Cancer Flashcards
1
Q
Name 6 aetiologies of cancer?
A
Genetic Chemica Physical- radiation Diet Drugs Infective
2
Q
H.pylori associated with what cancer/
A
MALT tumours
3
Q
HPV associated with which cancers?
A
Oral, anal and cervical
4
Q
Non hodgkin and other Lymphoma is associated with which infection?
A
EBV nuclear antigens
5
Q
100 fold increase of hepatocellular carcinoma from what?
A
Hep B
6
Q
How do retroviruses increase chances of cancer?
A
Overexpression of oncogenes, can lead to T cell lymphoma
7
Q
which commonly prescribed drugs can increase the chances of cancer?
A
Immunosuppresants
8
Q
Most commonly used staging measure in cancer?
A
TNM
9
Q
What is the definition of a partial response to cancer treatment?
A
Radiologically shrinking of at least 30% but disease still present.
10
Q
Stable disease in cancer is defined how?
A
Less than 20% increase in size, or a less than 30% decrease in size.
11
Q
Progressive disease is defined how?
A
> 20% increase in new lesion size
12
Q
MRI is gold standard for imaging which tumour types?
A
Neurospinal, rectal, MSK, some head and neck sub types and prostate
13
Q
CEA is used as a marker for which disease?
A
Colorectal carcinoma
14
Q
What may give false positive raised CEA?
A
Smoking, IBD, pancreatitis, and hepatitis
15
Q
CA125 raise associated with which cancer?
A
86% of ovarian tumours have this
16
Q
Tumour marker produced by hepatocelluar carcinoma, some teratomas, prognosis?
A
Alpha fetoprotein++ = poor prognosis
17
Q
HCG raised in which tumours?
A
Hydatiform mole and choriocarcinoma, elevation of specific B units in non seminomatous testicular cancer.
18
Q
What is the value of PSA tyesting?
A
Can be raised from prostate exam, UTI or BPH, useful in assessing response however.
19
Q
Immunoglobulins role in cancer diagnoses?
A
Can be present with myelomas, also bence jones proteins in urine. Occasionally raised in non hodgkins.
20
Q
% patients curative with surgical resection?
A
30%
21
Q
Which metastatic sites may be resected curatively in metastasis?
A
Solitary lung masses from sarcomas, localises liver mets from colorectal.
22
Q
What is neoadjuvant chemo, and why?
A
Chemo before a surgery, shrink tumour, better margins- established in osteosarcomas, being tested elsewhere.
23
Q
Primary chemo uses?
A
Inoperable, uncertainty, may make surgery with curative intent feasible
24
Q
Adjuvant chemo uses?
A
Treatment of micromets after surgery = higher survival
25
Curative chemo in which diseases?
Often childhood, germ cells or lymphomas... often more intensive treatments.
26
Principles of multi drug chemo regimes?
significant single agent activities, non overlapping toxicity, different mechanisms.
27
What is high dose chemo, problems and treats what?
Chemo requiring bone marrow support, often through transplantation of bone marrow or stem cells. Can be curative in disease such as lymphoma, myeloma and leukaemias also germ cell tumours. Significant morbidity and mortality- 1-2%
28
After how many days post chemo does bone marrow suppression often occur and what is lowest point known as?
10-14 days - lowest point of drop know as nadir
29
Neutrophil count significant infection
0.5x10^9/L
30
Recovery of bone marrow occurs how long after?
3-4 weeks, matches with cycles of chemotherapy
31
Paralytic ileus may occur with which drugs?
Vinca alkaloids, and platinum based
32
What may be used to reduce hair loss in chemo?
Cold cap
33
Platinum, vincas ands taxanes often cause which neuro complications?
Residual defect of the peripheral sensory nerves, sometimes recovers but often doesnt.
34
Ifosamide and 5fu may be associated with CNS toxicity such as?
Encephalopathy and cerebellartoxicity.
35
High tone hearing loss may be associated with which chemo?
Cisplastin, pre-existing damage precludes use
36
Bladder toxicity caused by?
cyclophosphamide and isofamide
37
Nephrotoxic chemos?
Cisplatin and isofamide
38
Cardiac toxicity associated with which chemos?
Doxirubicin and paclitaxel = arrhythmia
39
Coronary artery spasm can be a complication of which chemo?
5-fu
40
Chemo causing photosensitivity?
5-fu
41
Pulmonary fibrosis and pigmentation caused by which chemo abx?
Bleomycin
42
Most common type of chemo to cause secondary malignancies?
Alkylating agents
43
Infertility is caused by which agents?
Alkylating
44
Pneumonitis associated with which type of chemo?
Alkylating
45
Haemoglobin below what level prompts consideration for transfusion in cancer patients?
