) Iron studies EUC -GFR -electrolytes -contrast CMP -hypercalcaemia LFTs -mets -stauffer Coags -PT in stauffer LDH -prognostic marker ``` CT abdo -coticomedullary/nephrogenic/delayed/non con MRI abdo Ultrasound (can be initial to exclude cysts) consider - chest/pelvic CT (mets) - MRI brain (mets) - bone scan (bone pain/al phos) - core biopsy

Answer 36

Urinalysis ``` PSA FBC -anaemia -baseline for ADT EUC -UTO -baseline for ADT CMP -hypocalcaemia LFT -baseline for ADT (risk of hepatitis) -al phos in mets Testosterone -baseline for ADT ``` ``` Bone scan with T99 -symptomatic -supplemented with plain xray Pelvic CT/MRI -lymph nodes MRI spine -with and without contrast -ESCC/LSS ``` Needle Biopsy - ultrasound guided - at least 12 biopsies (equal each side)

Answer 37

adnexal mass in menopause (LAUNCH) - leiomyoma - abscess (tubo-ovarian, abdomino-pelvic) - urinary tract (eg. bladder diverticulitis) - neoplasia (ovarian most common primary; mets from endometrium, breast, GI) - cysts (ovarian) - hydrosalpinx uterine bleeding (CRAP Ovaries) - other (bladder cancer, urethritis, diverticulitis etc) - coagulopathy (vWD) - replacement therapy - atrophy - polyps

Answer 38

Primary brain tumour: - low grade glioma (no uptake) - high grade glioma (heterogeneous uptake) - meningioma (homogeneous uptake) - primary CNS lymphoma (homogeneous) Metastatic tumour (homogenous): - breast - lung - melanoma ``` Vascular: infarct -cortical emboli -venous thrombus (bleeding, oedema) haemorrhage (subacute intraparenchymal) anamoly -cavernous malformation -AV malformation -posterior reversible leukoencephalopathy syndrome ``` Infection: - granuloma - progressive multifocal leukoencephalopathy (JC virus) - abscess Inflammatory: - demyelination (MS) - autoimmune encephalitis (para/non neoplastic)

Answer 39

Benefits - to accurately detect cancer in early stage so that treatment can be given to reduce morbidity and mortality - PSA testing is associated with greater detection of cancer - PSA testing reduces rate of detection of metastatic disease - Inconsistent evidence as to whether this reduces mortality (slow growing, most almost 3/4 men over 75% die with it rather than from it) - Inconsistent evidence as to whether early detection improves or reduces quality of life Harms - over-diagnosis by PSA approx 20-40% - no way of knowing which are require treatment, so all much receive investigations - investigations = anxiety, inconvenience, adverse outcomes (biopsy = 2% infection, pain, bleeding etc) - false positive - urinary incontinence = 15% radical prostatectomy - erectile dysfunction = 70% radical prostatectomy/radiotherapy/androgen deprivation - bowel problems = 20% external beam radiation

Answer 40

Epidemiology - prostate cancer second most common cancer in aus men - prostate cancer second most common cause of cancer death in aus men Risk factors - family hx - first degree relative = 2x incidence - higher = multiple members, younger diagnosis, BRAC1/2 - overweight and obesity - first degree relative = 2-3 x mortality rate - higher = multiple family members, died from prostate cancer

Answer 41

Recommendation -shared decision making as cannot offer definitive recommendation -men >50 with average risk and knowledge of risk/benefits who want to be screened should receive PSA every 2 years til 69 -men <50 concerned about risks, offer PSA every 2 years until 69 (if initial <75th % for age, cease till 50) (if initial <95 but >75 % keep screening) (if initial >95%, repeat etc.) -men >70 advise risks likely greater than benefits -life expectancy <7 years precludes screening -if base rate risk higher, start 40/45 and follow above algorithm

Answer 42

Normal ranges - 40's = 2.5ng/mL - add 1ng/mL for every decade after Causes elevated PSA - cancer - BPH - prostatitis - trauma (investigations, DRE, sexual activity)

Answer 43

IF 2-3ng/mL - repeat in 1-3 months with free:total - if now 5.5, offer biopsy - if not 5.5 but free:total <25%, offer biopsy

Answer 44

Non-invasive - DCIS - LCIS - >rare Invasive - infiltrating ductal carcinoma - >accounts for approx 3/4 invasive disease - infiltrating lobular - >approx 15% - >incidence is increasing with HRT - >occurs in older women - >better differentiated - >estrogen receptor positive - >more commonly bilaterally - >appear to have better prognosis - >metastasis later (to meninges and peritoneum) other - mucinous - tubular - medullary

Answer 45

non-proliferative (CAF) - not associated with increased risk of breast cancer - cysts - >very common - >30-50 year olds - apocrine change - >apocrine differentiation of ductal cells after insult - fibrosis - >can occur with rupture of simple cyst proliferative without atypia (I SURF) - small increased risk 1.5-2 x - Intraductal papilloma - >array of papillary cells growing from cyst into lumen - >can harbour DCIS - Sclerosing adenosis - >increased fibrosis tissue interspersed with glandular cells - Usual ductal hyperplasia - >increased cells within ductal space but normal cytology - Radial scar - >fibroelastic core with radiating ducts and lobules - Fibroadenoma - >most common - >well defined, mobile mass on exam - >benign solid tumour with fibrosis and glandular tissue atypical hyperplasia - increased risk of breast cancer (3.5-5.5x) - some but not all features of DCIS/LCIS - >atypical ductal hyperplasia - >atypical lobular hyperplasia

Answer 46

``` personal hx family hx genetic FACEBARS -female -age -caucasian -estrogen exposure ->menarche/menopause ->nulliparity ->pill -benign breast disease ->proliferative without atypia ->atypical hyperplasia -alcohol -radiation -socioeconomic status (high) ```

Answer 47

hx: - risk factors - mass - >onset - >evolution - >relation to menstrual cycle - skin - >erythema - >dimpling - nipple - >asymmetry - >inversion - >unilateral, bloody, serous, discharge - pain - trauma to breast - mets - >SOB, cough etc - >bone pain - >nausea, vom, anorexia ``` exam: -breast ->fixed, firm, irregular borders ->asymmetry skin ->peu d'orange ->erythema ->thickening -nipple ->asymmetry ->inversion -lymph nodes ->axillary ->supra/infra clavicular ->cervical -mets ->effusion ->boney tenderness ->jaundice ```

Answer 48

``` Breast cancer ..... CALMING Feel -cyst -abscess -lipoma -mastitis -ISURF (proliferative without atypia) -necrosis (fat) -galactocele -fibroadenoma ```

Answer 49

``` FBC CMP -calcium LFTs -al phos ``` imaging - mammography - ultrasound - consider MRI - >in high risk - >eg BRCA1/2 mutations biopsy - CNB preferred - FNA pre-treatment - ER and RR - >immunohistochemistry - >positive if >1% positive tumour nuclei - HER2 - >positive if 3+ on immunohistochemistry - >confirm with FISH (amplification of erbB2) with mets - CXR - >effusion - CT staging scan (chest abdo) - bone scan - MRI spine - >if neuro symptoms - consider - >PET scan - >CEA

Answer 50

three components - hx and breast exam - imaging - >mammography - >ultrasound - biopys - >CNB - >FNA performed in sequence -allows accurate interpretation of result outcome - positive if any component is suspicious/malignant/indeterminate - sensitivity - >greatest when combined - positive - >99% sensitive - >further investigations - >refer to surgeon - negative - >false negative= <1% - >safe to cease investigations

Oncology Flashcards

(74 cards)