Basics of Oncology Flashcards
Radiotherapy is prescribed in what units/given in what doses?
Gray (Gy) - one joule deposited per kilogram
Chemotherapy doses are usually calculated according to what?
Patients’ calculated surface area
If SVCO is caused by intrinsic clot, which treatment should NOT be used?
Stent
What type of back pain should particularly alert you to the possible diagnosis of spinal cord compression?
Radicular (pain “radiated” along the dermatome)
In a patient with hypocalcaemia, what would your initial management be?
IV fluids
Which type of lung cancer is most likely to lead to hypercalcaemia?
Squamous cell
If a patient is taking 30mg MST bd for pain control, what should their breakthrough dose of oramorph be?
10mg
Breast cancer can be treated with tamoxifen if the patient is what?
Premenopausal
When receiving radiotherapy, what happens to tattooed patients
Have tattoos marked on them
Patients can go home immediately following radiotherapy. True or false?
True
Patients may have what symptom following radiotherapy
Fever
Chemotherapy can cause renal failure. True or false?
False
Chemotherapy can cause oedema. True or false?
True
Will malignant spinal cord compression have a better outcome if treated with radiotherapy, chemotherapy, pharmacologically or surgically?
Surgically - but only limited patients are fit (eg disease at only one level and are fit for surgery)
Cervical cancer may cause what due to ureteric obstruction?
Renal failure
When starting a patient on opiate analgaesia, you should also prescribe which 2 drugs?
A laxative and an anti-emetic
Mrs Smith has ovarian Cancer. Screening of the tumour identifies a mutation BRCA1.
What is the next one action?
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
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?
Reassurance - no specific treatment indicated. Breast cancer in women >50 is not concerning
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?
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
ECOG/WHO performance status 0 means the patient is what?
Fully active, no restrictions on activities
ECOG/WHO performance status 1 means the patient is what?
Unable to do strenuous activities, but able to carry out light housework and sedentary activities
ECOG/WHO performance status 2 means the patient is what?
Able to walk and manage self-care, but unable to work. Out of bed more than 50% of waking hours
ECOG/WHO performance status 3 means the patient is what?
Confined to bed or a chair more than 50% of waking hours. Capable of limited self-cares
ECOG/WHO performance status 4 means the patient is what?
Completely disabled. Totally confined to a bed or chair. Unable to do any self-care
ECOG/WHO performance status 5 means the patient is what?
Dead
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?
Tumour lysis syndrome (spillage of intracellular ions)
What is the treatment of tumour lysis syndrome?
Pretreatment = allopurinol (uric acid reduction) + good hydration
Cardioprotection = calcium gluconate + cardiac monitoring
Emergancy treatment = dialysis
What metabolic abnormality commonly seen in cancer patients causes pain, nausea, polydipsia, tiredness, confusion and seizures?
Hypercalcaemia
What is the treatment for hypercalcaemia?
IV fluids + bisphosphonates
Which 4 cancers most commonly metastasize to the bone?
Breast, bladder, lung and prostate
What pharmacological treatments can be used in malignant cord compression?
Dexamethasone + analgesia (both neuropathic and opiates)
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?
Superior vena cava syndrome (compression of the SVC)
In a cancer patient, Beck’s triad (muffled heart sounds, low BP and raised JVP) + SOB, fatigue, palpitations and symptoms of pericarditis indicates what?
Malignant pericardial effusion
A fever in an otherwise well cancer patient who has neutropenia from treatment could be an early sign of which serious condition?
Neutropenic sepsis
What is the treatment for a clot causing SVCO?
Thrombolysis (streptokinase/alteplase) + anticoagulation (heparin+warfarin)
What treatment will give rapid symptom relief of SVCO with an extrinsic cause (usually compression from a mass)?
Stent
What imaging is needed in suspected spinal cord compression?
Urgent MRI
In patients >50 what is the most common cause of a lump in the neck?
Secondary lymph node(s) deposit(s) from a primary carcinoma in the head and neck
Where are metastatic lymph nodes from intra-abdominal cancer, eg stomach/pancreas usually found?
The left supraclavicular fossa
Which cancer has the most convincing evidence that exercise reduces risk?
Colon
What is the most commonly diagnosed cancer worldwide?
Lung
What is the most important avoidable cause of cancer in non-smokers?
Obesity
Which cancer is the most closely linked with obesity?
Endometrial
Breastfeeding increases the risk of breast cancer. True or false?
False
On the pain ladder, what is the recommended treatment for mild pain?
A non-opioid (eg Paracetamol)
+/-
Adjuvant (eg NSAID’s, TCA’s, anticonvulsants, corticosteroids, anxiolytics, muscle relaxants, antimuscarinics)
On the pain ladder, what is the recommended treatment for mild-moderate pain?
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)
On the pain ladder, what is the recommended treatment for moderate-severe pain?
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)
What are the most common side effects of opioids?
- Constipation
- N&V
- Drowsiness
- Unsteadiness
- Confusion
What is the most life-threatening side effect of opioids?
Respiratory depression
How much more potent is morphine than codeine?
10x
How much more potent is oxycodone than morphine?
2x
The dose of analgesics for breakthrough pain (eg oramorph) should be what percentage of the patient’s daily dose of said analgesic (eg morphine)?
1/6
for example if a patient is taking 30mg morphine (MST) bd their breakthrough dose of oramorph should be 10mg
What is the conversion of oral morphine to subcut morphine?
Divide by 2
What is the conversion of oral morphine to subcut fentaynl?
Divide by 200
Apart from lung, breast, prostate and bladder, what other common cancer is at a higher risk of causing spinal cord compression
Myeloma
Where is spinal cord compression caused by cancer most likely to occur?
77% in T-spine
Radicular back pain in spinal cord compression is exacerbated and relieved by what?
Exacerbated by - lying flat, weight bearing, coughing and sneezing
Relieved by - sitting
What is the best treatment option for spinal cord compression in a patient with multiple level disease?
Radiotherapy
What are the main intrinsic and extrinsic causes of superior vena cava obstruction (SVCO)
Intrinsic = clot (DVT), foreign body (e.g.line) or tumour in vessel (e.g. renal cancer) Extrinsic = mostly compression from mass
What is the initial investigation in SVCO?
CXR
Hypercalcaemia with no known malignancy should prompt a screen for which cancer?
Myeloma
What are the risk factors for chemotherapy induced N&V?
- > 50
- Female
- Alcohol intake
- Prone to N&V
What is the best combination of anti-emetics for chemotherapy induced N&V?
NK1 antagonist (eg aprepitant), 5HT3 antagonist (eg ondansetron) and dexamethasone
What is the most common side effect of radiotherapy?
Fatigue
What is bracytherapy?
Placing small radiotherapy sources into or next to the tumour
Oncagenes increase what?
Cell division
What is a driver mutation vs a passenger mutation?
Driver mutation = mutation that drives carcinogenesis
Passenger mutations = incidental mutations that happen because a tumour is unstable
What inheritance pattern is BRCA1?
Autosomal dominant
What is a polymorphism?
Any variation in the human genome that does not cause a disease in it’s own right (but may predispose to a common disease)
What is a single nucleotide polymorphism (SNP) and on average how many does a person have?
A single base alteration in a DNA sequence - the average person has about 3 million
What is the difference between hyperplasia and hypertrophy?
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
What is metaplasia?
Reversible change from one mature cell type to another (almost always occurring due to some sort of injury)
What is dysplasia?
Disordered growth/abnormal cells not in response to stimulus. Is a premalignant phase that has not crossed beyond the basement membrane