10g/dl, can be associated with lower quality of life
46
Thrombocytopaenia levels and when to take action?
Below 10= take action significant risk of spontaneous bleed
10-20 usually supported with transfusion especially when infections are present
20+ not routinely requiring transfusions
47
Most frequent complication of myelosuppression?
Neutropenic sepsis
48
Total white cell count below what with fever requires in patient management?
below 1x10^9/L
49
Trastuzumab (herceptin) used for what?
Her2+ disease in breast cancer
50
Ipilimumab used in what metastatic disease?
Melanoma
51
CLL and non hodgkin can use what monoclonal antibody?
Rituximab
52
What do tyrosine kinase inhibitors end with (drug name) ?
"ib" eg Sunitinib
53
What do Mtor inhibitors end in (drug name)
"us" eg everolimus, useful in renacl cell and metastatic breast disease
54
Goserelin, what does it do, useful for what?
Block sex hormones, useful in some breast and prostate cancers
55
How does tamoxifen work?
Blocks the action of oestrogen
56
Example of a steroidal anti androgen?
Cyroterone acetate, inhibit andrgoen in tumour and substitute for testosterone in hypothalamus = negative feedback.
57
Approx what % of patients are cured with radiotherapy?
40%
58
How does radiotherapy work v briefly?
Electrons fired with a linac, secondary electrons in body made "free radicals" destroys DNA growth stops. Normal cells can repair usually cancer cells defective
59
What is the small dose of radiotherapy called?
A fraction
60
The full dose of radiation to be delivered is measured in what unit?
Gray Gy
61
What is concurrent chemotherapy thought to do ?
Act as a radiosensitiser and enhance the response to radiotherapy.
62
Acute effects of radiotherapy treatment?
Diarrhoea, mucositis and local skin irritation
63
Late effects of radiotherapy when ?
3 months plus, effects can last years, include lung fibrosis, infertility and skin atrophy
64
What are the 3 phases of clinical trials?
phase 1 -establish toxicity and maximum dose, disease response not an end point
phase 2- assess anti tumour activity, no control, tumour shrinkage is outcome usually
phase 3- comparing new with conventional treatments, randomised
65
A screening test for cancer ideally would...?
Detect early, sensitive and specific, tolerated, easy to administer, inexpensive, and publicised.
66
What is the most effective screening program?
Cervical smears
67
When are womern invited for smears?
25-49 every 3 years and 49+ every 5 years (in england)
68
When and to whom is mammography offered?
47-70 years every 3 years although over 70 can request still
69
Bowel screening takes place what ages? what does it do?
Faecal occult blood, every 2 years, ages 60-69 (extended to 74 in england.
70
What % of cancer patients have pain?
80%
71
Describe bone pain and management in cancer?
dull, widespread ache or tenderness over bone. NSAIDS, radiotherapy and bisphosphonates
72
Describe visceral cancer pain, treatments too?
Dull, deep seated, poorly localised. Can be spasmodic or over organ areas,colicky pain = anticholinergic (buscopan), capsule pain = steroids other pain = opiates usually.
73
Raised ICP headache features and treatment?
Worse on coughing, when waking, bending forward sneezing nausea and vomiting also. often treated with steroids, NSAIDs and paracetamol.
74
Describe neuropathic pain?
Altered sensation, less defined areas, numbness, pallor sweating tingling burning. Anti convulsants help gabapentin etc also TCA amitryptiline... steroids helpful for compression
75
Side effects of opiates?
Constipation, drowsiness (on dose change), confusion (rarely hallucination), resp depression, addicition and dependance, nausea and vomiting
76
Two forms of morphine? how long acting? examples?
Immediate release- 4hrs relief, extended up to 12hrs relief. Immediate- sevredol and oramorph
extended- zomorph MST continus
77
Max strength codeine switching to morphine extended approx dose?
20mg BD
78
Renal impairment alternatives to morphine?
Fentanyl
79
What fraction of total dose should breakthrough dose be in morphine?
1/6
80
Converting oral morphine to diamorphine subcut would require dividing by what?
3 as diamorphine is 3 times as potent
81
Subcut morphine is how much as potent as oral morphine?
Twice so divide oral by 2 to get sc dose
82
Megestrol acetate and dexamethasone may be used to promote what?
Eating though effects often wear off
83
4 main causes of vomiting?
Cerebral, Gastric, Toxic, indeterminate
84
Gastric stasis anti emetic?
Metoclopramide 10-20mg
85
Toxic nausea causes?
drugs, infection, uraemia, hypercalcaemia
86
Treatment for toxic vomiting?
Haloperidol 1.5-5mg nocte (sedative effect)
87
Cerebral causes of vomiting?
raised ICP, tumour, morning headache, vomiting without nausea
88
Cerebral vomiting treatment?
