Epidemiology

Question 1

What type of secondary cancers does one get following ionising radiation?

Answer 1

radiation leukaemia happens between 2 - 8 years post

radiation carcinoma and sarcoma arise 5 years post, and continue to rise

Question 2

what is Li-Fraumeni syndrome?

Answer 2

this is a P53 germline mutation that is associated with

50% cancer risk by age 40
90% cancer risk by age 60

really can be associated with any type of tumour

it is AUTOSOMAL DOMINANT and is a tumour suppressor gene

Question 3

what is the tumour marker used in medullary thyroid cancer?

Answer 3

this is calcitonin

however, if the patient is RET positive, then you should just use that

Question 4

what is length time bias?

how does it differ from lead time bias?

Answer 4

interesting question, Mick!

lead time bias is when screening picks up a condition early, because there is significant period of detectability before disease occurs. This extra time does not alter the disease course

length time bias is when screening tends to pick up those with longer natural history (perhaps the more benign variants) - this gives us a false sense of doing better

Question 5

what is the management of SVC obstruction?

Answer 5

typically steroids, RTX or chemo

can use stenting sometimes

Question 6

does G-CSF have any impact on survival?

Answer 6

not if it is given once already septic

Question 7

what is hand foot syndrome?

Answer 7

this is also known as palmar-plantar erythrodysaethesia

it is related to 5-FU and capecitabine (5FU prodrug)

Question 8

what is the usual time frame for radiation pneumonitis?

what are the symptoms and what are the clinical findings?

Answer 8

usually about 2 - 3 months after treatment

RF include chemo, prev RTX, steroid withdrawal

symptoms usually dyspnoea +/- non-productive cough

findings might be limited. possibly crackles in affected zone (classically)

treat with ROIDS

Question 9

what sort of lung disease does bleomycin cause?

Answer 9

it causes pulmonary fibrosis

the RF include age >70, high dose, chest XRT, post operative

may be only partially reversible

on initial exam, CXR can be normal

Question 10

what is the major side effect with anthracyclines?

Answer 10

irreversible cardiac toxicity

it causes a cardiomyopathy

it dose related

you can use dexrazoxane which can reduce the cardiac toxicity (i think it’s a chelating agent)

Question 11

what are the cardiac concerns of cyclophosphamide?

what about 5FU?

Answer 11

cyclo causes an acute haemorrhagic pancarditis at high dose

5FU can cause coronary vasospasm, which can lead to ischaemia

Question 12

how do the platinum compounds cause renal injury? (what part of the kidney gets hurt?)

Answer 12

seems to be a tubular injury with potassium and mag wasting

this is dose related, and is cumulative

Question 13

what are the class of chemo agent that are associated with ovarian failure?

Answer 13

the alkylating agents are the worst

this is particularly true of cyclophosphamide

in men, the nitrogen mustard agents used to be worse for azoospermia

Question 14

what can be the complications of whole brain irradiation?

Answer 14

this can lead to acute oedema and swelling which can present with headache, N/V or neuro signs - the idea is that ‘roids help prevent this

long term changes can be a fibrosis of the brain. if focal, can lead to localising signs. If diffuse, can lead to seizures, neurocog effects etc

risks may be amplified by co-admin of chemo agents

Question 15

which of the chemo agents have potential neurologic toxicities?

Answer 15

the vinca alkaloids, such as vincristine can cause peripheral, central or autonomic injury

cisplatin - this can be dose limiting, and can even be a contraindication!

Question 16

with radiotherapy, what is the timeline for secondary cancer types? (solid v haematological)

Answer 16

the haem ones tend to emerge within the first few years (numbers weren’t provided, but perhaps 5 years?)

the solid organ don’t emerge until 5 - 9 years

in fact, most don’t occur in excess until 10 years post

Question 17

which of the chemo agents have a higher leukaemic risk?

Answer 17

1. usually the alkylating agents
   - usually happens with a year of MDS, then acute-non-lymphoblastic leukaemia

however, cyclophosphamide is substantially less leukaemogenic than:

melphalan
chlorambucil
lomustine
(about the same as carmustine)

2. the topoisomerase II inhibitors
   - such as anthracyclines and etoposide
   - these are difficult to treat, and often go straight to leukaemia without any MDS period

Question 18

in someone taking ondansetron and dexamethasone, what is the next prophylactic drug in someone with highly emetogenic chemotherapy?

Answer 18

we would be thinking of aprepitant

which is a neurokinin1-R antagonist

give it for three days. technically it is for acute nausea, but it also has an effect on the delayed symptom

Question 19

What is the gene with Peutz Jeghers syndrome?

Answer 19

Stk11

Also known as LKB1