oncology and palliative medicine notes detailing all common oncological pathologies and conditions across all bodily systems for medical school exams, including palliative care medicine. Notes made from multiple resources such as oxford handbook, question banks, university lectures and UK guideline...
Hallmarks of Cancer
Self-Sufficiency in Growth Signals Tissue Invasion and Metastasis
- Path: Do not require external signals to replicate - Path: Spreads from origin sites to elsewhere
Insensitivity to Anti-Growth Signals Evasion of Immune System
- Path: Resistant to growth-restricting signals - Path: Avoids detection by host immune system
Evading Apoptosis Tumour-Promoting Inflammation
- Path: Resistant to programmed cell-death - Path: BM degradation leads to Metastasis
Replicative Immortality Genomic Instability
- Path: No limit to number of cell divisions - Path: Mutations and chromosomal polyploidy
Sustained Angiogenesis Dysregulated Metabolism
- Path: Formation of new vasculature - Path: Alternative metabolism pathways
Lung Cancer in General
Classifications Investigations
- Small Cell Lung Cancer (SCLC) (15 %) - CXR: First line; 10 % of cases will have normal CXR
o Small cell carcinoma: Also called oat cell cancer - Contrast-Enhanced CT: Ix of choice for lung cancer
o Combined small cell carcinoma: Mix of SC + NSCLC - NB: HRCT involves slices so can miss cancer
- Non-Small Cell Lung Cancer (NSCLC) (85 %) - Bronchoscopy: Biopsy aided by endobronchial US
o Adenocarcinoma: 40 %; Occurs in non-smokers - PET: 18-FDG is preferentially used by NSCLC
o Squamous: 30 %; Occurs typically in smokers - Bloods: ↑ Platelet count (PTC)
o Large cell: 15 %; Occurs typically in smokers Referral Guidelines
o Alveolar cell: Rare; Unrelated to smoking - Referral for suspected cancer pathway (2 wk)
o Bronchial adenoma: Rare; 90 % are carcinoid o CXR: Suggestive of lung cancer
o NB: Carcinoid tumours can lead to carcinoid syn. o Features: ≥ 40 YO + unexplained haemoptysis
Presentation - Refer for urgent CXR (2 wk) if ≥40 YO plus one sx
- Key: Persistent cough; Haemoptysis; Dyspnoea o Sx: Cough; Fatigue; SOB; Pleurisy; ↓ Weight
- Other: Chest pain; ↓ Weight; SVC syndrome - Consider urgent CXR (2 wk) if ≥40 YO plus one sx
- Hoarseness: Pancoast tumour on Rec. Laryngeal n. o Sx: Multi-chest infx; Clubbing; ↑ SCL; ↑ PTC
- Examination: Supraclavicular lymphadenopathy (SCL) Risk Factors
- Auscultation: Monophonic rhonchi - Risks: Smoking; Radon gas; FHx; Asbestos; RT
Small Cell Lung Cancer Management
Features - Surgery: Very early disease (T1-2a, N0, M0)
- Location: Usually central - Chemo-Radiotherapy: Offered in limited disease
- Pathology: Typically arise from APUD cells - Palliative: Chemotherapy for extensive disease
- Histology: Kulchitsky cells (Enterochromaffin cells) Prognosis
Paraneoplastic Syndromes - Poor: 70 % diagnosed when metastasised
- ADH: Dilutional Hyponatraemia - 5-Year Survival: 6 % late; 27 % earlier
- ACTH: Cushing’s; Bilateral adrenal hyperplasia
- Lambert Eaton Syndrome: AID to calcium channels
Non-Small Cell Lung Cancer
Squamous Cell Cancer Management
- Sx: Grade IV Finger clubbing; HPOA (see below) - Surgery: Only 20 % suitable
- Location: Typically central - Mediastinoscopy: Sees lymph node involvement
- NB: Associated with ↑ PTHrp secretion causing ↑Ca2+ - Radiotherapy: Used curatively or palliatively
Adenocarcinoma - Chemotherapy: Tumours poorly respond
- Sx: Gynaecomastia; HPOA; New persistent cough Surgical Contraindications
- location: Typically peripheral - Location: Tumour near hilum
- NB: Commonest non-smoking LC - FEV1: <1.5 lobectomy; <2.0 pneumonectomy
Large Cell Lung Carcinoma - Metastases: Stages IIIb or IV; Malignant effusion
- Sx: May secrete β-hCG - Other: Vocal cord paralysis; SVC syndrome
- Location: Typically peripheral Prognosis
- NB: Anaplastic Ca; Minority neuroendocrine - Px: Large cell has worst prognosis
Mesothelioma
Description Investigations
- Location: Common – Pleura; Rare – Peritoneum - CXR: Effusions; Plaques (benign – Pre-malignant)
- Exposure: 90 % asbestos exposure; 20 % asbestosis - Pleural CT: Confirms diagnosis of tumour in pleura
- Latency: Period of up to 45 years post-exposure - Aspirate: Send effusion for MC&S and cytology
Presentation - Thoracoscopy: Biopsy diagnostic yield 95 %
- Key: Pleurisy; Dyspnoea; Recurrent pleural effusions - Biopsy: CT-guided pleural biopsy
- Other: ↓ Weight; Finger clubbing Management
Causes - Intervention: Chemotherapy ± Surgery if possible
- Asbestos: Crocidolite (blue asbestos) has highest risk - Compensation: Industrial injuries act
Prognosis Complications
- Poor: Median survival 12 months - Metastases: Highly metastatic (liver and bone)
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller sk25. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $7.75. You're not tied to anything after your purchase.
