Ward Round Notes

Lung cancer is one of the most common malignancies worldwide, but has one of the poorest outcomes as 2/3rds of patients present late with the disease. Given this it is important to be vigilant of the possibility of lung cancer in patients. Patients with lung cancer may present with r espiratory symptoms , with worsening chronic disease such as COPD, with symptoms suggestive of malignancy without symptoms specific to the respiratory system, and occasionally with other symptoms which are neither respiratory or point to a malignancy. NICE guidelines suggests that an urgent chest x ray (within 1 week) should be considered for the following symptoms: Haemoptysis Persistent (+3 weeks) cough Persistent shortness of breath Persistent chest signs Persistent hoarseness Persistent weight loss Persistent clubbing Persistent cervical lymphadenopathy Persistent chest or shoulder pain (think of pancoast tumours) Persistent signs or symptoms suggesting metastases such as bone pain...

Demographics Breast cancer is the most common cancer among women and the second largest cause of cancer death. The incidence of breast cancer increases with age and peaks between the ages of 45-55 and plateaus from then onwards. The incidence of breast cancer is increasing due to increased screening.  Aeitiology and pathophysiology:  Breast cancer is caused by accumulation of genetic mutations leading to malignant growth.  Risk factors of breast cancer include:  Previous breast cancer Family history of breast cancer (if more than 2 first degree relatives have breast cancer, the risk to other members is doubled. )  Age Genetical - individuals with 4 relatively common genes are more susceptible to developing breast cancer. This includes BRCA 1, BRCA 2, CHEK2 and FGFR2. In individuals with these genes, lifetime risk of developing cancer may be up to 80% with a 60% risk of developing ovarian cancer.  Hormone replacement therapy with oest...

Definition and demographics Occular melanomas are uncontrolled malignant proliferation of melanocytes in the eye. They can be divided into uveal melanomas, which arise in the iris, choroid body or ciliary body, and conjunctival melanomas which arise from the conjunctiva. Uveal melanomas are more common and is the most common type of primary eye malignancy, and second most common type of malignant melanoma.  Ocular melanoma is a rare condition which occurs equally in males and females and the with a peak incidence in people's 60s. It tends to affect fair skinned individuals more.  Aeitiology/pathophysiology Occular melanomas are caused by an accumulation of genetic changes. Sunlight exposure is a risk factor of developing melanoma. Other risk factors include being caucasion/fair skinned, having light coloured irides, melanosis or existing melanocytic naevi of the conjunctiva (moles), congenital ocular melanocytosis, neurofibromatosis and family history.  ...

Demographics:  Colon cancer is a common malignancy, it primarily presents in older patients, however it may occur earlier in two hereditary conditions which leads to colon cancer. Familial adenomatous polyposis (FAP) is a autosomnal dominant condition which causes the formation of multiple polyps in the colon. The condition tends to cause cancer in patients by the age of 40. Hereditary non-polyposis colorectal cancer (HNPCC) also causes colon cancer in younger patients. HNPCC is also associated with endometrial, gastric, renal, uteric and CNS cancers.  Risk factors and causes Crohn's and Ulcerative colitis increases colorectal cancer risk History of small bowel cancer, endometrial cancer, breast cancer or ovarian cancer Family history - family member with cancer before the age of 60 Specific hereditary causes : FAP and HNPCC Low fibre diet and high red meat diet is thought to increase risk Sedentary lifestyle, obesity, smoking, high alcohol intake Diabetes m...

Tumour markers are molecules found in the blood which are sometimes secreted by some tumours. They may be helpful in confirming a diagnosis where cancer is suspected, but they are not by themselves diagnostic and may be present because of a number of other processes. Tumour markers are not routinely used as screening tests as they do not have high sensitivities at an early stage in the disease. In some cancers, tumour markers help monitor the effectiveness of the treatment, and tumour markers may be helpful in determining prognosis. Some tumour markers include: CA 27, CA29 - Breast cancer , also seen in colonic, gastric, hepatic, lung, pancreatic, ovarian and prostate cancer, other breast liver and kidney disorders and ovarian cysts. CEA - Colorectal cancer , also seen in lung, gastric, pancreatic, breast and bladder cancers, medullary thyroid, and other head and neck, cervical and hepatic cancers, lymphomas, melanomas, smoking, peptic ulcers, inflammatory bowel diseases, pancr...

Lung cancer Definition : Uncontrolled invasive (malignant) growth originating from the lungs Presentation:   Depends on the site of the tumour and the type of cancer.  Patients may present with Chest signs and symptoms : (more common in cancers occurring centrally in the bronchial tree, late symptoms in peripheral cancers, may also present on a background of existing lung problems eg. COPD or emphysema)  *Haemoptysis *Cough Wheeze Stridor Pain Hoarse voice clubbing lymphadenopathy localized chest signs superior vena cava obstruction - caused by compression of the superior vena cava

Malignancy occurs when cells mutate to replicate uncontrollably, outside of the body's normal control mechanisms and immune response, and gains the ability to invade into other tissues. Cell cycle As cancer cells tend to replicate faster than other cells, chemotherapy primarily affects cancer cells by affecting their replication.