Dexamethasone 8-16, and or cyclizine 50mg tds
89
Anticipatory nausea treatments?
Benzos, CBT and therapy
90
Intractable or unknown cause vomiting consider?
Levopromazine 6.25-12mg (very sedating)
91
How often should laxatives be reviewed in palliative care?
2 days
92
Stool softener examples?
Docusate and lactulose
93
Bulk forming laxatives use in palliative?
rarely used
94
Stimulatn laxatives?
Senna and dantron
95
Combination laxatives used in palliative?
Movicol + co-danthramer
96
What is co-danthrusate?
Danthramer + docusate
97
What may ocreotide be used for in cancer patients?
Bowel obstruction
98
Causes of sudden onset dyspnoea in cancer patients?
Asthma, Pulmonary oedema, PE
99
SOB arising over days in cancer pts?
COPD exacerbation or pneumonia, bronchial obstruction, SVC obstruction
100
Gradual on SOB in cancer pts?
Anaemia, pleural effusions, ascites, Lymphangitis
101
Common cancers causing spinal compression?
Breast, prostate and bronchus
102
Where do 2/3 of metastatic spinal lesions occur?
Thoracic
103
Signs and symptoms of spinal compression?
Back or nerve root pain, weakness, bladder and bowel dysfunction (late sign insidious), "walking on cotton wool"
Painless bladder distention, increased reflexes below lesion.
104
How soon should MRi be done if suspecting compression? What given?
Within 24hrs, give dex (16mg)
105
Definitive management of compression of cord?
Radiotherapy, surgery, combination
106
Symptoms and signs of SVC obstruction? Causes?
usually bronchial/lymphoma tumour but any solid tumour can cause it.
Headache, fullness in head, facial swelling, SOB, hoarseness, engorged vessels neck and chest
107
SVC obstruction treatment?
Commence high dose dex, stenting treatment of choice often chemo and radio also given
108
Hypeercalcaemia associated with what?
Usually breast, lung myeloma and scc's but any tumour can cause it. Do not need bone mets to have hypercalcaemia
109
Symptoms of hypercalcaemia?
Malaise, anorexia, polyuria, polydipsia, N&V, constipation, confusion, fits, coma.
110
Initial management of hypercalcaemia?
Rehydrate with IV fluids.
111
Definitive management of hypercalcaemia?
IV bisphosphonates zolendronic acid, 70% respond to treatment
112
Most common female cancer?
Breast- 19% of all female cancers.
113
Risk factors for breast cancer?
Increased age, (more oestrogen)> null parity, early menarche, late menopause obesity
HRT, radiation, BRCA,
114
Most common breast cancer type/
Ductal
115
How are breast cancers graded?
Due to differentiation - 1 being good 3 being poor
116
Common presentation of breast cancer?
Lump- less commonly nipple changes and discharge or metastatic disease.
117
What is triple assessment?
history imaging and then biopsy if needed (USS best in <35years)
118
Primary management of localised breast cancer?
Surgery, mastectomy or conservative wide local exision, assessment of local nodes
119
When is radiotherapy offered with breast cancer?
After surgery and sometimes in mastectomy pts if large mass was found, if full axillary node clearance has occurred should not use radiotherapy. Sentinel node biopsy increasing use
120
Factors to consider for systemic therapy of breast cancer?
Hormone status receptors, menopause, previous response, performance status.
121
What is tamoxifens roles?
Blocks oestrogen provides benefit to recurrence in oestrogen positive cancers. Reduced contralateral cancer seen regardless of ER Status.
122
Tamoxifen side effects/risks?
Increased endometrial cancer, and thrombotic problems.
123
Aromatose inhibitors useful when and how/
Block oestrogen, superior to tamoxifen in post menopausal women, can be used after 2-5years of tamoxifen to continue the effects. Can cause osteoporosis
124
HER 2 treatment?
Trastuzamab (herceptin helpful)
125
Ovarian ablation why and how?
Chemo induced menopause or oopherectomy to reduce the oestrogen
126
Metastatic patients who responds best to endocrine treatments?
ER positive 50-60%
127
Poor prognosis factors for breast cancer?
ER negative HER2 positive, higher grades >5cm size lymph involvement
128
How common lung cancer?
2nd most common after the most common breast and prostate in men and women.
129
Risk factors for lung cancers?
Smoking (80-90% cases) Age, occupational exposures
130
Most common lung cancer type?
Non-small cell
131
Small cell cancers often associated with what ?
Neuroendocrine secretion, acth or adh
132
% lung cancer seen on xray? % sputum cytology?
95% and 80%
133
Chance of metastasis in SCLC?
very high early on
134
Management of Small cell?
Chemo 99% response with combined chemo but often relapse after 12 months with resistant disease. rarely surgical
135
Radiotherapy value in small cell?
