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4th Year Oncology > Basics of Oncology > Flashcards

Basics of Oncology Flashcards

1
Q

Radiotherapy is prescribed in what units/given in what doses?

A

Gray (Gy) - one joule deposited per kilogram

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2
Q

Chemotherapy doses are usually calculated according to what?

A

Patients’ calculated surface area

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3
Q

If SVCO is caused by intrinsic clot, which treatment should NOT be used?

A

Stent

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4
Q

What type of back pain should particularly alert you to the possible diagnosis of spinal cord compression?

A

Radicular (pain “radiated” along the dermatome)

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5
Q

In a patient with hypocalcaemia, what would your initial management be?

A

IV fluids

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6
Q

Which type of lung cancer is most likely to lead to hypercalcaemia?

A

Squamous cell

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7
Q

If a patient is taking 30mg MST bd for pain control, what should their breakthrough dose of oramorph be?

A

10mg

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8
Q

Breast cancer can be treated with tamoxifen if the patient is what?

A

Premenopausal

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9
Q

When receiving radiotherapy, what happens to tattooed patients

A

Have tattoos marked on them

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10
Q

Patients can go home immediately following radiotherapy. True or false?

A

True

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11
Q

Patients may have what symptom following radiotherapy

A

Fever

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12
Q

Chemotherapy can cause renal failure. True or false?

A

False

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13
Q

Chemotherapy can cause oedema. True or false?

A

True

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14
Q

Will malignant spinal cord compression have a better outcome if treated with radiotherapy, chemotherapy, pharmacologically or surgically?

A

Surgically - but only limited patients are fit (eg disease at only one level and are fit for surgery)

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15
Q

Cervical cancer may cause what due to ureteric obstruction?

A

Renal failure

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16
Q

When starting a patient on opiate analgaesia, you should also prescribe which 2 drugs?

A

A laxative and an anti-emetic

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17
Q

Mrs Smith has ovarian Cancer. Screening of the tumour identifies a mutation BRCA1.
What is the next one action?

A

Test Mrs Smith for the BRCA mutation - the tumour can have the mutation even if the person doesn’t, so first you actually have to confirm Mrs Smith has the BRCA1 mutation

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18
Q

Mrs Jones is 32 and comes to your clinic worried about her risk of breast cancer. She is
healthy, but her mother was affected with breast cancer at 56. There is no other family history.

What should you offer Mrs Jones?

A

Reassurance - no specific treatment indicated. Breast cancer in women >50 is not concerning

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19
Q

Mrs Green 32 comes to your clinic, worried about her risk of breast cancer. She is healthy but
her mother was affected with breast cancer at 70. Her Aunt (mother’s sister) had breast cancer at
32 (still alive) and her mother’s mother had ovarian cancer at 40 ( now dead).

How should you proceed with this case?

A

BRCA mutation analysis for the Aunt - you should always test an affected person in suspected BRCA before the unaffected as you don’t know if the unaffected person has inherited the mutation. Also, the Aunt having breast cancer at 32 looks more like an autosomal dominant inheritance of BRCA1 from the grandmother than the mother’s breast cancer at 70. Therefore you should test the aunt not the mother as she is the most likely carrier of a BRCA gene

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20
Q

ECOG/WHO performance status 0 means the patient is what?

A

Fully active, no restrictions on activities

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21
Q

ECOG/WHO performance status 1 means the patient is what?

A

Unable to do strenuous activities, but able to carry out light housework and sedentary activities

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22
Q

ECOG/WHO performance status 2 means the patient is what?

A

Able to walk and manage self-care, but unable to work. Out of bed more than 50% of waking hours

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23
Q

ECOG/WHO performance status 3 means the patient is what?

A

Confined to bed or a chair more than 50% of waking hours. Capable of limited self-cares

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24
Q

ECOG/WHO performance status 4 means the patient is what?

A

Completely disabled. Totally confined to a bed or chair. Unable to do any self-care

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25
Q

ECOG/WHO performance status 5 means the patient is what?

A

Dead

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26
Q

A patient with a lymphoma/germ cells tumour/etc develops oliguria, cardiac arrhythmia, seizure, tetany and confusion. Blood results show a rising potassium and phosphate and a falling calcium. What syndrome do they have?

A

Tumour lysis syndrome (spillage of intracellular ions)

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27
Q

What is the treatment of tumour lysis syndrome?

A

Pretreatment = allopurinol (uric acid reduction) + good hydration
Cardioprotection = calcium gluconate + cardiac monitoring
Emergancy treatment = dialysis

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28
Q

What metabolic abnormality commonly seen in cancer patients causes pain, nausea, polydipsia, tiredness, confusion and seizures?

A

Hypercalcaemia

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29
Q

What is the treatment for hypercalcaemia?

A

IV fluids + bisphosphonates

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30
Q

Which 4 cancers most commonly metastasize to the bone?

A

Breast, bladder, lung and prostate

31
Q

What pharmacological treatments can be used in malignant cord compression?

A

Dexamethasone + analgesia (both neuropathic and opiates)

32
Q

A patient with lung cancer/agressive non-hodgkin’s lymphoma presents with a puffy face, neck and arms, headache, lethergy, SOB and neck veins that don’t compress. What is the likely cause?

A

Superior vena cava syndrome (compression of the SVC)

33
Q

In a cancer patient, Beck’s triad (muffled heart sounds, low BP and raised JVP) + SOB, fatigue, palpitations and symptoms of pericarditis indicates what?

A

Malignant pericardial effusion

34
Q

A fever in an otherwise well cancer patient who has neutropenia from treatment could be an early sign of which serious condition?

