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Cancer Flashcards

1
Q

Myelodysplastic Syndrome Patho

A

Exp to Chemo/RadioTx => BM fail + clonal expansion of Abnormal cells

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2
Q

MDS Features

A

Cytopenia, Hypercellular BM, Abnormal blast cells

If BM myeloblasts > 20% (WHO) or > 30% (FAB) => Acute Myeloid Leukaemia

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3
Q

MDS Mx

A

EPO,
G-CSF (Granulocyte Colony Stim Factor) Inj,
Blood Transfusions (w/ Iron Chelation),
BM Transplant

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4
Q

PV, ET Types of ?

A

Chronic Myeloproliferative Diseases

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5
Q

PV Signs, Sx

A

Hyperviscosity
(Headaches, Visual disturbances, Tinnitus, Thrombosis – Stroke, PE/DVT)
Pruritus (Histamine release)
Erythromelalgia (Sudden, severe burning in Hands + Feet w/ Inflamm)

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6
Q

PV Ix

A

(+) JAK2,
FBC (Raised RBC’s, Hb, Hct, WCC + Plt’s),
Low EPO,
BM Biopsy (Hypercellular)

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7
Q

PV Mx

A

Aspirin 75mg OD (Aim for Hct < 0.45: Reduce risk of VTE)

If Young: Venesection, If Old: Hydroxycarbamide

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8
Q

ET Signs, Sx

A

Thrombosis,
Easy Bleeding/Bruising (esp from Mucous Memb),
Erythromelalgia

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9
Q

Def Erythromelalgia

A

Sudden, severe burning in Hands + Feet w/ Inflamm

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10
Q

ET Ix

A

50% (+) JAK2,
FBC (Raised Plt’s: > 600),
BM Biopsy (Excess Megakaryocytes)

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11
Q

ET Mx

A

If Plt’s: 400-1000: Aspirin 75mg OD

If Plt’s > 1000/Thrombosis: Hydroxycarbamide

(Anagralide: Inhib Plt maturation => Reduce PC)

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12
Q

Def PV, ET

A

Polycythaemia Vera: (Excess Abnormal RBC’s):

Essential Thrombocytopenia: (Excess Abnormal Plt’s):

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13
Q

Primary Myelofibrosis Patho

A

Clonal proliferation of Megakaryocytes => Increase in Plt-derived GF (PDGF)

Replacement of Haematopoietic Tissue w/in BM w/ CT (via Collagen Fibrosis)

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14
Q

Primary Myelofibrosis Signs, Sx

A 
Extramedullary Haematopoiesis (=> Hepatosplenomegaly), 
Hypermetabolism (Fever, Night Sweats, Weight loss), 
BM Fail (Pancytopenia)
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15
Q

Primary Myelofibrosis Ix

A

50% (+) JAK2,
FBC (Pancytopenia),
Blood film (Immature Blast cells, Teardrop Poikilocytes),
BM Biopsy (Hypercellular -> Hypocellular w/ marked Fibrosis: Dry Tap)

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16
Q

Primary Myelofibrosis Mx

A

Replacement RBC’s/Plt’s + Immunoglobulins

Splenectomy

Allogenic BM Transplant

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17
Q

ALL Def, Eped, Patho

A

Acute Lymphoblastic Leukaemia (ALL):
(M Comm Child Cancer, Peak: 2-5yo):

Arrest of maturation + proliferation of Lymphoblasts (=> B + T cells) => BM Fail

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18
Q

ALL Sx

A

Severe/Recurrent/Atypical Inf,

Anaemia, Thrombocytopaenia

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19
Q

ALL Ix

A 
FBC (Normal/Raised WCC – esp Lymphoblasts, Low RBC’s/Plt’s/Neutrophils), 
BM Asp (> 20% Blasts)
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20
Q

ALL Mx

A 
Replace blood products
Allopurinol (Prevent Hyperuricaemia)
Inf Prevention: Cotrimoxazole, Ciprofloxacin, 
Inf Tx: Gentamicin + Tazocin
ChemoTx
BM Transplant
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21
Q

