Diseases with associated cancers
Certain diseases and conditions increase the risk of specific cancers due to 🧬 genetics, 🔥 chronic inflammation, 🧪 precursor dysplasia, or 🛡️ reduced immune surveillance. These associations are classic exam triggers - learn them as “condition → cancer” pairs.
🔗 High-yield associations (Condition → Cancer)
- 🧬 Down syndrome: Acute lymphoblastic leukaemia (ALL), acute myeloid leukaemia (AML) (esp. megakaryoblastic).
- 🧬 Xeroderma pigmentosum (DNA repair defect): Basal cell carcinoma (BCC), squamous cell carcinoma (SCC), melanoma (sun-exposed skin) ☀️.
- 🧠 Tuberous sclerosis: Subependymal giant cell astrocytoma (SEGA) 🧠, cardiac rhabdomyoma ❤️, renal angiomyolipoma (benign but important).
- 🧪 Barrett’s oesophagus: Oesophageal adenocarcinoma (intestinal metaplasia → dysplasia → cancer) 🔥.
- 🩸 Cirrhosis (any cause): Hepatocellular carcinoma (HCC) (risk rises with chronic HBV/HCV, alcohol, NASH) 🍺.
- 🧻 Ulcerative colitis: Colorectal cancer (risk correlates with duration, extent, inflammation severity) 🧻.
- 🧲 Primary sclerosing cholangitis (PSC): Cholangiocarcinoma + colorectal cancer (especially if co-existing UC) ⚠️.
- 🍔 Chronic atrophic gastritis / pernicious anaemia: Gastric adenocarcinoma + gastric neuroendocrine tumours (type I) 🥼.
- 🦠 H. pylori infection: Gastric adenocarcinoma + MALT lymphoma (may regress with eradication) 🦠.
- 🧬 Familial adenomatous polyposis (FAP): Colorectal cancer (near-inevitable without colectomy) + duodenal/ampullary cancer 📈.
- 🧬 Lynch syndrome (HNPCC): Colorectal + endometrial + ovarian cancers (also gastric/urothelial) 🧬.
- 🧬 BRCA1/2: Breast + ovarian cancer; BRCA2 also prostate + pancreatic cancer 🎗️.
- 🦴 Paget’s disease of bone: Osteosarcoma (rare but classic) 🦴.
- 🩸 Multiple myeloma / plasma cell dyscrasia: AL amyloidosis + renal disease; (also think “anaemia, bone pain”) 🦴.
- 🧠 Neurofibromatosis type 1: Optic glioma, malignant peripheral nerve sheath tumour (MPNST) 🧠.
- 🧬 Neurofibromatosis type 2: Bilateral vestibular schwannomas + meningiomas 🎧.
- 🧯 Plummer–Vinson syndrome: SCC of the upper oesophagus (iron deficiency + webs) 🍽️.
- 🧴 Acanthosis nigricans (sudden onset in older adult): Consider underlying malignancy - classically gastric adenocarcinoma (also others) 🚩.
- 🛡️ HIV/AIDS / immunosuppression: Kaposi sarcoma (HHV-8), non-Hodgkin lymphoma, cervical cancer (HPV) 🦠.
- 👶 Cryptorchidism: Testicular germ cell tumours (seminoma risk ↑) ⚠️.
- 🚬 Asbestos exposure: Mesothelioma + bronchogenic carcinoma 🫁.
- 🧪 Ulcerative colitis (longstanding) or chronic colitis of any cause: Colorectal cancer (inflammation-driven carcinogenesis) 🔥.
🧠 Why these links exist (Mechanisms)
- 🧬 Genetic instability: Inherited mutations or repair defects (e.g., XP, Lynch, BRCA) → faster accumulation of driver mutations.
- 🔥 Chronic inflammation: Persistent cytokine signalling + oxidative stress → DNA damage and dysplasia (e.g., UC, PSC, cirrhosis).
- 🧪 Precursor lesions: Metaplasia/dysplasia precedes invasive cancer (e.g., Barrett’s → adenocarcinoma).
- 🛡️ Reduced immune surveillance: Immunodeficiency/immunosuppression → virus-associated malignancies and lymphoproliferative disease.
- 🦠 Oncogenic infection: Chronic infection promotes malignant transformation (e.g., H. pylori → MALT/gastric ca; HPV → cervix/oropharynx; HBV/HCV → HCC).
🩺 Management & prevention (UK exam framing)
- 🔍 Screening/surveillance: Colonoscopic surveillance in extensive longstanding colitis; endoscopic surveillance for Barrett’s (per local/UK pathways).
- 🦠 Eradicate triggers: Treat H. pylori in chronic gastritis/MALT lymphoma when present.
- 💉 Vaccination: HPV vaccination (reduces cervical + other HPV cancers) and HBV vaccination (reduces HCC risk).
- 🛡️ Immunosuppression vigilance: Transplant/HIV patients need careful monitoring for lymphoma and virus-associated cancers.
- 🚩 Red flags: Sudden acanthosis nigricans, unexplained weight loss, iron deficiency, dysphagia, persistent lymphadenopathy → investigate.
📚 References
- National Cancer Institute (NCI): Cancer Risk Factors - https://www.cancer.gov/about-cancer/causes-prevention/risk
- World Health Organization (WHO): Cancer Fact Sheet - https://www.who.int/news-room/fact-sheets/detail/cancer
- BMJ Best Practice / NICE CKS (topic-specific): cancer risk & surveillance guidance (use for UK pathway details).
