Introduction to Diagnosis and Treatment of Cancer

Question 1

What is the most common cause of disease-related death in children in the UK?

Answer 1

Cancer.

Question 2

List the two most common childhood cancers.

Answer 2

1 - Leukaemia.

2 - CNS cancers.

Question 3

How many new cases of cancer are diagnosed per year in the UK?

How many of these diagnoses are made in people under the age of 16?

Answer 3

• 357,000.

- 1,500 are under the age of 16.

Question 4

How many new cases of cancer are diagnosed per year in the UK?

How many of these diagnoses are made in people under the age of 16?

Answer 4

• 357,000.

- 1,500 are <16.

Question 5

What proportion of adult cancers are diagnosed at a late stage?

Answer 5

Half.

Question 6

Which adult cancer is increasing in mortality at the highest rate?

Answer 6

Liver cancer.

Question 7

List 5 common presenting symptoms of lung cancer.

Answer 7

1 - Breathlessness.

2 - Cough.

3 - Pain.

4 - Loss of appetite.

5 - Haemoptysis.

Question 8

List 6 common presenting symptoms of colorectal cancer.

Answer 8

1 - Changes in bowel habits.

2 - Bright red or dark blood in the stool.

3 - Discomfort in the abdomen.

4 - Unexplained weight loss.

5 - Anaemia.

6 - Tenesmus.

Question 9

List 5 investigations used in the diagnosis of cancer.

Which of these investigations is required to be positive before treatment is initiated?

Answer 9

1 - History taking.

2 - Physical examination.

3 - Imaging.

4 - Blood tests.

5 - Tissue biopsy (required before treatment is initiated).

Question 10

Why might Horner syndrome be reason to investigate for cancer outside of the head and neck region?

Answer 10

Because it is indicative of spread to the head and neck.

Question 11

Why might Horner syndrome be reason to investigate for lung cancer?

Answer 11

Because it is indicative of spread

Question 12

List 3 methods that encourage early diagnosis of cancer.

Answer 12

1 - Screening programmes.

2 - Public awareness of symptoms.

3 - Faster referrals.

Question 13

What is the average wait for referral to cancer specialists from a GP?

Answer 13

2 weeks.

Question 14

What is the average wait for referral to cancer specialists from a GP?

Answer 14

2 weeks.

Question 15

What do the letters of the TNM staging system of cancer mean?

Answer 15

• T = size of the primary tumour (subcategories depend on the type of tumour).
• N = status of lymph node metastases.
• M = presence or absence of metastases.
• G = the histological grade of the tumour.

Question 16

List the N subcategories of the TNM staging system.

Answer 16

• N0 = no node metastasis.
• N1 = 1-3 regional nodes.
• N2 = >3 regional nodes.
• N3 = nodes at a distant site.

Question 17

List the M subcategories of the TNM staging system.

Answer 17

• M0 = no metastasis.

- M1 = distant metastasis.

Question 18

Describe the Duke staging of colorectal cancer.

Answer 18

• Dukes A: Invasion into but not through the bowel wall.
• Dukes B: Invasion through the bowel wall penetrating the muscle layer but not involving lymph nodes.
• Dukes C: Involvement of lymph nodes
• Dukes D: Widespread metastases.
• Dukes isn’t really used any more.

Question 19

Describe the Duke staging of colorectal cancer.

Answer 19

• Dukes A: Invasion into but not through the bowel wall.
• Dukes B: Invasion through the bowel wall penetrating the muscle layer but not involving lymph nodes.
• Dukes C: Involvement of lymph nodes
• Dukes D: Widespread metastases.

Question 20

Give an example of a targeted agent used in chemotherapy.

For which cancer is this targeted agent used?

Why are targeted agents less toxic than other chemotherapy drugs?

Answer 20

• Imatinib for chronic myeloid leukaemia.

- Targeted agents are less toxic than other chemotherapy drugs because they are more highly specific.

Question 21

What underlies the responsiveness of non-small cell lung cancer to gefitinib?

Answer 21

A mutation in the epidermal growth factor receptor.

Question 22

Describe the concept of adjuvant therapy for cancer treatment.

Answer 22

1 - Neoadjuvant therapy is given to shrink the tumour size to make surgery or radiotherapy feasible.

2 - This is followed by surgery or radiotherapy.

3 - Adjuvant therapy is given to residual tumours following surgery or radiotherapy to prevent recurrence.

Question 23

Describe the concept of adjuvant therapy for cancer treatment.

Answer 23

1 - Neoadjuvant therapy is given to shrink the tumour size to make surgery or radiotherapy feasible.

2 - This is followed by surgery or radiotherapy.

3 - Adjuvant therapy is given to residual tumours following surgery or radiotherapy to prevent recurrence.

Question 24

What is the second commonest bone tumour in childhood?

Answer 24

Ewing’s sarcoma.