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Oncology > Clinical > Flashcards

Clinical Flashcards

1
Q

What is leukaemia

What’s the result of it?

A 
Un regulated proliferation of immature WBC
Accumulation in BM
BM can’t function - anaemia 
- thrombocytopenia, bruises
- leukopenia, infections
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2
Q

People with leukaemia normally die ofwhat

A

Fetal infection or bleeding if untreated

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3
Q

What type of population makes bone transplant difficult

A

Life long smokers

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4
Q

What are the symptoms for leukaemia

A
  • anaemia
  • tired
  • bruises
  • bleeding
  • freq inf
  • SOB
  • petechiae sm red spot on skin caused by minor bleeding
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5
Q

Types of leukaemia

A

Acute (>30% blast in BM upon diagnosis
Chronic (manage symp not cure
Lymphoid leuk
Myeloid leuk

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6
Q

Which type of leukaemia is the most common in childhood 75% of childhood leuk

A

ALL

Acute lymphoblastic leuk

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7
Q

What are the diseases that can be treated by bone marrow transplant

A

Leukaemia,lymphoma, myeloma, bm failure, metabolic disorders

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8
Q

What are the indications for autologous bone marrow transplant

A

Lymphomas
Myeloma
Not leuk bc there will always be some leuk cells in pt bm

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9
Q

How does high-dose therapy (of chemo) work? Administered before the transplant

A

To eradicate any residue leukaemic or cancer cells in the bone marrow
Immunosuppresses patient
Ensure bm can’t be recovered wo stem cell infusion

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10
Q

What’s leukapheresis

A

Separation of leuk cells from blood

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11
Q

What are the two main sources of stem cells

A

Peripheral blood
Or
pelvic hipbones

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12
Q

What are the two methods of collecting stem cell

A

Peripheral blood stem cells from circulating blood
Bone marrow harvest from hipbone - Needle to hip bone where large amount of marrow exists
A way of collecting stem cells

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13
Q

What are the post transplant complications

A 
Infections
Anaemia SOB
bleeding (GIT, etc ) petechiae
UE imbalance
Graft vs host 
Mucosités (breakdown of tissue lining the mouth and throat caused by chemo on rapid dividing cells (eg methotrexate -symp dsyphasia - TPN
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14
Q

Trt for GvHD

A

High dose corticosteroid
Mabs- immunosuppress anti-tnf
Etanercept
Medenchymal stem cell- increase repair

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15
Q

Symptoms for lung cancer

A 
Often asymptomatic at early stage 
Haemoptysis (coughing blood)
Persistent cough >3w
Chest pain
Dyspnoea
Wt loss
Hoarseness
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16
Q

Staging TNM - T

A

T1 <3cm
T2 3-7cm, partial collapse
T3 >7cm collapsed lung, chest wall invasion
T4 invasion of mediastinum/ spine. Nodules in other lobes of same lung

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17
Q

Stage TNM -N

A

N0 none
N1 ipsilateral hilar
N2 ipsilateral hilar. Subcarinal
N3 contralateral (opposite side of same lung) supraclavicular

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18
Q

Late presentation of lung cancer

A

1/3 present as an emergency to hospital

19
Q

Surgery suitability

A

N0 or N1
Not T4
Lung function & co morbidities (smokers)

20
Q

Adjuvant chemo for lung cancer
Indication
Drug of choice

A

Tumour size > 4cm
And/or nodal involvement
4 cycles of cisplatin doublet (vinorelbine) 3weekly
Start w/i in 12 week of surgery

21
Q

What’s SABR

Indication

A

Steoreotactic ablative body radiotherapy - very high dose of radiotherapy in a few fractions

  • peripheral lung cancer < 5cm w/o nodal involvement
  • not fit for surgery
22
Q

Conventional radiotherapy indications

A

M0

Invasion or more extensive nodal (N2) involvement

23
Q

Conventional radiotherapy s/e

A

Dose to Sc
Volume of treated lung (acute pneumonitis)
Baseline lung function n development of fibrosis

24
Q

What are SACT?

A

Systemic anti cancer therapy

  • chemo
  • immunotherapy mabs
  • target therapy nibs
25
Q

Chemotherapy SACT how is it given
CT scan at baseline and …
Max cycles
When to stop

A 
1 dose every 3 weeks (1 cycle) for 3 months (12 week’s) 
Total 4 cycles 
After 3 cycles (9 weeks)
4-6 cycles max
If toxicity
26
Q

1st gen EGFR inhibitors for lung cancer

A

Gefitinib 250mg od

Erlotinib 150mg od

27
Q

1st gen EGFR inhibitor s/e

A 
Diarrhoea
Acne like skin rash 
Stomatitis -inflam of mouth or lips 
Paronychia - nail deformation 
Hepatitis
28
Q

2nd gen EGFR inhibitor for lung cancer

A

Afatinib 40mg od

Increase to 50mg od after 1m

29
Q

3rd gen EGFR inhibitor for lung cancer

A

Osimertinib 80mg od
Target mutated Lung cancer T790M
Reduced metastasis due to better brain penetration
1st line

30
Q

List the three ALK inhibitors

A

Crizotinib 250 bd
Ceritinib 750mg od
Alectinib best evidence

31
Q

S/e with crizotinib

A 
Visual disturbance (overlapping  tails of light — driving!
NV
diarrhoea 
Rash 
Oedema
QT prolongation 
Bradycardia
32
Q

Name the I-O (immunotherapy) used in lung cancer

A

Pembrolizumab

33
Q

What is pembrolizumab

A

A PDL1. / PD1 inhibitor

34
Q

What is PDL1 /PD1

A

Programmed cell death 1 PD1
Its ligand is PDL1
They are immune checkpoint proteins that inhibits T cell response

35
Q

Why use immunotherapy?

But what’s the se

A

No chemo s/e such as diarrhoea rash NV stomatitis hairloss neutropenia

Autoimmune response eg cytokines storm

36
Q

What are the two main groups of Lung cancer

A

SCLC 15% - aggressive, metastatic, high response rate but replapse quickly, 100% are smokers
NSCLC - 85%, three types - squamous cell/ adénocarcinoma / large cell carcinoma
Cancer profiling important - EGFR ALK

37
Q

What’s the name of cancer that is occurred on the pleura of lung

A

Mesothelioma

38
Q

Can you do surgery in SCLC? what’s the trt options

A 
No surgery 
If limited stage
RT AND CHEMO
Cisplatin / carbo + et opposed
If extensive stage no RT
39
Q

How to reduce the risk of brain metastasis in lung cancer

A

Prophylactic cranial irradiation PCI

40
Q

What are the clinical features of the lung cancer

A 
Palpable cervical 
Clubbing 
Obstruction of vena cava
Stridor
Pleural effusion 
Pancoast syndrome 
Metastasis 
Hypercalcium
Hyponataemia
41
Q

Referralnoathway for lung cancer

A
  • refer by GP
  • CT in 2 weeks
  • biopsy for diagnosis
  • imaging for staging
  • magement plan
  • trt within 62 day
42
Q

What are the main diagnostic tools for lung caner

A

Bronchoscopy (central)
CT guided lung biopsy (peripheral)
EBUS - ultrasound

43
Q

What do we use for imaging of cancer

A

CXr
CT
PETCT - positron emission tomography - more sensitive to metastasis and N involvement - use flurodeoxyglycose

Oncology (7 decks)

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