A

Neutropenic sepsis

35
Q

What is the treatment for a clot causing SVCO?

A

Thrombolysis (streptokinase/alteplase) + anticoagulation (heparin+warfarin)

36
Q

What treatment will give rapid symptom relief of SVCO with an extrinsic cause (usually compression from a mass)?

A

Stent

37
Q

What imaging is needed in suspected spinal cord compression?

A

Urgent MRI

38
Q

In patients >50 what is the most common cause of a lump in the neck?

A

Secondary lymph node(s) deposit(s) from a primary carcinoma in the head and neck

39
Q

Where are metastatic lymph nodes from intra-abdominal cancer, eg stomach/pancreas usually found?

A

The left supraclavicular fossa

40
Q

Which cancer has the most convincing evidence that exercise reduces risk?

A

Colon

41
Q

What is the most commonly diagnosed cancer worldwide?

A

Lung

42
Q

What is the most important avoidable cause of cancer in non-smokers?

A

Obesity

43
Q

Which cancer is the most closely linked with obesity?

A

Endometrial

44
Q

Breastfeeding increases the risk of breast cancer. True or false?

A

False

45
Q

On the pain ladder, what is the recommended treatment for mild pain?

A

A non-opioid (eg Paracetamol)
+/-
Adjuvant (eg NSAID’s, TCA’s, anticonvulsants, corticosteroids, anxiolytics, muscle relaxants, antimuscarinics)

46
Q

On the pain ladder, what is the recommended treatment for mild-moderate pain?

A

Opioid for mild to moderate pain (eg Co-codamol 30/500, dihydrocodeine, tramadol)
+
A non-opioid (eg paracetamol)
+/-
Adjuvant (eg NSAID’s, TCA’s, anticonvulsants, corticosteroids, anxiolytics, muscle relaxants, antimuscarinics)

47
Q

On the pain ladder, what is the recommended treatment for moderate-severe pain?

A

Opioid for moderate-severe pain (eg Morphine, diamorphine, oxycodone, hydromorphone,
methadone)
+
A non-opioid (eg paracetamol)
+/-
Adjuvant (eg NSAID’s, TCA’s, anticonvulsants, corticosteroids, anxiolytics, muscle relaxants, antimuscarinics)

48
Q

What are the most common side effects of opioids?

A
  • Constipation
  • N&V
  • Drowsiness
  • Unsteadiness
  • Confusion
49
Q

What is the most life-threatening side effect of opioids?

A

Respiratory depression

50
Q

How much more potent is morphine than codeine?

A

10x

51
Q

How much more potent is oxycodone than morphine?

A

2x

52
Q

The dose of analgesics for breakthrough pain (eg oramorph) should be what percentage of the patient’s daily dose of said analgesic (eg morphine)?

A

1/6

for example if a patient is taking 30mg morphine (MST) bd their breakthrough dose of oramorph should be 10mg

53
Q

What is the conversion of oral morphine to subcut morphine?

A

Divide by 2

54
Q

What is the conversion of oral morphine to subcut fentaynl?

A

Divide by 200

55
Q

Apart from lung, breast, prostate and bladder, what other common cancer is at a higher risk of causing spinal cord compression

A

Myeloma

56
Q

Where is spinal cord compression caused by cancer most likely to occur?

A

77% in T-spine

57
Q

Radicular back pain in spinal cord compression is exacerbated and relieved by what?

A

Exacerbated by - lying flat, weight bearing, coughing and sneezing

Relieved by - sitting

58
Q

What is the best treatment option for spinal cord compression in a patient with multiple level disease?

A

Radiotherapy

59
Q

What are the main intrinsic and extrinsic causes of superior vena cava obstruction (SVCO)

A 
Intrinsic = clot (DVT), foreign body (e.g.line) or tumour in vessel (e.g. renal cancer)
Extrinsic = mostly compression from mass
60
Q

What is the initial investigation in SVCO?

A

CXR

61
Q

Hypercalcaemia with no known malignancy should prompt a screen for which cancer?

A

Myeloma

62
Q

What are the risk factors for chemotherapy induced N&V?

A
  • > 50
  • Female
  • Alcohol intake
  • Prone to N&V
63
Q

What is the best combination of anti-emetics for chemotherapy induced N&V?

A

NK1 antagonist (eg aprepitant), 5HT3 antagonist (eg ondansetron) and dexamethasone

64
Q

What is the most common side effect of radiotherapy?

A

Fatigue

65
Q

What is bracytherapy?

A

Placing small radiotherapy sources into or next to the tumour

66
Q

Oncagenes increase what?

A

Cell division

67
Q

What is a driver mutation vs a passenger mutation?

A

Driver mutation = mutation that drives carcinogenesis

Passenger mutations = incidental mutations that happen because a tumour is unstable

68
Q

What inheritance pattern is BRCA1?

A

Autosomal dominant

69
Q

What is a polymorphism?

A

Any variation in the human genome that does not cause a disease in it’s own right (but may predispose to a common disease)

70
Q

What is a single nucleotide polymorphism (SNP) and on average how many does a person have?

A

A single base alteration in a DNA sequence - the average person has about 3 million

71
Q

What is the difference between hyperplasia and hypertrophy?

A

Hypertrophy is an increase in the size of the cell while hyperplasia refers to an increase in the number of cells. Both are in response to a stimulus

72
Q

What is metaplasia?

A

Reversible change from one mature cell type to another (almost always occurring due to some sort of injury)

73
Q

What is dysplasia?

A

Disordered growth/abnormal cells not in response to stimulus. Is a premalignant phase that has not crossed beyond the basement membrane

4th Year Oncology (6 decks)

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