AML Def, Eped, Patho

A

Acute Myeloid Leukamia (AML):
(Increased risk w/ Age):

Neoplastic proliferation of Myeloblasts => BM Fail

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22
Q

AML Ix

A 
FBC (Low RBC/Plt, Normal/Raised WCC), 
BM Asp (> 20% Blasts, Auer Rods)
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23
Q

AML Mx

A

Replace blood products
Allopurinol (Prevent Hyperuricaemia)
Inf Prevention: Cotrimoxazole, Ciprofloxacin,
Inf Tx: Gentamicin + Tazocin
ChemoTx
BM Transplant
(Early: Autologous replacement, Late: Chemo + Total Body Irradiation => Destroy BM w/ Allogenic Replacement)

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24
Q

CLL Def, Eped, Patho

A

Chronic Lymphocytic Leukaemia (CLL):
(Older males, M Common Leukaemia):

Neoplasm of mature B-cells

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25
Q

CLL Sx

A

Asymptomatic

Symmetrical, Painless Lymphadenopathy (Gradually Obstruct),
Hepatosplenomegaly,
(+/- Evan Synd: Auto-Immune Haem Anaemia + ITP)

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26
Q

CLL Ix

A 
FBC (Raised WCC – Lymphocytosis w/ Low serum Ig), 
Blood Film (Smudge Cells: Cells w/ Bact surrounding)
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27
Q

CLL Mx

A

Chemo: Fludarabine, Cyclophosphamide, Rituximab

RadioTx

(1/3 never progress, 1/3 progress w/ time, 1/3 Act progress => Large B-cell Lymphoma)

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28
Q

CML Def, Eped, Patho

A

Chronic Myeloid Leukaemia (CML):

Clonal proliferation of Myeloid cells (Reciprocal translocation btw Chromosomes 9 and 22 => BCR-ABL fusion gene => Increased Tyrosine Kinase Act)

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29
Q

CML Phases

A

Chronic Phase (< 5% blasts: Asymptomatic),

Accelerated Phase (10-20% blasts: Late-onset),

Blast Crisis/Acute Leukaemia (> 20% blasts: Inf, Anaemia, Bleeding/Bruising, Rapid-cell Turnover/Proliferation => Hypophosphataemia)

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30
Q

CML Ix

A

FBC (Raised WBC’s, If Accelerated/Blast Phase: Low Hb/Plt’s),
BM Asp w/ Cytogenic Analysis (Philadelphia +)

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31
Q

CML Mx

A

If Phil(+): Imatinib (Tyrosine Kinase Inhib)

If Phil(-)/Blast crisis: Allogenic SC Transplant

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32
Q

NHL Def, Sx

A

Non-Hodgkins Lymphoma: (80%):

Lymphadenopathy:
Symmetrical, Multiple Sites
Painless
Spreads discontiguously

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33
Q

NHL Ix

A

Raised LDH,
LN/BM Biopsy (Grading),
CT/MRI CAP (Staging)

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34
Q

NHL Mx

A

If Low grade: Chemo (Chlorambucil)

If High grade: R-CHOP21 (Rituximab, Cyclophosphamide, Doxorubicin HCl, Vincristine, Pred) given for 21 days

If relapse: BM Transplant

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35
Q

HL Def, Sx

A

Hodgkins Lymphoma: (20%, ass w/ EBV):

Lymphadenopathy:
Asymmetrical (M common: Cerv LN’s)
Painless (+/- Alc-induced Pain)
Spreads contiguously to Adjacent LN’s

(Pruritus, Pel-ebstein Fever: Cyclical Fever)

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36
Q

HL Ix

A

Low Hb,
Raised ESR,
LN Biopsy/FNA (Grading, Reed-sternberg Cells: Large, Multi-nucleated),
CT/MRI CAP (Staging)

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37
Q

HL Mx

A

Chemo: ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine)
RadioTx
(If relapse: BM Transplant)

38
Q

Ann Arbor Staging

A

1: Single LN region
2: > 2 Nodal Areas (Same Side)
3: Nodes on both sides of Diaphragm
4: Extra-nodal Sites (Liver, BM)

