900. Oncology Tutorials

Question 1

What is cancer?

Answer 1

Abnormal division of cells that divide without control

Cardinal signs: loss of regulation of cell division and cell death
The ability to invade surrounding structures
The ability to metastasise

Question 2

What do you call a cancer of the epithelial tissues?

Give some examples

Answer 2

Cancer that begins in the epithelial tissues such as:

Adenocarcinoma- glandular epithelium
Squamous CC
Transitional cell CC-
Small CC

Question 3

What do you call a cancer of the mesenchyme

What do you call a cancer of the blood

What do you call a cancer of the immune system?

Answer 3

Mesenchyme (bone, cartilage, fat, muscle)- sarcoma

Blood forming cells- leukaemia

Immune cancer- lymphoma and myeloma

Question 4

How does cancer spread?

Answer 4

Direct invasion

Lymphatic spread-

Heamotgenous spread- blood

Trans-coelomic spread- pleura, peritoneum, pericardium.

Question 5

What are the four aims of cancer treatment?

Answer 5

Curative or radical treatment- aimed at cure

Palliative- improve quality of life

Adjuvant therapy- eradicate micrometastatic disease

New-adjuvant- treatments given before the definitive potentially curative treatment

Question 6

What are the four different types of systemic therapy?

Answer 6

Chemotherapy
Biological agents- monoclonal antibodies, TKI
Hormonal therapy
Immunotherapy- interferon, interleukin

Question 7

What tissues in the body are most affected by chemotherapy?

Answer 7

Rapidly dividing cells e.g.

Hair follicles
GI tract mucosa (mouth ulcers and diarrhoea)
Bone marrow stem cells (neutropenia)

Question 8

What is the mode of action of chemotherapy?

Answer 8

Interrupts mitosis (DNA synthesis, integrity, microtubule function)

Question 9

What are some examples of chemotherapy agents?

Answer 9

Alkylating agents- cisplatin
Anti-metabolites- methotrexate
Mitotic inhibitors- taxanes
topoisomerase inhibitors- doxorubicin
other antitumor antibiotics- actinomycin

Question 10

What is the pattern of cell signalling?

Answer 10

Ligand binding to a cell of a signalling involves
Dimerization of that transmembrane receptor
Activation of the intracellular tyrosine kinase domain
subsequent downstrain events leading to
Nuclear events

Question 11

What are the two main categories of biological agents?

Answer 11

Monoclonal antibodies- (imabs)

Tyrosine Kinase inhibitors (inibs)

Question 12

How does hormone therapy work?

Answer 12

Many cancers express hormone receptors and respond to hormone manipulation. (breast,prostate,endometrial)

Question 13

How do immunotherapies work?

Answer 13

Stimulate the immune system through the interferon and interleukin pathways mainly

Good for melanoma, lung, head and neck cancer and renal cancer

Question 14

Explain the Pd-1 pathway of recognising cancer

Answer 14

When PD-1 is activated by PDL-1 the T cell response is inhibited, making the cancer invisible to the immune system.

This allows treatments to target PDL-1 to inhibit he interaction

Question 15

How does radiotherapy work to treat cacner?

Answer 15

Radiotherapy uses ionising radiation to destroy chromosomes, causing a loss of reproduction.

Alternatively radiotherapy exceeds the radiation tolerance or certain tissues leaving them unable to function.

Question 16

How do you avoid damage to superficial tissues?

Answer 16

Tumour is irradiated from multiple angles

Question 17

What is brachytherapy?

Answer 17

delivered via close proximity (injection into blood stream/ wire implanted near cancer

Question 18

What are the four main oncological emergencies?

Answer 18

Neutropenic sepsis
Spinal cord compression
Superior vena cava obstruction
Hypercalcemia

Question 19

When does neutropenia tend to happen in a patient receiving chemo?

At what level does neutrophil count cause an increased risk of infection?

Answer 19

Around day 7-14 of the three week cycle
Can be seen up to 6 weeks post chemo

Below 1.0- increased risk
<0.5- very increased risk

Question 20

What signs are post chemo patients warned to look out for?

Answer 20

Hot/ feverish or cold and shivery
aching joints or muscles
focal infectious signs (cough, sore throat etc)

Temp >38.5 or <36
Two readings>38.0

Question 21

What investigations would be done for someone suspected of having neutropenic sepsis?

Answer 21

FBC, serum biochemistry, U&E's, LFT's, CRP, cultures, coag screen
MSSU
Stool culture
Throat swabs
sputum culture
swabs of infected skin lesions
CXR
Other clinically relevant investigations

Question 22

What is your initial management?

Answer 22

Volume resusitation
Oxygen therapy
Mouthcare?
G-CSF- boost neutrophil count
Piperacillin/tazobactam (BSA)

Question 23

How would you change antibiotic management in response to disease changes?

Answer 23

Meropenem IV- if patient remains febrile after 48 hours

Switch to oral ciprofloxacin