Gems Flashcards
PET for lung cancer upstages what proportion
30%
If take off a superficial bladder cancer, what is the risk of it coming back without further treatment
70%
Need intravesical BCG or CTx- gemcitabine or mitomyxin
Risk factor for bowel cancer recurring post resection
resect fewer than 11 LN
How many doses of IPI?
4 doses
Transient worsening before disease progression
Treat autoimmune colitis
steroids
if not better in 48 hours then give infliximab
How is ifosfamide nephrotoxic
Tubular dysfunction
Pall care person falling asleep , pain well controlled
consider psychostimulants like dexamphetamine and modafenil
p53 function
- guardian of the genome
- present in low level in all cells
- eg radiation damage activates–>act as transcription factor for p21 which inhibits cyclin dependent kinases that regulate the cell cycle
- sometimes in cancer cells increased levels of MDM2 and 4 which are its neg regulators
- sometimes causes apoptosis when activated
- most mutations are substitutions leading to misfolding. Actually increase levels in cells as harder to break down HIGH levels
2 main factors for determining local recurrence
margins
presence or absence of extensive in situ component
2 main factors for ipsilateral recurrence
lymphatic invasion
age under 35
also size over 2 cm
and higher grade
NOT subtype or nodal status
most common gene mutation associated with renal clear cell
VHL
when this is silenced by second hit or methylation, Hypoxia inducible factor (HIF) accumulates
IN colorectal cancer, KRAS, BRAF and EGF pathways all mediated via MAPK (and EGF via PI3K as well). What is the clinical difference>
BRAF more likley found in small adenomas, proximal cancers, serrated adenomas, hyperplastic polyps
EGF blockers do not work if downstream signalling mutations eg activating mutations in KRAS, BRAF, PI3K
DNA damage from radiation is mended by what mechanism usually?
nucleotide excision repair
how do you diagnose pheo compared with carcinoid tumour
pheo 24 hour urinary metanephrines or VMA
carcinoid urine 24 hour 5-HIAA
Best drug combination for highly nauseating chemo?
dex
aprepitant
5HT3 antag
bisphos or denosumab better in castration resistant prostate cancer with bony mets?
denos
may be superior in breast
non inferior in non breast non prostate
good in renal dysfunction
hypocalcaemia more common
ADT in prostate cancer what effect on bone mets?
increase risk of fracutre
which are the only sarcomas where chemo is used?
Ewing and rhabdomyosarcoma
SVC BUT UNKNOWN TUMOUR- DO WHAT?
recent reviews show not really that life threatening and get a tissue diagnosis first- only urgent if mental state or collaspse or upper airway obstruction
age group breast cancer screening
50-69
causes 14-32% mortality reduction as long as your life expectancy is 5 years or more
normal PSA and prostate cancer
does not rule out
what is the concept of free PSA
PSA from cancer cells tends to bind more avidly to proteins, so free PSA percentage is low
when do you get chemo in breast cancer surgery
axillary node involveemnt
node negative and tumour over 1cm or other bad things like age under 35, neg oestrogen receptor status or prog, gigh grade
how to screen a brca woman
age 25-30
MRI plus mammography
ultrasound increases false positives so not sued
consider preventative mastectomy
ovaries out after children as later onset of ovarian cancer than breast cancer in BRCA carriers
discuss chemoprevention
When do you use cetuximab
head and neck squamous cell
EGFR positive, KRAS WILD type colion cancer
When is trasuzumab used
HER2 positive gastric or GOJ cancer
HER2 postiive breast
remember the heart failure is NOT related to cumulative dose risk
if stop to let recover from heart failure, can often re challenge
cardiac biopsy does NOT show the myocyte destruction like with anthracycline
Erlotinib MOA
REVERSIBLE
TKI
targets MULTIPLE receptors
including VEGF2 and 3 receptors, PDGFR B, FLT 3 and cKIT
GBM treatment
adjuvant chemoradiotherapy (radio increases the sens to chemo) then chemo alone after dubulking the GBM Use temzolomide
Teratoma tumour markers
beta HCG and AFP negative
only treatement is surgerys
no role chemo radio
Choriocarcinoma where do they like to go
bleed in the BRAIN
choriocarcinoma tumour markers
beta HCG in the THOUSANDS SUPER SUPER HIGH
If see long bone mets sparing vertebral column, think…
gastric primary
management of seminoma and non seminoma stage 1
seminoma probably give 1 dose carboplatin
non seminoma 1-2 cycles BEP
WHat does sunscreen do?
Blocks UVB
Studies show reduce SCC and melanoma not BCC
UVA penetrates to deep dermis (UVB only epidermis) and causes free radical generation and other bad things
What does SJS look like
blistering lesions TRUNK almost always MUCOSAL too 4-21 days after first dose drug full thickness epidermal necrosis also febrile, photophobia, sore throat, dysphagia
What happens in porphyria cutanea tarda?
Acquired deficiency in hepatic uroporphyrinogen decarboxylase - accumulation of uroporphyrinogen and porphyrinogen in the liver–>plasma and urine
Photosensitising in the skin
ALT and AST up
Alcohol increases susceptibility
skin- subepidermal bullae on biopsy
Erythrocyte porphyrins normal
Urine orange with woods lamp
most common cause of erythema nodosum
strep pharyngitis!!
also seen in TB, sarcoid, IBD, cancer, deep fungal, OCP