(A: No B Sx, B: B Sx)

39
Q

MM Patho

A

Neoplasm of Act B-cells (Memory Cells) => Uncontrolled proliferation of Plasma/B-cells + secretion of Immunoglobulins (IgG + IgA) + Cytokines

Deposition of Immune complexes => Organ dysfunction

Prod of IL-6 => Act of Osteoclasts + Inhib of Osteoblasts => Osteoporosis

40
Q

MM Hx

A

Osteolytic bone lesions (Backache, Bone Pain, Path #’s, Vertebral collapse)

BM Infiltration + Fail,

Renal Fail (Deposition of Ig’s + Light chains, Hypercalcaemia)

41
Q

MM Ix

A

(If > 50yo w/ Back Pain: ESR, Serum Electrophoresis):

FBC (Anaemia), 
Blood Film (Pancytopenia w/ Raised Plasma Cells), 
Raised ESR/PV, 
Raised Urea + Cr, 
Hypercalcaemia w/ normal ALP

Urine Electrophoresis (Bence-Jones Proteins)

X-ray (Skeletal Survey): Punched-out Lytic Lesions, Pepper-pot Skull, Vertebral Collapse, Path #’s

42
Q

MM Criteria

A 
(CRAB):
Ca2+ > 2.6mmol 
Renal Insuff 
Anaemia (< 10g/dL) 
Bone Lesions

(Other: Clonal BM Plasma cells > 10%, Urine/Serum monoclonal Proteins)

43
Q

MM Supp Mx

A 
Supp: 
Analgesia (Avoid NSAIDs) for Bone Pain 
Bisphosphonates 
EPO, Transfusions (Anaemia) 
Hydration +/- Dialysis (Renal Fail) 
Prophylactic Broad-spec Abx (If recurrent Inf: IVIg)
44
Q

MM Chemo

A

Fit Pt’s:
Lenalidomide + Dexamethasone
(BM Transplant: Maintenance)

Unfit Pt’s:
Melphalan + Pred + Lenalidomide
(If relapse: Bortezomib)

45
Q

Neutropenia Sepsis Features + Mx

A

Neutrophils < 0.5 w/ Fever (> 38) +/- Sepsis Sx

Mx:
Sepsis 6,
G-CSF (Promote Granulocyte/WBC cloning)

46
Q

Hyperviscosity Synd Patho + Sx

A

Raised RBC/Hct (> 0.5) - PV
Raised Plt’s (> 1000) - ET
Raised WCC (> 100) - Acute Leukaaemias
Raised Plasma proteins - MM

=> Bleeding, Headaches, Vis Disturbances, Seizures, Thrombosis

47
Q

Hyperviscosity Synd Mx

A 
(Aspirin: Prevent VTE)
PV: Venesection 
ET: (Anagralide)
Leukaemia: Leukophoresis (Avoid Transfusion before WCC lowered) 
MM: Plasmaphoresis
48
Q

DIC Patho

A

Release of Pro-coagulants (Widespread clotting),
Use of Clotting Factors + Plt’s => Bleeding,
Fibrin strands => Haemolysis (Anaemia),
Anaemia + Reduced blood flow => Ischaemia

49
Q

DIC Ix

A

FBC (Reduced Hb, Plt),

Clotting (Reduced Fibrinogen, Raised FDP => Raised APTT/PT)

50
Q

DIC Mx

A 
Replace (FFP, Cryoprecipitate), 
Control Bleeding (+/- Heparin)
51
Q

Tumour Lysis Synd Patho

A

Massive Cell destruction =>
Raised K+, Urate + Phosphate (=> Renal Fail)
(High Phosphate will bind to Ca2+ => Hypo-Ca2+)

52
Q

Tumour Lysis Synd Mx

A

Increase Fluid Intake + Allopurinol (24hr Pre-Chemo)

53
Q

Spinal Cord Compress Patho, Sx

A

Extra-dural Metastasises/Crush #’s

=> Back Pain (+/- Radiculopathy),
Motor/Sens/Reflex disturbances,
Bladder/Bowel Dysfucnt

