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Year 4 CCC > Blue Book > Flashcards

Blue Book Flashcards

1
Q

Why can some chemicals cause cancer?

A

They act as carcinogens - damaging cellular DNA and inducing mutations in oncogenes and tumour suppressor genes.

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2
Q

How do carcinogens in cigarette smoke cause cancer?

A

Cigarette smoke causes specific mutations in the p53 tumour suppressor gene

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3
Q

Aromatic amines are associated with which cancer?

A

Bladder cancer

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4
Q

Leukaemia is associated with which chemical?

A

Benzene

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5
Q

Wood dust is associated with which cancer?

A

Nasal adenocarcinoma

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6
Q

Vinyl chloride is associated with which kind of cancers?

A

Angiosarcomas

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7
Q

How is diet associated with the development of cancer?

A

Western diets that are low in fibre as associated with colorectal cancer, whereas diets with lots of smoke food (e.g. in Japan) are associated with gastric cancers.

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8
Q

What is the name of the carcinogen found in foods such as processed and cured meats, beer and some cheeses?

A

Nitrosamines

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9
Q

Why do low fibre diets contribute to development of cancer?

A

Low fibre diets lead to an increased transit time through the bowel, thereby increasing exposure to carcinogenic substances

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10
Q

How does the Human Papilloma Virus (HPV) cause cancer?

A

The E6 protein produced by HPV16 binds to and inactivates the p53 protein. This leads to dysregulation of the cell cycle and apoptotic pathways and subsequent malignant transformation of the epithelial cells infected.

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11
Q

Which cancers are associated with sexual transmission of HPV?

A

Cervical and anal

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12
Q

Epstein-Barr Virus is associated with which cancer?

A

Non-Hodgkin’s lymphoma (and other lymphomas)

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13
Q

Which specific strain of EBV is thought to cause a genetic abnormality?

A

EBNA - Epstein Barr Nuclear Antigens

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14
Q

EBNA causes a translocation mutation between which chromosomes?

A

8 : 14

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15
Q

What happens during the translocation?

A

The proto-oncogene c-myc on chromosome 8 becomes transcriptionally controlled by the control elements of immunoglobulin genes on chromosome 14

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16
Q

The retrovirus HTLV1 is associated with which lymphoma?

A

T-cell lymphoma

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17
Q

Which tumour in particular is H.Pylori associated with?

A

MALT - mucosal associated lymphoid tissue

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18
Q

There are 4 main/general presenting symptoms for cancers, what are they?

A
  1. Lumps
  2. Bleeding
  3. Pain
  4. Change in function
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19
Q

What kind of lumps commonly present? (3)

A
  1. Breast lumps
  2. Change in moles
  3. Nodes, nodules and MSK lumps
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20
Q

What type of bleeding is presented? (4)

A
  1. Haemoptysis
  2. Rectal bleeding
  3. Haematuria
  4. Post-menopausal or irregular menstrual bleeding
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21
Q

What change in functions/new onsets can be suggestive of cancer? (6)

A
  1. Change in bowel habit
  2. New cough
  3. Dyspnoea
  4. Weight loss
  5. Fever
  6. Acute confusional state
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22
Q

In addition to symptoms, what else is important when taking a history, particularly if cancer is a possibility? (8)

A
  1. Age
  2. Sex
  3. Occupation and environmental exposures
  4. Smoking
  5. Family history
  6. Ethnicity
  7. Past medical history
  8. Drugs/alcohol
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23
Q

What does the grade of the cancer signify?

A

The extent the tumour resembles normal tissue or has a bizarre appearance

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24
Q

What does G1 refer to?

A

Well differentiated - similarities remain to normal tissue of the organ of origin

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25
Q

What does G3 refer to?

A

Poorly differentiated - bizarre cells

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26
Q

What system is used to define the response to treatment?

A

RECIST

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27
Q

What does CR stand for/mean?

A

Complete response - so no disease is detectable radiologically

28
Q

What does partial response mean?

A

All lesions have shrunk by at least 30%, but disease is still present

29
Q

What does stable disease mean?

A

Less than 20% increase in the size or less than 30% decrease in size

30
Q

What does progressive disease mean?

A

New lesions or lesions that have increased in size by more than 20%

31
Q

MRI is the gold standard for imaging which tumours? (5)

A
  1. Neurospinal
  2. Rectal
  3. Prostate
  4. MSK
  5. Staging head and neck
32
Q

What are tumour markers?

A

Substances produced either by, or in response to, tumours.

33
Q

The tumour marker; CEA (carcino-embryonic antigen) is a cell surface antigen, commonly used in which cancer?

A

Colorectal

34
Q

How is CEA used with regards to colorectal cancer?

A

Its levels are measured and aid in staging the cancer

35
Q

Although CEA is elevated in colorectal cancer, it can also be elevated in people with which other conditions? (5)

A
  1. IBD
  2. Hepatitis
  3. Pancreatitis
  4. Gastritis
  5. Smokers
36
Q

Which tumour marker is used in ovarian carcinoma?

A

CA125

37
Q

Which tumour marker is elevated in hepatocellular carcinomas and teratomas?

A

Alpha Fetoprotein (aFP)

38
Q

Although the HGC marker is commonly associated with pregnancy, which cancer in males can also elevate its levels?

