Blue Book Flashcards
Why can some chemicals cause cancer?
They act as carcinogens - damaging cellular DNA and inducing mutations in oncogenes and tumour suppressor genes.
How do carcinogens in cigarette smoke cause cancer?
Cigarette smoke causes specific mutations in the p53 tumour suppressor gene
Aromatic amines are associated with which cancer?
Bladder cancer
Leukaemia is associated with which chemical?
Benzene
Wood dust is associated with which cancer?
Nasal adenocarcinoma
Vinyl chloride is associated with which kind of cancers?
Angiosarcomas
How is diet associated with the development of cancer?
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.
What is the name of the carcinogen found in foods such as processed and cured meats, beer and some cheeses?
Nitrosamines
Why do low fibre diets contribute to development of cancer?
Low fibre diets lead to an increased transit time through the bowel, thereby increasing exposure to carcinogenic substances
How does the Human Papilloma Virus (HPV) cause cancer?
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.
Which cancers are associated with sexual transmission of HPV?
Cervical and anal
Epstein-Barr Virus is associated with which cancer?
Non-Hodgkin’s lymphoma (and other lymphomas)
Which specific strain of EBV is thought to cause a genetic abnormality?
EBNA - Epstein Barr Nuclear Antigens
EBNA causes a translocation mutation between which chromosomes?
8 : 14
What happens during the translocation?
The proto-oncogene c-myc on chromosome 8 becomes transcriptionally controlled by the control elements of immunoglobulin genes on chromosome 14
The retrovirus HTLV1 is associated with which lymphoma?
T-cell lymphoma
Which tumour in particular is H.Pylori associated with?
MALT - mucosal associated lymphoid tissue
There are 4 main/general presenting symptoms for cancers, what are they?
- Lumps
- Bleeding
- Pain
- Change in function
What kind of lumps commonly present? (3)
- Breast lumps
- Change in moles
- Nodes, nodules and MSK lumps
What type of bleeding is presented? (4)
- Haemoptysis
- Rectal bleeding
- Haematuria
- Post-menopausal or irregular menstrual bleeding
What change in functions/new onsets can be suggestive of cancer? (6)
- Change in bowel habit
- New cough
- Dyspnoea
- Weight loss
- Fever
- Acute confusional state
In addition to symptoms, what else is important when taking a history, particularly if cancer is a possibility? (8)
- Age
- Sex
- Occupation and environmental exposures
- Smoking
- Family history
- Ethnicity
- Past medical history
- Drugs/alcohol
What does the grade of the cancer signify?
The extent the tumour resembles normal tissue or has a bizarre appearance
What does G1 refer to?
Well differentiated - similarities remain to normal tissue of the organ of origin
What does G3 refer to?
Poorly differentiated - bizarre cells
What system is used to define the response to treatment?
RECIST
What does CR stand for/mean?
Complete response - so no disease is detectable radiologically
What does partial response mean?
All lesions have shrunk by at least 30%, but disease is still present
What does stable disease mean?
Less than 20% increase in the size or less than 30% decrease in size
What does progressive disease mean?
New lesions or lesions that have increased in size by more than 20%
MRI is the gold standard for imaging which tumours? (5)
- Neurospinal
- Rectal
- Prostate
- MSK
- Staging head and neck
What are tumour markers?
Substances produced either by, or in response to, tumours.
The tumour marker; CEA (carcino-embryonic antigen) is a cell surface antigen, commonly used in which cancer?
Colorectal
How is CEA used with regards to colorectal cancer?
Its levels are measured and aid in staging the cancer
Although CEA is elevated in colorectal cancer, it can also be elevated in people with which other conditions? (5)
- IBD
- Hepatitis
- Pancreatitis
- Gastritis
- Smokers
Which tumour marker is used in ovarian carcinoma?
CA125
Which tumour marker is elevated in hepatocellular carcinomas and teratomas?
Alpha Fetoprotein (aFP)
Although the HGC marker is commonly associated with pregnancy, which cancer in males can also elevate its levels?
Non-seminomatous testicular cancers
Which marker is used in prostate cancer, although it is not very sensitive or specific?
PSA - prostate specific antigen
Where is Bence-Jones protein measured and what can it be a sign of?
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)
What have recent studies show surrounding CA-125 monitoring?
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
Why are chemotherapies give as a combination of different drugs, as opposed to a single-agent chemotherapy?
- Different classes of drugs have different actions and may kill more cancer cells together
- There is less chance of drug-resistant malignant cells
- Drugs with different sites of toxicity means dose can be maintained for each drug
What is chemotherapy given in cycles?
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
Which normal cells in the body are affected by chemotherapy the most and what is the consequence? (2)
- Haematopoietic stem cells (myelosuppression)
2. GI tract lining (mucositis)
What is normally the maximum amount of time chemotherapy cycles are given - due to resistance emerging and toxicity increasing
6 months
Most routine chemotherapy doses are calculated according to what?
The patient’s body surface area (BSA)
Which chemotherapy drug is the only one to have its dose calculated directly according to renal function?
Carboplatin
Which newer drugs are calculated based on weight alone?
Monoclonal antibodies e.g. trastuzumab
What are the most common side effects of chemotherapy? (13)
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
What are the long-term complications of chemotherapy treatment? (5)
- Reduction in fertility
- Pulmonary fibrosis
- Cardiac fibrosis
- Psychological
- Social
When is myelosuppression at its peak during chemotherapy treatment?
10 - 12 days post-treatment
Which cancers can lead to pancytopaenia? (4)
- Haematological malignancies
- Breast cancer
- Lung cancer
- Prostate cancer
What are the signs of significant thrombocytopenia? (4)
- Petechial haemorrhage
- Spontaneous nose bleeds
- Corneal haemorrhage
- Haematuria
What levels of platelet counts are associated with significant risk of spontaneous bleeding (e.g. intra cerebral bleeding)?
Platelet count less than 10 x 10^9/L
What platelet count range would indicate platelet transfusion?
10x10^9/L - 20x10^9/L
What are patients advised regarding chemotherapy treatment and the possible development of neutropenia?
If they develop any kind of fever/high temperature, then they need to seek immediate attention from the oncology department/A&E
When would the patient with possible neutropenia be given immediate broad sprectum antibiotics?
If they have a white count less than 1 x 10^9/L and a fever
What investigations need to be carried out in suspected neutropenic sepsis?
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
In which two cancers is high dose chemotherapy given with curative intent?
- Hogkin’s disease
2. Testicular cancer
To increase the efficiency of clinical trials, new trial designs are being used, what are the three new types of trial called?
- Basket trials
- Umbrella trials
- Platform trials
What is a basket trial?
Where tumours harbouring a particular genetic mutation are tested with a new drug that targets that mutation
What is an umbrella trial?
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
What is a platform trial?
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
If a patients pain is uncontrolled on maximum dose of co-codamol, what is the appropriate next step?
MST 20mg bd
If a patient is taking 20mg bd MST, what would their breakthrough PRN dose be?
40 / 6 = 6.666 so in the region of 5 - 10mg PRN oramorph
Which 3 groups are laxatives commonly grouped into?
- Bulk forming
- Stool softeners
- Stimulants