54
Q

Spinal Cord Compression Mx

A

Urgent MRI Spine,
Dexamethasone,
(RadioTx/Surg)

55
Q

SVCO w/ Airway compromise Sx

A

(+) Pemberton Sign: Raise Arms > 1min => Facial Plethora,
Raised JVP,
Insp Stridor/S.O.B,
Swollen Face + Arms w/ Thread Veins in SVC distribution

56
Q

SVCO w/ Airway compromise Ix

A

CXR/CT,

Venography

57
Q

SVCO w/ Airway compromise Mx

A

Dexamethasone,

Balloon Venoplasty + SVC Stenting

58
Q

Hypercalcaemia Patho + Sx

A

Prod of PTHrP (Squamous CLC, Breast Cancer, RCC)/Lytic Bone Metastasises

=> Bones/Stones/Groans/Moans

59
Q

Hypercalcaemia Ix

A

Serum Ca2+ (> 3mmol)​
Low PTH (Excl Hyper-PTH)​
CXR​
Isotope Bone scan​

60
Q

Hypercalcaemia Mx

A

Aggressive Fluid rehydration (0.9% NaCl 1L/4hrs)​

(Monitor fluid status: When full => Furesomide)​

Bisphosphonates (Once Hyper-PTH Excl)​

61
Q

Raised ICP Hx​

A

Headache, N+V (Worse in morning + on bending)​

Papilloedema​

Focal Neuro Def, Focal Seizures​

62
Q

Raised ICP Ix + Mx​

A

CT/MRI​

Mx:​
Dexamethasone​
Radio/ChemoTx​

63
Q

Febrile Neutropenia Criteria + Mx​

A

Criteria: Fever + Neutrophil count: < 1x10^9​

Mx:​

Isolation + barrier nursing​

Broad-spect Abx/Antivirals/Antifungals​

(Prophylaxis: Cotrimoxazole)​

64
Q

Most Common Cancers

A

Skin,
Breast/Prostate,
Lung,
Colorectal

65
Q

Most Deadly Cancers

A

Lung,
Breast/Prostate,
Colorectal

66
Q

Most Common sites of Metastasises

A

Bone
Liver
Lung
(Brain, LN)

67
Q 
Tumour Markers:
aFP
CEA
PSA
CA19.9
CA-125
hCG
A 
aFP: HCC
CEA: Colon
PSA: Prostate
CA19.9: Pancreas
CA-125: Ovarian
hCG: GC
68
Q

Chemo SE

A

N+V (Prophylaxis Granisetron + Dexamethasone)​
Alopecia​
(10 days Post-chemo) Neutropenia​
Extravasation (Leakage of Chemo):​
=> Pain, burning, bruising at Infusion site​
Mx: Stop Infusion, Steroids + Cold Ice pack​

69
Q

Alkylating Agents​ SE

A

(Adds Alkyl group to Guanine preventing normal DNA linking​)

Cyclophosphamide +/- =>
Haem Cystitis (Mesna),
Alopecia,
BM Supp​

Cisplatin +/- =>
Ototoxicity, Nephrotoxicity (Both: Amifostine)​

70
Q

Anti-metabolites SE

A

Methotrexate (Inhib DHF Reductase => Lack of Folate​) +/- =>
Nephrotoxicity (Leucovorin),
BM Supp (Filgrastim)​

5-FU ​(Inhib Thymidylate Synthase + Incorporates metabolites into DNA/RNA)​ +/- =>
Mucositis​

71
Q

Vinca Alkaloids SE

A

(Binds Tubulins + Arrest cells in Metaphase)​

Vincristine, Vinblastine +/- =>
Periph neuropathy​
BM Supp​

72
Q

Cytotoxic ABx

A

(Inhibs DNA replication + produces Superoxides​)