A

Non-seminomatous testicular cancers

39
Q

Which marker is used in prostate cancer, although it is not very sensitive or specific?

A

PSA - prostate specific antigen

40
Q

Where is Bence-Jones protein measured and what can it be a sign of?

A

It can be measured in the blood or in urine and is an immunoglobulin light chain, which occurs in myeloma and Waldenstrom’s macroglobulinaemia (which is a type of non-Hodgkin’s lymphoma)

41
Q

What have recent studies show surrounding CA-125 monitoring?

A

CA-125 monitoring to try and gauge the best time to restart chemotherapy for patients with ovarian cancer does not improve overall survival and worsens quality of life

42
Q

Why are chemotherapies give as a combination of different drugs, as opposed to a single-agent chemotherapy?

A
  1. Different classes of drugs have different actions and may kill more cancer cells together
  2. There is less chance of drug-resistant malignant cells
  3. Drugs with different sites of toxicity means dose can be maintained for each drug
43
Q

What is chemotherapy given in cycles?

A

This is to allowed normal cells to recover from the toxicity of treatment - giving the treatment every 3 - 4 weeks allows these cells to recover

44
Q

Which normal cells in the body are affected by chemotherapy the most and what is the consequence? (2)

A
  1. Haematopoietic stem cells (myelosuppression)

2. GI tract lining (mucositis)

45
Q

What is normally the maximum amount of time chemotherapy cycles are given - due to resistance emerging and toxicity increasing

A

6 months

46
Q

Most routine chemotherapy doses are calculated according to what?

A

The patient’s body surface area (BSA)

47
Q

Which chemotherapy drug is the only one to have its dose calculated directly according to renal function?

A

Carboplatin

48
Q

Which newer drugs are calculated based on weight alone?

A

Monoclonal antibodies e.g. trastuzumab

49
Q

What are the most common side effects of chemotherapy? (13)

A 
1. Nausea and vomiting
2 Myelosuppression
3. Gastrointestinal - mucositis/diarrhoea/constipation (due to dehydration) 
4. Alopecia 
5. Peripheral neuropathies 
6. Central neurological toxicity
7. Ototoxicity (cochlear damage) 
8. Nephrotoxicity 
9. Bladder toxicity 
10. Cardiac arrhythmias 
11. Palmar plantar erythema (Hand-foot syndrome) 
12. Myalgia/arthralgia 
13. Lethargy/fatigue
50
Q

What are the long-term complications of chemotherapy treatment? (5)

A
  1. Reduction in fertility
  2. Pulmonary fibrosis
  3. Cardiac fibrosis
  4. Psychological
  5. Social
51
Q

When is myelosuppression at its peak during chemotherapy treatment?

A

10 - 12 days post-treatment

52
Q

Which cancers can lead to pancytopaenia? (4)

A
  1. Haematological malignancies
  2. Breast cancer
  3. Lung cancer
  4. Prostate cancer
53
Q

What are the signs of significant thrombocytopenia? (4)

A
  1. Petechial haemorrhage
  2. Spontaneous nose bleeds
  3. Corneal haemorrhage
  4. Haematuria
54
Q

What levels of platelet counts are associated with significant risk of spontaneous bleeding (e.g. intra cerebral bleeding)?

A

Platelet count less than 10 x 10^9/L

55
Q

What platelet count range would indicate platelet transfusion?

A

10x10^9/L - 20x10^9/L

56
Q

What are patients advised regarding chemotherapy treatment and the possible development of neutropenia?

A

If they develop any kind of fever/high temperature, then they need to seek immediate attention from the oncology department/A&E

57
Q

When would the patient with possible neutropenia be given immediate broad sprectum antibiotics?

A

If they have a white count less than 1 x 10^9/L and a fever

58
Q

What investigations need to be carried out in suspected neutropenic sepsis?

A

Blood cultures, urine output, lactate levels, sputum samples, CXR. Physical examinations to try locate site of infection however rectal/vaginal examinations should NOT be done because of risk of causing bacteraemia

59
Q

In which two cancers is high dose chemotherapy given with curative intent?

A
  1. Hogkin’s disease

2. Testicular cancer

60
Q

To increase the efficiency of clinical trials, new trial designs are being used, what are the three new types of trial called?

A
  1. Basket trials
  2. Umbrella trials
  3. Platform trials
61
Q

What is a basket trial?

A

Where tumours harbouring a particular genetic mutation are tested with a new drug that targets that mutation

62
Q

What is an umbrella trial?

A

Where patients have a particular type of cancer (e.g. NSCLC) and are all tested to establish the genetics of their tumours and then offered different experimental treatments depending on the results

63
Q

What is a platform trial?

A

Where multiple experimental arms are compared with a single control arm to reduce costs and increase the number of patients able to receive novel therapies

64
Q

If a patients pain is uncontrolled on maximum dose of co-codamol, what is the appropriate next step?

A

MST 20mg bd

65
Q

If a patient is taking 20mg bd MST, what would their breakthrough PRN dose be?

A

40 / 6 = 6.666 so in the region of 5 - 10mg PRN oramorph

66
Q

Which 3 groups are laxatives commonly grouped into?

A
  1. Bulk forming
  2. Stool softeners
  3. Stimulants

Year 4 CCC (17 decks)

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