Adjuvant primary treatments, cranial to avoid mets and palliative
136
Prognosis of small cell?
2-4 months or 11 with treatment
137
Management of non small cell?
Most die within a year, although stage 1 and 2 resections have good prognosis over 5 years(80%)
138
Surgery useful in what % of non small?
30% mediastinal involvement usually precludes surgery
139
Use of radio in nsclc?
Can help but only 20% survival in stage 1/2
140
Chemo for non small cell?
Limited effectiveness up to 30% response but duration is short.
141
Risk factors for colorectal cancer?
Diet, rich in animal fats and meat, poor in fibre common in western world.Inflammatory diseases, Familial conditions.
142
% cancers in rectum?
40%
143
Majority of colon cancer what type?
Adeno
144
How many rectal tumours can be felt?
3/4
145
Tumour marker for colorectal?
CEA, but not diagnostic
146
Dukes staging?
A-wall confined, B- invading through C-lymph node involvement D-Metastases
147
Usual treatment for colon cancer?
Radical resection, early stage usually achieves cure
148
Radiotherapy value colorectal?
Usually used in rectal tumours
149
Chemo for colorectal?
Yes role in dukes stage C not great evidence to suggest dukes B benefit. 5 FU most active agent.
150
Prognostic factors for colorectal?
Lower age <40 possible more aggressive tumour
151
Screening for colorectal?
60-74 year old faecal occult blood 10% detected 44% in early stages
152
Incidence of testicular cancer what ages?
15-45 years 20/million population
153
Risks for testicular cancer?
Non descended testicles, family history or atrophy of testicle
154
What type of tumour most testicular and cure rate?
Germ cells 95% high cure rate divided in to non semitous 60% and seminomas 40%
155
Investigations for testicular cancer?
USS, bHCg raised in seminomas and non seminomas up to 75% patients. Alpha fetoprotein only if non seminomatous present. LDH can be helpful to monitor progress.
156
Main treatment for testicular cancer?
Orchidectomy through inguinal canal for treatment and biopsy
157
Chemo for testicular cancer?
Can use one dose carboplatin for seminoma
| Non seminoma 2 cycles (BEP bleo etop and cisplatin) very intense
158
Value of radiotherapy testicular?
Para aortic nodes, but one dose carboplatin has been show to be just as effective and less complications.
159
Prognostic factors testicular?
Highly raised markers seminos >4cm Pulmonary metastases not affecting prognosis
160
Incidence of prostate cancer in white and black males?
Most common cancer in men 1/8 white males 1/4 black males.
161
Aetiology of prostate cancer?
No clear links, diet, BRCA2 and steroid use may be linked
162
Type of cancer prostate and where?
Adenocarcinoma usually posterior of the prostate- BPH often central
163
Gleason grading scale?
T1- no palpable mass T2 cancer within, T3 cancer breaching capsule T4 cancer extending out of capsule(rectum/bladder)
164
Symptoms of prostate cancer?
Usually asymptomatic, poor stream, dribbling, nocturia, frequency or metastatic features
165
Main treatment for prostate cancer?
Observation is best if confined to prostate, raised psa but no clinical signs is unknown evidence
166
Surgery options for prostate cancer?
Can resect but significant mortality, trans urethral resection palliatively used or to help urinary symptoms.
167
Radiotherapy in prostate cancer uses?
Can be used as adjuvant, can be alternative to surgery should be at least 6/52 after TURP to avoid strictures.
168
Hormonal treatment for prostate cancer?
Can be effective in reducing androgens and work in up to 80%. May be used to downsize/grade tumour prior to surgery. Eamples goserelin. Anti androgens cyproterone acetate.
169
Chemo for prostate cancer?
Docitaxel and carbazitaxel improves quality of life in metastatic disease.
170
Prognosis prostate cancer?
good usually if not advanced, serum psa high correlates with worse prognosis.
171
% pts with unknown primary, what needs to be thought about?
10% holistic approach, fitness, co-morbidities, probable sites and patient wishes need to be thought about.
172
Most likely site of unknown adenocarcinoma?
GI breast ovary lung
173
Squamous unknown primary could be?
Lung head and neck
174
Young men midline disease think what cancers?
possible germ cell tumour which may be cured!
175
Women with axillary or thoracic nodes but no known primary?
Treat as breast cancer
176
Women with abdominal carinamatosis?
Treat as ovarian
177
men with bony mets treat?
As prostate
178
Multiple medium sized nodal areas no known primary?
Treat as lymphoma
179
Treatment basis of unknown cancers?
Epirubicina nd platinum based cover msot solid tumours and 5fu for GI. Radiotherapy may be given for palliation
180
Poor prognostic factors for unknown origin cancers?
Male, increased organ sites. hepatic, adenocarcinomas