Doxorubicin +/- =>
Cardiomyopathy (Dexrozoxane)​

Bleomycin +/- =>
Pulmon Fibrosis​

73
Q

Taxanes SE

A

(Binds Microtubules + Arrest mitosis)​

Paclitaxel +/- =>
Hypersensitivity reaction​

74
Q

Monoclonal Ab’s​

A

Rituximab: Anti-CD20 (Non-Hodgkins Lymphoma)​

Trastuzumab: Anti-HER2 (Breast Cancer)​

75
Q

Tyrosine Kinase Inhib​

A

Imatinib: (Chronic Myeloid Leukaemia)​

76
Q

Endocrine modulators​

A

Tamoxifen: SERM (Breast cancer)​

Anastrozole: Aromatase Inhib (Breast Cancer)​

77
Q

Breast Cancer Hormone Tx​

A

HER2 (+): Trastuzumab (Herceptin​)

ER2 (+): Anastrozole (Post-menopausal: Aromatase Inhib), Tamoxifen​ (Pre-menopausal)

Node (+): FEC–D Chemo​

Node (-): FEC Chemo​

78
Q

RadioTx Types​

A

Radical: (Curative Intent)​
40-70 grays, 15-30 daily fractions​

Palliative: (Sx Relief)​
8-30 grays, 1-10 daily fractions​

(Reduce bone pain, cough, S.O.B, haemoptysis, bleeding)​

​

79
Q

RadioTx Early SE’s​

A 
Fatigue​
Skin React (Erythema, Ulceration)​
Mucositis​
N+V, Diarrh​
Cystitis​
BM Supp​
80
Q

RadioTx Late SE’s​ - 7

A 
Brachial Plexopathy (Following Axillary RadioTx => Numb, Weak, Painful Arm)​
Lymphoedema​
Panhypopituitarism
Pneumonitis (Dry cough/SOB, Mx: Pred)​
Dry mouth/Xerostomia (Salivary Gl Fail)​
Benign Strictures/Fistulas​
Reduced Fertility​
81
Q

WHO Pain Mx Ladder​

A

Mild Pain: Non-opioid (Paracetamol)​
Mod Pain: Weak Opioid (Codeine, Tramadol)​
Severe Pain: Strong Opioid (Morphine, Fentanyl)​

82
Q

Calc Breakthrough Doses​

A

Total Daily PO Morphine / 2 = Total Daily SC Morphine

Total Daily SC Morphine / 6 = Breakthrough (PRN) Dose (4hrly)​

83
Q

Opioid conversions​: PO Morphine

  • > SC Morphine​
  • > PO Oxycodone
  • > ​PO Codeine/Tramadol​
A

PO Morphine (Total mg/day):​

Divide by 2:​
=> SC Morphine​
=> PO Oxycodone​

Multiply by 10:​
=> PO Codeine/Tramadol​

84
Q

Breast Cancer Screening

A

All women 50-70yo offered Mammogram every 3yrs

85
Q

Breast Cancer Referral

A

2wk-wait:
> 30yo w/ unexplained Breast Lump
> 50yo w/ Unilat Nipple changes

Consider:
> 30yo w/ unexplained Axillary Lump
Skin changes

86
Q

Breast Cancer Sx

A

Painless, Hard, Irreg, Fixed Mass (Breast/Axilla)
Skin changes (Tethering, Inflamm/Erythema, Peau d’orange - Dimpling/Oedema)
Nipple Retraction +/- Discharge
Axilla Lymphadenopathy

87
Q

Breast Cancer Ix

A

Triple Assessment:

  • Hx + Ex
  • USS (< 30yo)/Mammogram
  • Core Biopsy/FNA

(LN Assessment: USS +/- FNA)

88
Q

Breast Cancer Mx

A

Surg:
- Breast-conserving (Wide-local Excision)
- Mastectomy
+/- Axillary/Sentinel LN Clearance

RadioTx/ChemoTx

89
Q

Breast Cancer F/up

A

All patients treated to have Mammograms yearly for 5yrs

90
Q

Lymphoedema Patho

A

Impaired lymphatic drainage due to lack of Axillary LN’s

Interstitium becomes swollen w/ excess, protein-rich fluid (+/- => Inf)

91
Q

Lymphoedema Mx

A

Massages (Manual Lymphatic drainage)
Compression Bandages
Lymphoedema Exercises
(Weight loss + Skin care)

Medicine (13 decks)

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